In this week's edition, we take a look at the effects of the latest heatwave Egypt witnessed, and the seriousness of the government in mitigating its effects. We also shed light on the causes of the drug shortage crisis, and alternative solutions to improve access to medicine in Egypt
Heatwave in Egypt: A Sign of Worse to Come
During the first two weeks of July 2023, the earth&nbsp;<a href="https://www.nytimes.com/interactive/2023/world/global-heat-map-tracker.html">recorded</a>&nbsp;its highest temperature since 1940. Average July temperatures were&nbsp;<a href="https://www.axios.com/2023/07/07/earth-four-hottest-days-thursday">the highest</a>&nbsp;on record, while Egypt witnessed a&nbsp;<a href="https://www.egyptindependent.com/heat-wave-striking-egypt-continues-until-middle-of-next-week-ema-official/">prolonged heatwave</a>&nbsp;in the second half of July all over the country. Egypt is among the countries&nbsp;<a href="https://www.lse.ac.uk/granthaminstitute/news/climate-change-food-consumption-and-child-health-in-egypt-how-can-outcomes-be-improved/">most vulnerable</a>&nbsp;to global warming and among the&nbsp;<a href="https://www.ec-rf.net/wp-content/uploads/2022/11/%D9%85%D8%B5%D8%B1-%D9%88%D8%A7%D9%84%D8%AA%D8%BA%D9%8A%D8%B1-%D8%A7%D9%84%D9%85%D9%86%D8%A7%D8%AE%D9%8A-..-%D9%87%D9%84-%D8%B3%D9%8A%D8%AE%D8%B1%D8%AC-%D8%A7%D9%84%D8%A3%D9%85%D8%B1-%D8%B9%D9%86-%D8%A7%D9%84%D8%B3%D9%8A%D8%B7%D8%B1%D8%A9%D8%9F-.pdf">least able</a> to adapt. Despite action taken by the government to mitigate climate change through adaptation and mitigation, its disregard for some measures&mdash;increasing green spaces in cities and scaling down the use of fossil fuels to produce electricity&mdash;has exacerbated the climate impacts on the country.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/1e53afde-e4a0-66c5-b922-9351a70e7b25.png" width="546" height="432" />
Climate impacts that threaten Egypt
Egypt has been&nbsp;<a href="https://www.unicef.org/egypt/climate-change">experiencing</a>&nbsp;temperature increases for three decades at a rate of 0.53&ordm; Celsius per decade, or&nbsp;<a href="https://www.lse.ac.uk/granthaminstitute/news/climate-change-food-consumption-and-child-health-in-egypt-how-can-outcomes-be-improved/">0.9&ordm;</a>&nbsp;Celsius since 1990, according to other sources. The most significant threats that global warming poses for Egypt are:
<ol style="font-weight: 400;">
<li>Food security: Data&nbsp;<a href="https://www.imf.org/en/News/Articles/2022/06/15/CF-Egypt-Nile-Delta-sea-level-rise">show</a>&nbsp;that sea levels on the Egyptian coast will rise by an average of 30 cm by 2050, threatening a quarter of the coastline from Port Said to Alexandria and increasing the salinity of agricultural land and groundwater. Climate change could also&nbsp;<a href="https://www.ifpri.org/publication/climate-change-and-egypts-agriculture">affect</a>&nbsp;agricultural production, bringing crop yields down 10% by 2050. Over the past two decades, the rate of growth of maize, wheat, and rice production&mdash;Egypt&rsquo;s staple food crops&mdash;<a href="https://www.lse.ac.uk/granthaminstitute/news/climate-change-food-consumption-and-child-health-in-egypt-how-can-outcomes-be-improved/">has slowed</a>&nbsp;due to global warming. In addition, food production in southern regions&nbsp;<a href="https://www.ec-rf.net/%D8%AA%D9%82%D8%B1%D9%8A%D8%B1-%D9%85%D8%B5%D8%B1-%D9%88%D8%A7%D9%84%D8%AA%D8%BA%D9%8A%D8%B1-%D8%A7%D9%84%D9%85%D9%86%D8%A7%D8%AE%D9%8A-%D9%87%D9%84-%D8%B3%D9%8A%D8%AE%D8%B1%D8%AC-%D8%A7%D9%84/?fbclid=IwAR1WpHpqA8GBAsFNmjI38BI3GBem9-GaDWiABS_uRHnCUJqR39mr2Q9-drY">may decline</a>&nbsp;by up to 30% by 2040 due to an increase in the number of hot days, according to the UN World Food Program.</li>
<li>Water security: Already suffering from water scarcity, Egypt is approaching the threshold of absolute scarcity, defined by the UN at 500 m3 of water per capita per year. Egypt&rsquo;s per capita water share&nbsp;<a href="https://www.almasryalyoum.com/news/details/2678718">dipped</a>&nbsp;down to 560 m3 per year in 2021, and the water flow in the Nile River&nbsp;<a href="http://www.siyassa.org.eg/News/18391.aspx">may fall</a>&nbsp;by about 20% by 2040 as a result of climate change impacts in upstream countries. This is without taking into account the impact of non-climate related threats such as the increased demand for water at the source and the completion of the Renaissance Dam in Ethiopia. The Nile provides approximately 95% of Egypt&rsquo;s water needs.</li>
