SOUTH-EAST ASIA: Fake Drugs in Poor Nations Worry Health Experts

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

BANGKOK, May 9 2005 (IPS) - Despite the odds weighing heavily against it, the World Health Organisation (WHO) is placing its faith in the Internet to battle the alarming spread of counterfeit drugs in South-east Asia’s poorest countries.

The U.N. health agency’s initiative comes in the form of a web-based system to track the ”activities of drug cheats.” The Rapid Alert System (RAS), which was unveiled last week in Manila, is the first of its kind in the world.

This system will alert health authorities and the public in the region almost immediately after a fake drug is identified, Dr. Budiono Santoso, a pharmaceuticals expert at WHO’s Western Pacific Regional Office, told IPS. ”It will help to combat the counterfeiters.”

”We have to stop this silent killer (fake drugs) moving around,” he added. ”It has become a transnational crime, because there is a lack of coordination between the countries to clamp down.”

The RAS invites health experts and the public to report cases of counterfeit medicine they encounter either through the Internet or more conventional forms of communication, like faxes. The system provides forms seeking specific information, such as the name of the drug, where it was discovered, how it was packaged and name of the manufacturer, in addition to details about the informant.

Yet the countries that stand to gain most from this effort in the region suffer from a technology deficit. Burma has 0.5 Internet users per 1,000 people, while Cambodia has 2.2 per 1,000. Laos is no better – it has 2.7 users per 1,000 people, according to a United Nations Development Programme (UNDP) report.

By contrast, the two most technologically savvy countries in the region, Singapore and Malaysia, have 504 and 320 Internet users per 1,000 people respectively.

On top of that, Internet users in both Burma and Laos encounter limited freedom when exploring this medium due to the iron-fisted policies of Burma’s military regime and Laos’ communist-dominated government.

But WHO experts like Santoso feel there is a compelling need to persist with the RAS, given South-east Asia’s reputation as a region where fake drugs offered for many illnesses, including the killer disease malaria, are rampant.

In 2001, for instance, nearly a third of a potent anti-malaria drug, artesunate, in Burma, Cambodia, Laos, Thailand and Vietnam were counterfeits, a WHO study revealed.

”A follow-up study in 2004 showed that the situation had worsened, with 99 out of 188 artesunate samples found to be counterfeit,” states the WHO.

The World Bank expressed similar concern in a report released in late April, declaring that the region’s rampant trade in fake drugs had made it the worst affected area for ”drug-resistant malaria.”

The reality emerges in the wake of South-east Asia being listed as having the second highest number of malaria related deaths after Africa. Out of the one million annual malaria deaths, over 80 percent of them are in Africa.

”From a global perspective the proportion of malaria cases has shifted slightly from Africa to Asia,” states the ‘2005 World Malaria Report’ jointly released last week by the WHO and the United Nations Children’s Fund (UNICEF).

In South-east Asia, for instance, the killer disease had been brought down to low levels in the 1960s and 1970s through the use of insecticides like DDT and the supply of anti-malaria drugs, the report added. ”But transmission never ceased completely and the disease re- emerged in the 1980s and 1990s, as control efforts ran out of steam and resistance to drugs and insecticides spread rapidly.”

Burma ranks among the worst affected in this region, with 716,000 malaria cases reported in 2003, according to the WHO-UNICEF study. Of that number, 2,476 people died.

In 2002, there were 721,739 reported malaria cases and in 2001 there were 661,463 cases.

Consequently, malaria remains the leading cause of deaths and illnesses in that military-ruled nation, with almost two-thirds of the reported cases being people over 15 years. The most vulnerable include migrant adult workers labouring in gem mines, agriculture, plantations, construction and logging, states the world report.

It is this vulnerable group that shops selling fake drugs target. ”There are many shops across the country that are not registered to sell medicines, offering fake drugs,” Dr. Cynthia Maung, who runs a medical clinic along the Thai-Burmese border, told IPS. ”There is no system of quality control.”

The limited availability of pharmacies that dispense the genuine medication has also driven desperate patients into the arms of the counterfeiters. ”In the rural areas, away from the towns, there are little safe options available for the people ill with malaria,” added Maung, a refugee from Burma.

In Cambodia, where there were 71,258 malaria cases in 2003, of which 492 people died, the situation is less severe. At least in the state-run hospitals malaria patients do have access to the actual drug, Dr. Bart Janssens, medical coordinator in Cambodia for the global humanitarian agency Medicins sans Frontieres (MSF), said in an interview.

”Counterfeit drugs is a worrying issue in the private sector,” he said. ”You have to have good drugs available to drive out the counterfeits.”

WHO’s Santoso agreed likewise, saying that the bulk of the fake drugs were being flogged in the ”huge, unregulated” private sector. ”Governments must go after these fake drugs, since they not only kill people but lead to drug-resistant malaria.”