Of all the continents, Africa is arguably the worst afflicted by substandard and fake medicines. But African health professionals seem surprised to learn of that fact. This is the unexpected conclusion of a health professionals’ workshop and lecture that I gave in Cape Town at the annual meeting of the Public Health Association of South Africa. Simply put, I scared the wits out of many of my African colleagues, which is hardly what I expected.
To those of us who research poor quality medicines—or to be more precise intentionally “falsified” and unintentionally “substandard” medicines—it often goes without saying that the most concerning studies of medicine quality are from Africa. Although African studies are still too few in number, those that exist almost always point to grimmer results than studies conducted elsewhere. Africa is ground zero in the deadly and dangerous impact of falsified and substandard medicines today.
For example, my colleague Roger Bate with his team recently published results on the most important tuberculosis medicines, isoniazid and rifampicin, and found that the African failure rate was higher than in India or various middle-income countries. Fully 16.6% of these medicines—or one in six—of these medicines is dangerously substandard or falsified in Africa.
If Roger’s results roughly hold across the continent, and there is no reason to believe that they do not, then faulty medicines are possibly the leading cause of multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis—which is fatal, becoming more prevalent, and frighteningly near incurable. In India it is well understood that bad quality medicines have contributed to the subcontinent’s resistance problem, including at the severest and invariably fatal level, totally drug-resistant tuberculosis. Africa imports a great deal of Indian-made medicines, so could this be an overlooked explanation for resistance in Africa too?
To my surprise, this question hardly has been posed among African public health experts. While polls show that a majority (sometimes a large one) of Africans are aware of fake medicines where they live, this sentiment seems less common among the African doctors who I addressed, and who of course wish to believe that the medicines they offer patients are helping them. After the workshop, many health professionals from South Africa, Nigeria, Malawi and elsewhere came up to me and said things like, “I never knew.”
So having alerted my African colleagues to this danger, will there now be more rigorous research of medicine quality in Africa? I hope so: Africans’ lives depend on it. Certainly the problem is now a high priority for Public Health Association of South Africa and World Federation of Public Health Associations, who have prepared a communiqué on the workshop. Expect that document to call for more research, and to endorse an idea that we have been advocating for consistently: a global treaty to establish standards of medicine quality, to build drug regulatory capacity in Africa and other poor parts of the world, and to apprehend and punish the organized criminals who so cruelly—and fatally—debase the quality of medicines on which we all depend.