February 13 was a sad day when hundreds of people had gathered at Lahore’s Charing Cross near Punjab Assembly to lodge their protest. These included owners and workers of pharmacies, medical stores, drug distribution companies, drug manufacturing companies and so on.

They were highly concerned about the recent amendments to the Punjab Drugs Act 1976 and feared the newly-introduced harsh punishments and monitoring procedures would harm them and their businesses. It was during this protest that a suicide bomber made his way in, and blew himself up, resulting in several casualties.

The protestors had shut down their facilities in protest, causing inconvenience to people needing urgent medicines.

Though the legal amendments had been introduced in Punjab, many medicine markets in Sindh and Khyber Pakhtunkhwa (KP) also expressed their solidarity with pharmacists and chemists in Punjab and remained shut.

At the moment, the strike has been called off conditionally on assurances from the government to look into the contentious parts of the law.

The Punjab government’s representatives hold that the fears of retailers and wholesalers are out of place. Their focus is mainly on the manufacturing of quality medicines and checking irregularities during the production process.

Ali Rasikh, a distributor of medicines in Lahore, challenges this assertion. He says, "the medicine storeowners are directly affected because they are now required to employ full-time qualified pharmacists. Now a pharmacist will have to be present all the time. If a drug inspector finds a medical store without one, it will be sealed right away and the owner will also be arrested".

He explains, "Earlier, the practice was that a pharmacist would allow the proprietor of a medical store to paste a copy of his degree on the wall. The pharmacist would get a fixed amount, ranging from Rs4,000 to Rs8,000 per month."

Rasikh believes the medical storeowners are averse to the idea of hiring full-time pharmacists as it would add to their cost of business. "If a store remains open for 24 hours, it would have to hire three pharmacists for three shifts," he says, adding, "A qualified person must be present at a medical store as he knows which medicine shall be given in case the branded one subscribed by a physician is not in stock."

Another major issue is the involvement of a third party to evaluate drug manufacturing facilities, to rule out the possibility of a drug inspector extorting or pressurising manufacturer for some illegal gratification.

The law states the provincial government may, on the recommendations of the Provincial Quality Control Board, engage the services of a consultant or a firm of consultants for independent inspection and evaluation of units for manufacture of drugs, distribution networks or sale-points as the government specifies. Only qualified consultants will be engaged for the purpose.

Dr Riaz Ahmed, Vice Chairman Pakistan Pharmaceutical Manufacturers Association (PPMA), states the manufacturers object that there is no difference between fake and substandard medicine in the law. "Fake drugs are made in mysterious locations, using powder or other ingredient. A substandard drug may have an active ingredient in inadequate quantity."

Ahmed says the provision that prescribes six-month punishment and Rs10 million fine to those obstructing a drug inspector from performing his duty will open doors of exploitation. "Now, it will be easy for a drug inspector to blackmail a factory owner and report against him if his demand is not met," he adds.

Ahmed complains that in this law, the owner of a factory or a medical store has been made culpable regardless of the fact that a particular employee is responsible for the violation.

Under this law, a violator may be imprisoned for up to 10 years, and fined up to Rs50 million and no less than Rs25 million.

An official in the Federal Investigation Agency (FIA) tells TNS on condition of anonymity that a large number of people smuggle medicines into Pakistan at prices lower than that of their counterpart in Pakistan. Now, he says, they are worried since the sale of medicine without license is liable to stricter punishments. "Besides, counterfeiting in which a genuine medicine is sold in packaging of a brand carrying higher price is also enlisted in crimes carrying severe punishments."

The authority, he adds, has been acting against unscrupulous elements in the drugs business for long but now a proper framework has been introduced in the province.

Rasikh admits that the medical storeowners are worried, as they may be held responsible if a substandard medicine is found in their store. "Their point is that if a manufacturing company makes a substandard medicine, then why punish a retailer. They demand a mechanism whereby responsibility can be fixed".

Khawaja Imran Nazir, Punjab Minister for Primary and Secondary Health, says, "The only objective of introducing amendments in the Drug Act 1976 is to ensure quality of medicines, and put an end to all malpractices that pose risks to people’s health and lives."

He adds just like fake medicines, substandard medicines in which the required active ingredients are not added are harmful for human lives. "They misguide doctors. The less than required quantity of an active ingredient reduces the medicine’s efficacy."

According to him, the recent steps taken by the Punjab government are aimed at strengthening provincial institutions such as the Provincial Quality Control Board, the Chief Drugs Controller office and the Drugs Testing Laboratories, and putting an end to the control of unscrupulous elements on medicine industry. However, "the government and the industry will be holding talks and striving for the fulfillment of this noble cause."

Dr Syed Mansoor Hussain, a health sector expert, tells TNS that the crux of the matter is that medicines industry has remained unregulated, and, now, when a mechanism is being put in place, these people are disturbed. "Mostly the small pharmacies in not-so-posh areas are affected as they buy cheaper products from suppliers and sell them with low incomes. When you want to bring down the prices, you have to compromise on the quality."

Hussain says the contentious issue is that the medical stores demand the government must arrest the manufacturer, and not them, whereas the manufacturers say the regulatory mechanisms must not be so harsh and exploitative.

He further adds that just as it has been discovered that neither milk nor meat sold here is pure, there are fears that the reality of substandard and spurious drugs will be explored. He also supports the idea of strict punishments and third party inspections, saying the low-paid drug inspectors are vulnerable to corruption.