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About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.

Post

Medicines That Kill

Published 14th July 2010 - 21 comments - 7329 views -

Akinye developed a high fever overnight. At only three years of age, her little body was shaking badly, and her mother had difficulty comforting her. There was little more she could do then to cool the child’s head with a little water. Luke-warm water from a clay pot in the corner of the hut. She would have to wait until dawn as it was unsafe to walk the seventeen kilometres to the dispensary during darkness. When the sun finally ascended over the tree line she set out through the forest, carrying Akinye on her back. In a fold of her kanga she carried the few remaining shillings she’d earned last week with selling cassava on the village market. Exhausted but relieved, she reached the clinic almost two hours later. Indeed, as she had feared, Akinye was diagnosed to suffer from malaria. A nurse then gave her a small envelop with anti-malaria tablets, for which she paid.

Back home, Akinye was given the tablets precisely the way the nurse had instructed her mother to do. But two days later she was dead. Although her mother had taken immediate action when her little daughter developed a high fever, had taken her to the clinic, bought her drugs with the few coins that remained, and treated her well, Akinye’s death was imminent.

 

 

 

 

 

This tablet would have saved Akinye's life....    

This is the tablet that killed her...

Welcome to the world of counterfeit drugs. Drugs that contain no or hardly any active ingredients - produced and 'marketed' by criminal organisations. 

Forget about cocaine

Selling cocaine is illegal but highly profitable. One kg may yield some 40,000 $. Selling of counterfeit drugs is illegal too, but can yield almost double that amount. So, if you're a criminal anyway, why not focus on drugs rather than on narcotics? If you get caught with cocaine you're in for serious time in jail. With counterfeit drugs you will be fined. 

Around the world, but mostly in India and China, criminal organisations have come to these same conclusions. At present, the trade in counterfeit drugs is estimated in to be in the tens of billions of dollars annually. Kenya fears that 40% of all drugs sold over the counter are fake. Global estimates for drugs sold over the internet go as high as 50%. The World Health Organization (WHO) reckons that 10% of all drugs sold worldwide are nothing more than chalk. Chalk worth 500 billion $ annually.

At least a third of all antimalarials sold in Kenya, Tanzania, Ghana, Nigeria and Rwanda are fake. For Senegal that's nearly every other tablet. Tablets that will do nothing to cure you. Tablets that will kill Akinye's school mates when they contract malaria next. Perhaps worse is the fact that insufficient amounts of active ingredients rapidly lead to the development of parasite resistance. 

Implications

The impact of counterfeit drugs goes beyond Akinye's death and the development of parasite resistance.

A year after Akinye's death, her two-year older brother developed malaria. But this time his mother no longer decided to visit the clinic. There she lost her baby girl and spent money on drugs that did nothing to save her. She lost confidence in the staff of the clinic that prescribed the drugs. Instead, she took her son to a local traditional healer, who prescribed some herbal concoction that merely aggravated his condition. He too died of malaria. Counterfeit drugs induce scepticism and lack of trust in western medicine.

Scientists got worried that drug resistance had surfaced in the area where Akinye and her brother died of malaria. They spent huge amounts of money to study the problem, only to find out much later that real drugs worked perfectly well and cured patients. Counterfeit drugs blur insight in the efficacy of drugs and make it almost impossible to monitor resistance.

War on counterfeit drugs

In countries where customs officials can easily be bribed and ivestigative bodies and authorities to track down counterfeit drug businesses remain undersourced, it is unlikely that anything can be done to counter the situation. Criminals will have free play.

Since 2006, WHO has set up a special task force to deal with this catastrophe. The IMPACT (International Medical Products Anti-counterfeit Taskforce) group is challenged with the difficult task of aligning the multitude of stakeholders, ranging from pharmaceutical companies to law enforcement bodies (Interpol), from scientists to drug sellers and distributors, from customs officials to Ministries of Health. A daunting task.

The Millennium Development Goals set out to provide citizens in developing countries with drugs to cure diseases like malaria and enable people to live with HIV. Millions are now being reached with these life-saving drugs. It's only that we can no longer be sure that this will gain more than handing out sweets...


Category: Health | Tags: africa, africa, malaria, drugs,


Comments

  • Bart Knols on 15th July 2010:

    An example of today: 1 child dead and more than a hundred people ill in China, after taking dubious drugs against malaria: http://sg.news.yahoo.com/afp/20100715/tap-health-china-disease-8d4ea94.html


  • Hanna Clarys on 15th July 2010:

    Wow, this is sad. Never thought this was such a huge problem, but I could have guessed if I would have thought about it more thoroughly. Lots of money is involved in this businness.
    This is a very important post - thanks.


