Africa’s deadly fake drug deluge

This file picture taken on November 1, 2007 at Shagamu dump site in Ogun State, southwest Nigeria shows seized cartons of fake drugs set ablaze by officials of the National Agency for Food and Drug Administration and Control (NAFDAC). -
This file picture taken on November 1, 2007 at Shagamu dump site in Ogun State, southwest Nigeria shows seized cartons of fake drugs set ablaze by officials of the National Agency for Food and Drug Administration and Control (NAFDAC). -

After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.

But far from curing him, the medication he was given at the neighbourhood clinic made him far worse — eventually costing him one of his kidneys.

The drugs were fake.

“After four days of care, there was no improvement, but I started to feel pain in my belly,” Hievi, 52, said.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation’s capital, Lome.

“The doctors told me that my kidneys had been damaged ... the quinine and the antibiotics used to treat me in the medical office were fake drugs.”

Now, more than four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.

Hievi’s horror story is far from unique in a continent awash with counterfeit medicines.

The World Health Organisation (WHO) estimates that every year about 100,000 people across Africa die from taking “falsified or substandard” medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in Sub-Saharan Africa.

Weak legislation, poor health-care systems and widespread poverty have encouraged the growth of this parallel — and deadly — market.

Since 2013, Africa has made up 42% of the fake medicines seized worldwide.

The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and antimalarials, experts say.

And bogus drugs not only pose a risk to the patient — they also play a worrying part in building resistance to vital front-line medications.

In an attempt to tackle the scourge, presidents from seven countries — the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda — meet on Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.

The goal is to bolster co-operation between governments and encourage other African nations to join the initiative.

But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.

Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what is  available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.

“It is very difficult to trace where the fake medicines come from,”  Togo’s pharmacist association president Dr Innocent Kounde Kpeto said.

“The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs.

“The manufacturers cover their tracks so as not to be identified,” Kpeto said.

It is estimated that between 30% and 60% of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.

Efforts to staunch the deadly torrents of counterfeits have made some headway.

Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.

In mid-November, the police in Ivory Coast made a record seizure of 200  metric tons in Abidjan and arrested four suspects, including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.

It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of about $85,000 (R1.2m).

In a show of force in July, the authorities burnt more than 67 metric tons of counterfeit pharmaceuticals.

But even given these recent successes, those in the industry such as Dr Kpeto insist that the threat is still grave and involves “highly organised criminal networks”.

“The phenomenon remains major,” he said.

Traffickers can turn an investment of just $1,000 (R14,300) into a profit of $500,000 (R7.2m), he claimed.

The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

Nigeria, Africa’s most populous country with a market of 200-million people, is the top destination on the continent for fake drugs and a showcase of difficulties being faced.

In September 2016, the World Customs Organisation seized tens of millions of fake pills and medicines at 16 ports around Africa: 35% were intended for Nigeria.

In an attempt to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4m (R20.1m) to help Nigerians track their medication from producer to user.

“The country doesn’t have a reliable and centralised distribution network,” she said.

“A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs.

“How can you have quality control with so many suppliers?”

As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals — both state and private. — AFP