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.
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...