Experts from the World Health Organization were in Hanoi this week to discuss ways of tackling the problem of counterfeit medicines with officials from countries in Asia's Mekong delta region.
WHO sees the problem of fake or substandard medicines as a serious public health threat in the "greater Mekong subregion," which includes Vietnam, the Lao People's Democratic Republic, Cambodia, China, Myanmar, and Thailand.
It hopes that the meetings will kick-start efforts to raise awareness among decision makers, health professionals, and the general public and to strengthen inspection and post-marketing surveillance.
Recent WHO estimates suggest that Cambodia has about 2800 illegal medicine sellers and 1000 unregistered medicines on the market. In 2001, China had roughly 500 illegal medicine manufacturers, and the Lao People's Democratic Republic had about 2100 illegal medicine sellers. In Thailand, substandard medicines account for 8.5% of those on the market.
The drugs most likely to be counterfeited in the region are those that treat diseases of most serious concern, such as antimalarial drugs, antibiotics, and tuberculosis drugs. For example, one report (Lancet 2001;357:1948) showed that 38% of samples of "artesunate" bought from shops in Cambodia, Laos, Myanmar, Thailand, and Vietnam did not contain the antimalarial.
WHO has been working on the issue with regional governments for some time, and late last year, a meeting in Bangkok led to the development of country specific plans of action. The government of Australia has made funds available through the WHO for fighting counterfeit drugs in the region.
The Mekong initiative is part of WHO's effort to clamp down on fake and substandard medicines around the world, including Africa where a recent survey of the quality of anti-malarials in Gabon, Ghana, Kenya, Mali, Mozambique, Sudan, and Zimbabwe found that between 20% and 90% of the products failed quality testing.
"Combating low quality or illegal medicines is now more important than ever," Dr Lee Jong-wook, the director general of WHO, said in a statement. "We are in a global emergency phase where expanding access to safe, effective treatment for AIDS and other illnesses is no longer an option; it is an imperative."
WHO has already begun a series of training workshops in African countries to help manufacturers upgrade their standards, and regulatory authorities to strengthen their screening and testing of local and imported products.
"Many tools exist to improve medicines quality control and supply systems," said Dr Vladimir Lepakhin, head of health technology and pharmaceuticals at WHO. "The problem is one of resources. Most of the countries with the lowest quality pharmaceuticals are also the ones with the highest disease burden and the poorest economies."
WHO estimates that as much as 10% of the world's drug trade—25% in poor countries—consists of counterfeits. Fakes have been sold around the world, including the United States, China, Russia, and India (where the death penalty was recently recommended for those who make or sell counterfeit drugs (23 August, p 414)).
"Profiting from spurious drugs that might harm or kill innocent people is equivalent to mass murder," said the Indian health minister, Sushma Swaraj. Indian state government inspectors last year found that 9% of drug samples were poor quality drugs and that fake medicines made up 0.3% of the samples.