In markets and on roadsides across Yaoundé, counterfeit and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Sep 5 2013 (IPS)

When Francois Biloa fell ill with malaria, his family did what they had always done in the past – they gave him anti-malaria drugs and antibiotics bought from the local market. Only when his condition worsened and he became bedridden and fell unconscious, did his family take him to a local clinic in Cameroon’s capital Yaoundé.

According to the clinic’s health attendant, six out of every 10 patients there had been using illegal or counterfeit drugs readily available in this Central African nation’s market place prior to admittance.

“We bought medicine from a store because it worked for us with [previous] malaria attacks and it is very affordable. With just about two dollars we usually afford a [fake] Coartem packet, which is a full treatment for malaria,” Biloa tells IPS from his hospital bed.“Self-medication [with illegal and counterfeit drugs] result in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly." -- Williams Takang from the Yaoundé University Teaching Hospital

In pharmacies, a packet of Coartem costs seven to eight dollars, while on the illicit market a packet can be bought for less than three dollars. A medical consultation costs four dollars on average.

“But in this hospital, I am told my bill is now over 75 dollars. The doctor says that I have a resistant strain of malaria and also typhoid fever,” Biloa says.

“I felt like I was dying during my attempted treatment at home. I only started regaining energy and full consciousness after [coming to] this clinic.”

In markets and on roadsides across Yaoundé, fake and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Trading in these drugs is illegal. The are available as a result of weak regulation, poor health services and high medical costs.

There are no precise figures on the quantity of illegal drugs entering Cameroon, but up to 70 percent of drugs sold here are traded on the black market, says Christophe Ampoam of the National Council of the Pharmaceutical Society of Cameroon.

According to Ampoam, this trade in illicit medication is so well organised that government officials and the police are helpless to halt it.

“The trade in illicit drugs in Cameroon operates like a very powerful mafia-like network, which is very difficult to dismantle. It is estimated that investment in illicit sales of medicines is five times more lucrative than through the regular system. Local officials dread dismantling the network because it has also infiltrated the judicial and customs system,” Ampoam tells IPS.

“Corrupt regulatory and legal systems are easily exploited by criminal smugglers and additional rules have only increased corruption.”

Ampoam says that most of the counterfeit drugs are made in the Middle East and East and South Asia, yet many carry the inscription ‘Made in Germany’. They are smuggled into Cameroon by sea and through the porous borders this country shares with Nigeria and the Central African Republic.

“Although it is difficult to give an exact statistic on the percentage of illicit drugs found in local markets today, the availability of drugs in local markets, makeshift shops, on the streets and along the highways tells of the deplorable situation in Cameroon,” he says.

The World Health Organisation (WHO) estimates that worldwide 200,000 deaths per annum could be prevented if people did not use counterfeit drugs. According to the International Policy Network report, fake tuberculosis and malaria drugs alone are estimated to kill 700,000 people globally each year.

“Most of the drugs in circulation have been banned in certain countries because they are toxic or counterfeit. Some have the correct ingredients but in low quantities. Some of the drugs are samples or medicines donated by NGOs,” Ampoam explains.

Marlise Loudang, director of the pharmaceutical inspection service at the ministry of public health says that government teams in every region across the country are clamping down on the illegal trade, but so far efforts have been unsuccessful.

“Self-medication [with illegal and counterfeit drugs] is a big public health problem in Cameroon that affects almost every family. This stems from the easy access to drugs of doubtful origin and quality all over the national territory,” Loudang tells IPS.

Marcel Olinga is a vendor of counterfeit and illegal drugs and says that even though authorities have raided him, it has not deterred him from continuing. “Once in a while the police come around and seize my drugs, but it is a loss worth incurring because the raids are not regular and our main stocks are never where we sell.”

Olinga says he makes about 40 dollars a day.

“We receive many customers daily. Some come with prescriptions from doctors others seek our advice before buying and some simply demand what they want,” he tells IPS.

According the WHO, there are 13,514 patients for every doctor in Cameroon, although some say the ratio is higher, especially in rural areas. Poverty also limits many from seeking medication from hospitals and health clinics.

“Some patients run from costs of consultation in hospitals and fall in the hands of illegal drug vendors who are ready to sell drugs at prices far more below the legal market price,” Williams Takang from the Yaoundé University Teaching Hospital tells IPS.

“Self-medication [with illegal and counterfeit drugs] results in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly,” he says.

“The intake of fake and illegal medicines can lead to life-threatening consequences especially for diseases with high mortality rates like malaria. Unfortunately most of the patients suffering from these common diseases put themselves on medication without any prior medical consultations,” Takang says.

A packet of 1,000 colourful, empty capsules costs roughly 2.25 dollars and is freely available at major medicine markets in Karachi. Credit: Adil Siddiqi/IPS

By Zofeen Ebrahim
KARACHI, Dec 14 2012 (IPS)

When 26-year-old Muhammad Qasim, a rickshaw driver from Lahore’s low-income Shahadra settlement, died last month, his family was shocked to learn that the cause of death was an overdose – of cough syrup.

