Africa, COVID-19 and the increasing risk of substandard and falsified medical products

Prof. Moustafa Mijiyawa, Minister of Health, Republic of TogoPolitical Coordinator of the Lomé Initiative; Michel Sidibé, Special Envoy of the African Union, African Medicines Agency; Greg Perry, Assistant Director-General, IFPMA and Vice-Chair, Fight The Fakes Alliance & Richard Amalvy, Chief Executive, Brazzaville Foundation

Imagine a sick child in a developing African country, suffering from a life-threatening condition, being cared for by desperate parents.  The family is offered medication at a price they can afford, but – unknown to them – the offer is by unscrupulous traffickers of false medication.  The family parts with the little money they have.  They administer, in good faith, a medication that, in the best-case scenario, will do nothing, and in the worst-case scenario, would harm the child, failing to treat the disease.

For almost a quarter of the world’s population, this could be an all-too-familiar reality.  Astonishingly, two billion people – a quarter of the world’s population — lack access to essential medicines, vaccines and medical devices.  Where there is demand, there will be supply, and this vacuum is, too often, filled by substandard and falsified medicines, peddled by unscrupulous organisations in search of profit, no matter what the human cost.

These organisations will kill 122,000 children under five, who die each year due to poor-quality antimalarials in sub-Saharan Africa.  And in a number of African countries, falsified medicines account for between 30% and 60% of all medical products. In contrast, in countries where regulations have been implemented and strictly enforced, this figure falls to just 1%.  In the latest four-year period for which figures are available, the WHO reports receiving 1,500 reports of cases of substandard or falsified products, with the largest number of the reports coming from the African continent.  Since the onset of the Covid-19 pandemic, this figure has only increased, opening new challenges in supply chains with falsified vaccines, therapeutics and diagnostics in circulation.

Even more shockingly, up to 169,000 children die each year from pneumonia, with a further 158,000 dying from malaria due to falsified or substandard antibiotics or antimalarials.  As many as 97% of websites offering medicines for sale are illegal, with Interpol noting the sale of substandard and falsified medicines has risen by nearly a fifth during the Covid-19 pandemic.

Moreover, the Covid-19 has amplified the urgent need for African countries to invest in effective and efficient regulation of medicines, medical products and technologies.  In this regard, the ratification and establishment of the African Medicines Agency (AMA) will be an essential instrument to strengthen the fight against substandard and falsified medicines and medical products, and enable all patients in Africa to have access to quality medicines that are safe and effective.

In January 2020, at the initiative of the President of the Togolese Republic, Faure Gnassingbé, the Brazzaville Foundation organised an international summit in Lomé to discuss the challenges that substandard and falsified medicines pose to global security, supply chains and to some African communities. The event brought together six African heads of state and ministers from the Republic of Congo, Ghana, Niger, Senegal, Togo and Uganda. Together they launched the Lomé Initiative to criminalise the increase and spread of falsified and substandard medical products. Gambia has recently announced that it is also joining this fight. The WHO and the African Union have supported this unique global initiative.

Africa Day is this week, as is the World Health Assembly.  These events follow last week’s Global Health Summit, where world leaders called for stronger and more transparent drug supply chains, strong regulatory systems as well as equitable access to medical supplies.

To pursue this vital conversation, the Brazzaville Foundation is gathering another set of global leaders to continue to discuss this worrying public health and security issue. Their impetus, along with the Brazzaville Foundation, is to smash the $200bn illegal market in substandard and falsified medicines, which represents up to 15% of all drugs in circulation.

The seven states which now support the Lomé Initiative have committed to fighting the trafficking of substandard and falsified medicines via ratifying existing international agreements, introducing new criminal sanctions against traffickers, and raising awareness about the public health issue.  But further action can and will be taken.

Tuesday’s[Today’s] roundtable will take stock on existing and new national and global initiatives and assess how COVID-19 has exacerbated the increasing risk of falsified and substandard medicines circulating in Africa.  With leading figures from the African Union, the World Health Organisation and the UNODC, we will discuss how future health systems and supply chains can be strengthened and how our security and our state of law can be improved.  Only together, in partnership, can we build robust supply chains and national plans to ensure that everyone has access to affordable quality medicines and medical devices to achieve Universal Health Coverage by 2030.