Egypt’s dental clinics have faced a renewed shortage of local anaesthetic in recent months, disrupting access to a product essential for routine treatment and surgery. The crisis has returned repeatedly in recent years without a lasting solution.
On the surface, it appears to be a supply problem involving interrupted imports and insufficient domestic output. Dentists interviewed by Zawia3, however, describe deeper weaknesses in how the market is managed and the absence of a clear policy to guarantee uninterrupted availability.
While the Egyptian Drug Authority has described the shortage as temporary, with supplies provided through the Dental Syndicate for distribution to clinics, practitioners say recurring disruption points to structural problems.
On 29 October, Public Business Sector Minister Mohamed Shimi chaired a meeting with Dental Syndicate president Ihab Heikal and representatives of the Holding Company for Pharmaceuticals and Alexandria Pharmaceuticals, a major producer of dental anaesthetic.
According to the ministry’s statement, the meeting examined production and supply arrangements for dental medicines and equipment and cooperation between the syndicate and state-owned companies. Shimi described the sector as strategically important to public health and said the ministry was modernising production lines and localising technology to provide safe, effective products at affordable prices.
The Dental Syndicate had itself warned that the shortage was worsening. It said its role was to organise distribution between producers, importers and dentists through an electronic application to ensure orderly and fair access.
The syndicate attributed the crisis to interrupted imports, higher international prices and importers’ reluctance to supply the market because of official pricing differentials, alongside problems on state-owned production lines. Its statement estimated that available domestic production covered only around 10% of market needs.
It said black-market prices for imported anaesthetic had exceeded the regulated price by more than EGP 1,000. The syndicate asked the Drug Authority and Public Business Sector Ministry for urgent measures to resume imports and stabilise local supplies.
Temporary relief from a recurring shortage
Similar shortages were reported in 2017, when imports were partly interrupted and local output fell. A Spanish supplier was no longer providing sufficient quantities, while only one Alexandria-based company was producing the anaesthetic locally.
Despite repeated interventions by the Public Business Sector Ministry and its pharmaceutical companies, shortages returned, notably in 2022 and again in recent months, as technical problems coincided with weak reserves and delayed imports.
Dental Syndicate president Ihab Heikal tells Zawia3 that the latest crisis has effectively been contained. He says there is no longer a full-scale shortage, although available quantities remain relatively limited. The immediate disruption, he explains, resulted from routine maintenance whose effect on production had not been adequately planned for.
Heikal says the syndicate’s electronic distribution system has made allocation fairer and more transparent. He characterises the latest episode as a limited administrative failure by the producer and the Drug Authority that was addressed quickly.
He adds that the public business sector minister has taken steps to prevent recurrence through production-line upgrades and more stable strategic reserves.
Zawia3 contacted the Egyptian Drug Authority for an official response on the shortage and its plans to prevent another crisis, but had received no reply by publication.
Mohamed Badawi, a dentist, former syndicate board member and former candidate for its presidency, disputes the description of the shortage as an isolated event. He calls it a chronic problem that has appeared and disappeared for more than four years without a fundamental solution.
Badawi points to purchase limits and requirements to buy one pack of a less-used product to obtain two packs of a more commonly used type. “That only happens in a crisis,” he says. “It clearly indicates a real shortage.”
He attributes the problem to reliance on a single local producer whose output cannot meet demand while imports are disrupted. Official prices, he argues, have not kept pace with changes in the dollar exchange rate, leaving importers facing losses when the regulated retail price is below the actual import cost.
Disagreement over electronic distribution
While Heikal presents the application as part of the solution, syndicate board member Khaled Abdel-Baset says its management has made the shortage worse.
Abdel-Baset explains that DAF is the syndicate’s authorised agent for distribution through the electronic system, under arrangements involving the Egyptian Pharmaceutical Trading Company. He alleges mismanagement and misuse of the platform and says quantities have been sold outside it.
He argues that the distributor lacks a reserve capable of covering interruptions in supplies from Alexandria Pharmaceuticals, the main local producer.
“The situation with imported anaesthetic has been known for months,” he says. “Must we wait until it disappears completely before contacting local factories to increase production? Must we wait until a pack costs EGP 2,000 on the black market before finding a lasting solution?”
Abdel-Baset also criticises the syndicate’s latest statement, saying it was published without being presented to or reviewed by the board. He says information in it about 80% of local production being exported remains unconfirmed.
He wants dentists to be able to purchase through the application and through other channels at the same time. Access to a strategic medicine, he argues, should not depend on a platform that may experience technical faults or updates.
He also criticises shipping charges and additional electronic-service fees. In his assessment, dentists bear extra costs without receiving the discounts that institutional customers might obtain, while intermediaries benefit without passing those advantages on to buyers or resolving the shortage.
Badawi similarly argues that DAF Digital Solutions has come to control distribution in a manner resembling a monopoly. He says the system has not delivered equitable access, instead producing repeated shortages and unequal allocations.
“If the quantities allocated to the company did not reach dentists as they should, where did they go?” Badawi asks, calling for clarity over allocation and distribution.
DAF plays a central role in digital distribution through the syndicate’s application as part of broader efforts to digitise pharmaceutical supply chains. In October 2024, it also signed a cooperation protocol with GS1 Egypt for a medicine-tracking project.
The dispute raises questions about transparency in allocations, resilience when production or technology fails, and dentists’ ability to obtain the product fairly and consistently.
New production lines, unanswered questions
Alexandria Pharmaceuticals announced a new dental-anaesthetic production line in 2023, with investment of EGP 45 million, to increase supply for domestic use and exports. Yet the shortage returned, prompting questions about production interruptions and the quantities reaching the market.
Reports have put the company’s share at around 80% of domestic production. That figure concerns its share of local output and is separate from the disputed claim about the proportion exported, or the syndicate’s estimate of how much total market demand domestic supplies currently cover.
Badawi questions why a recently installed line would stop for maintenance without continuity of supply. He also calls for transparency in the contract between the syndicate and the distribution company.
“Intervention in the market should be regulatory, to protect the public interest, not to control it and make a profit,” he says. He believes private interests within the distribution arrangements help explain why crises recur.
Mahmoud Fouad, head of the Right to Medicine Association, describes the shortage as an old problem returning in new episodes. He links it to maintenance and raw-material difficulties affecting Alexandria Pharmaceuticals’ production lines over the past five years.
Such disruption creates opportunities for black-market intermediaries, he argues, while syndicates, dentists and patients bear the cost. During shortages, distribution through local syndicate branches limits each dentist to a small number of packs, a measure Fouad regards as temporary and vulnerable to exploitation.
When domestic supplies fall, dentists turn to more expensive imported alternatives, including Albanian and French products. Fouad says this raises treatment costs and adds to patients’ hardship.
He calls for reliable data on domestic consumption and actual production, arguing that regulators are repeatedly surprised by shortages they should be able to anticipate. Modernising state-owned factories and maintaining genuine strategic reserves, he says, are essential to stable supply.
“The absence of anaesthetic in dental clinics does not just interrupt work,” Fouad says. “It means direct suffering for the patient who is denied treatment.”
The latest easing of supply has not settled the underlying dispute. Producers, regulators and the syndicate face continuing questions about contingency planning, transparent distribution and early warning mechanisms that could prevent another cycle of shortages and temporary fixes.
