This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Iran in recent decade faced several regional and international sanctions in foreign
trade, financial and banking services. Iran national pharmaceutical industry has always
played a major role in providing medicines to the Iranian patients. However, following
the sanctions it has faced profound difficulties for importing of both finished products
and pharmaceutical raw materials. Although medicines are exempted from sanctions,
due to restriction on money transaction and proper insurance Iranian pharmaceutical
companies have to pay cash in advance for imports of medicines and raw materials or
to secure offshore funds at very high risks. Current situation in Iran pharmaceutical
market confirms that the sanctions against Iran are affecting ordinary citizens and
national health sector which resulted to reduction of availability of lifesaving medicines
in the local market and has caused increasing pain and suffering for Iranian patients.

Keywords:

International sanctions; Medicines; Iran

Background

In the past decades, regional and international economical sanctions have been used
by some countries in order to impose political intentions in the sanctioned countries.
The main objective of sanctions is to interrupt a country’s diplomatic and/or economic
relations in a worldwide scale. Sanctions could be categorized based on its scope
on a regional or international base. Local or regional sanctions are usually employed
by some limited countries against one specific country. This obviously is less effective
for reaching to its objectives since the sanctioned country usually diverts its political
and economical relations to other countries. Article 41 of the United Nation (UN)
Charter is usually referred to for imposing international sanctions against UN member
states. This article authorizes international community to implement measures not
involving the use of armed forces including complete or partial interruption of economic
relations for a specific objective.

In the past decades, most of the time, sanctions have been employed by developed market
economies against weaker and more dependent states. Regional or international sanctions
have been used in recent decades against countries such as Haiti, Iraq, Yugoslavia,
South Africa, Cuba, Burundi, Nicaragua, Gaza Strip, Zimbabwe and Iran [1-4]. However with exception of South Africa there is not any evidence indicating that
sanctions have reached their primarily objectives as it was claimed. Sanctions imposed
by European Union (EU) against Zimbabwe are a clear example that sanctions most of
the time fail to reach their originally specified targets. As a contingency measure
against EU sanctions Zimbabwe shifted its focus from the EU and its western allies
and formed economic partnerships with the Eastern countries [2].

Although most of the time it is claimed that sanctions and especially “targeted sanctions”
aimed political leadership of sanctioned countries, unfortunately sanctions are blunt
instrument which could hurt large number of people. There is now substantial evidence
that regional and international sanctions cause severe civilian hardship and profound
social and economic dilemma for ordinary people of the sanctioned country. Sanctions
could devastate countries economical infrastructure in different sections and most
notably in health care sector. Sanctions could profoundly disrupt health services
in the sanctioned country. The impact of sanctions on health and health services is
not limited to difficulties with supply of medicine and will go far beyond to disrupt
health services.

Although almost all sanctions in the recent decades had provision for exemptions of
medicines and food stuffs, sanctions through complications in transportation, difficulty
in transferring hard currencies or either lack of capital commonly lead to disruption
of health services and even basic nutrition of the ordinary people in the sanctioned
countries. Published reports show that economical sanctions will increase suffering
and death among civilians particularly among the most disadvantaged and vulnerable
groups including mothers, children and patients with chronic disease. Obvious reduction
in public resources allocated for heath sector along with restrictions on importation
of vital medicines and equipments will ultimately result to a weakened physical and
medical infrastructures and strain the ability of health system to provide medicines
and services to the patients. Sanctions are associated with reported substantial declines
in health and welfare of the ordinary citizens of Cuba, Iraq, former Yugoslavia, Gaza
Strip, Burundi, Zimbabwe and Nicaragua [1-4]. Although countries such as Cuba have managed to establish a viable health care service
for their citizens despite decades long unilateral sanctions by USA, others may not
be successful as such. Iraq for example had invested heavily in health and education
services in the 15 years prior to the embargo and in 1990 it had an advanced health
care system. However, the county lost all of its achievements in health sector following
international sanctions [1]. These changes left all Iraqis at greater risk of poor health outcomes just before
military invasion by USA and its allies.

