Counterfeit drugs hamper realization of MDG; Asia and Africa victimized


Malaria basic facts/epidemiology:
World Health Organisation (WHO) estimated 216 million episodes of malaria infections in the world in 2010. 81% of these infections occurred in Africa. Approximately, 6,55,000 people died due to malaria, 91% of these deaths occurred in Africa. Of all the deaths, children under 5 years of age accounted 86%.

Malaria is one of the major killers of children. Consequences of malaria related morbidity and its impact on the economy and the wellbeing of people is detrimental. Though the situation of malaria control programs is grim, the fact that some pharmaceutical companies are selling fake medicines is shocking.

A recent study by Nayyar and colleagues report that one-third of anti-malarial medicines are fake. The study claims, 36% of 1437 tested drugs from Southeast Asia were fake. Similarly, 20% of the anti-malaria drugs in the sub-Saharan Africa were falsified. The study included anti-malaria drugs from 28 countries sold between 1999-2010.

The research further identifies that 35% of the tested samples did not have enough drugs in them to work against the malaria parasite. Repacking of the expired anti-malaria drugs has also been reported. Further, 46% and 36% of the anti-malaria drugs in Southeast Asia and in the sub-Saharan Africa respectively had substandard packing.

Consequences of fake medicines:

  1. Swallowing preparations with fake ingredients gives people a false sense of security. Children and pregnant women who are vulnerable owing to week immunity fall prey to malaria.
  2. Inadequate and substandard ingredients in anti-malarial drugs lead parasites to develop resistance. Because of this, also the newer medicines are also developing resistance. In addition, it is wastage of a lot of resources.
  3. Most of the drugs after their expiry dates convert to toxic metabolites. These toxins can damage our organs like kidney and lever.

Malaria – a basic concept:
Malaria is a mosquito-borne infection caused by parasites of plasmodium species. Once the parasites get access to the human body, they cause symptoms ranging from fever and headache to unconsciousness and death.

Till a few decades, malaria was widespread throughout the world. However, following improvements in sanitation measures, proper case detection and its timely treatment; today malaria is localized mostly in tropical and subtropical regions of Sub-Saharan Africa, Asia and South America. Malaria is not only posing a severe threat to human health, but it is also causing negative impacts on overall socio-economic developments.

Malaria – developments at international arena:
The Millennium Declaration of the United Nations affirms, “every individual has the right to dignity, freedom, equality, a basic standard of living that includes freedom from hunger and violence, and encourages tolerance and solidarity”. Based on this, the Millennium Summit held in 2000 chalked out Millennium Development Goals (MDG). The 6th MDG is to combat HIV/AIDS, malaria and other diseases. Following the inclusion of a goal to combat malaria in the MDG, malaria has gained a lot of international attention and priority. To meet the set goals, a series of strategies are formulated and actions are undertaken. WHO claims, despite shortage of budget, a major achievement is accomplished in malaria control program. World Malaria Report 2011 writes, for the years 2010–2015 a budget of US$ 2 billion per year was available, when the requirement to meet the set objectives is US$ 5 billion per year.

Fake medicines – the ethical aspects:
More than 650 000 people die of malaria each year and 86% of these deaths occur in children under 5 years of age. When this is the situation, some drug companies produce fake medicines and they sell to poor people. What shall be the role of UN in this situation? How should the international community deal with this? What shall be the role of medical institutes and human rights watchdogs? How can the international community provide justice to sick, hungry and poor?


  1. Malaria is a curable infection if an anti-malarial drug of quality is taken. A sick person should feel better within 12 hours after taking the medicine. If the sickness deteriorates, or if there is no improvement, a sick person should doubt of fake medicine.
  2. People should be aware of the fact that fake medicines are in the market. People should be alert. They should try to find out the type of medicine (e.g. package of the medicine, the pharmaceutical company that manufactured the drug, drug-dealers, etc.) taken by a patient who dies due to malaria. People should collect such samples. Testing of medicines for its ingredients and its quality is very costly, needs expertise and equipment. Therefore, the suspicious samples should be handed over to the regional offices of local and international organizations.
  3. People should be aware that in production and distribution of fake medicines, many powerful people are involved. A business of fake medicine is earning black money. Therefore most of the time, not only the pharmaceutical companies but also the government officials, drugs procuring governmental organisations, implementing local and regional organizations, etc. are involved. Being alert is the only mechanism to stop these types of crime.

Reference : Gaurvika M L Nayyar, Joel G Breman, Paul N Newton, James Herrington (2012), Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa, Lancet Infect Dis 2012; 12: 488–96.

One of the Contributing Editors of the Bhutan News Service on health issues, Dr. Lakshmi Prasad Dhakal, a Netherlands based physician, is originally from Dagapela, Bhutan. The health problems and the health needs of the immigrant population are often different from that of the host communities. Among the immigrant population, there exists a huge gap in knowledge and awareness on health issues. Therefore, in an attempt to raise health awareness and to promote adoption of healthy behaviours among the immigrant population and among people of the developing countries, in collaboration with other public health experts Dr. Dhakal have founded, Global Health Promotion. It is a free knowledge-sharing institute operating online at