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October 24, 2024

Fatemeh Hashemi Rafsanjani: We should have managed the blue drug crisis / Azar Taherabadi

In recent months, if we haven’t personally experienced the problem of finding and obtaining medication in Iran, we have definitely seen or heard from the sidelines that many patients are facing much more serious problems than in the past.

Considering the subject of the special issue of the Peace Line magazine, we approached Ms. Fatemeh Hashemi and arranged a telephone interview with her to inquire about the factors that have led to problems in drug production in Iran.

Fatemeh Hashemi is the daughter of Akbar Hashemi Rafsanjani, the head of the Foundation for Special Diseases in Iran. The Foundation for Special Diseases, as a non-governmental and public institution, began its activities in Ordibehesht month of 1375 (April/May 1996) with the aim of organizing and improving the situation of special diseases.

A few days ago, in a letter addressed to Ban Ki-moon, the Secretary-General of the United Nations, he listed the serious problems of these patients caused by the banking sanctions against Iran and called for effective action by the United Nations.

Ms. Hashemi, as the head of the Foundation for Special Diseases, can you confirm that the sanctions imposed on our country have caused a shortage of medicine in Iran?

Yes, one of the problems that has led to the shortage and high cost of medication is sanctions.

In these circumstances, where we can almost say we are facing a “drug shortage crisis”, is there anything we can do to alleviate this crisis?

If we use proper management, this is achievable. See, part of our problem was due to currency. This currency was allocated for certain things that were not actually necessary for the country in these circumstances. We can limit the allocation of this currency for non-essential issues and allocate it to essential medicines in the country, and ultimately, there must be savings in various areas so that we can overcome this crisis.

Mrs. Hashemi, we had a large amount of medication at customs that caused problems during clearance. What happened to these medications? Can we still use them?

This issue was also one of the problems of mismanagement in the country and did not have any communication sanctions. However, there was indirect communication, but it could be resolved with proper and good management. Fortunately, in recent times, the head of the customs has ordered all these drugs to be cleared and injected into the market, and some of these drugs that are related to specific diseases that I am following up on and am aware of, have been removed from the black market.

Have you taken any other actions besides the ones within the country and the letter you sent to Ban Ki-moon, the Secretary-General of the United Nations, in which you criticized the UN Secretary-General’s silence on the sanctions against special patients in our country? Have you made any other efforts on the international stage to solve this problem so far?

Yes, in addition to them, we also sent a copy of the letter to other associations around the world that are active in relation to specific diseases, and we asked them to follow up on this matter. Of course, everyone replied to us that the drug is not under sanctions, and we ourselves knew that the drug is not explicitly under sanctions, but the sanctions imposed were in a way that affected it. For example, oil was under sanctions and could not be purchased, and naturally, we faced a shortage of currency. On the other hand, currency transfers were not easily done and a percentage had to be paid for currency transfers; all of these issues led to problems in the field of medication.

So in reality, the oil sanctions have had an impact on medicine…

Oil sanctions, banking sanctions, and shipping sanctions have all joined hands and created problems for medicine. However, we still purchase medicine from different countries.

You are in charge of the Foundation for Special Diseases, the management that you have mentioned in your previous interviews. In which department of the country’s executive branch do you exist and what exactly is the management, especially in the previous government, and what should they have done?

Finally, we knew that we were going to be sanctioned and the Ministry of Health and the government at that time should have predicted that after the sanctions, problems would arise. Therefore, the least they could do was to procure medicine for one to one and a half years and store it in warehouses to avoid this crisis, and on the other hand, they should have made currency savings, which unfortunately they did not do.

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Mrs. Hashemi, medicines usually have an expiration date; how can we store them for several years? Especially considering that it is not clear how long these sanctions will last…

See, medicines usually have a two-year expiration date, and if we don’t buy the overstock medicines that are only a few months away from their expiration date, we could manage the shortage. In some situations, we saw that overstock medicines were being imported into the country with a very close expiration date. These were usually medicines that were left in warehouses around the world and were purchased at a cheap price; however, when they arrived, they were sold in the Iranian market at the global price! But if the medicine is purchased directly from the manufacturing factories and at a specific time, some of these medicines can be stored in warehouses for up to two or three years. So, storing medicines was definitely beneficial for us.

It is true that we did not know how long these sanctions would last, but these medicines were necessary for the country and we had at least one or even two years of medicine during the first or even second year of sanctions, and we managed the crisis and had the opportunity to plan for the next few years and future purchases so that we would not rush to obtain medicine quickly and face many problems.

Let’s move on to a broader topic! Who is a special patient primarily referred to and what population does it include in Iran?