In related to its nuclear activities, Iran in recent decade faced several regional
and international sanctions. In addition to international sanctions, EU and USA have
also imposed restrictions on cooperation with Iran in foreign trade, financial and
banking services, energy sectors and technologies, and banned the provision of insurance
by insurers in member states to Iranian-owned companies. Before sanctions Iran national
pharmaceutical industry played a major role in providing essential medicines to the
Iranian patients [5]. In recent years the country’s national industry was also able to locally manufacture
several lifesaving biopharmaceuticals [6]. However, following the sanctions Iran pharmaceutical market has faced profound difficulties
for importing of both finished products and active pharmaceutical ingredient (API)
for fulfilling its responsibility on providing necessary medicines for the patients
in need. In the other hand as a result of sanctions and due to reduction of the country’s
international incomes, Iran national currency (Rial) has also experienced drastic
devaluation against international currencies. These have caused both substantial price
increase and shortage of the medicines in Iran pharmaceutical market. This obviously
has imposed unnecessary pain and suffering on Iranian patients and their families.

Although medicines are always exempted from sanctions, many international companies
failed to fill orders from Iran due to restriction on money transaction, proper insurance
and sometimes assurances that the item indeed was exempted from the embargo. In the
other hand local pharmaceutical companies are finding it extremely difficult to access
lines of credit for importing medicines or APIs. Currently Iranian pharmaceutical
companies have to pay cash in advance for imports of medicines and APIs or to secure
offshore funds at very high risks if they could do it at all.

In order to improve availability and affordability of plasma derived medicines (PDM)
since 2005 Iran has successfully implemented a contract fractionation program for
surplus of recovered plasma produced in its national transfusion service. In this
program locally produced plasma by Iran Blood Transfusion Organization (IBTO) is sent
to the fractionator and end products are returned to the country for distribution
into the local market [7]. The medicines received under this contract fractionation program provide for 100%
of IVIG and clotting factor IX used in Iran, as well as 15% of the clotting factor
VIII and 40% of the albumin. The cost differential between imported products and those
obtained via the contract fractionation program resulted in significant saving for
Iran health sector. Therefore Iran’s contract fractionation program has substantially
improved accessibility and affordability of PDM and resource allocation in the national
health system [8].

However, unfortunately in past two years, economical restrictions imposed by EU on
Iran banking system and flow of the money has pushed Iran national contract fractionation
program to the verge of total collapse. These restrictions on importation of PDM into
Iran have also created a dreadful condition for patients in need of such medicines
including hemophilia and primary immunodeficiency disorders patients who need these
medicines for their survival. Unavoidably price increase and more importantly shortage
of these medicines in the market have drastically compromised treatment of these patients.
Although establishment of a contingency plan might enable IBTO to continue its contribution
for providing lifesaving PDM for these patients, continued pressures and restrictions
by EU on Iran health sector might get its high toll in near future. One practical
contingency plan could shift IBTO to search for partners in non European countries.
However, due to limited number of qualified plasma fractionators in non European countries
e.g. Asian and South America, this approach to the East might not be fruitful approach
to survive the contract fractionation program at least in short term.

Conclusion

There is now consensus among political scientists that the record of sanctions in
achieving their stated objectives is very low [1]. Instead ordinary people who live in sanctioned countries have to bear costs attributed
to the sanction. Although most published reports of assessment of sanctions effects
on health focuses on clinical health services, shortages of medicines and inability
to diagnose or treat illness and the functional loss of equipment due to lack of access
to spare parts is common.

Results of observations from current situation in Iran pharmaceutical market confirm
that the sanctions against Iran are affecting ordinary citizens and health sector
which resulted to reduction of availability of lifesaving medicines in the local market.
As the Iran’s political leadership has withstood the economic sanctions over last
decade, it is clear that sanctions have not achieved their stated political to objectives.
However, this is obvious that sanctions against Iran, due to lack of timely access
to the lifesaving medicines, has caused increasing pain and suffering for Iranian
patients.

References

Garfield R: The impact of economic sanctions on health and well-being.