On the one hand our future looks bright. It took us 200,000 years of evolution to expand the human population to 1 billion, but over the last 200 years we have multiplied it 7 times, to reach a global population of 7.2 billion. The last 200 years of human history have witnessed some great human achievements. Our ability to innovate and discover has led to technological and medical advancements, that have enabled better healthcare provision, resulting in more of us living longer.
And yet, we are our worst enemy. Just as the world is coming together to tackle a multitude of diseases that still pose a big threat to humanity, there are greedy criminals out there trying to make a quick buck, whatever the cost. They are making products that look like medicines, but don’t contain the ingredients needed to make us better. They spend a lot of money on using sophisticated packaging that misleads the doctors and pharmacists into believing it is a drug that could help save lives. And the only time they are caught is when the drug doesn’t have the required medical effect, or someone suspects foul-play.
When medicines do not work, they can prolong illness, inconvenience, time off work (economic impact), and often the misery of the illness. Doctors and health care workers waste precious time trying out alternatives treatments, and in worst cases, people die, either from untreated disease or because the fake product itself kills them. This causes mistrust of doctors, medicines, and healthcare systems which could lead to those needing help seeking alternative routes.
It is estimated that 10% of drugs in circulation are fakes and/or ineffective. Low and middle- income countries spend approximately $300 billion in total pharmaceutical sales; so medicines that don’t work account for $30 billion in the poorer countries. This is money that they could be spending on saving the lives of millions in their countries, but instead is being cashed-in by criminals. The criminals however don’t concentrate on one product, one manufacturer, one country or one therapy. They fill a gap of demand, when certain drugs are experiencing shortages or are particularly expensive. Traditionally, they used to only target countries with poor governance, where criminal activity could almost go undetected. But, the internet has now opened up all markets for criminals, to target any of us wherever we may be located. It relies on us ordering medicines directly from the internet, where there are less stringent controls in place.
An additional complication of fake and ineffective drug market is that sometimes the criminals add some of the right ingredient of the “real drug”, and create a watered down version, so the tests available don’t detect that it’s a fake. This causes antimicrobial resistance. This means that the bug comes into contact with a watered down medicine (fake), the bug survives and figures out how to survive. It evolves to deal with the challenge, so the next time the real drug is given, then it has no effect on the bug. The bug is suddenly more powerful than it was, because our protection (way to combat the illness caused by the bug) has just been rendered useless.
In the fight against malaria, that kills hundreds of thousands every year, one of the key challenges is antimicrobial resistance. Two commonly used drugs to fight malaria are not recommended any more as they are already resistant. The current medicine (ACT) relies on a combination therapy of drugs, but this is also under threat in certain regions of the world, and there is a danger that super bugs can spread to all corners of the world. We have no other therapies available that can replace this current treatment for malaria. So, we are literally running out of time to tackle this issue.
I don’t have much faith that criminals are going to stop their criminal ways by recognising the cost to humanity. So, it is up to us to take action. Firstly, only buys medicines from trusted sources. Secondly, check for fakes when using medicines, and report them if you are suspicious:
- Inspect your package and product (compare it to an old pack; fakes may have more spelling mistakes – criminals have not been to medical school and can’t spell a lot of complicated words!)
- Check the colour, smell and texture of product (especially if it is one you take regularly)
- Look for evidence of tampering
- Check the expiry date
- If a medicine is not working the way it is meant to according to the information given by the manufacturer, then it could be a fake
- Report suspicious packs to World Health Organisation GSMS (Global Surveillance and Monitoring System) team or your local regulator, like FDA (in US) or MHRA (in UK).
This is one challenge that none of us can tackle alone. Criminals work across borders and enter the complex supply chain that most medicines have in place these days. To respond to this threat, we need international attention globally and co-operation across borders, to face up to the challenge. And, the only way to do this is for the citizens (YOU) to demand political action on this issue. And, this is a battle we can win.…just think back at all that we have achieved in just a few decades. This is but a miniscule challenge in comparison, wouldn’t you say?