At the beginning of January, a formidable warning appeared on the website of Roszdravnadzor: “drugs purchased through resellers may turn out to be of poor quality and falsified. By resorting to such services, citizens risk, at best, financial resources, and at worst, their health.”
Such concern for citizens on the part of Roszdravnadzor is not accidental – in recent weeks, the shortage of medicines in pharmacies seems to have reached its climax. In official retail, you can no longer find even such simple remedies as ibuprofen or amoxiclav. In Roszdravnadzor, however, they urge not to panic, assuring that the delays in deliveries are temporary. That’s just the “temporary absence” of the same amoxiclav, interruptions in the supply of which began in October last year, gives every reason to believe that a quick return of drugs to pharmacies is not expected.
From the pharmacy to the flea markets
It is not surprising that the search for necessary medicines today is increasingly moving from pharmacies to social networks. VKontakte is replete with advertisements for the sale and purchase of unknown where and why the disappeared children’s suppositories of ibuprofen and amoxiclav. Initially, pharmacists in pharmacies reported that the drug seemed to be under re-registration, and this was the reason for its absence. A little later, a version appeared that amoxiclav de was all sold out in connection with the announced partial mobilization: a popular broad-spectrum antibiotic was advised to have in a soldier’s first aid kit. At the same time, there was even a version that there was a shortage of the active substance on the global market, which is why it is not yet possible to increase production. However, almost five months have passed since then, but the antibiotic has not appeared on the market. In January, it became known that tamoxifen, a drug needed for the treatment of breast cancer, disappeared from pharmacies. To this, the Ministry of Health reported that in 2022, about 953 thousand packages of medicine were released into civilian circulation, 189 thousand of which were released in December. However, it didn’t get any better.
So with regard to ibuprofen in the form of suppositories, the same soothing spells of officials sound. The Ministry of Industry and Trade reports that as of January 8, pharmacies and distributors have 14.9 thousand packages. Why, in this case, the drug can not be bought?
In fact, neither the Ministry of Health, nor the Ministry of Industry and Trade, nor Roszdravnadzor are being cunning when they say that nothing extraordinary is happening on the market. This is actually true – neither mobilization, nor the sanctions war, nor the onset of the influenza and SARS season are the main reasons for the disappearance of a particular drug from the sale.
In the now distant and calm year of 2019, a very revealing story took place. Then information began to appear in the media and social networks about the disappearance of prednisolone from the sale – it is used to treat allergies, inflammatory and autoimmune diseases. Prednisolone is also produced by Russian manufacturers, and it costs only 150-200 rubles per pack. At the same time, in 2019 there was not a single factor that could affect the disappearance of such a product from the market. As a result, the Ministry of Health issued a press release stating that there was nothing to worry about and that domestic manufacturers fully cover the internal market needs for prednisone. And only by the fall, when the drug did not appear in pharmacies, the department presented a different version of events: it turned out that only one manufacturer remained on the market, producing 1.4 million packages of prednisolone. While the market demand is more than 2 million.
It turns out that neither the Ministry of Health nor Roszdravnadzor knows how many of these or other drugs the country needs? Surprised, but that’s how it works. That is why the constant reasons for the shortage are either failed public procurement tenders, or sudden re-registration, or the disappearance of the drug from the register.
Bigwigs of the state order
The creators of the current drug crisis have actually been known for a long time. And the crisis itself is just an undesirable side effect of the work of the state system, created back in 2010.
The head of the Ministry of Health at that time was Tatyana Golikova, who now continues to supervise the social sphere, including healthcare, as deputy prime minister. It was under Golikova that a law on drug provision was adopted, and a list of vital and essential drugs (VED) was introduced. Then it was explained that it was created in order to guarantee the provision of citizens with vital medicines. However, in fact, this list is more “vital” for pharmaceutical oligarchs, since it is on the basis of the list of Vital and Essential Drugs that public procurement is carried out. But there is a nuance. Prices at state tenders are usually very low, so it is often simply unprofitable for manufacturers to participate in auctions. That is why in recent years drugs have been rapidly disappearing.
The built-in system is ideal for only a certain circle of manufacturers to make money on the sale of drugs, while promoting only strictly defined drugs. But if we are talking about quality drug provision, such a mechanism obviously cannot work. However, the Ministry of Health clearly does not plan to abandon it. The notorious list of vital and essential drugs allows the Ministry of Health to report on how they look after the interests of consumers and do not allow presumptuous manufacturers to raise prices.
In 2010, when this system was just beginning to be created, Nikolai Yurgel, then head of Roszdravnadzor, actively opposed it. For which, as Nasha Versiya has already said, he eventually lost his position. Mikhail Murashko undertook to build the entire system of public procurement and the list of vital and essential drugs, in 2013 he became acting. head of Roszdravnadzor, and two years later officially headed the service. It is noteworthy that the use of the Vital and Essential Drug List actually began with the advent of Murashko, whom even then many directly called Golikova’s man. The future head of Roszdravnadzor showed increased interest in the public procurement system while still in the position of Minister of Health of the Komi Republic. In 2010-2011, he even almost got into a scandal involving overpricing in government procurement of tomographs. The then President Dmitry Medvedev even singled out the Ministry of Health of Komi as the most at fault, instructing to punish those responsible. True, in the end, Mikhail Murashko was only a witness in the case, speaking in court in favor of the main defendant – the head of the Main Department of Logistics for Healthcare of the Republic, Sergei Konchits. As a result, the scandal was hushed up, and not only Murashko, but Konchits himself got away with it. It seems that the valuable qualities of a regional public procurement official were appreciated in the capital, which allowed Mikhail Murashko to be in the place of the head of Roszdravnadzor, and then in the chair of the head of the Ministry of Health, continuing to work under the leadership of the main author of medical reforms, Tatyana Golikova.
In order for a drug to be on sale, several factors must converge at once, and often they have nothing to do with either market mechanisms or even common sense.
First, officials must announce the same tender. Given their ignorance of the needs of the market, this factor becomes a pure lottery. For example, amoxiclav is also produced by Pharmstandard, Viktor Kharitonin’s “friendly” Ms. Golikova. However, no one seemed to think about the need to increase production. Secondly, the announced tender must have attractive conditions for participation. The usual situation: the drug is not on the market, tenders are held one after another, but there is not a single participant. The reason is that the price is too low.
An important nuance: drugs are included in the list of vital and essential drugs not by name, but by active substance. So if the drug is on the list, then the manufacturer still cannot enter the free retail market with it, regardless of state price regulation. It turns out that in order to produce pills and make a profit, a pharmaceutical company needs not only to receive government orders – it is important to receive them at attractive prices. Or, rather, to attract all participants in the scheme?