Report on the spread of fake drugs in poor countries

The global trade in fake medicines is vast and growing, according to a newly released report by IPN (Keeping it real:  combating the spread of fake drugs in poor countries).  The spread of fake medicines results in millions of people unwittingly consuming cement, talcum powder, sawdust, paint and an array of other toxic or inert substances.  It thwarts efforts to cure disease and worsens illness.

While it is sometimes argued that “counterfeit” drugs and “substandard” drugs must not be spoken of together, in practice it can be extremely difficult to differentiate between the two as it is not always clear whether or not the actions leading to faulty drugs were made deliberately.  Furthermore, the difference is of little concern to a patient harmed by bad medicine.

The main dangers to health posed by fake drugs are:
1. Failure to provide effective treatment
2. Drug resistance
3. Direct harm

IMANI (a non-profit, non-government organization based in Ghana) estimates that counterfeit drugs kill over 700,000 people every year.

Even near-perfect copies cause harm by competing with legitimate supplies of medicines.  This can crowd out manufacturers of high quality generics as well as undermining incentives for future research and investment.

Fake medicines are most prevalent in poor countries and seem to be prevalent across all classes of drugs.  Estimates suggest that counterfeits represent up to a third of medicines in some least developed countries (LDCs) – notably in Africa. With non-counterfeit substandard medicines also highly prevalent in poor countries, the picture is bleak. 

The following studies reinforce this finding:

Sub Saharan Africa

• Senegal - of the 22 ampicillin drugs sampled, 21 were made of flour
• Angola, Burundi, and the Congo – 46 per cent of drugs are substandard
• Burkina Faso – 10.6 per cent of drugs procured from licensed sellers and 90 per cent purchased from unlicensed sellers were substandard

Asia

• Laos, Myanmar (Burma), Vietnam, Cambodia – 68 per cent of artesunate (anti-malaria) drugs did not contain the correct amount of active ingredient
• In some areas 30–50 per cent, or even more than 50 per cent, of drugs you buy randomly from pharmacies are actually fake  (Report from Oxford University, Bangkok’s Mahidol University and the Wellcome Trust)

Latin America

• Peru – according to the Association of Pharmaceutical Laboratories (ALAFARPE), the counterfeit medicines market in Peru is worth $66 million (up from $40 million in 2002)
• Dominican Repulblic – the Public Health Department reported that 10% of imported medicines were counterfeit

One set of figures from the European Commission showed 75 per cent of counterfeit drugs being imported from India.  After India, China is the second largest source.

Update from the World Health Assembly – May 20

Live Twitter updates from the 62nd World Health Assembly:  www.twitter.com/patientspatents

Discussions on issues of public health and innovation have been further delayed.  They were to be discussed yesterday, but have been rescheduled for later today.  With other issues such as climate change, social determinants of health and pandemic influenza preparedness also on the agenda, it seems likely this could be further delayed.

This morning, delegates in the Committee A meeting endorsed a resolution on the prevention of avoidable blindness and visual impairment, which will be brought to the attention of the full Assembly.

The revised meeting schedule is available on the WHO site.

WHO and 30 vaccine manufacturers meet: commit to meeting public health needs re H1N1

WHO Director-General Dr Margaret Chan and United Nations Secretary-General Ban Ki-moon met with over 30 vaccine manufacturers from developing and developed countries at WHO headquarters yesterday.  Industry representatives affirmed their wish to cooperate in making supplies of any eventual vaccine for Influenza A(H1N1) available to developing countries, and said they stood ready to produce the vaccine when requested.

At a press conference later in the day, Dr Chan said, “We have a very serious commitment from companies in the North and in the South to work with WHO.”  She said the Secretary-General’s ability to mobilize resources “is extremely vital when the world is under threat of an imminent pandemic.” 

Together with the UN and other members of the global community, Dr. Chan stated that the WHO would work to find innovative funding mechanisms to ensure that developing countries were not denied access to vaccines because of lack of means.  Both the Director-General and Secretary-General expressed their appreciation of the efforts of the manufacturers, with support from governments, to further increase their production capacity.

While the development and production of a vaccine for Influenza A(H1N1) is certainly essential, there has been some debate recently regarding whether production efforts should be diverted to provide for a potential swine flu pandemic or remain focused on creating vaccines for traditional seasonal viruses.  This is of particular concern in areas of Latin America and Africa which are approaching their main flu seasons.

Update from the 62nd World Health Assembly

Live Twitter updates from the 62nd World Health Assembly:  www.twitter.com/patientspatents

The 62nd World Health Assembly opened yesterday (May 18, 2009) and much of the administrative details (election of the President, chairmans of the committees, adoption of the agenda, etc.).  Dr. Margaret Chan also addressed the Assembly.

