Eastern Mediterranean Health Journal | All issues | Volume 31 2025 | Volume 31, issue 5 | Accelerating access to medical products in the Eastern Mediterranean Region

Section menu

You are here

Accelerating access to medical products in the Eastern Mediterranean Region

Print PDF

PDF version

Editorial

Hanan Balkhy 1

1Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Keywords: medicine, medical products, availability, accessibility, affordability, Universal Health Coverage, Eastern Mediterranean

Citation: Balkhy H. Accelerating access to medical products in the Eastern Mediterranean Region. East Mediterr Health J. 2025;31(5):303–305.

https://doi.org/10.26719/2025.31.5.303.

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Availability, accessibility and affordability of safe, effective and quality essential medicines and medical products are central to the provision of reliable and sustainable health care services (1). Equitable access to medicines and vaccines can save up to 10 million lives annually, which is critical for achieving Universal Health Coverage and the health-related Sustainable Development Goals (2,3).

Inadequate access to essential medicines is a challenge globally, particularly in the low- and middle-income countries (4,5). The WHO Eastern Mediterranean Region (EMR) is uniquely affected because of the conflicts and crises in more than half of its countries, which still experience inadequate access to medical products.

The major barriers to accessing essential medicines in the EMR are high prices, weak regulation, existence of substandard or falsified products, inefficient supply and procurement systems, limited intercountry collaborations, inadequate infrastructure and heavy reliance on imports (4). Local manufacturing, especially of vaccines, biosimilars and other biological products, remains limited and related research is underfunded.

Heavy reliance on imports causes disruptions and delays in medical supply chains, as was the case during the COVID-19 pandemic. It increases medicine prices and eventually out-of-pocket expenditure for health. It benefits mostly the exporting economies. Studies have shown that several essential medicines are prohibitively expensive in most EMR countries (5).

Substandard and falsified medicines pose a significant threat to public health (6). They increase health care costs and fatalities, due to poor treatment outcomes or treatment failures. At least 1 in 10 medicines in low- and middle-income countries are substandard or falsified, with countries spending an estimated US$ 30.5 billion per year on substandard and falsified medical products (6). A WHO report estimates that approximately 10.5% of medicines in low- and middle-income countries failed the quality test, while a systematic review and meta-analysis reported 13.6% (7). The economic impact is estimated at US$ 10–200 billion (7,8).

Access to medical products has received priority attention in the EMR in recent years. In 2020, EMR developed a regional strategy to improve access to medicines and vaccines, which aims to strengthen partnerships and collaborations at the regional level for timely access to quality, safe, effective and affordable, medicines and vaccines (4).

When I became Regional Director in 2024, I proposed 3 flagship initiatives, of which access to medical products is one. Through this initiative, we aim to enhance access to essential medical products by strengthening local production capacity through, for instance, capacity-building of industry workforce, improving research and development, and facilitating technology transfer; enhance national regulatory systems to ensure availability of safe, effective and quality medical products; modernize supply chains with digital tools and systems to ensure efficient procurement, storage and delivery; and establish a regional pooled procurement mechanism to improve bargaining power and equitable access to critical supplies (1).

In December 2024, the WHO Regional Office for the Eastern Mediterranean signed an agreement with the Pan-American Health Organization (PAHO) to facilitate implementation of the medicines pooled procurement system in the EMR, thus benefiting from PAHO’s decades-long experience (10).

WHO’s support to strengthening medical products regulatory systems in the EMR is yielding tangible results. For example, the Egyptian Drug Authority reached maturity level 3 and Saudi Food and Drug Authority achieved maturity level 4 for medicines and vaccines regulation (11,12). Achieving maturity level 3 and above is a pre-requisite for WHO vaccine pre-qualification, which will contribute to the sustainability of local vaccine production (13). At maturity level 4, the Saudi Food and Drug Authority is now recognized among the world’s most advanced national regulatory authorities for medicines and vaccines. Jordan has conducted a comprehensive assessment of the national medical supply systems and implemented recommendations from the assessment.

The regional pharmaceutical market is progressing (14). For example, Egypt, the largest pharmaceutical producer in the Arab world, continues to invest in domestic medicine and vaccine manufacturing. Jordan exports to over 60 countries, including the United States of America and European Union (15). Localization of pharmaceutical manufacturing has reduced reliance on imports from 80% in 2019 to 70% in 2023 (16) in Saudi Arabia, and the United Arab Emirates is investing in biotech and AI-driven drug development (17). Egypt, Pakistan and Tunisia are participating in the WHO mRNA technology transfer programme, and Morocco has initiated vaccine manufacturing through a public-private partnership, indicating strong commitment to increasing local vaccine production capacity in Africa and the EMR.

Islamic Republic of Iran, which has a long history in biopharmaceuticals, has made significant progress in enhancing access to medical products through advancements in infrastructure, institutional development and in technology acquisition and transfer (18).

