Antimalarial quality worsening in two African cities?

Eleven years ago my colleagues and I first sampled antimalarial medicines from 6 African cities. We went back to two of them last month and looked at the medicines on sale. We found that 18 percent failed (24/134) basic quality control, of which three percent (4/134) were fakes. The rest were poorly made or stored in transit from India and China. Read the working draft of the paper here.

This is a better situation than we found in 2007 or in the next few years, but its worse than the last time we looked in 2014. Indeed what seems to have happened is that efforts against inferior antimalarials (fakes made by criminals and substandards badly made by legal producers) have stalled and possibly reversed.

Finding inferior medicines is embarrassing for political leaders and health authorities and unless deaths are obvious the overwhelming political desire is to ignore the process. This research is ongoing and I intend to visit other cities to assess quality, because, although unlikely, it may be that the two cities looked at so far are outliers and the situation overall is better.