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The often lethal “side effects” of sanctions on pharmaceutical systems

The often lethal “side effects” of sanctions on pharmaceutical systems

By Saleh Aljadeeah
on November 3, 2023

Sanctions are political and economic measures that are part of the political and diplomatic response against states or organizations that threaten international law. They are meant to restore international law, promote peace and security, discourage human rights violations, and put an end to extremist behavior. Sanctions can be imposed by states and international organizations.

The UN Security Council can impose sanctions on individuals, entities or states that bear responsibility for starting or maintaining conflicts. In some cases, the UN sanctions succeeded  in conflict prevention efforts, by pushing conflict parties to enter into dialogue. For instance, sanctions over a long period contributed to the international pressure on South Africa to end apartheid. However, in many cases, sanctions failed to make a change, as in the cases of Iraq and Iran.

The first sanctions regime was imposed by the UN Security Council in 1966 on Southern Rhodesia, today’s Zimbabwe. Currently, sanctions are in place against over 30 regimes globally, among others versus Syria, Iran, the Democratic Republic of Congo, Venezuela, Libya, Russia, Ukraine, and North Korea. The rationale put forward by those who enforce sanctions, is the protection of human rights – eg. against torture, extrajudicial, summary or arbitrary executions in Eritrea and South Sudan; large-scale arbitrary detentions of the Uyghur minority in China; or enforced disappearances in Libya. All parties that enforce sanctions also claim that they will make every possible effort to minimize adverse consequences on civilians. However, more often than not, these claims are not met. For instance, there is evidence that sanctions heavily impact on the performance of national pharmaceutical systems, causing a dramatic drop in access to essential medicines and other health products.

Formally, the pharmaceutical sector is never targeted by sanctions. However, sanctions typically hit the transport and supply infrastructure, some industrial sectors related to medicines (e.g. packaging materials), and they generally also cause hyperinflation that reduces a country’s purchasing power across sectors. Consequently, both import and production of medicines are hampered, leading to shortages and dramatic price increases. For instance, due to the US-led economic sanctions against Iran, the country has experienced a dramatic decrease in its pharmaceutical budget, which in turn reduced  its capacity to match the supply of medicines to the real needs, and caused frequent shortages. The sanctions also negatively affected the local manufacturing capacity and  distribution infrastructure. The resulting lack of access to essential medicines had a serious medical, social, and psychological impact on communities and the health system. For instance, operating theatres ran out of anesthetics, forcing hospitals to procure merely older types of anesthetics, no longer recommended due to their poor efficacy or safety profile.

In Syria, the UN and EU economic sanctions, levied gradually against the Assad regime since mid-2011, had a catastrophic impact on local manufacturers, due to the sharply increased costs of importing raw materials, delayed access to substances and equipment needed in the production process, and a total blocking of the import of certain raw materials. Consequently, many industries lost their manufacturing capacities and their licenses. The collapse of local manufacturing led to a 50% increase in the prices of medicines between 2018-2020. The preliminary findings of an ongoing ITM research project on medicines for noncommunicable diseases (NCD) in northern Syria indicate a five-fold price increase over the past two years, as well as frequent shortages of essential medicines for cardiovascular diseases and diabetes. The impact of sanctions is equally heavy for the country capacity to monitor the quality of medicines, due to the shortages of chemical references for testing medicines’ quality and purity.

Different scholars highlight that the patterns of the impact of sanctions on pharmaceutical systems observed in Iran and Syria are also found in other sanctioned countries , e.g. Cuba, former Yugoslavia and Iraq. UNICEF data shows that during the COVID-19 pandemic, pharmaceutical companies refused to sell COVID-19 vaccines to sanctioned countries: no pharmaceutical companies sold COVID-19 vaccines to, or signed a supply agreement with Afghanistan, Iran, North Korea, Syria, and Venezuela.

Sanctions are, at least in principle, important non-violent instruments to promote peace and human rights. Unfortunately, they often end up affecting citizens in addition to (/rather than) the regimes. Substantially, moreover. Their negative impact on access to healthcare, including medicines, is undeniable. Consequently, they have been called a “silent killer” – killing through the failure to care, in a blatant violation of International Covenants and the fundamental right to health. We should not look away from the sanctions’ lethal “side effects”.

Yes, oppressing regimes should pay the price for the violations of international laws and human rights. But not the civilian populations. Local and international stakeholders along with the international community should thus join forces to prevent sanctions that challenge/negatively affect health and pharmaceutical systems. Suggestions include the exemption of banking transactions associated with medicines from sanctions, and using the frozen assets of sanctioned countries in banks in Western countries to acquire medicine and medical supplies for the populations concerned. During pandemics and other health emergencies, special attention should be paid to the risk that sanctions prevent vital access to medicines for the population of sanctioned countries. Failure to do so might hamper an effective global response in controlling infectious diseases outbreaks. More research is needed to identify effective interventions that may be translated into policies and practices for overcoming the challenges presented to pharmaceutical systems due to sanctions, and save thousands of lives.

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