The latest issue of Pathogens and Global Health highlights the current debate surrounding the under-investigated, and politically sensitive, issue of counterfeit medicine. Issue 106.2 includes an interview with Dr Paul Newton, Head of the Laos arm of the Wellcome Trust's Major Overseas Programmes, and a number of articles highlighting the technological innovations and field initiatives that are challenging this threat to global health.
According to the World Health Organisation (WHO), 10% of prescription drugs sold worldwide are counterfeit; the packaging may be almost identical but the ingredients within the product are often absent or at lower dose than stated, or the product has been contaminated with other dangerous ingredients such as arsenic, heavy metals, pesticide, ink, and leaded paints.
In his interview, Dr Newton explains the important differences between substandard and falsified (or counterfeit) medicines, and how controversy over the definition of these terms is slowing down progress in combating them. These terms are important as accurate reporting enables an understanding of the epidemiology of medicine quality and guides interventions. After two years of debate a WHO Member State mechanism has been formed to try to tackle these issues.
Dr Newton states in his interview "Whether the new WHO Member State mechanism will be able to improve the current situation remains to be seen. It will need to take rapid action if the public health of vulnerable patients is to be protected."
He then goes on to comment on the consequences of falsified medicines being used in developing countries, including increased morbidity, increased health expenditure, and loss of confidence in health systems and pharmaceuticals. Additionally, anti-infective medicines containing inadequate amounts of the stated active ingredient will engender drug resistance. The WHO reports that 30% of countries have no drug regulation, or a capacity that hardly functions. Dr Newton states that more investment in Medicine Regulatory Authorities (MRAs) is required to reduce the number of errors occurring during the production of pharmaceutical products, and to allow essential medicines to be analysed within the poorer countries themselves.
It is believed that resolution can be found by implementing strict preventative measures transnationally, as well as taking action to reduce profits for counterfeiters. There will always be opportunities for the falsified medicine trade to flourish if medicine regulation, enforcement and manufacturing capacity building are not implemented.
Professor Andrea Crisanti, editor of Pathogens and Global Health, says in his editorial: "From a smuggler's standpoint, counterfeit medicine is great business. It is extremely remunerative; estimates suggest that it generates a 400-fold return on investment which is much higher than that of heroin traffic."
However, technology is making a significant impact in combating counterfeit medicine. This issue features an open-access report on the Worldwide Antimalarial Resistance Network (WWARN) AQ Surveyor, which is a database of more than 200 studies that report on antimalarial drug quality, describing the location, and the type of drug and its quality, in the hope that it will enhance the availability of information and stimulate action. It also features an article on various anti-counterfeit tools and devices; measures such as Radio Frequency Identification (RFID), mobile screening kits, and nanoencrypted tablets.
Pathogens and Global Health