The problem of counterfeit drugs is anything but new. The World Health Organisation (WHO) recently published a compiled report estimating one in ten medical products that circulate in low- to medium-income countries are either substandard or fake.

This meant that drugs made with cheaper – sometimes fatal – ingredients such as highway pain, floor wax and boric acid, all with the imprints of actual name-brand drugs, are circulated globally.

Of the 1,500 reports received since 2013 by the WHO, more than 40% of them came from African regions.

Africa, an extrapolated example of the problem

To make sense of the “1 in 10” number described by the WHO, it is necessary to humanise the data to better understand the magnitude of the catastrophe.

According to the London School of Hygiene and Tropical Medicine, an estimated 116,000 deaths per year arose from the substandard treatment of malaria in sub-Saharan Africa alone.

Another number put forth by the British think-tank, International Policy Network, several years ago, hovered at a staggering 700,000 deaths globally from fake malaria and tuberculosis drugs. This is akin to having "four fully laden jumbo jets crashing everyday" as described by the organisation.

“Substandard and falsified medicines particularly affect the most vulnerable communities,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Director General of the WHO, Tedros Adhanom Ghebreyesus says counterfeit drugs mostly affect poor countries. Photo credit: VOA News
Director General of the WHO, Tedros Adhanom Ghebreyesus says counterfeit drugs mostly affect poor countries. Photo credit: VOA News

Unfortunately, the problem constantly resurfaces despite efforts from local authorities to stamp out counterfeit drugs. This suggests that the issue is a systemic one, which inexorably stems from the intricate and interconnected socio-economic difficulties that have plagued the local rising population for decades.

The dire situation was exemplified in vivid narratives by vendors who traded counterfeit drugs in Ivory Coast. Speaking to the AFP, Mariam, who was one of the illiterate vendors in the Adjame quarter, said that "the police hassle us but they themselves buy these medicines."

"Many people came here with their prescriptions to buy medicine, even the owners of private clinics," claimed another vendor, Fatima.

High demand, low penalties spell easy money for syndicates

The illegal trade of counterfeit drugs is not limited to African countries. Another 2014 report by the INTERPOL stated that organised crime groups have participated in the distribution of counterfeit medicine through a network of online pharmacies and affiliate websites worldwide, particularly in Asia, Europe and North America.

For the EU, criminal syndicates target the weaknesses in the EU’s prescription drug wholesaling networks where parallel trade or cross-border trade. This makes it easy for criminals to have a ‘point-of-entry’ into the EU drug supply chain, which “would open the door to the global drug supply chain”, according to Peter Leininger, a former enforcement attorney at the US FDA Office of Chief Counsel.

The market for counterfeit drugs presents a classic "low risk and high reward" business model to many unscrupulous vendors.

(right) Brigadier General Long Sreng, a deputy chief of the anti-economic crimes department of the Cambodian interior ministry, looking through confiscated fake medicines in Phnom Penh, Cambodia, on 28 November 2014. About five tonnes of counterfeit medicines were seized. Photo credit: Phearum/Xinhua/Eyevine/Redux
(right) Brigadier General Long Sreng, a deputy chief of the anti-economic crimes department of the Cambodian interior ministry, looking through confiscated fake medicines in Phnom Penh, Cambodia, on 28 November 2014. About five tonnes of counterfeit medicines were seized. Photo credit: Phearum/Xinhua/Eyevine/Redux

Professor Paul Newton from the University of Oxford said the punishment for selling or trading counterfeit medicine is relatively weak compared to trading narcotics or human trafficking – resulting in tremendous interests to exploit the unmet market demand in many developing countries.

United Nations Office on Drugs and Crime (UNODC) puts the figure at USD1.6 billion per year for the sales of counterfeit drugs from Asia to South-East Asia and Africa.

Similarly, the supply of these counterfeit drugs is supported by an equally enormous demand for these trades to flourish. Drug shortages and exorbitant prices are frequently quoted as the main reasons that fuel the continuous demand for cheaper medicine – especially in developing countries, where healthcare is frequently not subsidised by public institutions.

In desperate search of solutions

Ending the counterfeit drug problem is not an easy task. Given the extensive and complex network of pharmaceutical manufacturing processes, there are plenty of opportunities for criminals to slip fake drugs into the supply chain.

Furthermore, these illegal traders often operate across numerous countries, which presents a significant challenge for local enforcement agencies to tackle these criminals alone.

The United Nations Convention against Transnational Organised Crime is, by far, the most promising body to combat the problem of counterfeit drugs, in addition to other international organisations such as the INTERPOL and the World Customs Organisation.

Similarly, WHO is well positioned to resolve the issue. However, it has declined to push countries to sign fake-drug-related treaties and has continuously used the term “substandard, spurious, falsely labelled, falsified and counterfeit” to talk about the issue. Experts say the main reason is so that the WHO does not alienate the pharmaceutical industry – a close partner and financial supporter.

The quest to rid the world of this plague seems likely to be a long one. What can only be done now, is to build upon the extensive news coverage to increase public awareness of the scale of counterfeit drugs. MIMS

Read more:
How bad is the counterfeit drug problem in Malaysia?
The medical industry’s newest problem – counterfeit medical device
Healthcare professionals: how can you spot counterfeit drugs?

Sources:
http://www.who.int/mediacentre/news/releases/2017/substandard-falsified-products/en/
http://www.un.org/africarenewal/magazine/may-2013/counterfeit-drugs-raise-africa%E2%80%99s-temperature
http://www.straitstimes.com/world/africa/killer-fake-medicines-flourish-in-africa?login=true
https://www.unodc.org/toc/en/crimes/counterfeit-goods.html
http://www.newsweek.com/2015/09/25/fake-drug-industry-exploding-and-we-cant-do-anything-about-it-373088.html
https://www.interpol.int/Crime-areas/Pharmaceutical-crime/Pharmaceutical-crime
http://www.nytimes.com/2012/04/23/opinion/the-wrong-way-to-stop-fake-drugs.html
https://www.cbsnews.com/news/the-difficult-fight-against-counterfeit-drugs/
http://thehill.com/opinion/healthcare/368134-who-just-exacerbated-the-counterfeit-drug-problem
https://www.standardmedia.co.ke/health/article/2001264329/one-in-every-10-medical-products-is-falsified-report-says