Medicine shortages deepen in Iran as sanctions, blockade and war strain the pharmaceutical supply chain

Iran is facing a deepening pharmaceutical crisis, with roughly 800 drug products in short supply nationwide—including 90 considered essential and life-saving—as US sanctions, a naval blockade and the ongoing war with the US and Israel strain the country's medicine supply chain. Hadi Ahmadi, a spokesman for the Iranian Pharmacists Association, reported the figures to local media, noting that 400 of the drugs in short supply are manufactured inside Iran.

The shortages have been accompanied by steep price increases. The state-run Mehr News Agency reported that the price of gabapentin查看药品详情, used to treat epilepsy (搜索)搜索该疾病 and nerve pain, has risen 220 percent over the past year. Acetaminophen查看药品详情 has risen by 375 percent, the antibiotic amoxicillin查看药品详情 by 285 percent, and the anti-depressant fluoxetine查看药品详情 by 100 percent. Insulin查看药品详情, a daily necessity for diabetics, now costs up to six times what it did a year ago.

War damage to manufacturing capacity

For years, Iran has pursued self-sufficiency in medicine, building domestic capacity to manufacture active pharmaceutical ingredients, equipment and finished drugs. However, the sector still relies heavily on imports for critical ingredients, equipment and rare medications. Washington's "maximum pressure" sanctions have hobbled the financial and logistics networks facilitating procurement of medical imports, leading to significantly higher costs despite existing humanitarian exemptions.

The shortages have worsened since the US and Israel's war on Iran, which began in February, damaged and destroyed some 44 pharmaceutical and medical equipment companies. According to Iranian officials, roughly 50 industry workers were also killed or wounded.

One of the main pharmaceutical firms bombed during the war was Tofigh Daru (搜索)搜索该词条, owned by Iran's largest pension fund. Maryam Farahani, the company's director of sales, told Al Jazeera that Israeli air strikes had struck all of its research and production lines, including those producing peptide and narcotic active ingredients as well as anticancer drugs.

"Our target audience are predominantly cancer (搜索)搜索该疾病 patients and people with chronic diseases," Farahani said. "Some of the medicine we used to produce were exclusive."

The company has since rented an alternate production line to keep output above zero, even as the US naval blockade and sanctions drive up import costs by blocking shipping through the Strait of Hormuz and disrupting air, rail and overland routes. Farahani estimated that partial rebuilding would require at least two years and tens of millions of dollars.

Tofigh Daru (搜索)搜索该词条 also manufactured glatiramer acetate查看药品详情, an injectable drug used to treat relapsing forms of multiple sclerosis (搜索)搜索该疾病. The original version, Copaxone查看药品详情, was developed and marketed by the Israeli company Teva (搜索)搜索该公司 and long dominated the global market before generic versions were developed elsewhere.

Policy instability compounds the crisis

The problem is no longer only that medicines are expensive or hard to find. Haleh Hamedifar, head of the Association of Medical Biotechnology Product Manufacturers, told the semi-official ISNA news agency that the main challenge facing Iran's pharmaceutical industry is not simply a shortage of foreign currency, but "instability in decision-making and lack of coordination in implementation."

"The pharmaceutical industry cannot be managed with daily decisions, changing circulars and unpredictable processes," she said.

Hamedifar warned that sudden policy changes disrupt the supply of raw materials, production and distribution, with effects that appear months later "in pharmacies, hospitals and ultimately at the patient's bedside." She said recent shifts in currency rules have forced some raw materials out of preferential currency categories and into exchange-rate systems that are not reliably funded, while alternative routes were introduced before the administrative infrastructure was ready.

Interior Ministry spokesman Ali Zeynivand separately acknowledged that high medicine prices are real and said the government does not deny that internal failures may be part of the problem. "Part of the problems are caused by the imposed war, another part by the sanctions that already existed, and part may be due to our shortcomings or lack of precision," he told the Dideban Iran news website.

A growing black market

For patients, the consequences are visible in higher out-of-pocket costs, incomplete prescriptions, empty pharmacy shelves and growing reliance on unofficial sellers. Mehdi Sanei, an investigator at Iran's medical crimes prosecutor's office, told the Iranian daily Shargh that Iran has only one legal medicine market: the official network supervised by the Health Ministry and Food and Drug Administration.

"As long as medicine shortages exist, the smuggling market will exist," Sanei said.

Sanei warned that the illegal drug market is unusually profitable because patients cannot postpone treatment. Families dealing with cancer (搜索)搜索该疾病 or chronic illness may sell savings, jewelry, cars or even homes to obtain scarce medicine. "I do not know of a commodity whose profit is as guaranteed as smuggled medicine," he said.

He estimated that more than 80 percent of medicines in the illegal market are now unauthorized domestic products rather than genuine imported drugs. These products may be made in illegal workshops with unknown or ineffective materials and fake packaging, and some may contain no active ingredient, contamination or harmful substances. "People pay heavy costs, and there is no guarantee that what they receive is really medicine," Sanei said.

Public health implications

Doctors in Tehran worry about the threat to public health from the drug shortages, including vaccines. A gastroenterologist and university professor in Tehran, speaking on condition of anonymity, described the recent rise in prices, including for domestically produced generics, as "staggering" and said it had become an insurmountable barrier for many vulnerable Iranians.

"Reports that rotavirus vaccine imports have been halted because of the maritime blockade—and that influenza vaccines may soon face the same problem—represent a serious and alarming threat to nationwide efforts to prevent vaccine-preventable communicable diseases," she said.

The doctor also warned of the impact on vulnerable groups, noting that runaway inflation, poverty and inadequate access to essential food groups among infants, children and pregnant women signal the onset and spread of malnutrition, raising the risk of both communicable and non-communicable diseases.

Despite the deteriorating conditions, Iranian authorities have sought to project resilience. Mahdi Pirsalehi, head of Iran's Food and Drug Administration, said Iran was facing fewer drug shortages than last year, but did not provide figures to support the claim.