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Sunday 25th August 2019

Fake drugs hamper fight against malaria

22nd May 2012

The widespread sale of fake or substandard anti-malaria drugs in southeast Asia and sub-Saharan Africa is undermining efforts to eliminate the disease, which kills up to 1.2 million people annually around the world.


According to a study published in The Lancet Infectious Diseases, around half the planet's population are at risk of getting malaria, and the disease, which is particularly deadly in children under five, is endemic in more than 100 countries.

Most of the drugs sold in the two regions are either fake or substandard, either wrongly packaged or containing too much or too little active ingredient. Too little active ingredient in a dose could contribute to resistance.

In India, around 7% of malaria drugs tested were either fake or substandard.

According to study co-author Gaurvika Nayyar from the Fogarty International Centre at the National Institutes of Health (NIH) in the US, much of the morbidity and mortality associated with malaria could be avoided if drugs available to patients were high quality, effective, and administered correctly.

The study examined data from seven countries in southeast Asia, including an analysis of 1,437 samples of seven malaria drugs. It found that more than a third failed chemical testing, while nearly half were incorrectly packaged, and about a third were completely counterfeit.

What's more, inadequate treatment with fake or poor-quality anti-malarial drugs could be fuelling resistance to front-line malaria treatments as the two main mosquito-borne Plasmodium parasites adapt to defend against the drug.

Among the drugs tested in the study were artemether, artesunate, chloroquine, mefloquine, quinine, sulfadoxine-pyrimethamine and tetracycline.

In southeast Asia, 46% of drugs tested had inadequate packaging, while 35% failed chemical analysis and 36% were judged fake.

Similar proportions of drugs in sub-Saharan African countries failed chemical analysis, although the levels of fake drugs were somewhat lower, at 20%.

The study was carried out by the US National Institutes of Health. The authors said that the recently documented emergence of artimesinin-resistant malaria strains on the Thailand-Cambodia border make improving the drug supply a top priority.

According to study co-author Joel Breman, poor quality antimalarial drugs could easily jeopardise the past decade's progress in controlling and eliminating malaria.

Falsified drugs that had been fraudulently manufactured with fake packaging and usually no or wrong active ingredient were prevalent in the regions identified, along with substandard products were poorly manufactured and good quality drugs that were compromised by poor storage, researchers found.

They said that antimalarial drugs are widely distributed and self-prescribed, incorrectly or correctly, in malarial areas, but that there were often not enough facilities to monitor the quality of antimalarial drugs. Consumers and health-workers alike were poorly educated about the therapies available.

A lack of regulatory oversight of manufacturing and little punitive action for counterfeiters compounds the problem.

Quality control is also hampered by a lack of globally accepted definitions of different kinds of inadequacy, nor standard testing procedures or content requirements.

Researchers said they hoped the study would serve as a "wake-up call" for governments and healthcare bodies to intervene to crack down on criminal production and improve the quality of drugs made in legitimate facilities.

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