The Fight Against Fake Drugs
In November 2008, 84 children in Nigeria were killed by a medicine called My Pikin Baby Teething Mixture. The syrup was fake, the standard glycerin replaced with cheaper diethylene glycol, which is an industrial solvent that attacks the central nervous system, kidneys and liver. In this case counterfeit drugs killed its victims outright. More frequently, they kill by robbing patients of the real drugs they need. And some counterfeits contain a small amount of active ingredient - not enough to cure an illness, but enough to promote resistance that renders the real medicine powerless. That is the most deadly effect of all.
It turns out that there is no way to tell if a pill is fake or real before taking it - or, for that matter, afterward. Malaria treatments are a good example. A study in Western Kenya found that only 38 percent of people who sought treatment for malaria actually had the disease. What people believed to be malaria, then, might have been another fever that resolved on its own — “cured” by a counterfeit with no active ingredient. Conversely, a drug's failure is not proof that it is counterfeit, as real drugs don’t always work. And there is always the question of whether patients take them correctly.
Nations with a counterfeiting problem can solve it by acquiring effective regulation and liability laws. Rwanda seems to be on its way. In Uganda, two organizations are co-operating to improve village health. The nongovernmental organization BRAC has long equipped its workers with medicines to sell. The other group, Living Goods, is using an Avon Lady style of direct sale: women buy medicines to sell to their neighbours. This gives villages access to reliable drugs, reducing other retailers’ sale of counterfeits. Before the NGOs came in, 37 percent of pharmacies sold counterfeit malaria drugs. Now, the amount of counterfeits sold in pharmacies has fallen by half. “You can get away with selling fakes if villagers have nothing to compare them to,” says Yanagizawa-Drott from BRAC. “When consumers try a reliable drug, they are able to observe quality.”
Providing genuine drugs is achievable in other ways. Tanzania is creating a network of Accredited Pharmacies which are given subsidies and are then tightly regulated and inspected. Another strategy was developed by an American company – Sproxil. Its CEO, Ashifi Gogo, created a cellphone identification system allowing shoppers to verify the authenticity of Whole Foods’ organic produce. “The system won a number of awards, but nobody bought it, because clients trusted Whole Foods,” Gogo says. “So I turned to emerging markets, like Nigeria, where that trust is absent, and from organic-food to pharmaceuticals,” he explains. Today, Sproxil makes labels, each with a unique scratch-off number, that are affixed to each medicine. Purchasers text the ID to a number on the box and get a text back saying whether the drug is fake or real.
Sproxil has provided 9 million verifications so far. One reason for its success is that in most countries its verification texts are free. “Setting up that deal with cell-phone companies has been a nightmare. It can take them a year to provide lifesaving service to their own customers,” Gogo says. But free is necessary. It allows people to send a text or to borrow someone else’s phone if they don’t have one. India doesn’t allow free texts, which has been a disadvantage for another mobile verification firm, PharmaSecure, which began in India in 2009. Also, free-text arrangements keep counterfeiters from faking the verification process. They do put fake numbers on products, but they aren’t going to sign any deals with phone companies.
PharmaSecure's CO, Nathan Sigworth, says the response rate on its verification labels is just a few percent in India and Nigeria. Sproxil’s rates vary between 10 and 30 percent - mostly because they cover more chronic diseases and use number-only codes which are easier to type on basic phones than PharmaSecure's alphanumeric codes. However, Sigworth sees great growth potential in Nigeria and India. PharmaSecure has already followed in Sproxil’s footsteps in sending patients personalised medical advice. “We began in anti-counterfeiting and realized the service opens a world of possibilities,” Sigworth says. “At the moment we are the only firm verifying the authenticity of agricultural products. Farmers in Africa could increase their yields 10-fold by buying hybrid seeds. However, 30% of hybrid seeds are fakes that fail to germinate. The risk of buying counterfeits keeps farmers from investing in products that could lift them out of poverty,” Sigworth explains. That’s another area in which counterfeits kill.