Stopping Fake Meds in the Third World

The United Kingdom's drug regulator recently seized nearly half a million pounds' worth of counterfeit drugs. It was a huge victory for British officials, but counterfeits have become so ubiquitous that the story barely made the news.

Over just two months last year, European Union officials seized more than 34 million fake prescription pills. In just one 2008 raid, Belgian authorities seized over 2 million counterfeit tablets. Fake drugs are everywhere, and they continue to harm millions across the globe. By expanding the use of sophisticated detection technologies developed in the United States and instituting stiffer penalties for counterfeiters, though, regulators could better fight this threat and save countless lives.

Fake meds pose an especially acute problem in Africa and Asia. The World Health Organization estimates that 20 percent of the Indian drug supply is fake or adulterated. A recent study in the British medical journal The Lancet estimated that around 40 percent of products in Thailand and Nigeria labeled as containing artesunate--an effective antimalarial--contain no active ingredients.

Counterfeit drugs that don't contain proper levels of active ingredients have contributed to the spread of many diseases, particularly malaria.

A study I authored in 2008 found that 35 percent of malaria drugs in Africa are substandard. Sometimes, these pills contain harmless ingredients. My research colleagues recently procured six samples of the powerful antibiotic ciprofloxacin from a pharmacist in Lagos, Nigeria; one of the packages contained nothing more potent than baby powder. Sick folks who ingest baby powder don't get better, of course.

But baby powder is much less harmful than toxins like heavy metals and antifreeze. And counterfeits are often laced with such ingredients. In 2006, 100 children in Panama died from taking counterfeit cough syrup containing antifreeze. Back in 1995, fake meningitis vaccines killed more than 2,500 Nigerians. And Marcia Bergeron, of Vancouver, died in 2007 from such contamination.

Other counterfeit medicines contain some active ingredients, but not enough to be effective. Just as vaccines we take are weakened forms of a disease that teach our bodies to overcome the disease, weakened drugs help bacteria, viruses and parasites build up immunity to medications, turning them into drug-resistant "super-bugs."

Counterfeit drugs that don't contain proper levels of active ingredients have contributed to the spread of many diseases, particularly malaria. Worldwide, malaria kills one million people annually. The WHO estimates that 20 percent of those deaths could be prevented if anti-malarial drugs were "effective, of good quality, and used correctly."

Of the eight anti-malarial drugs developed over the last 70 years, only one remains widely effective. The good news is that technology is improving detection of counterfeit drugs. Thin-layer chromatography (TLC) is a relatively inexpensive means of testing the chemical make-up of drugs. Unfortunately, though, TLC can only be used in a lab setting, and labs require a consistent source of electricity, potable water and trained staff. These are obstacles in the developing world.

Despite this, there are currently more than 300 labs in Africa and Asia using this method to root out counterfeits. And more are on the way. Fortunately, some new technologies make it easier to test the authenticity of drugs in field settings. Two American companies--Polychromix and Ahura Scientific--have developed handheld, battery-operated spectrometers that let modestly trained personnel test drugs just about anywhere, analyzing medicine through packaging and bottles in a matter of seconds.

Spectrometers like these are more expensive than TLC laboratories, while a fully equipped TLC lab costs just $10,000 to set up, these spectrometers cost about $50,000. But because these technologies are portable and work quickly, it's imperative that we expand their use. Countries could also help beat back the tidal wave of counterfeit drugs by stiffening penalties for counterfeiters.

India has taken steps in this direction, increasing fines and prison time for counterfeiting. Nigeria, a major victim of counterfeit drugs, recently brought the penalties for counterfeiting on par with those for dealing narcotics. The results have been impressive: Between 2001 to 2008, the share of Nigeria's drug supply that is counterfeit or substandard dropped from 70 to 16 percent. Government agencies, the pharmaceutical industry and humanitarian organizations must work together to stamp out counterfeits.

Roger Bate is the Legatum Fellow in Global Prosperity at AEI.

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About the Author


  • Roger Bate is an economist who researches international health policy, with a particular focus on tropical disease and substandard and counterfeit medicines. He also writes on general development policy in Asia and Africa. He writes regularly for AEI's Health Policy Outlook.
  • Phone: 202-828-6029
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