Another imminent global health emergency: COVID-19 and fake pharma

medications pills

Brick dust, paint and even pesticides are just some of the ingredients that criminals are using to replicate life-saving drugs. The COVID-19 pandemic is creating the perfect storm for the trade in these fake medicines to flourish around the world, further putting people in jeopardy and criminally taking lives.

Where demand outstrips supply, the market in falsified medicine booms. And the slick marketeers have already been busy ramping up the sale of everything from fake COVID-19 testing kits to vaccinations.

Testing covid-19
Photograph: Operation National Guard/Flickr

When Trump touted chloroquine as a miracle cure for the virus in March, unprecedented global demand for the drug led to reports of widespread shortages. Not long after, the run on the drug triggered a surge in falsified and low-quality versions flooding the market.

And it is not just “COVID cures” that the criminals are set to cash in on.

In China and India, the pandemic has slowed the manufacturing of active pharmaceutical ingredients (APIs), the basic building blocks of most medications. Since these two countries produce the bulk of these ingredients for the world’s pharmaceutical companies, a shortage of all drugs is imminent.

In Africa, where many countries already struggle with deficient supplies of drugs, these “Global Pharmacies” produce the majority of APIs for medication to treat the continent’s biggest killers – including HIV and TB. Ongoing factory closures and disruptions in supply chains could worsen an already fragile situation. With criminal syndicates all too willing to exploit weaknesses in systems, the continent could be on the brink of experiencing an unprecedented rise in cases of falsified ARVs and antibiotics.

Medicine supply shortages also inevitably lead to spikes in price. Such increases in the cost of legitimate drugs at this time will push them out of reach for many consumers, particularly in low- and middle-income countries, where the outbreak’s economic toll is severe. Within this context, those who are sick may be driven to informal and unregulated markets to purchase lower-cost drugs – greatly increasing their chances of encountering a fake pill.

pharmacist medication
Photograph: National Cancer Institute/Unsplash

Yet, at precisely the time efforts should be stepped up to combat the rise in fake pharma – operations to tackle it are being scaled back.

In countries worst affected by the trade, many in sub Saharan Africa, sweeps of markets and investigations to identify falsified products, usually conducted by private investigators hired by pharmaceutical companies, have been reduced or repurposed to focus on virus “treatments”. Some I have spoken to in the industry say that normal operations may not resume for many weeks. Law enforcement agencies across Africa have also drastically reduced anti-counterfeit enforcement activities due to strict lockdowns imposed by governments and a reallocation of resources to concentrate on containing the pandemic.

Reduction in surveillance and enforcement operations at a time where there is an increased likelihood of falsified drugs flooding marketplaces could have devastating consequences.

Prior to COVID-19, fake medicines were already a serious threat to global health. Falsified malaria pills alone are estimated to kill 250,000 children a year and there are upwards of one million deaths annually from the scourge.

And let us not forget, these medicines can kill us all, even if we do not take them. The World Health Organisation (WHO) estimates that as many as 1 in 10 antimicrobials in developing countries are substandard or falsified. Some of these drugs will have no therapeutic quality whatsoever, but others will have sub-therapeutic levels of active ingredient. The latter directly contributes to antimicrobial resistance, which has been estimated could kill up to 10 million people a year by 2050. If we allow this problem to deteriorate during the pandemic, all these figures will be drastically revised upwards.

As health systems are placed under immeasurable pressure over the coming months and countries grapple with drug shortages and consumers with reduced purchasing power – there must be a concerted international effort to ensure that criminals do not continue to exploit these vulnerabilities, particularly in low-income developing countries. The trade should be treated no differently to climate change in terms of the potential global impact. An exponential increase in falsified medical products will not only kill many thousands in the short-term but contribute to drug resistant strains of illnesses which could see the world sleepwalk into a parallel global health crisis.

Emma Hooper is a freelance consultant who has worked on projects across Africa in both the private and public sector – including on health programmes working to control the spread of HIV & Aids, TB and malaria. She has also worked for leading global brands to investigate and provide analysis on the supply and sale of counterfeit products in African markets.

Alongside her consultancy work, she is a PhD student at the Department of Development Studies at SOAS, conducting research into the trade in falsified malaria medication in West Africa.

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