Governments are to blame for the counterfeit drugs pandemic
IPN Opinion article
Globe and Mail, Canada
Bird flu is on the wing in Africa. It is wiping out poultry stocks in Nigeria, while neighbours nervously await its inevitable arrival--yet the supply of effective drugs is undermined by governments' failures that have created a plague of counterfeits.
The deadly HN51 strain of the virus may not mutate into a form that can be transmitted between people but Africans are right to be worried. The best drugs we have may be rendered useless by counterfeiters and complicit officials.
Fake drugs are a booming business in many poorer parts of the world. In Nigeria and parts of China the WHO estimates that a staggering 40 to 50% of all drugs in circulation are illegal copies. As well as lining the pockets of criminals, these counterfeits pose a serious threat to health.
Counterfeit drugs can make genuine branded drugs useless: containing too little of the active ingredient, they can act like an "inoculation" to the virus, bacterium or parasite they are designed to kill. They could help the bird 'flu virus mutate into new, drug resistant strains, rendering existing treatments useless.
In the event of an avian 'flu pandemic, we really do not want the best currently existing treatment, Tamiflu, to be redundant.
This is a very real and frightening prospect: it is already happening with malaria. Counterfeiters around the world have cashed in on the massive demand for the latest and most effective anti-malarial drug, artemisinin. Over half the drugs sold in South-East Asia contain incorrect levels of the active ingredient.
According to Dr Dora Akunyili, Nigeria's chief drug regulator, fakes are directly responsible for this resistance, as well as the doubling of malaria deaths over the last 20 years. The counterfeiters are threatening the lives of anyone who lives in a malarial area: over 100,000 people die each year from fake anti-malarials in South East Asia alone.
The same is true for the antiretroviral drugs used to treat HIV/AIDS sufferers: even the latest drugs are being undermined by drug-resistant forms of the HIV virus - largely due to counterfeits.
It is only a matter of time before the same fate befalls treatments for avian 'flu, as demand for Tamiflu grows and people turn to the black market.
Already the internet is awash with spurious Tamiflu, while consignments have been discovered as far apart as New York and Beijing. Chinese newspapers report 192,000 deaths from fake drugs every year but China is a top producers of counterfeits, along with India.
The reality is that governments around the world are responsible for the global counterfeiting plague. Most obviously, governments stimulate demand for cheaper fakes by artificially driving up the price of legitimate drugs through taxes and tariffs. It cannot be a coincidence that the two countries with the highest levels of counterfeit drugs--Pakistan and Nigeria--also top the league for medicine taxes.
Counterfeiters also thrive in countries which fail to uphold the rule of law. When the judicial system is corrupt and arbitrary, gangsters have little difficulty persuading the authorities to turn a blind eye to their activities, through bribery or intimidation.
China, has a particularly poor track record in clamping down on the racketeers. Furthermore, a weak rule of law means companies cannot protect their trademarks, vital for guaranteeing to consumers the quality and origin of a product: when consumers cannot tell the difference, counterfeiters get a free ride.
Finally, in countries with the rule of law, those harmed by counterfeits can obtain redress in the courts. But in the majority of lower-income countries, cases can take years to progress through corrupt and under-resourced courts.
The World Health Organisation is gathering officials and regulators from around the world this week in Rome to advocate "a mechanism for concerted international action against counterfeit medicinal products." But there are plenty of laws already: what is missing is the rule of law.
We can only beat the counterfeiters by strengthening and upholding the rule of law. This is not some arcane side issue. It goes right to the heart of economic failure or success. An economy will never grow without criminal and civil law, including contracts, trademarks, property rights and so on, being enforced impartially.
These are the software of civil peace, development and prosperity.
Governments that do not take this seriously are complicit in thousands of deaths. In the event of a bird 'flu pandemic, they will be responsible for many thousands more.
Philip Stevens is Health Programme Director at International Policy Network.