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The Scourge of Pharmaceutical Drug Counterfeiting in Africa

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The Scourge of Pharmaceutical Drug Counterfeiting in Africa

Africa is a continent beset by poverty and disease. It should come as no surprise, then, that it’s also the continent with one of the highest incidences of counterfeit pharmaceutical use in the world. Because when you or someone in your family is ill, and you can’t afford, or don’t have access to, legitimate medication, choosing all-too-readily-available fake drugs is very often your only option.

It’s also so often a tragic one.

In the wake of this article in BizCommunity, the spotlight has been very firmly thrown on the significant and concerning rise of counterfeit pharmaceuticals in Africa.

A 2023 report by the United Nations Office on Drugs and Crime claims counterfeit medicines in sub-Saharan Africa could be responsible for close to half a million deaths per year. Most of these are related to either antibiotics or anti-malarial products, but other medicines are also involved. In one tragic incident, for example, over 300 children died after taking counterfeit cough and pain syrups.

At present, there don’t appear to be any limits on what kinds of medicines can be faked. The availability seems directly linked to demand, with both generic and innovator medicines being falsified. These range from high-priced oncology drugs to inexpensive, over-the-counter products such as analgesics.

The problem is, not only do these drugs fail to treat the diseases for which they were purchased, they can cause serious harm to patients; many have been found to contain mercury, arsenic, rat poison, and cement.

Adding to the heartbreaking number of deaths, the World Health Organisation (WHO) estimates that the cost of providing remedial medical care to people in sub-Saharan Africa who have used fake or substandard malaria products alone is between $12m and $45m every year. This is simply unsustainable for a continent where over half a billion people live on less than $2 a day.

(For clarity, “substandard medicines” refer to those that are authorised but do not meet quality standards, whereas “counterfeit or falsified medicines” are those that deliberately misrepresent their identity, composition or source).

On October 23 this year, a team from JGL Forensics was privileged to be invited to the Anti-Counterfeiting Policy Dialogue, hosted by Adams & Adams in collaboration with The International Trademark Association (INTA) and Companies and Intellectual Property Commission (CIPC).

The event focused on the trade of counterfeit pharmaceutical products in Africa, and highlighted two key threats:

  1. To overall public health and safety
  2. To the economic viability of legitimate pharmaceutical businesses and the tax revenue they generate for governments.

The discussions focused on five main areas that need urgent attention:

  1. Strengthening public-private partnerships to secure the pharmaceutical supply chain
  2. Enhancing collaboration between law enforcement and the National Prosecution Authority
  3. Enhanced engagement with the judiciary
  4. Increasing consumer awareness of the existence and inherent risks of counterfeit drugs
  5. Advocating for updated legislation and regulations.

There was also unanimous agreement on the immediate need for legislative reform to regulate online pharmacies and the importance of continuous collaboration across the value chain.

The problem is obviously not just limited to African countries – a previous study by the WHO found that it’s rife in all developing countries, with as many as 10% of all medical products classified as falsified or sub-standard – but Africa accounts for close to half of all affected products.

Counterfeit antibiotics in particular have a longer-term, knock-on effect on overall healthcare, as they contain either incorrect dosages or the wrong active ingredients. This results in ineffective treatment, and the consequent survival of resistant bacterial strains. The WHO suspects this is a significant contributing factor to the increase in antimicrobial resistance they’re seeing throughout the African continent.

A WHO spokesperson said, “Pharma supply chains in many low- and middle-income countries are often complex, inefficient and fragmented; the region relies heavily on a limited number of suppliers for essential medicines, and many countries face significant challenges in procuring products in time, and effectively policing the quality of products in the market.”

The problem is exacerbated by the involvement of numerous middlemen in the distribution of products, making it far easier for substandard or falsified medicines to infiltrate the supply chain.

Sean Cavany, a mathematical modeller at the University of Oxford’s Centre for Tropical Medicine and Global Health, agrees that strengthening supply chains across the continent by enhancing infrastructure, improving logistics and implementing better surveillance-monitoring systems is key. He adds, however, that “there is also a lot that pharma companies can do by promptly reporting any cases of substandard or falsified medical products to national health authorities and the WHO rapid alert system, and contributing to capacity building.”

A WHO spokesperson supported this view, saying, “Recent incidents have demonstrated that we need a concerted multi-stakeholder approach to prevent, detect and respond to substandard and falsified products. Increasing public awareness of the scope, scale and potential harm that these products cause is a key activity in this.”

As a proudly South African company with a long history of helping to combat counterfeiting by investigating illicit markets, we are thrilled to see South Africans such as Dr Trevonia Nihal, who recently graduated with a PhD in Criminology and Forensics Studies from the University of KwaZulu-Natal, helping to shine a light on this growing problem. 

Throughout her recent research into the issue, one of her main concerns was how well-presented the counterfeit medication is. This means consumers can easily be conned into thinking it’s the real thing, thus exposing them to potential harm.

“That was one of the scariest discoveries I made,” she said. “It presents a huge public health concern.”

She stressed that the unavailability of affordable medicine is one of the major contributing factors contributing to the proliferation of counterfeit pharmaceuticals.

“Desperation is a big factor, some people have no other choice,” she says. “It’s worse in rural areas where counterfeit pharmaceuticals and substandard medication are concepts that many have not heard about before, and under-pressure doctors don’t have the time to educate every patient.”

There’s no doubt that education is a key weapon to tackling this worsening problem, but it’s clearly easier said than done.

It is encouraging to see, however, that the problem is receiving global attention.

Interpol’s Illicit Goods and Global Health Programme, for example, works with member countries and industry in general to improve global cooperation and enforcement capabilities.

One of their key prongs of attack is to help raise public awareness of pharmaceutical crime so consumers are better able to understand the risks – including those associated with buying medicines from unregulated websites – and make more informed choices.

Successes to date include seizures of illicit medical products with an estimated value of around $23,414,483 in 2021, and the removal of 113,020 websites.

At the end of the day, there’s an urgent need for industry leaders to unite against pharmaceutical counterfeiting. We need multi-sector collaboration to develop robust strategies for prevention and enforcement.

JGL Forensics will continue add our considerable expertise to both international and local investigations into incidents of counterfeiting, intellectual property and trademark violations, and other incidents relating to the manufacture, distribution and sale of fake pharmaceuticals.

We are doing everything we can, and implore others in positions of influence to do the same.