There may soon be a lack of ordinary penicillin in Ukrainian pharmacies. The Ministry of Healthcare launched an offensive on antibiotics.
At the suggestion of the department of Ulana Suprun, in March the Cabinet of Ministers approved the “National plan of action for combatting antimicrobial medicine resistance”. It is designed for two years and stipulates both educational actions for Ukrainians (to wean them off treating themselves) and rather drastic measures for doctors and pharmacists selling antibiotics without a prescription. As was specified by the acting Minister of Healthcare Ulana Suprun – up to criminal liability.
Officials of the Ministry of Healthcare do not hide that antibiotics are only the beginning. The list of medicines that will be sold strictly according to prescriptions will be expanded in the future.
They also explain that because of the uncontrolled administration of medicines, Ukrainians are not treated, and thus ruin their health even more. And the pharmacists who are more focused on making a profit are always glad to advise them to take “severe” medicines and, preferably, more expensive ones.
However, there are nuances. In order to get the desired prescription, now it will be necessary to get an appointment with the family doctor, which means – signing a declaration. “20-40% of citizens in Ukraine, depending on the locality, don’t have a declaration. This means that they risk being left without treatment in general,” explained the Vice Chairman of the Board of the Ukrainian Medical Society Konstantin Naduty to the Ukrainian “Strana” news agency.
How will prescription medicine sale schemes change and will people be jailed in Ukraine because of antibiotics?
War on antibiotics
The program from the Ministry of Healthcare includes several points. Before the third quarter of this year it is going to make changes to the laws “On Medicines” and “On the Protection of the Population against Infectious Diseases”, in which they want to record a norm on the sale of antibiotics strictly according to prescriptions, for example. By-laws on toughening prescription control will be also drafted. As it turns out from Ulana Suprun’s statements, This will involve draconian penalties and criminal penalty for pharmacists.
It’s still not clear how big the fines will be. But, for example, in Russia a pharmacists can be fined 10,000 rubles for selling medicine without a prescription, and a pharmacy – 30,000 rubles. In total the vendor can pay up to 16,000 rubles for each illegal sale of an antibiotic.
Until 2020 restrictions for antibiotics will also apply to veterinary medicine (as is well-known, drugs accumulate in meat and can harm people).
In parallel, they want to establish monitoring of the influence of antibiotics on the health of the population, and in particular, to study the resistance of Ukrainians to popular medicines.
The matter is that infections constantly mutate and learn to resist antibiotics. And the more tablets a person takes, the more difficult it is for them to overcome a disease later – it is necessary to involve more and more strong medicines, since the same penicillin does not help them any more. As a result, ordinary pneumonia, which in principle can be treated, can become deadly for a patient stuffed with antibiotics.
Such problem exists around the world. In 2016 the UN approved the resolution on the “Global Action Plan on Antimicrobial Resistance”. Now Ukraine is also a part of it. Our situation with antibiotics is much worse than it is in Europe and the US. According to the doctor, head of the pharmaceutical association “Lege Artis”, and business coach Alena Romanovskaya, up to 60% of Ukrainians self-medicate and do not go to the doctor. They prescribe medicines for themselves or consult pharmacists. And often at banal cold drink antibiotics, than affect the health.
Formally, antibiotics are prescription medicines also now. This is written in the instructions for most medicines in this group. “According to legislation, strict prescription medicines are subject to list A – strong medicines for example, tranquilisers, codeine-containing medicines, anaesthetics, and so on,” explained Alena Romanovskaya.
Also, Article 320 of the Criminal Code of Ukraine “Violation of rules related to circulation of narcotics, psychotropic substances, their analogues or precursors providing imprisonment” stipulates imprisonment for up to 3 years. But antibiotics do not belong to the list of “criminal” medicines yet.
In practice, nobody especially monitors the observation of these norms. In fact, pharmacies do not bear any responsibility for the sale of medicines without a prescription. Therefore most pharmacists simply ignore the rules.
