INFORMAL SURVEY OF JEDDAH PHARMACIES SUGGESTS

UNCLAS SECTION 01 OF 02 JEDDAH 000156 SENSITIVE SIPDIS DOS FOR NEA/ARP, STATE PASS USAID FOR GLOBAL HEALTH, OES/IHB, M/MED, NEA/RA E.O. 12958: N/A TAGS: AEMR AMGT ASEC CASC ECON KFLO KPAO KSAF MG PINR, PREL, SA, TBIO, KFLU SUBJECT: INFORMAL SURVEY OF JEDDAH PHARMACIES SUGGESTS RAPID SALES OF TAMIFLU/RELENZA ANTI-VIRALS WITHOUT PRESCRIPTIONS REF: A. STATE 43253 ¶B. ABU DHABI 421 ¶C. AMMAN 992 ¶D. CAIRO 743 ¶E. DOHA 288 ¶F. KUWAIT 436 ¶G. TEL AVIV 958 ¶1. (SBU) SUMMARY: Poloff's highly informal discussions with three local pharmacies in Jeddah, Saudi Arabia, during an April 30 weekend walk around the city suggest that anti-viral medications Tamiflu and Relenza, both shown to be potentially effective in limiting the severity of the 2009 H1N1 virus, are fast moving off the shelves in the Kingdom, with one potential purchaser attempting to buy mass quantities (1000 boxes). Purchasers in Saudi Arabia are not required to have prescriptions to purchase these medications and pharmacists appear to have no instructions and little knowledge of a potential swine flu pandemic. END SUMMARY. ¶2. (SBU) HIGH SALES VOLUME: Three Jeddah pharmacies reported greater than usual sales of the drugs Tamiflu and Relenza. In the first pharmacy visited, located in an affluent area of town and not directly next to a hospital, at least four boxes of Tamiflu and Relenza were sold in the past week, leaving just one box of each medication remaining. The Egyptian pharmacist noted that this sale volume is far higher than usual, but said the pharmaceutical chain had a large supply and could easily furnish more on request. In a second pharmacy, located directly across the street from a private hospital, another Egyptian pharmacist claimed that four boxes of Tamiflu were sold in the past week leaving none in his current stock. The pharmacist said that four boxes is the normal volume of the drug that would sell in one year. At a third pharmacy located inside a major shopping mall, yet another Egyptian pharmacist claimed that all ten boxes of Tamiflu in stock were sold to ten different purchasers in the past week. The pharmacist commented that previous sales of Tamiflu were rare. ¶3. (SBU) 1000 BOXES OF TAMIFLU: According to the pharmacist at the shopping mall pharmacy, a customer recently tried to purchase 1000 boxes of Tamiflu; the pharmacy had only ten(10) boxes in stock. The pharmacist was not able to provide any additional information as to the intention of the purchaser. (Comment: It is possible that the purchaser had plans to sell the medication on the black market. Schools or other organizations seeking to buy doses would probably be more apt to purchase the exact amount needed.) ¶4. (SBU) LOW PRICES AND NO PRESCRIPTION REQUIRED: Jeddah pharmacies are selling Tamiflu and Relenza far below prices in the West. For example, one pharmacy is selling a 10-pack of Relenza for 79 Saudi Riyals (US Dols 21). Meanwhile, two pharmacies are selling boxes of Tamiflu (10 doses X 75 mg) for between 128 and 139 Saudi Riyals (US Dols 34-37). No prescription is necessary to buy Tamiflu or Relenza in Jeddah. One pharmacist said he was trying to restrict sales to one box of Tamiflu per customer in order to maintain his stock. ¶5. (SBU) NO PIGS, NO FLU: One pharmacist said that he is not nervous about the potential for 2009 H1N1 virus since it is a "swine flu" and Saudi Arabia has no pigs and asked poloff what he thought about the risk. Poloff informed the pharmacist that since the disease is spread from person-to-person, according to WHO, the Kingdom's lack of pigs seemed unlikely to provide protection. Another pharmacist, complaining of 11-hour work shifts that gave him no time to keep abreast of the news, had not heard about "swine flu" and thought poloff was referring to avian nfluenza. He noticed the unusual demand for Tamiflu, but had not given it much thought. A group of Saudi medical students visiting the ConGen for an art exhibit said they had not heard much about the virus in their classes. ¶6. (SBU) STOCKPILE: According to one pharmacist, there are at least ten major pharmaceutical chains plus smaller, private pharmacies in the Kingdom. The large chains supply their branches with medications when ordered. The pharmacist claimed that his pharmacy's supply center has 100,000 doses of Tamiflu and Relenza and that other suppliers may have similar quantities. Press coverage suggests that Saudi JEDDAH 00000156 002 OF 002 SUBJECT: INFORMAL SURVY OF JEDDAH PHARMACIES SUGGESTS RAPID SALES OF TAMIFLU/RELENZA ANTI-VIRALS WITHOUT PRESCRIPTIONS Arabia maintains a stockpile of anti-virals althogh post has no information on quantities. This upply may be better controlled than the quantityavailable for consumer purchase thrugh pharmacies. ¶7. (SBU) MASKS AND HAND SANITIZERS: One pharmacy noticed interest by customers in purchasing surgical masks, noting he did not carry the (CDC-approved) N95 respirator masks. Another pharmacist said that sales of hand sanitizers had been very high in the past week. ¶8. (SBU) COMMENT: While personal stockpiling of anti-virals may be a normal response of individuals and families trying to be proactive in the face of a virus, the purchase of limited-supply medication by healthy individuals clearly works against the public health interest (dictating that sick individuals have first access to drugs). In a country in which the smuggling of alcohol and illicit drugs is reported in the press, the potential for individuals to create a black market may be developing as perhaps indicated by attempted purchase of 1000 boxes of Tamiflu. A distribution network already exists. The ease with which the last box of Relenza at a Jeddah pharmacy could have been purchased indicates that stricter government measures may be required to control supplies. It is likely that the SAG has mechanisms to regulate sales of anti-influenza medication as it does other drugs(including narcotics) -- should it choose to do so. To date no suspected cases of 2009 H1N1("swine flu") have been reported in the KSA. END COMMENT. QUINN