Medicine shortages and the political—and electoral—struggle in Colombia
By Jennifer Cardona Malaver*
The situation regarding medicine shortages in Colombia since late 2023, following debates in the House of Representatives over the government’s healthcare reform, has become a political and economic battleground where diverse interests, strategies of the national elite, and electoral narratives converge—all designed to reshape state power at the expense of Colombians. 2026 is a decisive election year for Colombia. On August 7, there will be a new president.
In this context, the lack of medicines has not merely been a logistical failure, but has functioned as a pressure tactic within the debate on healthcare reform: actors such as the Health Promotion Companies (EPS) and pharmaceutical distributors used the shortage as a bargaining chip, paralyzing the flow of medicines in the face of reforms that could alter their profit margins and business models. This strategy of “controlled suffocation” was exacerbated over the past two years by the accumulation of millions in debt by the EPSs, which forced laboratories to cut off supplies; the concentration of the distribution market, which eliminated competition; and finally, the government’s attempts to centralize procurement, causing further unrest in the private sector.
The gravity of the situation came to light when the Health Superintendency, during its 2025 inspections, found tons of medicines stored and nearing expiration in private warehouses, revealing that the problem was not a lack of supply, but rather the strategic hoarding of stocks and the disruption of the payment cycle—which turned public health into a bargaining chip in the struggle for control of the system.
In major cities such as Bogotá and Medellín, endless lines to claim medications have become routine. Hundreds of patients, especially those with chronic conditions (diabetes, hypertension, cancer, and HIV), have been forced to suspend their essential therapies because they are not receiving medications from pharmaceutical distributors and Health Promotion Companies (EPS).
Although the government has allocated the necessary funds and authorized the corresponding purchases, there are complaints and public statements—such as those by President Petro and various analyses from the health sector—indicating that some EPSs have withheld advance payments and failed to transfer the funds to pharmaceutical suppliers. By 2025, the system had accumulated a debt exceeding 24 trillion pesos, of which 4.2 trillion correspond specifically to the pharmaceutical portfolio; however, this figure does not necessarily reflect a lack of state resources, but rather a financial blockade mechanism that prevents medications from effectively reaching patients.
Bureaucratic barriers to authorizations, dependence on imports, and monopolistic practices by large pharmaceutical companies have created a structure of resistance that the government has attempted to dismantle, even going so far as to activate legal mechanisms to relax intellectual property restrictions and guarantee access to essential medicines. Despite these efforts to break down institutional barriers and secure resources, patient organizations representing more than 200 entities have pointed out that the persistence of shortages in between 8% and 41% of healthcare facilities (hospitals, clinics, health posts) is not due to a lack of will or state funding, but rather to intermediate management decisions—by the EPSs—and market dynamics that, at times, seem to prioritize commercial profitability over the continuity of care.
Furthermore, this situation is rooted in various factors, not only within the national context but also within the global landscape.
Monopolies and the Geopolitics of Healthcare Supply
Dependence on imports, international regulations on the production and marketing of medicines, and the concentration of production in a few hands—global monopolies—are used as a mechanism to pressure countries with healthcare dependencies, as is the case with Colombia.
The Colombian system remains deeply subordinate to international pharmaceutical monopolies that control production and set prices for critical drugs. This dependence limits the state’s ability to negotiate fair prices or ensure stable supplies.
In the current political-electoral context, candidates such as Abelardo de la Espriella and Paloma Valencia propose strengthening trade ties with the United States and the European Union, promising to guarantee the supply of medicines through free trade agreements and bilateral accords. Such narratives reinforce the idea that the only way to acquire medicines is by fully integrating into global value chains dominated by the West, rejecting the diversification of suppliers (for example, with Brazil, Argentina, China, or India) or the possibility that the country might regain its capacity to produce medicines.
The national government is constantly accused of fostering excessive bureaucracy to justify deregulation. The proposal from certain sectors, primarily those in the pharmaceutical market, has been to eliminate barriers to entry so that large pharmaceutical companies can operate with less oversight, which in practice would further consolidate their market power and ability to set prices, under the premise that the market regulates itself. And, of course, without considering the right to health and fair access to essential public health technologies for the entire population.
Shortages as a Tool for Political Destabilization
The private pharmaceutical sector and actors from the traditional political classes are part of a network of influence that seeks to maintain the status quo of high profit margins.
In recent years, there has been a noticeable increase in lobbying activity to block initiatives that promote the local production of generic medicines or strengthen the state’s negotiating power. In fact, the shortages we refer to are often the result of a political decision by actors in the supply chain to withhold authorization for the distribution of medicines and keep them in storage. The bureaucracy that is often criticized is, in reality, a mechanism to protect the interests of those who already dominate the market.
In addition to this, external actors have been using the environmental and human rights crises to halt local industrial projects that could reduce dependence on pharmaceutical imports, which would pave the way toward health sovereignty. In this regard, the right and far-right in Colombia adopt this rhetoric to argue that sovereignty is an excuse for backwardness, and that true independence comes from global economic integration. Although they refer only to integration with the major global powers, because bilateral agreements with countries in the region such as Brazil, Mexico, Cuba, or Argentina have never been an option.
The crisis generates massive discontent which, although stemming from people’s legitimate needs regarding their health conditions and illnesses, is politically channeled by the opposition to demand the fall of the current government. A narrative has been put forward by right-wing candidates and business sectors (such as representatives of the National Federation of Chambers of Commerce and pharmaceutical associations) framing the shortages as a war against the people orchestrated by government incompetence.
And, in the face of the urgency of the medicine crisis, proposals are being put forward that, in normal times, would be unpopular. The proposal to privatize the management of drug procurement and distribution—as suggested by some candidates—is being sold as the only quick fix, ignoring the risks of further fragmenting the system and losing public control over prices, while also continuing to consolidate the privatization and commercialization of Colombia’s healthcare system, thereby favoring the accumulation of wealth.
It is argued that price regulation and the prioritization of health sovereignty have alienated large multinational pharmaceutical companies, causing them to reduce the distribution of health technologies or stop investing in the local supply chain.
Discrediting the current government’s commitment to health sovereignty—by presenting it not as a public health necessity but as part of an ideological agenda that endangers citizens’ lives—is part of a strategy aimed at mobilizing the middle- and upper-class electorate, as well as urban sectors concerned about economic stability.
The May 2026 presidential elections are being presented as a referendum on two opposing models. On one hand, a health model that champions health sovereignty and seeks to reduce external dependence, promote domestic production of medicines and health technologies, regulate prices, foster applied health research, and strengthen the state’s role as a guarantor of health. On the other hand, a model of global integration that proposes deregulating the market, attracting foreign direct investment, eliminating drug price controls, and relying on the efficiency of the private sector to resolve shortages, while aligning geopolitically with the U.S. and Europe.
The medicine shortage in Colombia is a symptom of a deeper struggle for control of the state and its capacity for planning. Actors on the right and in the private sector are the architects of this crisis, not only to win votes but to push for the reconfiguration of the country’s economic architecture, fostering the weakening of the state’s capacity to intervene in the market and seeking to consolidate a model where health depends on the profit-driven logic of large global corporations.
Faced with this scenario of structural gridlock, the political response cannot be limited to electoral rhetoric. Immediate technical interventions are required that the state has the capacity to implement without waiting for major legislative changes: the activation of extraordinary powers to import generic drugs from alternative sources, direct state intervention in distribution logistics to eliminate speculative intermediaries, and full price transparency.
* Jennifer Cardona Malaver : Nurse, M.Sc. in Public Health. PHM Colombia coordinator and Latin America Coordinator for the Public Pharma Project