Medication: how to distinguish the real from the fake?

The war on falsified medicines cannot be won unless the public and the media join the fight, says Boukary Sana, health specialist.

The World Health Organization (WHO) offers a definition expanded and accepted of fake medicine or counterfeit medicine or even falsified medicine: "A medical product is forged when there is a misrepresentation of its identity and/or source. This applies to the product, its packaging or any other packaging or labeling information.“

A global scourge

The trafficking of fake drugs is a revolting and deadly crime. The general ignorance of this scourge, its illicit nature, the multiple realities that the falsification of medicines can represent as well as the diversity of its health and economic consequences make its evaluation complex and uncertain.

In 2015, the WHO indicated that counterfeit medicines would represent between 10 and 15% of the world market. But in parts of Asia, Africa and Latin America, fake drugs can account for up to 60% of drugs in circulation.

The WHO pointed out in December 2008 that 50% of medicines purchased on websites concealing their physical address would be fakes. Of one million annual malaria deaths in Africa, 200 000 could be avoided if the sick were treated with real drugs.

This applies, to only to what kinds of products your potential customers buy, but also to the way these products are promoted through advertising and marketing content. International Institute for Anti-Counterfeit Medicine Research (IRACM), for $1 invested, heroin trafficking yields around US$000, while the same amount invested in fake drug trafficking can yield between US$20 and US$000. That is a traffic 200 to 000 times more profitable than that of drugs.

In poor and developing countries, 1 medicine in 10 is substandard or falsified. With deadly consequences, between 72 and 000 children die each year from pneumonia treated with substandard or falsified antibiotics, according to a study produced by the University of Edinburgh.

Similarly, a study of the London School of Hygiene and Tropical Medicine reveals that between 64 and 000 additional deaths due to malaria are caused each year in sub-Saharan Africa by substandard or falsified antimalarial drugs.

All countries, rich or poor, are threatened by counterfeit medicines. But it is the poorest countries, the most vulnerable populations, who are the main victims of this deadly traffic.

In Nigeria and Pakistan, falsified medicines could represent 40 to 50% of all medicines in circulation, according to the organization Les Entreprises duMedicine. In Thailand and Nigeria, 36,5% antibiotics and antimalarials would be falsified. Seizures of falsified medical products are recurrent there, often colossal, and the testimonies are particularly worrying.

Several factors explain this situation. Among these is the lack of access to quality medicines. Access to quality medicines is a major problem in many countries, especially in Africa.

The extreme complexity of distribution systems in many countries, particularly in Africa, is a major cause of the spread of fake medicines. The complexity of the circuits multiplies the possible entry points for counterfeit drugs, and the total illegibility of these circuits prevents any effective control, thus making them the preferred “playgrounds” of traffickers.

Moreover, the proliferation of intermediaries and supply routes makes any traceability impossible and encourages corruption which is taking on endemic proportions in Africa.

The lack of means of the regulatory authorities is also indexed. Controlling the circuit is all the more difficult as the regulatory authorities are often sorely lacking in financial and human resources. It is the case of India where the drug quality control department is like a shadow department.

Some steps for consumers to take

How to deal with this situation? The war against falsified medicines can only be won if the public and the media join the fight.

The drug is not a product like the others. Its quality is rarely questioned in the minds of the public who do not imagine that this essential product can be falsified.

In recent years, noting the difficulties of adapting health systems to resist traffickers, particularly in the poorest countries, many projects have emerged focusing on digital technology and the spread of telecommunications to give patients themselves the power to verify the authenticity of the drugs they buy using their mobile phone:

• by sending a SMS containing a unique identification code of the product, to which an automatic response specifies whether the product is genuine or not;

• or by using a specific mobile application, when the equipment (smartphone) and Internet access allow it. In 2014, for example, the Turkish government decided to involve patients in the verification and authentication of medicines with the launch of a smartphone app allowing them to confirm that their medicine is indeed authorized by the Ministry of Health, not subject to a batch recall or even falsified;

• A checklist for the thorough visual inspection of medicines, namely:

• Do the box and closure protect the medicine from the outside environment (eg is it properly sealed)?
• Is the trade name and/or active ingredient name spelled correctly? Does the ® or TM symbol follow the trade name?
• Is the complete address of the manufacturer legible and correct? All manufacturers are required by international law to print their full address on the label. Many companies making substandard or falsified drugs do not have a traceable address on the label.

Conclusion

The criminal trafficking of falsified medicines constitutes a major global health threat and an intolerable obstacle to development in the poorest countries.

Faced with organized and determined traffickers, the general and coordinated mobilization of political decision-makers, health professionals, law enforcement, customs, judges and magistrates is imperative, at all levels.

And all means must be implemented to involve public opinion in this fight, and to make it aware of the danger represented by these criminal usurpers.

Boukary Sana, Teacher, Specialist in health promotion and protection, prevention of disease by vaccination, Nazi Boni University

This article is republished from The Conversation under Creative Commons license. Read theoriginal article.