African leaders have pledged to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support, writes David Richmond, CEO of the Brazzaville Foundation, an independent London-based charity that focuses on African issues.
Richmond writes: “The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200bn or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organisation, which relies largely on voluntary reporting by health-care professionals, we may know about ‘just a small fraction’ of all cases.
“What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems.
“Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality.
“Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor.
“Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.
“Like narcotics trafficking, however, it is a business that depends on – and reinforces – broader criminal activity, including that of terrorist groups. In fact, fake medicines are trafficked through the same organised-crime networks as illicit drugs and weapons. These networks destabilise communities and countries, particularly in already-fragile regions like the Sahel.
“Fortunately, seven African countries – The Gambia, Ghana, Niger, the Republic of Congo, Senegal, Togo, and Uganda – are set to take action to address the scourge of fake medicine. This month, the Brazzaville Foundation, of which I am CEO, will bring together the heads of these states in Lomé, Togo, to sign a political declaration and a legally binding agreement committing them to introduce legislation to this end.
“The agreement will include a clear timetable, and demand tough new criminal penalties. Furthermore, recognising the critical importance of rigorous enforcement, it will include provisions on capacity building, including community engagement, and on coordination among government agencies. As such, it will lay the groundwork for a broader campaign to ensure that all citizens have access to quality health care, including safe and effective medicines.
“The Lomé Initiative represents an historic opportunity to step up the fight against the trade in substandard and fake medicines. But to subdue this deadly business, which claims hundreds of thousands of African lives every year, more of the continent’s leaders must join the fight. And the international community must support them.
“Some international actors have embraced this imperative. Beyond the WHO, the Council of Europe has created the MEDICRIME Convention, the first international treaty against counterfeit medical products and similar crimes involving threats to public health. And the UN Office on Drugs and Crime has produced a guide to good legislative practices for combating falsified medical product-related crime.
“But more must be done, and the Lomé Initiative can go a long way toward ensuring that it is. To minimise the risks that fake medicines pose to us all, the world must offer its support.
On 18 January, 2020, seven African heads of state, global public health partners and NGOS committed to collaborating and coordinating efforts against the trafficking of substandard and falsified medicines as well as other medical products under the Lomé Initiative, reports Quartz.
Presidents Faure Gnassingbe of Togo, Macky Sall of Senegal, Yoweri Museveni of Uganda and representatives of heads of states of Ghana, Congo, Niger and The Gambia all signed the political declaration and framework agreement to stem the fake medicine problem in Africa. The hope is naturally that the scope of the initiative will expand beyond those countries.
The report says the Lomé Initiative, which shows the political will of the heads of states, will be followed by new legislation criminalising the trafficking and sale of fake medicines. The draft legislation is advancing a minimum 10-year jail term for offenders of fake drug-related crimes. In addition to the introduction of mechanisms to ensure the strict application of the new legislation, the initiative will ramp up calls for the signing of the Medicrime Convention and the Palermo Convention against transitional organised crime by African countries.
The report says Togo’s president Gnassingbe expressed optimism the initiative will raise awareness with other African countries and the international community. “Fake medicine has often been regarded as a violation of intellectual property right, and not a crime.” Making it a criminal offense like other crimes, he underscored, will deter traffickers from the malpractice.
Jean-Louis Bruguiere, a former French judge noted for his work on anti-terrorism, suggested other initiatives to fight fake medicine in Africa have been fragmented. “But when a law is put in place with political will, it can easily be implemented.”Project Syndicate material Full Quartz report