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Drugs that kill – the human cost of counterfeit medicines

Drug counterfeiting is not a problem of intellectual property. It is first and foremost a problem of public health. This is a fundamental point. The problems of intellectual property may exist, but they are secondary to the problems of public health.’ The words of Prof. Amor Toumi, Advisor to the World Health Organisation (WHO), recall how the specificities and magnitude of issues raised by counterfeit medicines go beyond the sphere of intellectual property rights.

Each year, fake medicines cause the death of 800.000 people, most of them in Africa. According to the OECD, 75% of counterfeit drugs come from China and India and half of these products transit through Dubai to mask their origins. They are then marketed all over the world; developing countries are the primary targets, but due to the expanding online market of fake drugs, the problem has become universal.

A crime against humanity in the developing world

The WHO defines counterfeit medicine as one ‘which is deliberately and fraudulently mislabelled with respect to identity and/or source’. Fake drugs include both branded and generic products and can contain substances which are ineffective against the disease they are purporting to cure, or, in many cases, highly toxic ingredients, such as rat poison and antifreeze. In some parts of Africa, Asia and Latin America, more than 30% of the medicines on sale are fake; the following video produced by the Fondation Chirac highlights the tragic, day-to-day implications of this data on the lives of individuals.

There are several reasons why developing countries provide ideal conditions for the traffic of counterfeit drugs, lack of access to high quality medicines being just one of them. The price of medication is beyond the reach of many who struggle to make ends meet; like Anjali in the Fondation’s video, these people often see no other choice but to purchase the cheaper, usually fake alternatives from unlicensed street vendors. The lack of means for regulatory authorities is another issue; when the police, customs and other administrative organisations suffer from inadequate staff, training and financing, it becomes impossible to effectively fight counterfeiting. Furthermore, government inspectors in African countries frequently accept bribes to allow fake drugs to pass borders, making corruption another factor in promoting the growth of the thriving fake drug market (worth over 400 billion euros). Added to all this are weak sanctions and, in certain countries, no laws for punishing counterfeiting, helping criminals take advantage of the legislative breach. Dora Akunyili, who had lead the National Agency for Food and Drug Administration Control (NAFDAC) of Nigeria and was one of the most prominent figures in the fight against counterfeit drugs, had described the resulting situation in an alarmingly pertinent way. ‘Counterfeit drugs are murder… It is the highest form of terrorism against public health because it kills a mass.’

Developed countries are not spared

According to data from the WHO, 40% of counterfeit medical products are destined for developed countries, while they make up only 1% of the total value of the medical market in these regions. The discrepancy between the figures is partially due to the effectiveness of measures protecting health systems from such products, but, equally, the size of the market in these countries. It should not lead to the assumption that developed countries, like the UK, are spared. Just recently, about 22.000 counterfeit and potentially defective condoms were seized in Castleford, West Yorkshire, along with 7000 non-compliant syphilis tests; an official from the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) claimed that using the condoms would be ‘playing Russian roulette with your health’. During the same raid, carried out by Interpol’s Operation Pangea (an international week of action tackling the online sale of counterfeit and illicit medicines), about four million doses of unlicensed medicines were seized. This shockingly high figure can be explained by the expansion of the global traffic of fake drugs, facilitated by the internet; the WHO estimates that 50% of the medicines sold online are fake. According to the International Institute of Research Against Counterfeit Medicines (IRACM), the web is an ideal channel for fake medicines, allowing counterfeiters to quickly reach millions of customers and providing several opportunities to deceive them (from false product photographs to faked testimonies). The fragmentation of the mailings weakens customs authorities’ capacity to operate controls and sites can exist under quasi-anonymity, further helping criminals evade punishment.

A 2009 survey of general practitioners in the UK found that 25% of their patients had experienced an adverse effect from a drug bought online. To avoid any health risks, it is important to pay attention to the warning signs; looking for contact information, checking whether the pharmacy has a license and making sure that it requires a prescription to buy prescription drugs should be among the basic considerations for anyone purchasing medicines online.

We feel passionately that awareness of the issue of counterfeit medicines must be broadened.
Many people do excellent work in this field, notably Mike Isles and his team at ASOP EU (http://asop.eu ) and the Medicines and Healthcare Regulatory Agency (https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency ).


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