Over recent months, the crisis of the shortage of the local anaesthetic used in dental clinics in Egypt has resurfaced: that vital preparation, indispensable for performing the simplest types of treatment and surgical operations. Although the crisis is not new, it has returned to impose itself once again on the medical scene, after a series of recurring crises in recent years without any party succeeding in putting in place a radical or permanent solution to it.
While the crisis appears, on the surface, to be merely a problem of medicine supply aggravated by the halt in imports and weak local production, dentists see it as going far beyond that. While the Egyptian Drug Authority affirms that the shortage is “temporary” and was recently contained by supplying quantities to the General Dentists Syndicate to distribute to clinics, the doctors we spoke to consider that what is happening reflects a recurring structural flaw in the management of the medicine file in Egypt, especially with regard to “dental anaesthetic”, in addition to the absence of a clear policy guaranteeing the stable availability of essential medical preparations without interruption.
In the context of official moves to address the crisis, the Ministry of Public Business Sector announced on 29 October last that it had held an expanded meeting chaired by the minister, Eng. Mohamed Shimy, attended by Dr Ehab Heikal, head of the Dentists Syndicate, with the participation of leaders of the Holding Company for Pharmaceuticals and Alexandria Pharmaceuticals Company, the largest producer of dental anaesthetic in Egypt and the Middle East.
According to the ministry’s statement, the meeting discussed mechanisms for developing the system for producing dental medicines and supplies and ensuring that the local market’s needs for them are secured with high quality and efficiency, through strengthening cooperation between the syndicate and the companies affiliated with the ministry. During the meeting, the minister affirmed that the state gives the medicine and medical supplies sector top priority, as a strategic sector directly linked to citizens’ health. He also stressed that the ministry is working to modernise production lines and localise modern technology to guarantee the provision of safe and effective products that meet the needs of the local market at suitable prices.
For its part, the Dentists Syndicate had officially announced the worsening of the local anaesthetic shortage crisis, describing it as affecting a strategic product indispensable to providing healthcare to citizens. The syndicate explained in its statement that its role is limited to organising the distribution process between the producing and importing companies and doctors through its own electronic application, to ensure that the product arrives in an organised and fair manner.
The statement revealed that the current crisis resulted from the halt in imports and rising global prices, along with some importers’ reluctance to supply because of official pricing differences, as well as problems in the production lines of the national companies and weak local production capacity, which covers only about 10% of market needs. The syndicate pointed out that the price of imported anaesthetic had seen an unprecedented rise on the black market, exceeding its mandatory price by more than EGP 1,000, which led to a clear disruption of the market’s balance.
The syndicate stressed that it had officially written to both the Egyptian Drug Authority and the Ministry of Public Business Sector, demanding urgent facilitation to resume import operations and to guarantee the provision of the product locally in a stable and regular manner.
A temporary solution to the crisis, and not the first time
The dental anaesthetic shortage crisis has recurred in recent years, with its beginnings dating back to 2017, as a result of a partial halt in imports and a decline in local production. At that time, the Spanish supplier company stopped supplying the Egyptian market with sufficient quantities to cover its needs, while only one company, based in Alexandria, was producing the anaesthetic locally, which caused a widespread shortage in dental clinics across the country.
Despite the measures taken by the Ministry of Public Business Sector and its affiliated pharmaceutical companies to address the crisis on more than one occasion, it returned in subsequent years, most notably in 2022 and then over recent months, because of technical breakdowns in the production lines coinciding with weak strategic stocks and delays in import operations.
Dr Ehab Heikal, head of the Dentists Syndicate in Egypt, explains in an interview with Zawia3 that the latest crisis has in fact been contained, and that there is no current crisis in the full sense, except that the quantities available on the market are relatively limited. He points out that the recent shortage was sudden and temporary, and resulted from the producing company’s machines entering periodic maintenance whose impact on the volume of production had not been planned for in advance, which led to a temporary decline in supply.
On the recurrence of the crisis in recent years and the possibility of it recurring in the future, Heikal affirms that the new electronic distribution system applied by the syndicate has helped organise the dispensing of anaesthetic to doctors with greater fairness and transparency, considering that what happened recently was a limited administrative failure on the part of the producing company and the Drug Authority, which was dealt with quickly. He adds that the Minister of Public Business Sector has already taken measures to ensure the crisis does not recur in the future, through a plan to modernise production lines and ensure the stability of the strategic stock.
For our part, we tried to contact the Egyptian Drug Authority to obtain an official response regarding the crisis and the authority’s future plans to ensure it does not recur, but we had not received a response by the time this report was published.
In contrast, Dr Mohamed Badawi, a dentist, former member of the syndicate council and former candidate for the post of head of the syndicate, believes that the dental anaesthetic crisis in Egypt is not “incidental”, as the syndicate describes it, but rather a chronic problem extending over more than four years, appearing and disappearing periodically without radical solutions.
Speaking to Zawia3, Badawi explains that what the market has recently witnessed in terms of restrictions on purchase quantities and unusual conditions, such as obliging a doctor to buy a pack of the less-used type in exchange for obtaining two packs of the more-used type, “only happens in times of crisis, and is a clear indicator of a real shortage in supply.”
Badawi attributes the current crisis to the monopoly of a single company over the production of local anaesthetic, whose output is insufficient to meet supply and demand amid the halt in imports, which resulted from a flaw in the pricing system and its failure to keep pace with changes in the dollar exchange rate, explaining that importers incur losses when the mandatory prices fixed on the packs remain lower than the actual cost of importing.
