Counterfeit or weakened versions of life-saving antimalarial drugs are making the rounds in Africa, potentially putting millions of lives at risk and encouraging drug resistance, say scientists.
In a study recently published in Malaria Journal, scientists working for a U.K. collaborative in Laos report that fake pills of artemisinin, a powerful antimalarial drug, were found in 11 countries in Africa. The counterfeit drugs contained either the wrong mixture of active ingredients or not enough medication to properly control infection.
The result, researchers say, is a particularly dangerous situation in which patients aren’t cured of their symptoms and the parasite has the chance to develop resistance to the substandard drugs.
Many of the circulating lower-quality drugs were tracked back to manufacturers in southern China, identified by traces of pollen indigenous to that region, which were found in the malaria medications. Makers from China have a history of counterfeiting drugs, as the U.K.’s Guardian reports: in 2001, Chinese authorities arrested Nigerian and Chinese men for producing fake versions of another malaria drug, halofantrine.
Spread mainly by mosquitoes infected with the malaria-causing parasite, the disease infects more than 200 million people each year and kills some 655,000, mostly children in Africa, according to the World Health Organization. Efforts to prevent malaria include insecticidal spraying and distribution of bed nets to protect people in the developing world, where malaria is endemic and where people often experience several bouts of the disease during their lifetimes. Researchers are also making progress in developing a vaccine against the disease, but antimalarial drugs like artemisinin are crucial for keeping malaria under control.
Artemisinin, one of the strongest drugs available to fight malaria, was originally developed by Mao Zedong’s scientists, who were desperate to ward off the malaria that was felling North Vietnamese troops in their war against the U.S., reports the New York Times. American scientists facing the same scourge embarked simultaneously on a medicinal solution, and while the U.S. researchers came up with another widely used medication, mefloquine, the Chinese scientists focused their attention on an ancient herbal remedy made from wormwood — artemisinin.
The flood of substandard medications result from both blatant criminal activity in making counterfeit drugs and shoddy manufacturing practices, say the authors of the new report. And the consequences could be deadly. As lead author Dr. Paul Newton of the Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration writes:
The enormous investment in the development, evaluation and deployment of antimalarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure. Malaria can be readily treated with the right drugs of good quality, but poor-quality medicines — as well as increasing mortality and morbidity — risk exacerbating the economic and social impact of malaria on societies that are already poor.
Worse still, they encourage drug resistance, potentially resulting in the failure of artemisinin treatments, with profound consequences for public health in Africa. Failure to take action will put at risk the lives of millions of people, particularly children and pregnant women.
Policing medicines in the developing world is a challenge, however. Currently, regulation of drugs worldwide is dangerously inadequate. According to WHO, 30% of countries have either “no drug regulation or a capacity that hardly functions.” Such failings not only risk the health of people in those nations, but in the case of infectious diseases like malaria, it also makes the entire world’s population vulnerable.