EDITORIAL: Pakistan’s healthcare debate has long been dominated by one question: how to keep medicines affordable? That concern is entirely legitimate in a country where out-of-pocket healthcare expenditure remains among the highest in the region and millions struggle to afford even routine treatment. Yet, affordability becomes a meaningless objective when medicines are simply unavailable.
The reported shortage of dozens of hardship-category drugs, following more than two years of delay in approving price revisions recommended by the Drug Regulatory Authority of Pakistan (DRAP), is therefore more than an administrative lapse. It is a reminder that price regulation, however well-intentioned, cannot be divorced from economic reality. That the list of affected medicines is hardly trivial is a fact. Cancer therapies, cardiac drugs, oral morphine for palliative care, paediatric formulations, vaccines and ophthalmic medicines are among those reportedly in critically short supply. These are not discretionary purchases that patients can postpone until prices stabilise. For many, interruptions in treatment carry irreversible consequences.
Successive governments have found themselves caught in a familiar dilemma. Approving higher prices for essential drugs carries political costs, particularly at a time when inflation has already eroded household purchasing power. Delaying those decisions, however, merely shifts the burden elsewhere. Manufacturers facing rising costs of imported raw materials, energy, logistics and regulatory compliance cannot indefinitely produce medicines at commercially unsustainable prices. Eventually, production slows or ceases altogether. The result is exactly what Pakistan is witnessing today: largely empty pharmacy shelves. But this should not be interpreted as an argument for unfettered pricing. Medicines are unlike most consumer goods. They occupy a unique position where public health considerations demand regulatory oversight. The challenge for policymakers is to strike the right balance between affordability for patients and commercial viability for manufacturers. Lean too heavily in either direction and the system begins to fail.
Pakistan’s recent experience itself offers an instructive contrast. The deregulation of non-essential medicines was defended on the grounds that it restored market supplies after years of recurring shortages, even though it also resulted in higher retail prices. Essential medicines, meanwhile, remained under price controls precisely because of their public health importance. But if revisions for those controlled medicines are delayed for years despite recommendations from the regulator itself, the intended protection becomes self-defeating.
It is important to note that broader concern extends beyond availability. As legitimate supplies disappear, patients inevitably turn elsewhere. Industry representatives have warned that shortages create a fertile ground for counterfeit, smuggled and substandard medicines to enter the market. That poses risks far greater than higher prices. A counterfeit chemotherapy drug or cardiac medicine is not merely an economic issue; it is a direct threat to patient safety and public confidence in the healthcare system. This episode also highlights a deeper weakness in economic governance. Regulatory uncertainty serves neither patients nor manufacturers. If hardship-category medicines qualify for periodic price reviews under the existing framework, those reviews must culminate in timely decisions rather than remain trapped in bureaucratic limbo. Predictability is as important as the decision itself. Manufacturers can plan around a transparent regulatory process; they cannot plan around indefinite delays.
The profound irony is that the policy intended to protect patients may ultimately inflict greater hardship upon them. A medicine whose price is capped but unavailable offers no relief to a patient battling cancer, surviving a heart attack or managing a chronic illness. Availability is itself an essential component of affordability. The government, therefore, need not choose between protecting patients and sustaining pharmaceutical production. Both objectives are achievable through a predictable pricing mechanism, timely regulatory decisions and targeted support for vulnerable patients where necessary. What it cannot afford is policy paralysis. In healthcare, delayed decisions seldom remain merely administrative. They eventually become clinical, with patients bearing the consequences. Swift decision-making and timely response to regulatory recommendations can help achieve best possible clinical outcomes.
Copyright Business Recorder, 2026
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