By Katie McQue [Source]
GATEWAY TO AFRICA | In Africa the cost of all medications, including generic drugs, exceeds the means of most and many people are faced with a grim choice: purchase counterfeit medications, ingredients unknown, or go without treatment.
With 30% of the total available pharmaceuticals in Uganda believed to be counterfeit, the country, like many others, is struggling to keep control of a business that is both deadly and lucrative.
“A lot of deaths occur. But nobody reports these and nobody is going to investigate,” said Suraj Ali, a partner at the Ugandan legal firm Muwema & Mugerwa.
The situation in Uganda is typical in much of sub-Saharan Africa, and the reasons are economic. In regions of high prevalence of poverty the cost of all medications, including generic drugs, exceeds the means of most. Few people have medical insurance, and they are faced with a grim choice: purchase counterfeit medications – ingredients unknown – or simply go without treatment.
The big pharmaceutical firms are worried. “When you visit a market in Tanzania, you see that they are being sold everywhere,” Ed Wheatley, AstraZeneca’s investigations director for the region, said at June’s Visiongain Pharmaceutical Anti-Counterfeiting conference, in which representatives from major drug makers gathered to deliberate the problem.
This big problem is also a big business – it is widely estimated that counterfeit drugs have an annual turnover of US$75 billion worldwide, with a profit margin of about 70%. This means that the global share of counterfeit medications is 10% of the pharmaceutical market. Around the world 200,000 people die annually due to counterfeits.
Most of the fakes hail from factories in China, India and Pakistan, and counterfeiters are more concerned with matching the packaging than the ingredients of the original. Criminals steal hospital vials with branded labels, print their own hologrammed boxes – even buy tablet-making presses on eBay.
The World Health Organisation estimates that 32.1% of these drugs do not contain any active ingredients; 20.2% have incorrect quantities of active ingredients; 21.4% include wrong ingredients and 8.5% have high levels of impurities or contaminates.
The loss of sales and reputation is significant, as users of the fake drugs may still associate their illness with the genuine article. In some countries, drug makers can also be liable for harm caused by fakes.
In Germany, for example, a company can be called to account if it can be proven that it did not utilise all the possibilities provided by state-of-the-art technology to prevent counterfeiting. In most US states, any part of the manufacturing and sales chain can be liable for damages to the consumer arising from faults in a product’s construction, manufacturing or labelling.
Given this risk it is understandable why pharmaceutical companies are keen to intervene in the African counterfeit market. Some assist local governments with on-the-ground intelligence, leading to raids and prosecutions. This assistance is necessary in countries where awareness is low, resources devoted to the problem are scarce and corruption is high.
“There is a lot of corruption,” Ali said. “A lot of the magistrates are underpaid and they get bribed.
“We have a national drug authority that is supposed to prevent counterfeiting, but it is underfunded,” he added. “There are very few inspectors; they don’t have the equipment to check drugs properly… Things find their way into the country – the borders are very porous.”