African youths' answer to counterfeit drugs

Africa’s counterfeit drug market is as complex as its distribution networks and the people involved in running them. The sector is estimated to be worth USD 200 billion annually, making drugs the most counterfeited consumer good the world over.

According to the World Health Organization, one in every 10 medical products in low-income countries, like those in African, is sub-standard or fake. The organisation further noed that 42 percent of all fake drugs that were reported to it between 2013 and 2017 originated in Africa. 

Exploiting a healthcare vaccum 

What has now become a public health crisis is fanned by the fact that with an underdeveloped health sector, the continent imports between 70 to 90 percent of all drugs -  amounting to approximately $14 billion annually.

The situation is particularly dire in Sub-Saharan Africa, where up to 500,000 people die as a result of consuming counterfeit drugs, according to a report by the United Nations Office on Drugs and Crime (UNODC).

Additionally, over 160,000 deaths each year in the region are linked to substandard or falsified antibiotics that are used to treat severe pneumonia among children. The annual cost of treating people who have used counterfeit drugs for malaria in the region ranges between $12 million and $44.7 million, according to WHO - as quoted in the UNODC report. 

In one case that caught global attention, Nigerian authorities revealed how more than 80 children had died after consuming a teething syrup that had been laced with a chemical usually used in engine coolants and which triggers kidney failure.

In March 2019, the authorities in Cameroon sounded the alarm on fake hypertension drugs, while  the government in Niger warned about fake meningitis vaccines and the WHO called attention to falsified versions of Augmentin antibiotics that were in circulation in Kenya and Uganda. 

"Investigations have revealed the involvement of a wide range of opportunistic actors in trafficking in medical products in the Sahel countries, from employees of pharmaceutical companies, public officials, law enforcement officers and health agency workers to street vendors, all motivated by potential financial gain," the UNODC report reads. 

John Otieno, a medical expert who studies the counterfeit markets across East Africa, told FairPlanet that a cocktail of factors has been responsible for the unprecedented proliferation of fake drugs in Africa.

"It is an intricate and sophisticated web that has taken advantage of weak legislation, enforcement challenges and porous borders," he said. "A growing demand for medicines occasioned by Africa’s lack of infrastructure to produce them locally has led to a supply shortage which has created this gap."

Experimenting with technology 

As the situation escalates, so are efforts to tame and counter the impacts of the black trade. Young Africans and startups from across the continent are launching a flurry of innovations, including apps, barcoding technology and scanners, that aim to identify counterfeit drugs. 

They are buoyed by personal experiences with fake drugs and a drive to find homegrown solutions to local problems at a time when the continent is experiencing a technology boom and a growing number of innovative young minds. 

Team Save-a-Soul, a group of female Nigerian techies, runs a mobile app dubbed FD Detector, Fake Drug Detector. It allows health officials and customers with smartphones to scan the barcode in a drug and monitor its authenticity while indicating its expiration date. The technology also allows users to report fake drugs to relevant authorities.

While appreciating the pivotal role the innovation plays in stemming the flow of counterfeit drugs, Otieno, the medical expert, claims it is limited in scalability, considering that a bulk of the population is illiterate and unable to access smartphones.

"[People] in rural areas have limited access to smartphones. It might be difficult for them to authenticate these drugs, which is why alternatives such as the short SMS codes that work with feature phones come in handy," he said. "But, most importantly, a lot of investment needs to go into creating awareness and empowering the citizens in this space."

In Tanzania, Bukhary Kibonajoro is the brains behind Okoa, Swahili for save, a cloud-based software that gives health officials, government personnel and citizens access to data reports on the movement of medical supplies from national stores to local health centres and to patients.

The platform automatically generates reports that assist in identifying any cases of theft across the supply chain while letting patients know of the availability of drugs in various health facilities before they visit them. This seals loopholes of pilferage and corruption, Kibonajoro claims. 