Electronic distribution: mismanagement and misuse
While the head of the Dentists Syndicate affirms that the crisis is over, and that the electronic application has contributed well to distributing dental anaesthetic to doctors fairly and regularly, Dr Khaled Abdel Basset, a member of the council of the General Dentists Syndicate, believes that the electronic application in question has contributed to aggravating the crisis rather than solving it.
Speaking to Zawia3, the member of the Dentists Syndicate council says that DAF Company is the syndicate’s accredited agent for distributing dental anaesthetic fairly to doctors via the electronic application system, under the contract concluded between the General Syndicate and the Egyptian Pharmaceutical Trading Company, affiliated with the Unified Procurement Authority, but the electronic system is suffering from mismanagement and misuse that has led to a clear flaw in the distribution process, pointing out that quantities of anaesthetic are being sold outside the application, which has aggravated the crisis, especially in the absence of a strategic stock on which the company can rely when supply from “Alexandria Pharmaceuticals”, the main local producer of anaesthetic in Egypt, stops.
Abdel Basset asks: “The situation of imported anaesthetic has been known to everyone for months, so do we wait until it is completely unavailable and then start contacting local factories to increase production? Must we wait until the price of a pack on the black market reaches EGP 2,000 before we move towards a radical solution that prevents the crisis from recurring?”.
At the same time, the syndicate member criticises the latest statement issued by the General Syndicate on the anaesthetic crisis, explaining that it was published without being presented to the syndicate council or reviewed by it, and that the information it contained, especially regarding “the export of 80% of local production”, has not yet been confirmed. He stresses the need to allow anaesthetic to be bought both inside and outside the application at the same time, as it is a strategic pharmaceutical product whose availability must not be tied to an electronic system that may be subject to breakdowns or updates.
He also points out that the increase in shipping fees borne by doctors without their receiving the usual discounts that shipping companies grant to small institutions, along with the additional fees for (e-services), calculated at a high rate estimated in the thousands on purchases through the application, represent an additional financial burden on doctors, while the intermediary companies benefit from the privileges without this being reflected on consumers or in an effective solution to the crisis.
For his part, dentist Mohamed Badawi points out that the “DAF Digital Solutions” company, contracted by the Dentists Syndicate to distribute anaesthetic via the electronic application, has come to effectively control the distribution process in the market, in what resembles a “monopoly”, adding that the current system has not achieved fairness in making the product available to doctors, but has instead created “recurring crises and disparities in quotas”. He also asks about the fate of the quantities that were supposed to be distributed via the application: “If the quota the company obtained did not reach doctors as it was supposed to, then where did these quantities go?”
The DAF company for digital services took on a pivotal role in the system for distributing dental anaesthetic via the Dentists Syndicate’s electronic application, as part of the comprehensive digitisation of the pharmaceutical supply chain. On a broader track, the company concluded a cooperation protocol with (GS1 Egypt) to launch a medicine-tracking project in Egypt, which reflects its role as a technical provider in medical supply and market regulation.
On the other hand, the shift to the electronic distribution of dental local anaesthetic through this platform has raised several questions: about transparency in the quotas distributed, the system’s ability to cope with breakdowns or interruptions in production, and the extent to which doctors are able to access the product fairly without confusion or pressure on quantities.
The absence of transparency: one of the parties to the crisis
Although Alexandria Pharmaceuticals Company, responsible for about 80% of local production, announced the launch of a new production line in 2023, at an investment cost of EGP 45 million, with the aim of significantly increasing the company’s production capacity to meet the needs of the local market and provide quantities for export, the crisis quickly returned, raising questions about the real reasons behind the halt in production and the scarcity of supply on the market.
Dentist Dr Mohamed Badawi explains that the new production line had been running for only one year before it suddenly stopped “on the pretext of periodic maintenance”, considering this halt “unjustified, and it is illogical for it to happen in a vital facility of this size”. He believes that the persistence of the crises results from “the lack of transparency in the contract concluded between the syndicate and the distribution company”, adding: “Any intervention in the market should be regulatory, to protect the public interest, not aimed at control and profit. But when intervention turns into a tool for private interests, the crises will keep recurring in a contrived way”.
For his part, Mahmoud Fouad, director of the Right to Medicine Association, affirms that the problem of local anaesthetic is “old and recurring”, linked primarily to disruptions in the production lines at Alexandria Pharmaceuticals Company over the past five years, because of maintenance problems and shortages of raw materials. He adds that these disruptions always create a black market from which intermediaries benefit, while the syndicates, the doctors and the patient bear the burden of the crisis.
With every crisis, the Egyptian Drug Authority resorts to organising distribution through the sub-syndicates, so that each doctor obtains a limited number of packs, which Fouad describes as “a temporary solution that opens the door to exploitation”. With the decline in local supplies, doctors turn to imported alternatives such as Albanian or French anaesthetic, which are more expensive and sometimes of lower quality, which raises the cost of the medical service and increases the patient’s suffering.
Fouad points out that the absence of an accurate database determining the volume of local consumption of anaesthetic and the actual rate of production “means the regulatory bodies are surprised by the crisis instead of anticipating it”, stressing the need to modernise the infrastructure of the public business sector companies and to provide an actual strategic stock to guarantee stable supplies.
He concludes by warning that the absence of anaesthetic in dental clinics “does not only mean the disruption of work, but is direct suffering for the patient who is deprived of treatment, and the matter may turn into something resembling unintended human torture.”
In the end, despite the temporary relief in the crisis of local anaesthetic for dentists, it has revealed a structural flaw in the management of the medicine market in Egypt, where medicine crises recur without a proactive plan or early-warning mechanisms, and the solution always remains within the limits of “temporary containment”, not radical reform and future plans to avert the crisis.