</ol>
The country&rsquo;s water and food security are further&nbsp;<a href="https://www.ec-rf.net/wp-content/uploads/2022/11/%D9%85%D8%B5%D8%B1-%D9%88%D8%A7%D9%84%D8%AA%D8%BA%D9%8A%D8%B1-%D8%A7%D9%84%D9%85%D9%86%D8%A7%D8%AE%D9%8A-..-%D9%87%D9%84-%D8%B3%D9%8A%D8%AE%D8%B1%D8%AC-%D8%A7%D9%84%D8%A3%D9%85%D8%B1-%D8%B9%D9%86-%D8%A7%D9%84%D8%B3%D9%8A%D8%B7%D8%B1%D8%A9%D8%9F-.pdf">linked</a>&nbsp;to social and economic security. Comparative studies of cities with differing temperatures and longitudinal studies looking at the same cities before and after heatwaves&nbsp;<a href="https://www.academia.edu/9945562/Tropic_of_Chaos_Climate_Change_and_the_New_Geography_of_Violence">have found</a>&nbsp;a positive correlation between high temperatures, unemployment rates, average annual income, and the prevalence of theft and street violence, as well as on the overall health of the economy.
Is Egypt diligently trying to mitigate the impacts of global warming?&nbsp;
Government efforts to address climate change&nbsp;<a href="https://www.youtube.com/watch?v=xyppVqVSxSs">are focused</a>&nbsp;on adaption and mitigation measures, including:
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/742be36d-e01d-37bf-21fa-81f13b992117.png" width="546" height="432" />
But the impact of these efforts is limited and undercut by policies that exacerbate the crisis, including:&nbsp;
1. Continued reliance on fossil fuels to generate electricity:
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/546c9a4b-a433-ea84-8473-73d3c001cd8d.png" width="546" height="432" />
2. Dwindling green spaces in cities:&nbsp;
Green spaces&nbsp;<a href="https://www.epa.gov/green-infrastructure/reduce-urban-heat-island-effect#:~:text=Trees%2C%20green%20roofs%2C%20and%20vegetation,releasing%20moisture%20into%20the%20atmosphere.">act</a>&nbsp;to purify the air and the shade they provide reduces the intensity of sunlight and provides a cooling effect.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/9ad9c95c-8232-640f-5146-a735446a69b0.png" width="546" height="432" />
While the Egyptian capital lost some 911,000 m2 of green space from 2017 to 2020, Heliopolis and East Nasr City areas alone lost 584,000 m2. This shrinking of green spaces is chiefly due to the expansion of the highway network within residential areas, part of a state plan that aims to increase the roads designated for private cars. As a result of this construction, car use&nbsp;<a href="https://businessforwardauc.com/2021/01/19/is-egypts-car-centric-development-damaging-the-economy/">has grown</a>&nbsp;four times faster than the population has.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/01f14e48-a18f-69c3-ba50-15a331dce0cd.png" width="546" height="432" />
Opportunities and alternatives
Relevant reports say that the government should reconsider its plans for urban development and energy security. They propose:
1.&nbsp;<a href="https://aps.aucegypt.edu/en/articles/947/cairos-green-sprawl-the-move-of-urban-green-space-towards-exclusivity">Adopting</a>&nbsp;policies that incentivize the private sector and civil society to invest in tree planting and increase rooftop gardens and greenery in crowded urban areas; it is important to set forth&nbsp;<a href="https://www.brookings.edu/wp-content/uploads/2023/02/Chapter-3.-Climate-action-in-Egypt-Challenges-and-opportunities-1.pdf">clear frameworks</a>&nbsp;for cooperation between sectors to govern resource allocation, freedom of action, and the launch of initiatives.
2.&nbsp;<a href="https://www.brookings.edu/wp-content/uploads/2023/02/Chapter-3.-Climate-action-in-Egypt-Challenges-and-opportunities-1.pdf">Expanding</a>&nbsp;databases on climate projections and impacts in all cities, and share them with government sectors and the public to enable more professional and comprehensive risk management. At a press conference about the recent electricity crisis caused by the heatwave, the prime minister&nbsp;<a href="https://youtu.be/AphKd6KjsIE?t=377">said</a>&nbsp;that it was much hotter than the Ministry of Electricity and the Ministry of Petroleum had anticipated, indicating a lack of prior planning.
The Drug Shortage: Why and What&rsquo;s Next?
