Photo: Jacqueline Cochrane/ISS

Substandard and fake medicines pose a significant threat to Africa. These products contribute to the global threat of drug-resistant illness and undermine Africa’s ability to achieve the Sustainable Development Goals (SDGs). They often have a tragic impact on individuals in need of effective antimalarials, antibiotics and other medicines.

The European Union-funded ENACT project’s research findings on the threat of counterfeit drugs in Africa were launched this week at a series of regional seminars in Ghana and Nigeria.

The events were co-hosted by the Kofi Annan International Peacekeeping Training Centre in Accra and the Institute for Peace and Conflict Resolution in Abuja. A new policy brief provides recommendations to guide policy makers on how better to address this severe and growing problem.

Globalisation has made it harder to regulate, track and quality assure medical products. Medicines are manufactured, printed and shipped to and from a number of countries. Fraud can occur at any point in the supply and distribution chain.

‘In Africa, the domestic pharmaceutical market is growing quickly. This creates new opportunities and challenges for the continent,’ says Robin Cartwright, lead author of the policy brief, The rise of counterfeit pharmaceuticals in Africa.

Currently, only 37 out of 54 African states have some level of pharmaceutical production, but as new, legitimate firms enter these markets, so will additional counterfeiters.

The trade in counterfeit medicines fuels a lucrative criminal economy, but the study found that processes for checking the quality of pharmaceutical products are neither systematic nor consistent.

A dearth of information makes it difficult to accurately assess the scope of the problem and formulate appropriate responses. It has been estimated that, worldwide, the counterfeit drug market is worth up to US$200 billion – making it the most lucrative sector in illegally copied goods.

Regardless of the size of the market, the research findings clearly show that the poorest and most vulnerable populations suffer the most.

According to World Health Organization (WHO) statistics, 42% of detected cases of substandard or falsified pharmaceuticals occurred in Africa. The London School of Hygiene and Tropical Medicine says that fake malaria drugs cause up to 158 000 deaths every year in sub-Saharan Africa.

Counterfeiters find Africa an easier target, because it has not developed the armoury of responses seen in other parts of the world, including supply chain regulation, track-and-trace technology and enforcement regimes. Corruption adds another layer of complexity. In many cases, public officials are bypassed as the counterfeits reach retailers unhindered.

‘While there has been some policy reflection, the links between corruption and healthcare require closer examination,’ says Eric Pelser, ENACT Programme Head at the Institute for Security Studies.

The case of Nigeria shows how a bespoke and comprehensive policy backed by political will can bring about real solutions. Nigeria managed to achieve an 80% reduction in counterfeit drug circulation by implementing targeted regulatory activities.

Among other steps, the Nigerian food and drug agency, NAFDAC, banned imports of medicines through all but two national points of entry and furnished customs officials with mobile ‘minilabs’, enabling them to identify falsified drugs.

Like Nigeria, other African nations should enact legislation that criminalises the manufacture and sale of counterfeits. Legislation should also provide clear authority and responsibility for the investigation, detection and seizure of counterfeit products.

Given their ability to authenticate drugs in the supply chain, track-and-trace systems of the type officially sanctioned and used in EU and USA have shown great potential to thwart the penetration of counterfeits.

The EU’s MEDICRIME Convention is the only international legal instrument that has made it a criminal offence to produce and distribute fake medical products or commit similar crimes.

‘International cooperation is essential for us to succeed in the struggle against this illicit market,’ says Sotirios Bazikamwe, Governance Adviser of the Delegation of the European Union to Ghana. ‘The MEDICRIME convention of the Council of Europe is the sole international legislative instrument available to effectively and efficiently fight these criminal networks. We therefore call on all our partners to accede to it.’