Five worrying facts about fake medicine

One million people die from fake drugs every year, with the worst continent being Africa where a suspected 200,000 die every year from fake antimalarial medication. There have been numerous well-publicised incidents that have taken the lives of those believing they were receiving treatment to aid their health. In the US, in 2008, 81 people lost their lives to counterfeit heparin, an anticoagulant that had been produced in China. One particular ingredient that has reoccurred numerous times, to damaging effect, has been diethylene glycol. The physical properties of diethylene glycol make it ideal for those looking to produce a cheaper alternative to pharmaceutical-grade glycerine. Its first use in medicine, in 1937, led to 105 deaths in just two months in the US. The incident led to the passing of the Federal Food, Drug and Cosmetic act of 1938 – the foundations of which the modern FDA still stands.

The most common medications that are fake are HIV/AIDS medications, antibiotics, weight loss pills and erectile dysfunction medication. The latter, commonly referred to by Pfizer’s brand name product, Viagra, is thought to be the most common fake drug in the world. In the UK, the MHRA, between 2014 to 2015, seized fake Viagra with a value of £3.9 million and the following year followed this up with a haul worth over £11 million. The side-effects of fake Viagra are generally minimal, as it usually does not contain an active ingredient but there is potential for it to contain traces of more dangerous material, such as lead or arsenic. What is more dangerous is the market for fake HIV/AIDs medication or antibiotics that users rely on for their health. Though it disproportionately occurs in Africa, there have been instances, such as in Germany in 2009, where fake HIV medications were found to be sold at numerous pharmacies in northern Germany.

Estimated to cost pharmaceutical companies is $46 billion annually while the worth of the market in total could be anywhere from $70-200 billion. The exact figures are murky by the very nature of the illegal trade but these are the best estimates. For instance, the EU Intellectual Property Office (EUIPO) estimates that the pharmaceutical industry loses €10 billion annually directly as a result of the presence of counterfeit medicines in the EU marketplace, working out at 4.4% of sales. The effect of this is not strictly limited to commercial loss of revenue but EUIPO also approximates that 38,000 jobs are also lost. All told, the impact within the EU, once other industries are factored in and the impact on government revenue is recognised, it adds up to a €17 billion loss.

Disproportionately impacts ‘developing’ nations, with 10-30% of medication being fake in these countries compared with 1% in ‘developed’ nations. In some areas of Africa and Asia that figure can rise to as high as 70%. In Nigeria, for example, the prevalence of fake drugs was estimated to be the largest in the world – finding that 70% of its drugs were fake. The severity of the issue came to light after 109 children died due to fake paracetamol syrup containing diethylene glycol. In reaction, the Nigerian government set about creating stricter regulation around drug manufacture and supply – the intervening years have seen fake medicine throughout the country fall by 80%. Wider than this, antimalarial medications are one of the most falsified drugs in global circulation and because Africa accounts for 90% of cases of malaria, African countries are disproportionately impacted. Between 200,000-450,000 are thought to die every year due to the contribution of the use of falsified or counterfeit malaria drugs.

The return on producing fake outweighs the return from other illegal trades and also carries shorter sentences for those caught. The example in the US is that crime syndicates can reap a return of $200,000 to $450,000 from fake medicines from just $1,000 of investment. This compares with $20,000 return from counterfeiting currency or heroin distribution, or $43,000 from selling counterfeit cigarettes. In one particular case in the US, counterfeit Avastin that contained no active ingredient had been sold onto approximately 1,000 pharmacies. The culprit was discovered to be Paul Bottomley, a British citizen, who plead guilty and received five years’ probation and six months’ house arrest. A fairly paltry punishment given the fact he had accrued property, $1 million in assets and a sports car on the back of his dealings; especially so considering the sentence that could have been expected to be handed out if the same profits had been made in illegal drugs.