Photo: Flickr / AKZOphoto
Clutching a prescription and a ticket numbered 192, Aris stood on the pavement and waited his turn at the state pharmacy. When speaking of his daughter, whose multiple sclerosis medication he had come to collect, the 74-year-old was short on words and visibly moved. When asked about the drug shortages afflicting his country, his reserve melted away and in its place came rage.”I was told that at some point there would be a problem,” he said of the drugs that can cost up to €2,500 (£2,000) for “a tiny box of 22 pills”.
“From what I can see, everyone is going to have a problem,” added the retired electrician. “If they don’t pay the suppliers, how are they going to bring drugs into the country?”
This time, Aris walked away with his daughter’s medication – giving as he went the traditional Greek gesture of insult, the moutza, to the “thieves and fraudsters” of the state. But not everyone is as lucky. On Thursday, the multiple sclerosis patients’ association warned that if the problems persisted, sufferers could be “led to their deaths”. Associations representing cancer, diabetes and kidney disease patients have also spoken of the gravity of the situation. “Finding medicines,” said the MS association, “has become a marathon for people with chronic illnesses.”
In the Greece of today, a country gripped by economic collapse and paralysed by political uncertainty, more and more users of expensive medicines are finding a healthcare system that had problems even before the eurozone crisis hit is close to disaster. Medicine shortages, reported by Greek health workers and patients for months, show signs of worsening as pharmaceutical companies become increasingly reluctant to deliver drugs on credit to a state whose debts to them are predicted to top €1.5bn by the end of this month. Public hospitals, which have had budgets cut by 40% over the past two years of austerity, do not have the money to stock all the drugs they are expected to, and struggle to pay suppliers – even as demand for their services increases.
But the problem does not stop there. Even if the medicines are theoretically available, they are not always accessible. Commercial pharmacies, which claim they are owed €540m by the EOPYY, the main state health insurance fund, are insisting customers pay up front for medicines. For many residents of a country in its fifth year of recession, that is simply not possible. State pharmacies providing the most expensive drugs for free or at a fraction of the cost do exist – but there are only 10 in the whole of Greece.
Konstantinos Lourantas, chair of the Parmacists’ Association of the Attica region in and around the capital, announced on Thursday that his group was opening a bank account into which philanthropic individuals could make donations for expensive drugs. But pharmacists, he added, could not continue “replacing the state”.
“We’re in debt up to here,” he said, gesturing at his neck and demanding urgent repayment from the state, which has repaid €200m of this year’s debt but still owes €70m. Caretaker health minister Christos Kittas has said that, by election day, the state will have paid €310m to the fund, and €130m to public hospitals. But by then, say critics, it could be too little, too late. According to a list brandished by Lourantas, 84 patients in the region had reported medicine shortages over the course of three days at the end of May and beginning of June. As Greece imports most of its medicines, most of the pharmaceutical companies with drugs on the list were foreign. Fifteen of the 33 medicines were for cancer.
That came as no surprise to Panos, a 44-year-old teacher who was diagnosed with stomach cancer five years ago and was told last year it had come back, and spread to his lungs. Fellow patients have talked of shortages “since January”, he said, although he has not encountered them himself, a fact he puts down to receiving his treatment in hospital rather than at home. A friend’s father was searching for two medicines to treat his prostate cancer, but could find neither in commercial pharmacies, he said.
While he may have escaped the shortages, Panos, who did not want to give his surname, is feeling the effects of EOPYY’s debts. Three years ago, he was refunded the cost of an MRI scan within four months. In September he had another scan, paid €1,500, but is still waiting to be reimbursed.
When EOPYY was formed six months ago from a number of health insurance funds, it inherited many of their debts as well. This week, Greece’s caretaker health ministry struck a deal with pharmaceutical companies to deliver a fresh supply of some of the most expensive medicines to EOPYY pharmacies, provoking a rush of patients . Health minister Christos Kittas promised to ensure a steady flow of medicines and said the state had to put patients “above everything”. But, as well as bringing some relief to those in need, the provision caused frustration among many who left empty-handed.
Exiting the pharmacy on crutches, Mariana, who said she was on dialysis, had been told her insurance fund was not yet part of EOPYY, which covers around 9 million of Greece’s 11 million people. She was told she would have to go elsewhere for her €200 medication. “I have to go to a regular pharmacy but pay upfront. And it’s a lot of money,” she said. Of some 1,700 people who had come to look for medicines at the pharmacy by late afternoon, at least 500 left emptyhanded, an employee said. “There was crying and screaming and moments of real tension,” she said.
Kalliope Metaxa, a retired paediatrician and volunteer for the Kefi cancer patients’ association, said fears were mounting despite the fresh supplies. “Does EOPYY have the money to procure more?” she asked. And what would happen after the elections of 17 June? “God knows.” She is convinced, however, the two parties that have dominated Greek politics for decades, Nea Demokratia and Pasok, do not deserve to be returned to power. “Everyone knows they sank the country,” she said.
One thing everyone agrees on is that the political limbo resulting from the election six weeks ago is only making the situation worse. At a press conference called by the Attica pharmacists, a spokesman for the association of kidney disease sufferers had two requests: that pharmacies start to provide drugs on credit once more if the state repays its outstanding debts from March, and that politicians form a coherent leadership in the immediate aftermath of the forthcoming vote. “The president,” he said, “should lock them in a room until they come up with a government.”
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