EDITOR, The Tribune. 

I read with great interest your recent article, ‘Bahamas’ double-edged sword over medications’, which featured comments from Dr Marvin Smith and Dr Duane Sands. While Dr Smith raised valid points regarding the potential impact of the Trump administration’s pharmaceutical tariffs on drug costs and availability, I would like to offer a broader perspective on how these dynamics affect the Bahamian market.

As it stands, manufacturer-authorised distributors in The Bahamas source branded medications directly from respective manufacturers. These products typically enter our market through supply chains based in Central America, not in the US. Other wholesalers, who do not hold distribution rights for particular brands, often obtain their supplies from the United Kingdom, other European countries such as Germany or Spain, or from Turkey. This sourcing pattern is intentional: Branded pharmaceuticals from the US are generally far more expensive than those obtained from European, Latin American and Asian markets.

Therefore, any tariff-related price increases in the US are unlikely to have a major or immediate impact on the Bahamian pharmaceutical brand market, as most of these products are not sourced from the US. The few exceptions tend to be newly-approved specialty drugs - those cleared by the Food and Drug Administration (FDA) within the past 18 to 24 months - that have not yet reached global distribution. These are usually sought only by a small percentage of patients who can afford such high-cost therapies. In most cases, suitable alternatives already exist within our region.

That said, the larger concern for The Bahamas lies not in the cost of US imports but in the quality control of pharmaceuticals entering our borders. The Bahamas is a non-registration market, meaning that any licensed pharmacy or wholesaler may import and sell pharmaceuticals without local product registration or batch testing. This regulatory gap creates opportunities for sub-standard or counterfeit medications (brand or generic) to enter the market, posing potential risks to public health.

While Dr Smith correctly notes that the majority of the world’s pharmaceuticals are manufactured in Asia, it is important to emphasise that countries such as the US, the UK and European Union (EU) members, along with registration-led Caribbean nations such as Jamaica and Trinidad, have systems in place to safeguard and verify the quality of products before release to the public. The Bahamas, lacking such infrastructure, relies heavily on these regulated markets to ensure product quality.

Dr Smith also referenced manufacturers certified by the World Health Organisation (WHO), which is certainly a step in the right direction. However, our lack of infrastructure to test products locally still leaves a gap in quality assurance. WHO Good Manufacturing Practice (GMP) certifications are typically issued every three years and, in some countries, every five. Without local verification of incoming batches from non-stringent markets, we risk receiving an initial high-quality shipment followed by sub-standard batches thereafter. This underscores the need for proper safeguards, including a pharmacovigilance department, a drug registration system and a local testing facility.

It is also important that conversations like these involve the actual importers and distributors who manage the pharmaceutical supply chain. These are the individuals and companies best positioned to determine whether the tariffs will have a meaningful impact and to collaborate on practical, proactive solutions. Regular dialogue and brainstorming among regulators, healthcare professionals and importers could help ensure the stability, safety and affordability of our national drug supply.

Before we focus on fears of rising prices or turn hastily toward unverified generic alternatives, The Bahamas must first establish stronger pharmaceutical safeguards. Specifically, we need:

• A pharmacovigilance department capable of conducting root-cause analyses, investigating complaints and monitoring the safety of imported medications.

• A drug registration system that requires all products entering the market to be approved and traceable.

• A testing facility to verify product quality through random testing and detect counterfeit or sub-standard drugs.

At a minimum, while relying on approvals from stringent regulatory authorities like the US and Canada, we should prioritise enhancing the integrity of our drug importation process in The Bahamas. This can be achieved by requiring licensed wholesalers to provide comprehensive documentation that verifies the authenticity and quality of their imports, whether brand or generic. Government oversight should include robust supply chain controls, verification of product authenticity and quality, and maintenance of auditable records. By enforcing proper standards, we can mitigate the risks of falsified or sub-standard products and safeguard public health.

These measures, combined with open collaboration among all stakeholders, would ensure that Bahamians receive safe, effective and affordable medications regardless of international trade shifts.

Sincerely

A Pharmacist