You’re the mother of a small child in rural Ghana. Your child has malaria – she’s sweating with fever, then shaking with chills. You send your husband to the nearest big city – Kumasi – and make what’s a huge fiscal investment for you in some artesunate tablets. Artesunate and other arteminisin drugs work rapidly and are often able to control serious malaria episodes.
The drug doesn’t work. Your daughter dies, despite the fact that you, as a parent, did everything you could to save her life. She’s one of 1.5 million people a year killed by malaria, a disease that should be treatable in virtually every patient who suffers from it.
The pills didn’t contain any artesunate – they contained chalk, starch or acetaminophen. In a recent study in Southeast Asia, 38% and 52% of “artesunate” blister packs sampled contain no active ingredient. Or perhaps the pills included artesunate, just not enough – 10 miligrams, rather than the 50mg needed to cure the disease. The malaria parasites continue to live and are carried by other mosquitos, but they’ve developed a resistance to artesunate by encountering it in the victim’s bloodstream in a non-lethal dose. The authors of the paper on Asian counterfit drugs state, “We make no apology for the use of the term manslaughter to describe this criminal lethal trade. Indeed, some might call it murder.”
Counterfit pharmaceuticals are a massive problem in West Africa. Dr. Dora Akunyili, the head of Nigeria’s National Agency for Food and Drug Administration and Control reports that, at one point, more than 80% of drugs on Nigerian shelves were fake. Akunyili’s sister, a diabetic, died in 1988 after taking fake insulin. Her personal devotion to fighting fake drugs has helped NAFDAC become quite effective at seizing and destroying fake drugs… so effective that Akyunyili’s car was fired on by snipers four years ago as she drove through rural Nigeria. She keeps the headscarf that was pierced by a bullet over her desk as a reminder of the dangers of her job.
The fake medicines are easy to produce – high-quality color photocopiers can produce official-looking packaging, and firms in China and India have gotten into the business of manufacturing huge volumes of fake, diluted or out of date drugs for sale throughout the world, mostly in developing nations.
You’d expect legitimate pharma companies to be highly active in combatting these fakes. An article by Robert Cockburn in the American Prospect accuses GlaxoSmithKline of burying reports of fake drugs and intimidating people who report the drugs from making public announcements, for fear that it will scare people away from their products. (Needless to say, GSK disputes Cockburn’s analysis.)
Friends of mine are working on a new project in Ghana designed to combat pharma fakes. The project, called mPedigree, seeks to build a system first in Ghana, and then throughout Africa, that tracks drugs from their original producers all the way to the pharmacy shelves, allowing each buyer in the chain to ensure that they’re dealing with a legimate product. The idea of this system comes from the ePedigree system being implemented to track medications in the US using RFID tags.
It’s probably prohibitively expensive to put RFID tags on every box of medicine coming into Ghana. But a system that takes advantage of the ubiquity of mobile phones in Ghana, allowing a purchaser to check whether the pills she’s buying in a pharmacy are registered and tracked would be a great use of appropriate technology to tackle a difficult problem. That’s what mPedigree proposes to do. The project is being implemented by a very new company called Syncrytel, which has spun out of a social entrepreneurship project at Dartmouth’s Thayer School of Engineering.
It’s hard to think of an application in which information can save more lives than in providing information on whether a drug is fake or real. My fingers are crossed for the success of mPedigree and of all efforts to destroy the trade in fake pharmecuticals.