To minimise risks of fake medicines, world must offer its support

Fake medicine bought at a hospital on August 24, 2013. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide. PHOTO | FILE | NATION MEDIA GROUP

What you need to know:

  • Like narcotics trafficking, it is a business that depends on — and reinforces — broader criminal activity, including that of terrorist groups.

  • Fake medicines are trafficked through the same organised-crime networks as illicit drugs and weapons that destabilise communities and countries, particularly in fragile regions like the Sahel.

Niger’s government is sounding the alarm about bogus meningitis vaccines — and it is not the first time. Five years ago, hundreds of Nigeriens died after receiving fake vaccines.

ERODING TRUST

However, the problem is not vaccines; it is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion (Sh20 trillion), or 10-15 per cent of the total pharmaceutical market.

But it could be much bigger: According to the World Health Organization, which relies largely on voluntary reporting by healthcare professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42 per cent of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent healthcare systems.

Needless to say, the use of substandard or falsified medicines — which range from ineffective to poisonous — can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality healthcare who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality.

SIDE EFFECTS

This can result in higher costs for victims, who pay more to treat the original illness as it has progressed and any side effects from the fake medication if they survive at all.

A 2015 study estimated that in sub-Saharan Africa, 122,000 children under five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance — a trend that doesn’t discriminate between rich and poor.

Yet fake-medicine traffickers have little incentive to stop. Every $1,000 (Sh100,000) traffickers ‘invest’ in counterfeit medicines can yield as much as $450,000 (Sh45 million) in profit — 10-25 times larger than what illicit narcotics sellers earn. And the massive rewards are not counterbalanced by significant risk. When caught, they often avoid prison time, merely paying a fine to get back to business.

CRIMINAL PENALTIES

Like narcotics trafficking, it is a business that depends on — and reinforces — broader criminal activity, including that of terrorist groups. Fake medicines are trafficked through the same organised-crime networks as illicit drugs and weapons that destabilise communities and countries, particularly in fragile regions like the Sahel.

Seven African countries — Gambia, Ghana, Niger, the Republic of Congo, Senegal, Togo, and Uganda — are set to address the scourge. Last week, the Brazzaville Foundation brought together their heads in Lomé, Togo, to sign a political declaration and a legally binding agreement committing them to legislate to this end. The agreement includes a clear timetable and demands tough new criminal penalties.

RIGOROUS ENFORCEMENT

Recognising the critical importance of rigorous enforcement, the agreement also includes provisions on capacity building, including community engagement, and on coordination among government agencies. As such, it will lay the groundwork for a broader campaign to ensure that all citizens have access to quality healthcare, including safe and effective medicines.

The Lomé Initiative represents a historic opportunity to step up the fight against the trade in substandard and fake medicines. But to subdue this deadly business, which claims hundreds of thousands of African lives every year, more of the continent’s leaders must join the fight. And the international community must support them.

Some international actors have embraced this imperative. Beyond the WHO, the Council of Europe has created the Medicrime Convention — the first international treaty against counterfeit medical products and similar crimes involving threats to public health. And the United Nations Office on Drugs and Crime has produced a guide to good legislative practices for combating falsified medical product-related crime.

WORLD SUPPORT

To minimise the risks that fake medicines pose to us all, the world must offer its support.

Sir David is the chief executive of the London-based charity Brazzaville Foundation. (Project Syndicate: www.project-syndicate.org.)