Pakistan’s healthcare landscape is increasingly shaped by pharmaceutical companies, raising concerns about conflicts of interest and the integrity of medical research. As government support for independent research declines, private sector influence grows, directing health priorities toward profit-driven solutions. Anzal Abbas Jaffari argues that addressing public health challenges like antimicrobial resistance requires a multidisciplinary approach, stronger regulation, and investment in independent research institutions to counterbalance corporate influence.
The structure of the healthcare system in Pakistan consists of multiple stakeholders (public and private). Post 18th amendment, health (along with multiple other governance subjects) was devolved to the provinces. The current healthcare system of Pakistan has since been decentralized at the provincial level, while the federal government’s role is limited to dealing with national health emergencies, coordinating among provinces, and reporting on national health goals.
This article highlights the pressing issue of increasing private sector influence in setting up the health agenda and directing local research; a consequence of reduced government support for independent research and academic institutions working on public health. Pharmaceutical companies are increasingly directly funding and directing local medical research. They have also set up their own “public health research” department. These concerning trends rings alarm bells for critics worried about conflict of interest and the integrity of health research.
The case of Antimicrobial resistance (AMR) in Pakistan, which the pharmaceutical companies’ “public health research department” claims to tackle, illustrates the issue. AMR is a complex public health challenge as it requires a multidisciplinary approach, focusing on prevention, education, and systemic changes in the healthcare system. Pakistan has one of the highest AMR rates globally. An estimated 88% of adults and 95% of children receive unnecessary antibiotic prescriptions. One reason for this overuse of drugs is that doctors in Pakistan, often incentivized by pharmaceutical companies, frequently prescribe antibiotics for common flu. Therefore, pharmaceutical companies, which profit from antibiotic sales, worsen the problem. As profit-driven entities, they often skew research priorities toward marketable solutions. Cases like this also distract from the fact that their involvement in constructive development of the health sector is invaluable.
One of the key reasons for the dominance of pharmaceutical companies in Pakistan’s health landscape is the lack of health professionals that are able to approach health issues from a social determinants of health framework. The framework emphasizes the role of social, economic, and environmental factors in shaping health outcomes, and it calls for interventions that address these root causes rather than merely treating symptoms. Unfortunately, most doctors in Pakistan are trained primarily on biomedicine that focuses on individual-level treatment rather than population-level prevention. This narrow focus makes them more susceptible to the influence of pharmaceutical companies, which promote drug-based solutions to health problems.
The involvement of for-profit companies in driving Pakistan’s health agenda also highlights a more systemic problem: the financial incentivization of general practitioners by pharmaceutical companies. A study evaluating the influence of pharma companies in physicians practices revealed that 90% of PDs (physicians) met with SRs (pharma’s sales representatives) at least once a week, with 15% meeting over 25 SRs weekly. Nearly all interviewed PDs and SRs indicated that the practice of exchanging financial and non-financial incentives is still widespread and deeply ingrained.
To address the challenges posed by the dominance of pharmaceutical companies and the lack of a multidisciplinary approach to health, Pakistan needs to invest in independent research institutions and train health professionals who can analyze health issues through multiple perspectives. This requires a fundamental shift in the way health is conceptualized and taught in Pakistan. Medical schools must incorporate courses on public health, epidemiology, and social determinants of health into their curricula, and the government must increase funding for independent research that prioritizes preventive and population-level interventions.
Moreover, Pakistan must adopt a multisectoral approach to tackling health challenges such as AMR. This includes promoting hygiene and sanitation in schools and households, regulating the sale of antibiotics, and educating the public about the dangers of self-medication.
The views expressed in this post are those of the author and in no way reflect those of the International Development LSE blog or the London School of Economics and Political Science.
Featured image credit: A female doctor examines a woman patient at a mobile health clinic in Pakistan. DFID/Russell Watkins via Flickr.