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http://news.independent.co.uk/world/africa/article2444464.ece

Drug giants accused of ignoring fake medicines that kill millions

By Saeed Shah
Published: 13 April 2007

The world's major drug companies have been 
accused of turning a blind eye to the 
multibillion-dollar trade in fake medicine that 
has resulted in an explosion of child malaria 
deaths in developing countries.

Governments have not tackled the problem and 
pharmaceutical companies are burying the issue, 
afraid that any publicity given to their 
medicines being faked will lead to a fall in the 
sale of the genuine product, according to a 
documentary.

The problem has been particularly acute with the 
treatment of malaria in Africa, with anti-malaria 
drugs faked on an industrial scale. Professor 
Nick White, of Oxford University, one of the 
world's leading experts on malaria, said: "We 
estimate that there are more than one million 
deaths each year - which is the equivalent of 
seven jumbo jets going down every day. And 90 per 
cent of those deaths are in children."

Professor White said that counterfeit medicine 
was a major reason why malaria had become, over 
the past 30 years, Africa's biggest child killer, 
from an illness that used to be easily treated 
with medicines.

Some of the fake drugs contain no medicine at 
all, but others have tiny traces of the real 
ingredients - which leads to another, potentially 
bigger problem: it allows the malaria parasite to 
build up resistance to the drug.

Nigeria's campaigning drugs regulator, Dora 
Akunyili, described counterfeiting as "mass 
murder". She told the documentary, which will be 
aired today on The Business Channel, a satellite 
station: "The fake drug racket and the silence 
associated with it have led to the resurgence of 
malaria... The companies kept quiet. The 
regulators were paid off and everybody was 
helpless. Drug counterfeiters operated in this 
country and in most developing countries for 
almost three decades, unchallenged."

There is now just one family of drugs left that 
malaria has not built up resistance to, 
Artemisinins - which are also being faked. 
Professor White said: "Resistance to the 
Artemisinins would be an absolute catastrophe for 
our current attempts to try to control malaria."

It is estimated that the global fake drug racket 
is worth $40bn (20bn) a year, and between 50 and 
90 per cent of medicine in some African and Asian 
countries is counterfeit. Graham Satchwell, the 
former head of security at GlaxoSmithKline, the 
British-based global pharmaceutical giant, told 
The Independent: "Each therapy area is highly 
competitive, so if one person's drug is 
undermined, their market share will suffer. It 
takes a brave company to say they have a problem."

Mr Satchwell said that the "majority of the 
industry are sitting on their hands", rather than 
tackling the problem - for instance through radio 
tracking of their products. He also pointed out 
that the figures from the industry's own 
organisation, the Pharmaceutical Security 
Institute, showed many cases of counterfeiting in 
the US, but hardly any in China or Africa - 
despite firm evidence from other sources that 
tens of thousands die each year in China and 
Africa as a result of fake medicines each year.

Dr Akunyili said: "If the companies had risen up 
to their responsibilities early enough, the issue 
of the preponderance of fake drugs would not have 
gotten to the level it got in Nigeria. It is this 
silence that is actually largely encouraging drug 
counterfeiting"

Dr Martin Meremikwu, of Calabar University 
Hospital, in southern Nigeria, said that he had 
seen child malaria deaths soar. He said that, by 
the time children who had been treated with fake 
drugs got to the hospitals, it was often too late 
to save them.

"Malaria should not kill people. It's a curable 
disease. But if the patient uses the wrong drug - 
either because they are fake or they are 
ineffective because of higher resistance - then 
they are lying here with complications.

"And in children, young children, the time 
between a mild disease and a severe disease can 
be as little as eight hours, or 24 hours or 12 
hours. So time is of the huge essence here. You 
really cannot afford to try some other drug 
before trying a good one. You can't. Because you 
don't have that time."

The drugs don't work

* Counterfeit medicines are swamping unregulated 
markets in developing nations with unknown and 
sometimes fatal results. Not only are thousands 
dying needlessly, but patients are also becoming 
immune to the effects of the real thing. 
Counterfeit drugs occasionally contain small 
doses of the active ingredient - enough to induce 
resistance

* The UN World Health Organisation estimates the 
incidence of counterfeit medicines is about 10 
per cent in developing countries, with prevalence 
higher where regulatory control is weakest. But 
in many parts of Africa, according to the WHO, as 
well as in some countries in Latin America and 
South Asia, prevalence sits at around 30 per 
cent. The patients hit are the sickest and the 
poorest.

* WHO estimates that 200,000 of the one million 
malaria deaths every year would be prevented if 
all the drugs taken were genuine. The popularity 
of combination malaria drugs - which are more 
expensive than other treatments - has seen 
counterfeit peddlers cash in on the opportunity 
to boost sales. In Cambodia, Tanzania and 
Cameroon, up to 90 per cent of such drugs on sale 
in local markets are believed to contain nothing 
but chalk or maize flour.

* As recently as 2001, about 68 per cent of 
medicines in circulation in Nigeria were 
unregistered, and as much as 41 per cent were 
believed to be fake.