  • Daniel Nylin Nilsson on 15th July 2010:

    Really, really sad :( Nothing short of a scandal.

    Tania touched on the subject of patents for drugs. Countries like India and China have long been complaining about patents that make drugs unaffordable. Do you think that a reform of patent legislation, and more generic drugs would shrink the market for counterfeits?


  • Bart Knols on 15th July 2010:

    @Hanna - this was fairly new stuff for me too. When I got deeper into it, I realised how serious this is, and is really undermining malaria control efforts.

    @Daniel - Generic drugs or not - there are criminal organisations out there making huge profits on selling chalk. What is needed here is international efforts to control this traffic of counterfeit drugs, and this is exactly where the complexity comes in. It is in many way like fighting narcotics, a hard to win war.

    But tragic, very tragic indeed, as innocent lives are taken…


  • Luan Galani on 16th July 2010:

    Bart, totally shocking.

    Thanks for this incredibly insightful post. It really deserves our attention, urgently.

    About controlling this traffic, any chance of testing or analysing one tablet/drug of each allotment received?

    I’m overwhelmed!


  • Bart Knols on 16th July 2010:

    @Luan - equipment to detect quickly if a drug is counterfeit has been developed, see:
    http://www.asdi.com/products/rxspec-700z-portable-counterfeit-drug-analyzer

    However, you still need to get these in place, used, maintained, etc…the task is indeed daunting I’m afraid…


  • Clare Herbert on 16th July 2010:

    Harrowing stuff Bart, thanks for highlighting it.


  • Bart Knols on 16th July 2010:

    Thanks Clare - it is indeed nasty, and particularly bad with regards to the developing world and malaria.

    But I also came across an article ref counterfeit Viagra… and that I consider rather funny…


  • Johan Knols on 16th July 2010:

    @Bart,
    My first thought was that your last comment would worry you…..


  • Bart Knols on 16th July 2010:

    @Johan - Hey you, Knols, don’t put my personal issues online, will you? I only hope that my last comment will not massively increase the Viagra spam mails I get wink)


  • Luan Galani on 16th July 2010:

    @Bart, I got chuffed about this equipment. Thanks for the link. Very fresh new for me.

    But, as you pointed, maintaining it working is challenging, and it daunts me as well.

    Do you know if such equipment is already being used somewhere?


  • Bart Knols on 16th July 2010:

    @Luan - frankly, I’m not sure if such equipment is already being used in developing countries to detect counterfeit anti-malarials…will try to find out more…


  • Clare Herbert on 17th July 2010:

    @ Bart: I can only imagine how hilarious that was!! :D


  • Luan Galani on 17th July 2010:

    @Bart, thanks. Still keeping my fingers crossed.


  • Bart Knols on 19th July 2010:

    @Luan - today an article on SciDev.net with 3 new proposed techniques to identify counterfeit drugs, see it here: http://www.scidev.net/en/news/smart-security-could-combat-counterfeit-medicines.html


  • Luan Galani on 20th July 2010:

    @Bart, these methods from the US, Belgium and Portugal come in handy. Thanks for letting me know it. But, and there is always a but, as the link points, these are only to buy time. “Every type of anti-counterfeiting technology gets counterfeited in the end”. I still think that that equipment is the better solution so far.


  • Bart Knols on 20th July 2010:

    @Luan - correct. Technology will only buy us time. It is precisely like with narcotics: as long as there is big cash to gain, they will circumvent whatever solution you come up with, regretfully…


  • Luan Galani on 02nd September 2010:

    @Bart, came across this piece and thought of you: http://alertnet.org/thenews/newsdesk/LDE67T062.htm

    Check it please and let me know your opinion. It is a bit scary, but their conclusion can be disputable, can’t it?


  • Bart Knols on 03rd September 2010:

    Thanks Luan - an interesting link and study. Production of generics of course does not equal the production of counterfeit drugs. Generics (drugs often become generics after the patent has expired) can indeed be sold at much lower prices, and may thus be more widely affordable in the developing world. The key is to make sure that the QUALITY of the generics remains similar to the branded product, which of course remains the big challenge when each and everyone can start producing these drugs…


  • Luan Galani on 09th September 2010:

    @Bart, I read your answer a long time ago, but only now officially saying thanks. Thank you!


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