Having worked on the fake medicines issue for a number of years, it came as a surprise that the issue is reaching the mainstream, which is what happened at London’s Chatham House recently when the issue of poor quality medicines was presented to an audience of international affairs analysts.
Panel member Professor McKee gave an overview of ‘falsified’ medicines – suggesting the solution was to strengthen national regulation through advice and support, improve intelligence and enforcement of criminal activities, especially organised crime – but he fears that money will not be found to support public health.
Professor KcKee is right to emphasise that this is a problem of under-capacity in developing countries, although there is a strong role to be played by international co-operation on intelligence and enforcement, which was discussed by other panel members. But his pessimism may be misplaced because those worst affected are taking action, witness the agreement signed in Washington DC at the end of October between regulators and business to deploy Minilabs to Ghana and train staff to use them to detect medicines of poor quality.
Dr Charles Clift, who convened the meeting, suggested a discussion of possible action against legal, but deliberately substandard products (where licensed producers cut corners to reduce costs while disregarding safety standards), which may also be distributed on a far greater scale, and attract no suspicion if they come through international aid channels.
Sadly, no panel member chose to take up this thread even though what evidence we do have suggests that substandard but legal meds are a far greater risk to public health than fakes made by criminals.
Representing WHO and Novartis respectively, Michael Deats and Andrew Jackson held similar stances – they want information about the nature of the counterfeiting business: what demand is it feeding? What are the logistics – where and how are the products moved around?
In fact, both are part of international cooperation with the likes of INTERPOL, WCO, WIPO which have been quietly doing sterling work in building partnerships, running training and technical programs and orchestrating large-scale operations to break up international criminal networks involved in trafficking fake medicines.
There are of course, advantages in raising awareness – not least in that it increases the chance of funding – but it can be a distraction and the old hands like Deats and Jackson were visibly weary at having to rehearse long-familiar arguments to a new audience in the face of their various, tangential and often misconceived views.