Who Owns the Gulf's Medicine? Finished-Product versus API Import Concentration for WHO Essential Medicines across the Six GCC States

Background. Gulf Cooperation Council (GCC) states import most of their medicines, but published local-production figures disagree because they rest on different definitions. Objective. To measure supplier-country concentration of medicine imports in all six GCC states, and to compare the finished-product layer with the active pharmaceutical ingredient (API) layer for tracer medicines from the 2025 WHO Model List of Essential Medicines (EML). Methods. • We defined a 24-molecule tracer set from the EML (diabetes, cardiovascular, coagulation and antibacterial sections) and mapped it to Harmonized System (HS) codes. • We took reporter-declared import, export and re-export data for 2019–2024 from UN Comtrade. • For each reporter, year and code we computed the Herfindahl–Hirschman Index (HHI), the top-1 and top-3 partner shares, and the number of partners supplying more than 5%. Results (preliminary). • Aggregate finished medicaments (HS 3004) came from 49–101 partner countries per reporter-year, with HHI between 588 and 2,277. • Retail insulin (HS 300431) was highly concentrated. Latest-year HHI was 5,663–9,407, and Germany was the leading partner in five of the six states. • Bulk inputs: recorded imports of bulk insulin (HS 293712) were negligible. • Antibiotic APIs, where they were imported in material amounts, were more concentrated than the matching finished products and came mainly from Asia. • UAE re-exports were large: about a quarter of HS 3004 imports and about 92% of retail insulin imports in 2023. • Sensitivity: Oman's apparent concentration in HS 3004 disappears once GCC partners are excluded (HHI 1,940 → 823). Insulin stays highly concentrated in every specification. • Mirror data for the UAE confirm insulin concentration in 2024 (HHI 8,246; Germany 91%). They also show China, rather than India, as the largest exporter of antibiotic APIs to the UAE. Conclusions. At heading level, GCC import dependence looks diversified. At tracer level it is concentrated, and for insulin it rests almost entirely on finished-product imports from one or two European suppliers. Ownership-ladder coding is planned for phase 2.