"Drug theft is an organised crime and a multi-million-dollar business that involves high profiled people, including staff at the central government, health facility officials, businessmen and doctors. I faced so much resistance from all quarters I nearly gave up. I am glad I never did," Bukhary noted, appreciating the pivotal role technology continues to play in streamlining the health sector in the continent. 

"Technology is our saving grace, especially for vital sectors like health. From early diagnoses, timely interventions, improving operations to taming fraud," he added, "If Africa wants to streamline its health sector, then it definitely has to embrace technology, there are no two ways about it."

mPedigree, a Ghanaian startup, is also on the frontline of the fight against fake drugs, and generates text message codes to help users authenticate the status of medicines. 

The innovation tracks drugs from production to consumption through a software that allows consumers to scan and verify the medication they buy by a code that they text to a toll-free line or by scanning a barcode with their phone camera. 

But while the innovation has been hailed as a game changer, some industry players and reports take issue with the use of barcoding as a remedy against counterfeits, and point out that weaknesses in the system leave the supply chain vulnerable to the proliferation of fake drugs.

"A glaring weak spot is the barcode attached to exterior drug packaging - boxes with blister packs of tablets, and bottles containing loose pills," noted a report by PwC Strategy dubbed 'Fighting counterfeit pharmaceuticals: New defenses for an underestimated - and growing - menace.' "This might allow a counterfeiter with a smartphone camera and access to production or distribution facilities to compromise codes on external containers.

It further reads, "Counterfeiters could snap photos of legitimate, packagespecific barcodes, and use the images to create forgeries. They could then slap the forged codes on packs of falsified drugs, and slip them into distribution channels with little chance of detection, provided the fakes arrive at dispensation points before legitimate products bearing identical codes."

The flurry of innovations is making a marked contribution to a battered yet crucial sector of the continent, and experts argue that technologies aimed at stemming the flow of illicit drugs will greatly benefit from increased political will and adequate policy frameworks. 

A boon and a curse 

But while technology has been broadly hailed as a silver bullet in the fight against counterfeits, it has also contributed to the proliferation of fake drugs. For instance, there has been a mushrooming of illegal online pharmacies spread across even the remotest parts of the world. They bypass traditional physical security checks and barriers, further complicating the tracking of counterfeits.

According to the World Health Organization, 50 percent of drugs available online are fake. At the same time, out of the 50,000 operational online pharmacies, approximately 95 percent do not comply with consumer protection laws and industry standards, according to a PwC Strategy report. 

Dr Harrison Mueke from Kenya’s Maseno University School of Medicine, claims that a collaboration between government and the private sector can go a long way in taming proliferation of fake drugs online, as technology evolves and counterfeiters look for more innovative ways to beat the system.

"Government cannot do it on its own," he told FairPlanet. "The private sector is directly involved in the supply chain and understands the dynamics." 

A case in point was the partnership between the Center for Safe Internet Pharmacies, internet providers including Microsoft, Google and Yahoo and the US government, which resolved to close illegal sites while pushing for awareness of the counterfeit menace. 

Experts further point out that innovations cannot operate in a vacuum, and can only be effective if the right policies and laws are adopted. And while a bulk of African countries have instituted regulations pertaining to fake drugs, their Achilles heel remains implementation, with many nations designating numerous anti-counterfeit bodies that compete over authority while giving counterfeiters a field day. 

There is also the challenge of implementation of regulations across borders. Certain policies may apply and govern medicines produced and distributed within a single nation or block of countries, but lack the same vigour in enforcement in another. This compromises the supply chain integrity. 

A host of African countries are trying to address this gap. In 2020, heads of state from seven African nations met in Togo’s capital to find a multifaceted and unified approach to tackling fake drugs in the region. The result was the Lome Initiative, a political declaration that seeks to classify trade in fake pharmaceuticals as a serious crime punishable with the most stringent laws. 

As more innovations come into play to tackle the counterfeit drugs crisis, and as the fake drugs market expands, information sharing, collaboration and setting implementable laws and policies may prove to be a crucial step in getting ahead of counterfeiters, experts say. 

Image by Maatla Seetelo.