Trade in medicines and\xa0the public's health: a time series analysis of import disruptions during the 2015 India-Nepal border blockade

Abhishek Sharma,Shiva Raj Mishra,Warren A Kaplan

doi:10.1186/s12992-017-0282-0

Abhishek Sharma, Shiva Raj Mishra + Show 1 more

Open Access

https://doi.org/10.1186/s12992-017-0282-0

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Abstract

BackgroundNepal was struck by devastating earthquakes in April–May 2015, followed by the India-Nepal border blockade later that year.MethodsWe used the United Nations Commodity Trade Statistics (UN Comtrade) database to analyse exports of various health commodities from India to Nepal from January 2011–September 2016. We used time-series regressions of trading volume vs. unit price to ask how well Nepal’s trading history with India prior to the earthquake and blockade was able to predict unit prices of health commodities imported into Nepal during and after the earthquake and the blockade. Regression residuals were used to quantify the extent to which the blockade impacted the price of healthcare commodities crossing into Nepal.ResultsDuring the blockade period (September 2015-early February 2016), the volume of all retail medicines traded across the India-Nepal border was reduced by 46.5% compared to same months in 2014–2015. For medical dressings, large volumes were exported from India to Nepal during and shortly after the earthquakes (May–June 2015), but decreased soon thereafter. During the earthquake, the difference between observed and predicted values of unit price (residuals) for all commodities show no statistical outliers. However, during the border blockade, Nepal paid USD 22.3 million more for retail medicines than one would have predicted based on its prior trading history with India, enough to provide healthcare to nearly half of Kathmandu’s citizens for 1 year.ConclusionThe India-Nepal blockade was a geopolitical natural experiment demonstrating how a land-locked country is vulnerable to the vagaries of its primary trading partner. Although short-lived, the blockade had an immediate impact on traded medicine volumes and prices, and provided a large opportunity cost with implications for public health.

Highlights

Nepal was struck by devastating earthquakes in April–May 2015, followed by the India-Nepal border blockade later that year
We have previously described the background to the 2015–2016 blockade faced by Nepal which resulted from a domestic conflict and a diplomatic standoff with India [17]
Nepal relies upon India as its largest trading partner, we found that the unit price of a “basket” of all retail medicines increased as the blockade took effect and trade volume decreased

Summary

Introduction

Nepal was struck by devastating earthquakes in April–May 2015, followed by the India-Nepal border blockade later that year. Understanding the relationship between international trade and health is critical to managing access to medicines in the global public health “ecosystem” [1]. Dependence on international trade is likely to increase, especially in those low and middle income countries with limited local production of health technologies and. There have been long-standing debates focused on aligning trade policies with human rights and improving access to essential health technologies, but these have been limited primarily to the global intellectual property rights (IPR) regime and those discontented with it [4,5,6,7]. Despite efforts to identify appropriate indicators and mechanisms to continuously monitor for any potential public health risks associated with trade policies, there is a general lack of empirical evidence on how Sharma et al Globalization and Health (2017) 13:61 international trade, the cross-border movement of health technologies, enhances or deteriorates population health [8]. The global economic crisis led to increase in mortality rates due to poor quality of care in Greece [12]

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