Fake malaria drugs signal catastrophe

Staff Writers | 01 Jun 2008
East African Standard

The Revelation last week by Kenya's Minister for Medical Services, Prof Peter Anyang Nyong'o, that at least 16 per cent of the malaria medicines in the country are counterfeit is a matter of grave concern.

While the figure differs substantially from the 38 per cent level suggested by a recent American study, the admission by the minister suggests that Kenya — and East Africa — has become a target for dumping by unscrupulous drug racketeers. Unchecked, the problem could snowball into a major public health problem.

In Southeast Asia, for example, the World Health Organisation now estimates that up to 53 per cent of anti-malarial drugs are substandard, being either wrongly formulated, expired or contaminated.

For Kenya, which has a higher incidence of malaria than most of Southeast Asia, such a high prevalence of counterfeit medicines could be catastrophic. Before the nationwide bednets campaign was rolled out two years ago, malaria was estimated to be killing more than 35,000 children below the age of five each year, as well as thousands of adults. The disease was also thought to be causing a contraction of GDP of anywhere between 1 and 3 per cent.

This situation, which has somewhat improved, could rapidly worsen.

Elsewhere, the proliferation of counterfeit anti-malarials substantially raises the risk of the emergence of resistance to artemesinin combination therapy, ACT, the last truly effective treatment against the killer fever.

It is instructive that misuse of other malaria drugs, such as chloroquine in the 1980s and sulphadoxine/pyrimethamine in the 1990s, resulted in the malaria parasite becoming resistant to them. Hundreds of thousands of people in malaria-prone areas around the world could have died as a result.

Of particular danger is the wrong usage of artemesinin — the only drug that has never exhibited resistance. Last year, to prevent artemisinin-resistant strains of malaria from developing, the WHO asked all the world's drug companies to stop selling it except in multi-drug cocktails. This is advice that counterfeiters are paying scant attention to.

It is not far-fetched to warn that the continued distribution of counterfeit malaria medicines could lead to the emergence of a drug-resistant super-bug as has occurred with tuberculosis, where the world now has to deal with the so-called extremely multi-drug resistant TB (X-MDR TB).

In the circumstances, the Kenyan government must invest more to strengthen the Pharmacy and Poisons Board, as well as the National Drug Quality Control Laboratory, to guarantee the quality of medicines in distribution. The current situation, in which less than 50 medicine inspectors are expected to police the country's pharmaceutical sector, is untenable.

Local manufacturers of malaria medicines must also ensure that they adhere to the set standards. Those that don't should be punished according to the law. In the American study referred to above, which involved tests on 195 packs of malaria drugs bought at private pharmacies in six cities including Nairobi, Kampala, Kigali and Dar es Salaam, nearly half of locally manufactured anti-malarials failed the quality test, as did a third of those made in Asia.

By contrast, none of the three samples of the medicine Coartem, a multi-drug cocktail made in Switzerland for global health agencies, failed.

Meanwhile, the government must also work with international agencies, including the WHO and regulatory authorities in Southeast Asia and China, to identify the primary sources of the counterfeits. The disease, after all, requires an international cure.