The WHA was significantly shortened due to the H1N1 outbreak.  As a result, several important issues (including counterfeit medicines) were dropped from the agenda.  Some of the items of note scheduled to be discussed today are:

• Item 12.4 Primary health care, including health strengthening
• Item 12.5 Commission on the Social Determinants of health
• Item 12.6 Monitoring of the achievement of the health-related Millennium Development Goals
• Item 12.8 Public health, innovation and intellectual property: global strategy and plan of action (to be continued and completed on Wednesday)

The updated programme of meetings is available on the UN site.  Not surprisingly, the schedule has already been pushed back by H1N1 discussions so item 12.8 will likely be discussed very late this evening if at all today.

World Health Assembly to be cut short due to swine flu

Earlier this week, the UN announced that the sixty-second World Health Assembly would be cut short due to global concerns about the spread of influenza A (H1N1) – swine flu.  Instead of the previously scheduled 10 day meeting (May 18-27), the WHA will be cut in half and will run from May 18-22, 2009.

Due to the shortened meeting, discussion on many global public health issues has been postponed until the next World Health Assembly in May 2010.

The following is an official UN Statement on the revised WHA agenda:

Due to the evolving situation with regard to influenza A (H1N1), and the stated wish of Member States to minimize the absence of senior public health officials from their national constituencies, a meeting was convened on 7 May attended by, inter alia,  representatives of the Member States. Recognizing that unusual circumstances called for a flexible and pragmatic approach, and without prejudicing the role of the General Committee on the composition of the provisional agenda and on the duration of the Health Assembly, those present agreed in principle to shortening the duration of the World Health Assembly and Executive Board. Through reducing the number of items on the provisional agenda the World Health Assembly would be reduced to five working days (18 to 22 May 2009), and the 125th session of the Executive Board would be convened on the Saturday, for one day, on 23 May 2009.

To that end please find attached a revised provisional agenda which will be submitted to the General Committee on Monday 18 May 2009 for its consideration.

The Provisional agenda (reflecting proposed amendments discussed on 7 May 2009) is included below:

Controlling healthcare costs through effective use of prescription drugs

 To effectively evaluate  any healthcare system, the true costs of the delivery of appropriate care  must be understood (and the costs of not providing treatment).  The following is an interesting article on the much-debated topic of Health Reform in America and the drivers of health spending — chronic conditions, hospital expenditures, etc.

Prescription drugs scapegoat for rising health care costs
Popular belief is that prescription drug prices are responsible for high healthcare costs. But the evidence contradicts that belief. In fact, prescription drugs have helped control total healthcare costs in recent years.

The Office of the Actuary National Health Expenditures reported prescription drug spending growth in 2007 reached a historic low of 4.9 percent, the lowest rate since 1963 and below the 6.1 percent rate of growth for healthcare overall. Hospitals (7.3 percent) and physician and clinical services (6.7 percent) helped drive the growth in overall healthcare spending. Prescription drug spending growth has declined in seven of the last eight years.

The cost of caring for people with chronic diseases represents 75 percent of all U.S. healthcare spending and is expected to remain the largest cost category for years to come. The national obesity epidemic, to cite one example, has led to an upsurge in chronic health problems. The use of prescription drugs to manage chronic illness tends to reduce medical spending by eliminating the need for surgeries or prolonged hospital stays. A study published in the journal Medical Care found that every additional dollar spent on drugs for blood pressure, cholesterol and diabetes reduces other healthcare spending by an average of $4 to $7. Similarly, the National Bureau of Economic Research found that Medicare saves $2.06 for every dollar it spends on medicines.

The facts argue against trying to curb overall healthcare expenditures by primarily focusing on cutting prescription drug spending. Such a misguided approach could have the unfortunate, unintended consequence of shrinking the amount of money available for future research and development. In practical terms, this means pharmaceutical companies might not have enough funds at their disposal — or an incentive — to invest in the work needed to find potentially life-enhancing, life-saving and cost- effective medicines.

Mahmud Hassan is a professor of finance and economics at Rutgers Business School. He is director of its Pharmaceutical Management Program and its Blanche and Irwin Lerner Center for Pharmaceutical Management Studies.

World Asthma Day – May 5th

Today (May 5th) is World Asthma Day and this year’s theme is “You Can Control Your Asthma.”

60% of the estimated 3 million people in Canada living with asthma do not have their symptoms under control.  With this is mind, the Asthma Society of Canada will observe World Asthma Day with several initiatives concerning control.

World Asthma Day is sanctioned by the United Nations and is coordinated by the Global Initiative for Asthma (GINA).  Check out GINA’s website for a listing of Asthma Day events around world.