Counterfeit Drugs and Malaria Resistance

Counterfeit drugs, including fake, substandard, adulterated or falsely labeled medicines, have become a growing threat to global health. The problem is especially serious in developing countries. Thousands of people die from ineffective medicines and millions more from the drug resistant strains of pathogens. A 2009 report from the International Policy Network revealed that fake tuberculosis and malaria drugs alone may kill about 700,000 people a year. Perhaps the greatest single widespread disease being boosted by the presence of fake drugs is malaria. A 2006 study published in the American Journal of Tropical Medicine and Hygiene found that 68 percent of anti-malaria drugs found in Laos, Myanmar, Vietnam and Cambodia did not contain the correct amount of active ingredient. Malaria claims a child’s life every thirty seconds and over a million lives annually but the WHO estimates that 200,000 of those deaths could be prevented if all anti-malarials were genuine.

Counterfeit malaria drugs are contributing to a growing resistance to the treatment of disease. Many drugs are cheaply made and do not contain the right chemistry or are stored at incorrect temperatures. Some of them are deliberate fakes that have authentic looking pills and packaging but contain only a small percentage of the active ingredient in each pill. Resistance to a drug develops when the pathogen is exposed to low levels or incorrect doses of a medication.

Counterfeit drug makers have learned to thwart the system by adding minimal levels of active ingredients so that quality screening tests reveal a false positive.  These types of counterfeits are ineffective at killing the parasite infection and increase the likelihood of mutation and resistance. People in Cambodia are unknowingly using improper drugs and fake drugs which create resistance. This is causing the death of growing numbers of Cambodians from malaria even while taking anti-malarial medicines.

A recent study conducted a quality assessment test of available anti-malarials in six urban or rural settings in southeast Nigeria. Thirty seven percent of the tested drugs did not meet USP standards. Furthermore, this study implied that drug quality in rural settings was significantly worse than in urban settings, with 66% of quinine medications were substandard as compared to 43%, respectively. This suggests that the poor socio-economic groups often receive the lowest quality of treatment, perpetuating a cycle of poverty in endemic areas.

Counterfeit drugs are a major barrier to combating malaria throughout the underdeveloped world. Consumers can only protect themselves by paying attention to the drugs they take. The idea is to closely examine drugs, use available anti-counterfeiting solutions and report anything suspicious to appropriate authorities.