Mexico’s Cancer and HIV Patients Hunt for Medicine After AMLO Decree
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For 10 years, it was pretty much like clockwork at the Mexico City clinic where Paquito Barrera picks up his HIV drugs every month. Then, in October, he left empty-handed. Ever since, he has had unnervingly uneven success in getting the antiretroviral-therapy cocktail that helps keep him alive.
“I’ve lost count of how many times they’ve told me to come back later,” said Barrera, a 34-year-old dressmaker. “How can they let this happen?”
He meant the government, which has struggled to respond to unusually stark shortages of medicines and medical supplies that are roiling Mexico and driving street protests. The roots of the crisis, by most accounts, were sweeping changes President Andres Manuel Lopez Obrador ordered last year to public-health programs in the name of rooting out corruption and cutting costs.
The unintended consequences rippling through the system are raising concerns about preparedness for the novel coronavirus; Mexico confirmed its first cases last week. “With the levels of shortages we’re seeing, it’s worrying,” said Senator Martha Marquez, a member of the opposition National Action Party who sits on the Health Committee.
Mexico has long been plagued by spot scarcities of drugs and medical equipment, sometimes severe enough to cause cancellations of crucial surgeries. But the situation now is extraordinary, according to patients, nonprofit health-care groups and independent analysts. Even cotton balls and alcohol are impossible to find in some hospitals, nurses and other staff say.
Lopez Obrador has dodged questions about whether his policies are responsible for the dearth of a range of drugs identified by advocacy groups and patients, including for chemotherapy and other cancer treatments. Deputy Health Minister Hugo Lopez-Gatell recently told reporters that unidentified “interests” are behind the complaints and demonstrations.
“There has been a lot of misinformation,” he said.
But at the president’s daily press conference Tuesday, his staff offered a slide presentation to show how the government is taking action, with plans for medical professionals in 17 states to receive this week the cancer medicines they have requested and updates on progress about getting supplies to public hospitals.
Deadly Disarray
How did a system that was functional, at least, fall into such potentially deadly disarray? Simply put, there was too much change too quickly that was too little researched, said Salomon Chertorivski, a former minister of health and now a professor at the Center for Economic Research and Teaching in Mexico City.
Until last year, the Mexican Institute of Social Security was responsible for acquiring most of the medicines, vaccines and supplies, such as surgical gloves, for the country of 128 million. Teams of specialists would study disease patterns and trends to anticipate demand. Because the government is the No. 1 client of many Mexican pharmaceutical companies, they usually didn’t start manufacturing until they got an order from the agency known as IMSS.
Then Lopez Obrador abruptly announced the Finance Ministry would take over this job from IMSS. He also cut the middlemen -- distributors including Grupo Farmacos Especializados and Farmaceuticos Maypo -- out of the process. His argument was that too few companies had too many lucrative contracts and the government would get a better deal by buying directly from producers.
The moves, which delayed government purchases of medicines, stunned health-care experts.
‘Noble Cause’
“We can celebrate the government’s attempt to avoid corruption and to maximize resources, that’s a noble cause,” said Fatima Masse, an economist and project coordinator at Mexico’s Competitiveness Institute, a think tank. “But you have to do it in a viable way. Sick people can’t wait.”
It was shortsighted to end contracts with distributors, Chertorivski said. There were so few companies because they need big investments to run networks with specialized vehicles and strict standards. “You can’t just use any milk truck and be done with it.”
Officials with the president’s office and the Ministry of Health didn’t respond to requests for comment on the shortages or the criticism of Lopez Obrador’s health-system overhaul.
“It would be one thing if they were managing to buy more medicines and supplies with the same amount of money through good deals; I’d applaud that,” said Xavier Tello, a health-policy analyst at Strategic Consulting in Mexico City. “But people crying on the streets because they can’t find medicines is inhumane -- it’s unthinkable.”
Lopez Obrador’s approval ratings had held up until recently, when national polls showed his backing was taking a hit, with almost daily protests and angry posts on social media.
“President, why are you abandoning the most vulnerable Mexicans? Women with cancer are desperately asking for your help because they want to live,” one woman posted on Twitter last week. “You show little compassion for those who suffer... many of them because of you.”
A contingent of HIV patients recently demonstrated in front of IMSS headquarters, covering walls and windows with graffiti messages, including the word “murderers” over and over in red. Women with breast cancer marched outside the National Palace holding signs that said “Cancer doesn’t wait” and “We want to live.” Parents of children with cancer have staged several protests blocking the entrance to Mexico City’s airport.
Jose Narro, who was health minister until November 2018, said the president and his advisers should regroup. “If someone were to ask me if the health system was perfect when I left, I’d say of course not,” he said. “We had problems, but the system worked.”
To contact the reporter on this story: Andrea Navarro in Mexico City at anavarro30@bloomberg.net
To contact the editors responsible for this story: Brendan Case at bcase4@bloomberg.net, Anne Reifenberg, Melinda Grenier
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