Overall, EMR Member States have shown strong willingness to work together in increasing equitable and timely access to safe and affordable medical products. To realize this aspiration, policy options that promote generic medicines and alternative financing mechanisms are needed. There is a need to further build end-to-end capacities and capabilities in research and development, regulation, local manufacturing, and supply chains management. More research will provide reliable and up-to-date evidence and increase understanding of the context-specific gaps at country level. Achieving these will require increased and sustained public and private investments through multisectoral partnerships involving governments, manufacturers, philanthropies, civil society, and development partners.

References

  1. World Health Organization. Regional flagship initiative 1: Expanding equitable access to medical products. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Flagship-Initiative-Expanding-Access-Medical-Products-eng.pdf.
  2. Ghanbari A, Moazen M, Azizi A, Abdollahiasl A, Soleymani F. Availability and affordability of selected medicines in the Islamic Republic of Iran. East Mediterr Health J. 2024;30(9):632–640. https://doi.org/10.26719/2024.30.9.632.
  3. Özler G, Işik O. Prices, availability and affordability of selected essential medicines for chronic diseases in Türkiye. East Mediterr Health J. 2023;29(11):850–860. https://doi.org/10.26719/emhj.23.117.
  4. World Health Organization. Regional strategy to improve access to medicines and vaccines in the Eastern Mediterranean, 2020–2030, including lessons from the COVID-19 pandemic. Cairo: WHO Regional Office for the Eastern Mediterranean, 2020. https://applications.emro.who.int/docs/EMRC676-eng.pdf.
  5. Oldfield L, Penm J, Mirzaei A, Moles R. Prices, availability, and affordability of adult medicines in 54 low-income and middle-income countries: evidence based on a secondary analysis. Lancet Glob. Health 2025;13(1):e50-e58. DOI: 10.1016/S2214-109X(24)00442-X.
  6. World Health Organization. Substandard and falsified medical products. Fact Sheet, 3 December 2024. https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products.
  7. World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: World Health Organization; 2017. https://iris.who.int/bitstream/handle/10665/331690/9789241513432-eng.pdf?sequence=1.
  8. Ozawa S, Evans DR, Bessias S, Haynie DG, Yemeke TT, Laing SK, Herrington JE. Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Netw Open. 2018 Aug 3;1(4):e181662. doi: 10.1001/jamanetworkopen.2018.1662.
  9. World Health Organization. WHO Global Surveillance and Monitoring System for substandard and falsified medical products. Geneva: World Health Organization, 2017. https://apps.who.int/iris/bitstream/handle/10665/326708/9789241513425-eng.pdf.
  10. World Health Organization. WHO’s Region of the Americas and Eastern Mediterranean Region sign an agreement to enhance access to medicines. News, 17 December 2024. https://www.emro.who.int/media/news/whos-region-of-the-americas-and-eastern-mediterranean-region-sign-an-agreement-to-enhance-access-to-medicines.html#:~:text=The%20initiative%20builds%20on%20PAHO's,working%20groups%20to%20monitor%20progress.
  11. World Health Organization. Egypt’s regulatory system reaches WHO maturity level 3 in medicines regulation. News, 20 December 2024. https://www.who.int/news/item/20-12-2024-egypt-s-regulatory-system-reaches-who-maturity-level-3-in-medicines-regulation#:~:text=With%20this%20latest%20recognition%2C%20Egypt,against%20more%20than%20250%20indicators.
  12. World Health Organization. Saudi Arabia regulatory system becomes third to reach WHO Maturity Level 4. News, 30 October 2023. https://www.who.int/news/item/30-10-2023-saudi-arabia-regulatory-system-becomes-third-to-reach-who-maturity-level-4.
  13. World Health Organization. Conditions for Acceptance of an Application. Geneva: World Health Organization, n.d. https://extranet.who.int/prequal/vaccines/conditions-acceptance-application.
  14. Horizon Grand View Research. Middle East & Africa Pharmaceutical Market Size & Outlook. https://www.grandviewresearch.com/horizon/outlook/pharmaceutical-market/mea#:~:text=The%20pharmaceutical%20market%20in%20Middle%20East%20%26%20Africa,%26%20Africa%20pharmaceutical%20market%20from%202025%20to%202030.
  15. The Jordan Times. JFDA says Jordan exports medicine to over 60 countries. The Jordan Times, 11 April 2019. https://www.jordantimes.com/news/local/jfda-says-jordan-exports-medicine-over-60-countries.
  16. Saudi Press Agency. Saudi Arabia Explores Pharmaceutical Localization Opportunities in Denmark. Saudi Press Agency, 9 May 2025. https://www.spa.gov.sa/en/N2314939.
  17. Anthony Awad. The UAE's Emerging Role in Global Biotech and Precision Medicine. DeciBio, 24 September 2024. https://www.decibio.com/insights/the-uaes-emerging-role-in-global-biotech-and-precision-medicine.
  18. Atiyeh Safardoust, Mostafa Ghanei, Fereidoun Mahboudi, Mohsen Pourqasem, Soode Mirmohammadi, Mohammad Mahdi Moghadasian. The current status, trends, and developments in biopharmaceutical policy making in Iran. J Sci Tech Policy Mgt. 2025. DOI: 10.1108/JSTPM-01-2023-0009.