Thursday, March 6, 2008

Making an IMPACT against fake malaria pills

In the past few years, panics about pet food, beef, and toys from China have occupied popular discourse — garnering attention from all media outlets. About a year ago, a single article appeared in the New York Times, buried in the health section, on the problem of counterfeit malaria pills. Evidently in some regions, more than half the available malaria medicine is fake. Perversely, this phony malaria medication often contains a small amount of active ingredient, which suppresses symptoms. Doctors and patients alike think the treatment is working, until it is too late. Carried by anopheles mosquitos (below right), malaria, a completely curable disease with proper medication, kills 1 million people a year, the continued lack of attention to this problem is striking. (credit for photos of pills with phony hologram and of mosquito)
Counterfeit pharmaceutical production is an attractive industry that will account for $75 million in annual global sales by 2010. There is an almost endless market for fake malaria pills, created by the sheer number of people affected by the disease and coupled with the high price of pharmaceuticals. It’s also less expensive to enter than, say, the illicit drug industry, because of a lack of local or international laws directly targeting fake drug production. Further, fabrication of counterfeit malaria pills only requires making a product that looks real — there’s no burden to make a pill that actually does anything measurable to the body. There’s also little resistance on the part of local governments to establish manufacturing centers because the industry creates much-needed jobs and because of corruption that allows officials to turn a blind eye. (See also Maria Nelson et al., Counterfeit Pharmaceuticals: A Worldwide Problem, 96 Trademark Reporter 1068 (2006)).
One great place to look for potential solutions to the problem is the International Medical Products Anti-Counterfeiting Taskforce (IMPACT). Founded by the World Health Organization (WHO) in February of 2006, it is comproed of all of the major anti-counterfeiting players: international organizations, NGOs, enforcement agencies, associations of pharmaceutical manufacturers, and drug and regulatory authorities. IMPACT’s biggest project so far has been the creation of guidelines for states to combat the problem of counterfeit drug production. The guidelines stress that states need to strengthen and enforce local laws, including those related to intellectual property rights and to criminal laws defining manslaughter and murder. IMPACT further encourages the creation and support of regulatory agencies to oversee the safety of pharmaceuticals consumed by their citizens. The guidelines also advise states on the need to address socioeconomic conditions by taking steps including: lowering prescription drug costs, increasing information to patients about diseases like malaria (as with its brochure depicted below), and building more comprehensive local health care industries.
There is clearly no quick fix to such a pervasive transnational problem. However, we expected that because of the gravity of the problem, in a year, the international community would be considering the issue more seriously. Sadly, that hasn’t been the case. While IMPACT has been working on localized projects, we think it should be aiming high by drafting a protocol or convention that would bind state parties — similar to the successful conventions relating to drug trafficking or money laundering.
China has been making changes, however. Likely as a result of last year’s media coverage, just a few weeks ago Chinese authorities announced that they arrested four people involved in a counterfeit malaria pill distribution ring. The manufacturer, however, is still at large. But even as China responds to international pressure to clean up its exports, just this week the New York Times published an article quoting a malaria expert at the Johns Hopkins Bloomberg School of Public Health as saying that eradication of malaria is “a pipe dream.” Citing obstacles such as poverty and civil strife, public health specialists appear pessimistic about the possibility of eradication. This negative outlook, while potentially demoralizing, isn’t necessarily bad. If countries worked to fix these bigger issues, as IMPACT advises, the market for counterfeit malarials will decrease, and lives will be saved.


Marjorie Florestal said...

Having lived in Malaria zones in West Africa, I have seen first-hand the impact of the illness--particularly on young children. Thank you both for a wonderful post!

Diane Marie Amann said...

For further evidence of the topical nature of this post, see the March 8, 2008, New York Times story respecting China-supplied counterfeit material found in the blood thinner heparin, resulting in a number of deaths:

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