“The bacchanalia with the sale of antibiotics is supported by pharmacies – if they did not issue medicines without a prescription, then the problem would disappear by itself. However, there are no laws that forbid pharmacies from doing it. It happened that when doctors ceased to be provided with prescription forms, they started to ‘prescribe’ medicines on ‘sticky labels’ instead of prescriptions, and pharmacies started to sell them,” explained Romanovskaya.
However, often pharmacists themselves advise buyers of antibiotics – for example, if they complain about a prolonged cough or cold. As a result, antimicrobial drugs give quite good sales. According to the head of the “Agency for Medical Marketing” and cofounder of the network of clinics “Available Doctor” Yury Chertkov, the proportion of antibiotics in the general pharmaceutical basket is about 4%, and in money this is $120 million per year. “It is clear that with toughening of conditions of sales, this sum much more will decrease,” he said.
Plus, pharmacists are rather afraid that prescriptions for antibiotics will be electronic. It is not excluded that they will be simply merged with the system that started to work from April 1st within the framework of “Available Medicines” program. In order to receive a prescription, the patient has to come to the family doctor, who will issue a prescription in the general electronic database and it will come to the patient via a code that is sent by SMS. This code should be given to the pharmacy, and only then will the pharmacist, having verified it with the same database, give out the medicine.
But in order to participate in this chain, pharmacies need to be connected to the general database and buy the necessary equipment and software. It is necessary to spend up to 20,000-30,000 hryvnia on the latter alone, which not all pharmacies can afford, especially rural ones. Therefore antibiotics may disappear from some outlets in general.
And, it is possible that in the future the list of medicines issued “strictly according to prescriptions” will only expand. In addition to antibiotics, sedatives, painkillers, cough medicines, etc. can also be included in it. Only the most simple medicines can be sold without a prescription – nasal drops, throats lozenges, or heartburn remedies. In fact, such a scheme operates in many countries in Europe. But there, inconveniences for patients are compensated by generous compensations – the majority of prescription medicines are given out free of charge or with a small surcharge, but not at full price, like it is in Ukraine.
There is also one more nuance. In order to receive a prescription, it is necessary to go to the family doctor, and for this purpose, at least, to sign a declaration with them. From April 1st the Ministry of Healthcare stopped the financing for so-called “red lists” (patients without declarations). And although formally it was promised that Ukrainians will nevertheless be able to receive medical aid, in practice many clinics already warn that they will not serve people in exchange for a “thank you”.
In addition, even if the doctor will agree to see you, they will need a declaration number in order to issue an electronic prescription. I.e., receiving a prescription without a declaration with a doctor is almost impossible.
According to the Ministry of Healthcare, about 26.5 million Ukrainians chose a family doctor. I.e., at least, 12.5 million people risk being left without medical assistance.
“And most of them may not agree to sign a declaration at all (let’s say, for example, on religious grounds). And some cannot simply do this – they go to a policlinic, and there they are told that there are no free doctors any more,” said Konstantin Naduty. According to him, instead of being the registered norm for the capacity of doctors (up to 2,000 patients), in some regions the figure reaches 4,000 and above.
In certain districts of the Kiev region, for example, there are 5,000-6,000
According to the head of the Kiev City Trade Union of Health Workers Sergey Kubansky, as of the beginning of this year the capacity of medics countrywide is less than 82% full, and across Kiev – 79.26% (there is a shortage of, in particular, 350 family doctors). The general deficiency of doctors across the country is more than 40,000.
“I.e., we did not resolve the issue with the availability of primary medical aid. And if against this background antibiotics start being sold strictly according to prescriptions, then many Ukrainians will not stand a chance of healing,” said Konstantin Naduty. For example, if a person has been ill for more than a week with a temperature and cough, then, most likely, it is necessary to drink antibiotics. Otherwise there can be serious complications, say, bronchitis will turn into heavy pneumonia.
As an option, it is possible to go to a private clinic. But in this case, besides 200-500 hryvnia for antibiotics, it is necessary to also pay 250-600 hryvnia for a doctor consultation, and not everyone can afford such expenses.
However, it is possible that pharmacists will find a way to bypass the bans. For example, they will start selling antibiotics over the Internet. However, if tablets become “risky goods”, they, most likely, will grow in price. Therefore Ukrainians will have to overpay even more for already not cheap medicines.
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