On Nov. 23, shortly before going to bed, Qasim drank a whole bottle of Tyno cough syrup, which he was in the habit of doing on a somewhat regular basis.

A little while later, his mother heard strangled noises coming from his bedroom and ran in to see him foaming at the mouth. He was rushed to the hospital, where he died soon after.

Qasim’s death brought the total number of overdose fatalities up to 19 in the month of November alone. According to the police, most of the victims consumed Tyno regularly.

However, results from Qasim’s postmortem found that the actual cause of death was not simply an overdose, but asphyxia – a deficiency of oxygen in the body caused by, among other things, the presence of a toxic substance in the bloodstream.

The tragedy has rekindled public discourse on drug regulation in the country, and highlighted the need to fine-tune the Drug Act of 1976, which has consistently failed to stem the proliferation of counterfeit drugs in the market.

Against the backdrop of the Isotab drug scandal last January, in which 125 patients in Lahore died after consuming adulterated heart medication, it is becoming increasingly clear that the market is awash with substandard drugs that don’t meet the required standards.

These imitation drugs are sold openly in bazaars and shops around the country.

Though statistics on fake drugs are hard to come by, the World Health Organisation estimated back in 2004 that 40 to 50 percent of drugs consumed in Pakistan were counterfeit. In 2006 the country was ranked 13th on a list of the world’s leading producers and sellers of fake medicines.

Nadeem Iqbal, head of the Islamabad-based Network for Consumer Protection, told IPS, “It’s a huge problem and one which cannot be ignored.” Yet, very little punitive action has been taken against those involved in this fraudulent business, he added.

Furthermore, the market is highly resistant to monitoring and quality control.

According to Iqbal, gaps in drug regulations, weak institutions, and lax law enforcement policies are largely responsible for allowing criminals to easily infiltrate medical supply chains.

Despite a public outcry – led by the media and consumer protection groups – Iqbal is convinced that the situation will not change until “proper laboratory testing facilities” become available.

Efforts underway

A slew of drug-related deaths triggered a move towards the establishment of the Drug Regulatory Authority of Pakistan (DRAP), which the president signed into being last month, to control the country’s pharmaceutical industry and ensure proper licencing, pricing and quality control of drugs.

According to National Regulations and Services Minister Firdous Ashiq Awan, “No pharmaceutical company owner will be considered for membership of the Authority’s (public) board.”

While acknowledging that this is a move in the right direction, many  experts are sceptical that the newly formed agency will be able to bring the drug industry to heel.

Dr. Samrina Hashmi, president of the Pakistan Medical Association’s Sindh chapter, believes that rampant corruption in the industry makes the best of laws nearly impossible to implement.

“This agency requires transparency in governance. People should be taken on board (based) purely on merit and should be technically competent, otherwise there is danger of (the agency) falling prey to vested interest groups,” Dr Sania Nishtar, founder of the Islamabad-based non-profit health policy think tank Heartfile, told IPS.

In addition, existing laws need to be properly imposed by increasing the inspection force, speeding up court processes and handing out tougher punishments, according to experts in the medical field. Under the 1976 Drug Act, the maximum punishment for counterfeiting is ten years’ imprisonment and a fine, depending on the nature of the crime; but this sentence has yet to be handed down to a single perpetrator.

Nishtar hopes the DRAP will bring about amendments in the drug law, which has “many exploitable gaps” and requires massive amounts of resources and technical expertise in order to become a truly independent body, capable of superseding corporate agendas.

Additionally, the number of drug inspectors, pharmacists and testing laboratories needs to be increased exponentially.

At the moment the country has a field force of 250 drug inspectors to monitor over 400 pharmaceutical companies and 50,000 pharmacies, according to Nishtar. “Not only are these numbers paltry, but even (inspectors’) expertise is weak,” she pointed out.

Only 200 trained pharmacists are spread out between the country’s 50,000 chemists’ shops. “It would take the country more than 20 years to train pharmacists for these outlets,” Nishtar said. “I am not sure if the country has the capacity to do that.”

A 2001 survey of 311 of the 506 pharmacies in the garrison city of Rawalpindi, published in the International Journal for Health Care, showed that only 19 percent of pharmacies met licencing requirements, only 22 percent had qualified pharmacists, only 10 percent had temperature monitoring and only four percent possessed an alternative supply of electricity for refrigerators.

The research concluded that most drug sellers had “fragmentary knowledge regarding drug dispensing and storage, and improper dispensing practices”.

DRAP should undertake the task of setting up a network of state-of-the art drug testing laboratories at the provincial level in an attempt to quickly identify the efficacy and quality of all ingredients used, strengthen pharmacists’ capacity, and promote the production of low-cost generic medicines that can be made available to the poor, said Hashmi.

According to the WHO’s ‘World Medicines Situation Report’, Pakistan spends 77 percent of its healthcare budget on buying medicines. But many consumers end up purchasing fake drugs, which have not been properly tested or have passed their sell-by date.