Medicines and Parapharmacy: Between Grey Areas and Wild Imports
Title: Medicines and Parapharmacy: Between Grey Areas and Wild Imports
Content: The sale of medicines in Mauritius is strictly regulated under the Pharmacy Act of 1983; however, there are significant gaps in the regulation of parapharmaceutical products. Pharmacists are sounding the alarm over insufficient control.
In any Mauritian supermarket, vitamins, protein supplements, and herbal products are readily available without the presence of a pharmacist or mandatory warnings. Yet, some of these products can interact with medications and affect patients with specific health conditions.
This presents a paradox at the heart of the local pharmaceutical and parapharmaceutical market: on one hand, there is strict legislation governing the sale of medicines; on the other, a significant part of the market escapes real control.
On paper, the framework is clear. According to the Pharmacy Act of 1983, sales are only permitted in pharmacies and specifically relate to products covered by the Dangerous Drugs Act. "The Pharmacy Act is very clear: pharmaceutical products must be sold in a pharmacy and a pharmacist must be present," explains Beebee Waheeda Gopee, director of pharmaceutical services at the Ministry of Health. However, exceptions exist, particularly when a doctor is present or when a person designated by the permanent secretary of the ministry supervises sales.
In the public sector—regional hospital pharmacies, specialized hospitals, and health centers—the law allows the permanent secretary to make medicines available to patients without a pharmacist being physically present at all times, although supervision is still required. "The pharmacist must monitor what is happening, meaning they must request, adjust stocks of necessary medicines, and observe trends." In the public sector, the system is well-regulated and organized, she assures.
In the private sector, two situations distinguish themselves. On one hand, retail pharmacies require a pharmacist's presence for all sales. "Here, we definitely need a pharmacist's presence," she emphasizes. On the other hand, some private clinics stock medicines under the supervision of a doctor for hospitalized or treated patients; however, for strict sales, a pharmacist's presence remains essential.
A Matter of Dosage
What is sold in supermarkets falls into a different category: parapharmaceutical products. "Parapharmaceutical products include dietary supplements and cover a wide range of items, such as herbal products, vitamins, minerals, and protein-based dietary supplements," details the interim director.
While these products are generally considered safe, some can interact with medications. The director notes that very few of these have been formally authorized in the local market, even though interactions with certain medications are possible for specific conditions.
In theory, all parapharmaceutical products, even those not covered by law, must be imported with permission from the pharmacy department of the Ministry of Health. However, in practice, since this area is not clearly regulated, some products slip through the cracks and are subject to parallel imports. The ministry has pharmacists at the airport, port, and post office to intercept illegal imports, but the lack of a solid legal basis complicates intervention.
The line between dietary supplement and medicine often hinges on dosage. Vitamin C is a prime example: up to 2 grams can be sold as a dietary supplement, but between 1,000 and 2,000 mg per day, a grey area arises between supplement and medicine. The Pharmacy Board can intervene to prohibit importation in supplement form and impose pharmaceutical registration. This system works well for vitamins and minerals, but for herbal products, the framework remains less clear. Mauritius draws inspiration from Malaysian, Singaporean, and European systems to set its dosage thresholds.
Individual Responsibility
The consumption of parapharmaceutical products is largely left to the consumer's discretion. "It is somewhat the individual's responsibility. If you want health professional advice, you will go to a pharmacy for guidance on usage. They can tell you which dietary supplements are suitable for you, the dose to follow, etc.," explains our interlocutor. Health alerts typically arise only retrospectively when patients report adverse effects via pharmacovigilance. At that stage, dosages are reviewed, and companies are notified to withdraw or reformulate their products.
Market monitoring is also shared among several bodies: the Ministry of Health oversees the circulation of products in the local market, while the Ministry of Commerce addresses pricing and points of sale.
Against this backdrop, several pharmacists lament the lack of control over the circulation of certain pharmaceutical and parapharmaceutical products, particularly on social media. The Pharmaceutical Association of Mauritius (PAM) and the association of small and medium pharmaceutical importers share this sentiment. They believe the law is not robust enough to prevent abuses. When an infraction is reported, the case is referred to the police, but the means of action remain limited.
A revision of the Pharmacy Act of 1983 and its amendments has been underway for about a decade, supported by a WHO consultant appointed by the ministry. A draft has been submitted to the State Law Office, but after review by pharmacists from both the public and private sectors, concerns were raised. Some believe the proposed model, seen as too close to an African system, is unsuitable for the Mauritian context. According to the interim director, the draft is currently under revision: Mauritius has largely adopted English laws while incorporating elements of French legislation, and the future law needs to be tailored to the specifics of the local health system. "We need someone who understands the subtleties of the Pharmacy Act," she insists, explaining why this revision is taking time.
Potential Supply Delays Not Ruled Out
The crisis in the Middle East poses a threat to the supply of medicines in Mauritius, a concern shared by both the Ministry of Health and the private sector. The vast majority of medicines—between 70 and 80%—come from India, and part of these deliveries pass through maritime routes via the Strait of Hormuz.
With the surge in freight costs, the interim director anticipates not a shortage, but a possible delay in deliveries. "I wouldn't say there will be a shortage, but there may be delays in delivery," she clarifies.
The Ministry of Health is closely monitoring the situation. Air supply remains secure for now, but at a higher cost for both the private sector and the government. In response to suggestions for parallel imports to mitigate any shortages, the director warns: regardless of the source country, the conflict in the Middle East impacts all markets—production, distribution, and prices. In this context, she discourages this solution, fearing the introduction of low-quality or counterfeit products. "Especially in our case in Mauritius, where we don't have a quality control laboratory that can quickly provide us with information," she states. Private laboratories and the Government Analysis Division can be consulted for occasional analyses.