In the definition of specific diseases, which are defined at the foundation, we call any disease that needs to be treated continuously and regularly with medication until the end of life – whether daily or weekly – and under permanent treatment, a special disease. In 1976, when my father was still the president, we chose three diseases, hemophilia, thalassemia, and dialysis, and it was approved by the government to be called a special disease and their treatment should be free. Of course, in our opinion, cancer, MS, and other diseases should also be considered as special diseases, but unfortunately, no government after Mr. Hashemi’s government accepted to add new diseases to this list. If we had added one disease to the list of special diseases every year, by now, the problems of 20 diseases in the country would have been solved.

Mrs. Hashemi, I had a question regarding this matter, why didn’t you suggest or manage diseases such as MS, Parkinson’s, or cancer, which are considered special diseases in the world, in the initial or subsequent lists to governments? In any case, the medical costs for these diseases are free in many countries, but in Iran, they are very costly and their medications are also difficult to access.

See, we made the suggestion, but unfortunately, as I mentioned, neither Mr. Khatami’s government nor Mr. Ahmadinejad’s government accepted to add these diseases to the list. But fortunately, in this government, we made the suggestion and Dr. Hassan Hashemi welcomed it and accepted the Foundation’s talks.

In a meeting that we had with insurance managers and officials from the Ministry of Health on September 18th, it was suggested that Multiple Sclerosis be classified as a special disease, as 90% of the costs for this disease are covered by insurance and the remaining 10% or 20% is paid by patients. However, unfortunately, with the increase in the cost of medication, insurance companies do not cover the difference; meaning they only pay the old price. In this meeting, it was decided that this issue should be followed up on and patients with MS should receive free services, just like patients with hemophilia, thalassemia, and dialysis. Now we have to wait for this proposal to reach the Minister’s hands and see what decision they make.

How long do you think it will take for these diseases to be added to the list of specific diseases?

See, they really have to sit down and plan for it and consider a budget; because ultimately these special patients need a budget. They have to investigate and see which part of the budget is available to them and then, I can say that within a week they can announce that this disease has been classified as a special disease and the insurances will cover its costs. This task requires a short, not a long-term planning, but the important issue is that they can cover the costs of this matter.

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Mrs. Hashemi, regarding the insurance that you mentioned, many insurances in Iran accept a very low percentage of expenses. Does your foundation have a program or solution for this problem?

Our foundation only suggests a solution because it cannot provide a budget. But this is very easy; when they have increased the costs of water, electricity, and many other things multiple times, they must include their subsidies in the expenses of providing social security for the people, one of which is insurance.

If all individuals who suffer from specific or incurable diseases, or even all people in the country, are insured, the expenses of this matter will be covered by the costs that are saved from cutting subsidies that are actually under the control of the government. On the other hand, our people pay a per capita amount, and all people have the same per capita amount, and not everyone gets sick at the same time. For example, one person may only get sick four times in their lifetime and have simple illnesses, or not have any problems or illnesses in a year, while another person may have a disease their entire life. Therefore, with the income that is under the control of insurance, people can be covered.

You can specify which diseases and also which medications in general have been affected more than others by sanctions in Iran and have become difficult to obtain for patients facing them.

It can be said that the majority of medicines are under the influence of sanctions and we have faced difficulties in supplying them. We generally have three categories of medicines. One group of medicines was directly imported from abroad, another group was produced domestically using imported raw materials, and there are also medicines that we produce using domestic raw materials. Currently, due to sanctions, we are facing difficulties in the first and second categories.

Based on your years of experience in managing this foundation, what do you know about short-term and long-term solutions to solve the problem of drug shortages in Iran, especially if the issue of sanctions is not resolved?

I would like to discuss a short-term solution in which a part of our patients must always and continuously take medication, and the medication is essential for them. If the medication does not reach this patient, they will die. Therefore, we cannot say that we do not have medication for these patients to provide for you. Therefore, the medication for these patients must be identified and quickly provided for the country.

In the long term – of course, when we say long term, not that we consider ten years, but rather solutions for four to five months are being considered – the rest of the necessary medications should be identified and provided through the Ministry of Health and made available to the people.

Thank you for giving us your time…

I will repeat this point that I have said many times: Medicine for patients, especially for special and difficult-to-treat patients, is even more necessary than dinner. This means that these individuals may not have dinner tonight, may not eat meat or chicken, but they cannot skip their medication.

Azar Taherabad
November 12, 2015

Azar Taherabad Expiration date Fatima Hashemi Foundation for Special Diseases Monthly magazine number 29 Sanction Sanctions on medicine ماهنامه خط صلح ماهنامه خط صلح