When Medicine Factories Stop, Patients Pay the Price

Production of nearly 60% of essential medicines reportedly halted as costs rise and energy shortages deepen

Bangladesh's pharmaceutical industry is facing a growing crisis that could soon move beyond factory gates and pharmacies to hospital wards and patients' homes.

The Bangladesh Association of Pharmaceutical Industries (BAPI) has reported that production of nearly 60% of the country's 117 essential medicines has stopped, citing rising production costs, prolonged price adjustments and shortages of gas and electricity.

The development raises a critical question: what happens to patients when essential medicines become unavailable or unaffordable?

For a patient holding a prescription, the consequences are immediate. If one medicine is unavailable, a more expensive alternative may be offered. For those who can afford it, the additional cost may be manageable. For low- and middle-income families, however, even a modest increase can force difficult choices.

A medicine may be dropped from the prescription. Treatment may be delayed or interrupted. A condition that could have been treated early may become more serious, eventually requiring hospitalisation and much greater expense.

This is why the shortage of essential medicines should not be treated simply as a pharmaceutical-sector problem. It is a public-health risk.

Rising costs, falling production

Pharmaceutical manufacturing requires more than raw materials. It depends on uninterrupted supplies of electricity, gas and water, as well as sophisticated storage, quality-control and production systems.

With electricity shortages disrupting industrial operations, manufacturers are increasingly dependent on generators, UPS systems and diesel. These alternatives provide continuity, but at a significantly higher cost.

Gas shortages are adding further pressure.

For pharmaceutical manufacturers already struggling with price structures that have not kept pace with inflation, exchange-rate movements, labour costs, raw-material prices and energy expenses, continued production of low-margin essential medicines can become financially difficult.

BAPI has argued that the pricing framework for essential medicines is based largely on a policy introduced in 1994, with only limited adjustments since then. That creates a fundamental policy dilemma.

How can a pharmaceutical industry operating in the economic realities of 2026 remain viable under a pricing framework rooted in the conditions of three decades ago?

Yet simply allowing manufacturers to raise prices is not a solution. The additional cost will ultimately be passed on to patients.

Poor Patients Face the Greatest Risk

Medicine-price increases do not affect all households equally. Wealthier patients may continue purchasing the same medicines. Poorer households, however, often have to choose between medicines and other necessities such as food, education and rent.

When essential medicines disappear from the market, the problem becomes even more severe.

Patients may be forced to switch to more expensive brands or alternatives. Over time, such substitutions can increase the overall cost of treatment and discourage people from completing prescribed courses.

That creates a dangerous cycle: Higher production costs → lower production → tighter supply → higher prices → reduced access to treatment.

The consequences can be particularly serious for chronic diseases, infections and emergency conditions where interruption of treatment can have immediate health consequences.

Hospitals cannot remain insulated

The crisis could also place additional pressure on hospitals. Emergency departments, operating theatres, intensive-care units and infection-control services all require uninterrupted supplies of essential medicines.

If pharmaceutical companies reduce production, hospitals may have to procure medicines at higher prices. Public hospitals could face difficulties stretching already limited budgets, while private hospitals may pass increased procurement costs on to patients.

The problem, therefore, can travel through the entire healthcare system—from manufacturers to distributors, pharmacies and hospitals, and finally to patients.

At the end of that chain is a simple question: Can the patient afford the medicine?

Protecting Industry, Supporting Patients

The pharmaceutical industry is a business, and manufacturers cannot reasonably be expected to produce medicines indefinitely at a loss.

But patients cannot be treated as the industry's final source of compensation either. The state must therefore find a middle ground.

If production costs have fundamentally changed, the pricing system needs to reflect economic realities through a transparent and predictable mechanism.

At the same time, affordability must remain a central consideration for essential medicines.

For medicines that are medically indispensable but commercially less attractive, the government could consider targeted incentives, subsidies or public procurement mechanisms to ensure continued production.

Such measures would not only protect patients. They would also protect domestic manufacturing capacity.

A Strategic Industry at Risk

Bangladesh's pharmaceutical industry is one of the country's major industrial success stories. Local manufacturers meet the overwhelming majority of domestic demand, while Bangladeshi pharmaceutical products are exported to more than 150 countries.

The country has moved from being heavily dependent on imported medicines to becoming an exporter.

That achievement represents decades of investment, technological development, skilled employment and regulatory capacity.

Allowing production to weaken because of energy shortages or an outdated pricing structure could therefore have consequences far beyond the current medicine market.

Lower production could discourage investment. Reduced investment could weaken capacity. Weaker capacity could affect exports. And a loss of international competitiveness could be difficult and expensive to reverse.

An industry may take decades to build. Its competitive advantage can disappear much faster.

Secure Energy, Secure Healthcare

The government should therefore treat uninterrupted gas and electricity supplies to pharmaceutical manufacturers as more than an industrial-policy issue. It should be considered part of national health security.

If essential medicine manufacturers are unable to maintain production because of unreliable energy supplies, the consequences eventually reach patients.

The government should identify which essential medicines are currently facing production disruptions, why manufacturers have stopped production, how much inventory remains and where shortages are emerging.

It should also monitor whether alternative medicines are available and whether their prices remain within reasonable reach.

Such information should be collected systematically and, where appropriate, shared with the public.

The Cost of Inaction

Bangladesh is now confronted with a choice. It can allow rising costs, energy shortages and outdated pricing mechanisms to gradually undermine essential-medicine production. Or it can intervene before the problem becomes a full-scale public-health crisis.

The solution does not lie in choosing between pharmaceutical companies and patients.

The industry needs a viable business environment. Patients need affordable access to essential medicines. Hospitals need reliable supplies. And the country needs to protect an industry that has become a major source of domestic pharmaceutical security and export earnings.

The policy objective should therefore be clear:

Factories must remain viable, medicines must remain affordable and patients must not become the casualty of an industrial crisis.

Because when factory wheels stop, the consequences do not stop at the factory gate.

They can follow a prescription all the way to the patient's bedside.

The author is a noted columnist, policy analyst and development worker.