From counterfeit vaccines to antibiotics to antimalarials, Africa is tackling the danger of fake medicines
More than 7tn of counterfeit pharmaceuticals and cosmetics were destroyed in Libreville on 16 January. This was the result of an operation lasting several weeks that brought together the Gabonese Directorate of Medicines and Pharmacy and the Directorate of Competition and Consumer Affairs against the fraudulent introduction and illicit sale of counterfeit products.
Porous borders, weak legislation, and poor healthcare provision provide fertile ground for the trafficking of fake medicines in Africa. On 18 January, in Lomé, seven heads of state pledged to strengthen their cooperation and criminalise this traffic.
In February 2019, a similar operation in Burkina Faso resulted in the seizure of nearly 3tn of illicit pharmaceutical products. Between 2017 and 2018, the authorities in Côte d’Ivoire seized 385tn.
While nearly 10% of medicines sold worldwide are counterfeit, Africa is the continent most affected by this scourge. The continent imports nearly 90% of its pharmaceuticals, making it particularly vulnerable.
Dr Idi Illiassou Mainassara, Niger’s health minister, said: “Counterfeit medicines are a real public health problem for the people of Africa. WHO studies show that nearly 60% of the medicines sold in some countries are of inferior quality or are simply falsified.” For him, “any medicine that enters a country through an irregular circuit is a fake medicine”.
Deadly imports but lucrative
In Africa, this illicit traffic includes antibiotics, antimalarials, painkillers, syringes and even bottles and cosmetics. An estimated 100,000 people die each year on the continent from fake medicines. In March 2019, as Niger launched a campaign to immunise children against meningitis, health authorities discovered a fake vaccine was circulating. Two years earlier, police had seized 13tn of counterfeit vaccine from India. Some vials contained only water.
The lucrative trafficking of fake medicines is all the more worrying in the Sahel countries, as it helps to finance armed groups and jihadists. The Paris-based Institut de Recherche Anti-Counterfeiting de Médicaments estimates that $1,000 invested can bring in up to $500,000.
Former anti-terrorism judge Jean-Louis Bruguière said: “From $80bn in 2010, the trafficking of fake medicines now represents $200bn worldwide. Its financial return is greater than that of drugs, and the risks [to the traffickers] are almost nil.” Most often, these fake drugs come from China, India, and Nigeria.
In addition to porous borders, the low penalties in several countries is another factor of why African markets and pharmacies are flooded with fake medicines. In Niger, the pharmaceutical laws date back to 1997. It provides for a fine of 100,000 CFA francs ($167) to 500,000 CFA francs and a prison sentence of only one to six months for perpetrators and accomplices.
More and more countries are tightening their legislation in the face of trafficking. Dr Atany Bernardin Nyansa, director of Togo’s Pharmacy, Medicines and Laboratories, said, “The new Togolese penal code, adopted in 2015, is stricter. Traffickers can be sentenced to between five to ten years imprisonment and a fine of between 5m CFA francs and 50m CFA francs. These are relatively dissuasive penalties for those involved in the illicit drug market.”
On 17 January, in Lomé, seven heads of state, three of whom attended the opening ceremony — Macky Sall, Yoweri Museveni and Faure Gnassignbé — pledged to strengthen their cooperation and to criminalise the trafficking of fake medicines. Initiated by the Brazzaville Foundation, a non-profit organisation created in 2014, the summit helped to put the spotlight on this scourge.
Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation (WHO), said: “This initiative has been set up by a few countries. For it to have an impact, it must be extended to the scale of the continent. We will accompany them in that direction. The African Medicines Agency, which is still in the planning stages, has very similar objectives, and we will ensure that it works with the Lomé initiative.”
Limited means of control
While waiting for this drug agency to be set up, each country is trying, as best it can, to regulate the sector. Various administrations are involved in issuing marketing authorisations and monitoring the quality of the products sold.
Dr Barira Dan Nouhou, director of Pharmacy and Traditional Medicine in Niger, said: “The fight against trafficking in fake medicines is an asymmetrical battle. We are working hard, with limited human resources, in the face of a highly organised traffic. The fact is that the better equipped your committee of experts is, the lower the number of marketing authorisations issued. Only 10% to 15% of the files go to the first instance in Niger.” His department, which has seven pharmacists and about 30 experts to evaluate the cases, also carries out systematic checks on all generic medicines.
Since 2010, there has been a common regulation for the member countries of the Union Economique et Monétaire Ouest Africaine governing the approval of medicines. The ultimate goal is to harmonize practices across Economic Community of West African States and other economic communities on the continent.
There is a need to strengthen coordination between the different services combating the illicit channels, especially in a country as vast as Niger, which has seven borders. “We work closely with customs. This often involves exchanges on WhatsApp to check documents. When they are suspicious, they send us photos to authenticate them,” says Dr Nouhou.
To make it more autonomous and increase its financial resources, more West African countries are transforming their National Directorates of Pharmacy into an agency. This is the case, for example, of Benin, which created a National Agency for Pharmaceutical Regulation in September 2019, and Burkina Faso followed suit in July 2018. Countries are also signatories to international conventions, such as the Council of Europe’s Medicrime Convention, which aims to strengthen the fight against trafficking by imposing stricter repressive measures at the national level. Togo’s President Faure Gnassingbé announced during the Lomé initiative that his country would sign this convention. Macky Sall said Senegal would ratify it.
Ensuring access to health care
But for Dr Atany Bernardin Nyansa, “it is not the criminalisation of the fake drug market that will make it disappear it is also the fact of making available to the population good quality medicines, taking into account their purchasing power.”
Aminata Touré, president of the Senegalese Economic, Social and Environmental Council, said: “Universal health coverage, introduced in Senegal, has now reached a coverage rate of nearly 50%. It is a political will that comes at a cost. When people can have access to health centres that meet the standards defined by the Ministry, with real control over the quality of the drugs, it is clear that this is an integral part of the fight.”
In Lomé, the African heads of state personally took up the subject. Speaking in a video broadcast at the 18 January ceremony, Niger’s President Mahamadou Issoufou called on civil society to join the fight. His Ugandan counterpart Yoweri Museveni added: “A mongoose alone cannot face a cobra. That’s why it is joining forces with others to repel it. That is also why we are joining forces today to combat the trafficking of fake medicines.”