The doctor prescribes an unnamed medication to manage your pain. It comes in flawless packaging …almost. In this true account as relayed by multinational Pfizer, the color has been clinched with floor polish and lead-containing paint while brick dust has been improvised as an adhesive. To top it, boric acid, known for its deleterious effects on the kidney is a constituent!
Welcome to the world of counterfeit drugs, the most profitable industry in the world of organized crime. As it turns out, with limited technological and human resource capacity, porous borders and sub optimal multi country collaboration between security agencies, regulatory bodies and professional unions, West Africa is hardly in pole position in the fight against counterfeit drugs. It is perhaps to remedy this that nine West African countries and other key stakeholders gathered in Dakar in the first quarter of 2011 under the aegis of international pharmaceutical Pfizer, to as it were, create synergy of effort.
Since 2004, Pfizer alone has discovered 65 million counterfeited drugs in addition to the discovery of active pharmaceutical ingredients to manufacture another 68 million drugs. In addition, Viagra is by far the most frequently counterfeited drug. Anti malarials have not been spared with dire implications for Africa where according to the World Malaria report 2010, 78% of cases worldwide and 91% of deaths worldwide from malaria were in Africa. Also, a study done in 2008 in six African countries including Ghana revealed 35% of anti malarials to be sub standard. Nigeria’s (full name) NAFDAC for example states unequivocally that antimalarials and antibiotics are the most frequently counterfeited drugs and have formed the focus of their efforts while deploying “cutting edge technology” like truscan.
The Ghana team that assembled included officials from the Criminal Investigations Division, Customs Division, Food and Drugs Board and professional bodies including the Ghana Medical Association and the Pharmaceutical Society of Ghana.
New dimensions in counterfeit trade
The counterfeiting world seems to have assumed new dimensions both in West Africa and elsewhere; clients purchasing drugs using the internet, linkages with the narcotic trade and money laundering. Perhaps in equal measure, those fighting this menace have responded through the deployment of new technologies like the truscan and mobile telephony services. Of course, and there was the not so small matter delivered though a lively debate of some manufacturers themselves introducing sub standard drugs unto the market after securing approval to produce drugs of the highest quality. Of course this was hotly contested!
With some countries citing a weak legal regime, Ghana’s challenge seemed to be more a question of enforcement and the application of deterrent sanctions following convictions in court. The Food and Drug Board’s Thomas Amedzro lamented individuals caught red handed dealing in counterfeits and yet hardly being slapped with the maximum 500 penalty units or the 600 GH¢. In one instance, after working extra hard to secure convictions, the convict was jailed for one week and then released which was a big demotivator to the anti counterfeit fight not to mention sending all the wrong signals to patrons of the thriving illegal trade.
Weak research capacity
Another challenge that became apparent in the Ghanaian context and indeed in the presentations of many others is the research capacity or lack thereof some of these agencies fighting counterfeits. There appears to be very little or no data to inform policy makers and managers as to whether the fight is being won or lost and what impact if any current interventions are making in ensuring that people indeed are increasingly having access to safe and efficacious medication. In fact in some statistics quoted by the Pharmaceutical Security International, the paucity of information from Africa on reported seizures and hence the unreliability of data for decision making and strategic planning couldn’t be clearer. In Ghana for example, it is crucial for relevant agencies to begin to collect data and where data is available, to begin to analyze same to enable questions like the prevalence of counterfeit levels in our country to be determined plus the percentages of the most commonly counterfeited drugs etc
Again, in Nigeria and Ghana especially, there might be the need to reorient the mandate of some of our Customs agencies. When governments strongly positions the Customs Division of CEPS as a revenue agency with defined revenue targets while downplaying its regulatory role, it reinforces t he weakened capacity of an otherwise strong anti-counterfeit ally through an unintended weakening of their regulatory role. It is time to begin to pay more attention to building the regulatory role capacity.
It is noteworthy that Ghana’s Food and Drugs Board following its recent proactiveness in the area of enforcement has decided to embark on a massive public education exercise. This should be comprehensive, focusing not just on the ways of combating counterfeits medications but on the harmful effects of the drugs on the man on the street who must be aided with basic street wise tools in detecting features of counterfeit medication. In addition, better collaboration ought to be built among all stakeholders including key ones like doctors, pharmacists who remain key to procuring medications for health institutions and dispensing same to clients etc. The public must know that every counterfeit detected is one life saved. They must know how a woman ordered a drug online and died the next day with fifteen times the normal aluminum levels being detected in her liver.
Use of text messaging services and portable devices like the truscan which require little/no technical expertise can ensure massive utilization at the ports, among providers, pharmaceutical companies etc in addition to the usual impromptu checks of undetermined effectiveness. Nigeria, for example, reports the existence and their use of a program that enables a text message to be sent to a code with a prompt reply confirming the genuineness or otherwise of a particular product.
Given intelligence indications of an observed shift of some barons from narcotics trade into counterfeit manufacturing, spurred by enviable profit margins and reduced security vigilance, now is a good time to join up our efforts at all levels.