Many pharmaceutical drugs, both locally manufactured and imported, have been in&nbsp;<a href="https://www.almasryalyoum.com/news/details/2932784">short supply</a>&nbsp;in recent months, and other vital, life-saving medications have become more costly. The shortage is a double burden for Egyptians, whose out-of-pocket spending on medicine exceeds global averages. In fact, about 70% of total health spending in Egypt&nbsp;<a href="https://aps.aucegypt.edu/ar/articles/675/background-paper-equitable-access-to-medicine-challenges-and-opportunities-for-the-pharmaceutical-industry">is paid</a>&nbsp;out of pocket, and half of that goes to medication. This is one of the highest rates in the world, where on average private health spending&nbsp;<a href="https://ourworldindata.org/grapher/share-of-out-of-pocket-expenditure-on-healthcare">constitutes&nbsp;</a>10&ndash;15% of total health expenditure.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/50afd8b0-130f-3298-40d0-d0b9e7e564f9.png" width="546" height="432" />
Dimensions and causes of the crisis
Several factors have combined to produce drug shortages, including:
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/28fdbd00-23e4-51a8-d78b-15b90ebab32c.png" width="546" height="432" />
In addition to the health risks the lack of medicine poses to patients&rsquo; lives, the crisis gives a foothold to criminal gangs trading in adulterated drugs, fosters a black market where medicine is sold at exorbitant prices or smuggled, and, given the lack of market regulation, encourages traders to hoard medications as they wait for prices to go up.
Efforts but no solutions
The government has made&nbsp;<a href="https://www.alittihad.ae/news/%D8%AF%D9%86%D9%8A%D8%A7/4270123/%D9%87%D9%84-%D8%AA%D9%88%D8%A7%D8%AC%D9%87-%D9%85%D8%B5%D8%B1-%D8%A3%D8%B2%D9%85%D8%A9-%D8%A8%D8%B3%D8%A8%D8%A8-%D9%86%D9%82%D8%B5-%D8%A7%D9%84%D8%A3%D8%AF%D9%88%D9%8A%D8%A9">various efforts</a>&nbsp;in recent years to achieve drug security, including:
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://mcusercontent.com/5e42bef7fee7e6a299c3d932d/images/c9dba0be-f019-516a-bd84-33d95a7e963d.png" width="546" height="432" />
Most of these efforts are geared to expanding the capacities of the pharmaceutical sector and attracting foreign investment to boost exports, but they have done little to mitigate recurring drug shortages or put a brake on the price hikes.
The way forward
In addition to the urgent need to prioritize dollar allocations to secure the release from customs of raw materials required to manufacture medications locally, experts are advocating the reinvigoration of the early warning strategy, previously announced by the Egyptian Drug Authority, and learn from relevant successful international experiences. The US-based Alliance for Safe Online Pharmacies, for example, has&nbsp;<a href="https://www.pharmaceutical-technology.com/interviews/drug-shortages-qa-how-can-the-us-maintain-access-to-essential-drugs/#catfish">developed&nbsp;</a>a data informatics tool called &ldquo;medicine supply map&rdquo;, through which they can identify areas of vulnerability in the supply chain of each drug, the economic causes of potential shortages, and provide short and medium-term solutions to avoid recurring deficits.
In addition, the Egyptian pharmaceutical sector needs a multi-pronged strategy to ensure citizens&rsquo; right to basic drugs without undue financial burden and in a fair and sustainable manner. In this regard, a policy paper by &ldquo;Alternative Policy Solutions&rdquo;&nbsp;<a href="https://aps.aucegypt.edu/en/articles/691/policy-paper-exploring-the-intellectual-property-policy-space-to-improve-access-to-medicines-in-egypt">puts forward</a>&nbsp;some recommendations that include:
<ul style="font-weight: 400;">
<li aria-level="1">Incentivizing local production of priority medicines in Egypt's Essential Medicines List (EML), which are identified based on their effectiveness, availability, affordability and Egypt&rsquo;s disease burden. In such a case, local production would be in line with local market needs.</li>
<li aria-level="1">Diversifying drug procurement sources from different countries.</li>
<li aria-level="1">Directing local manufacturers to produce medicines whose 20-year patent protection has expired, and then provide them at lower prices. Countries such as Brazil, India and Thailand, for example, have successfully pursued this strategy, and succeeded at producing HIV drugs, at lower costs.</li>
</ul>
<a href="https://aucegypt.us17.list-manage.com/subscribe?u=5e42bef7fee7e6a299c3d932d&amp;id=e0d95df1c1&amp;mibextid=Zxz2cZ">Subscribe to the weekly edition</a>
"Adasa"&nbsp;is a weekly policy digest by Alternative Policy Solutions. "Adasa" provides an analysis of a select number of policy developments and their effect on inclusive development and socioeconomic change

Read Also