The primacy of public health considerations in defining poor quality medicines

USAID

Lawrence Nwosu, Country Sales Director Sproxil Nigeria, talking with a pharmacist who sees the benefits from the scratch off labels used to identify counterfeit drugs.

Article Highlights

  • Attempts to improve medicine quality are hampered by confusion and controversy over definitions

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  • Public health should be prime consideration in combating counterfeit medicine

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  • International treaty on #med quality could be important step in fighting counterfeit drugs

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Summary Points

  • Poor quality essential medicines, both substandard and counterfeit, are serious but neglected public health problems. Anti-infective medicines are particularly afflicted.
  • Unfortunately, attempts to improve medicine quality have been hampered by confusion and controversy over definitions. For counterfeit (or falsified) medicines, this has arisen from perceived differences between public health and intellectual property approaches to the problem.
  • We argue that public health, and not intellectual property or trade issues, should be the prime consideration in defining and combating counterfeit medicines, and that the World Health Organization (WHO) should be encouraged and supported to take a more prominent role in improving the world's medicine quality and supply.
  • An international treaty on medicine quality, under WHO auspices, could be an important step forward in the struggle against both substandard and counterfeit (or falsified) medicines.


Poor Quality Medicines-A Major Public Health Problem

There is growing, but belated, concern that much of the developing world's supply of medicines-in particular, its supply of anti-infective drugs-is of poor quality. This constitutes a major public health problem because the high prevalence of poor quality drugs in developing countries results in avoidable morbidity, mortality, and drug resistance [1]-[7]. Moreover, any efforts to improve public health by developing new medicines or by changing treatment policies will ultimately be pointless if the drugs patients actually take contain insufficient or incorrect ingredients.

Unfortunately, efforts to improve the quality of medicines in developing countries are being hampered by confusion over the terms used to describe different types of poor quality medicines. This confusion has arisen because of poor science and because of tension between the defence of commercial interests and the public health importance of enhanced access to good quality medicines in developing countries. Specifically, some commentators have argued that counterfeit medicines are being viewed primarily as intellectual property (IP) rather than public health concerns and that the innovative pharmaceutical industry is using action against counterfeit medicines to impede the trade in competing generics [8]-[20]. In this essay, we call for public health concerns to be made the prime consideration in defining and combating counterfeit medicines and argue that recent World Health Organization (WHO) initiatives eschew IP concerns. We also discuss some related but neglected interventions that might help to improve drug quality in developing countries.

Roger Bate is the Legatum Fellow in Global Prosperity At AEI

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