IPN Health Blog

Fake Russian tamiflu comes as little surprise

As fears over swine flu peaked in the summer, search engine queries for "Tamiflu" soared by 1,400 per cent according to a report from software security firm Sophos.  The correlation is not hugely surprising, nor is the news that fake Tamiflu, thriving on this sudden internet-based interest, is being produced and transported from Russia.

In June 2008 the Russian Federation Council held a meeting entitled "The role of the state in the protection of the Russian market from counterfeit medicine."  A more honest meeting would have evaluated the role of the state in flooding the market with counterfeits in the first place.

Corruption and a complete disregard for the rule of law have been at the root of Russia's counterfeiting and 'grey market' pharmaceutical trades (for more info, see Making a Killing, page 21).

A company named Bryntsalov A produce up to 10 per cent of pharmaceuticals in Russia, yet this year they were found guilty of counterfeiting over 50 brands of medicine.  Remarkably, as reported on the excellent SecurePharmaChain blog, the punishment was little more than a "slap on the wrist", with token fines dished out of no more than $1,500.  By pure coincidence, two leading figures in the company are siblings Vladimir Bryntsalov and Tatyana Bryntsalova, the former being an ex-candidate for President (yes, of Russia). Both are said to have extremely strong political links.

It is therefore little wonder that only one victim company, Pfizer, had begun taking legal action according to the article (at IPN we've stressed the importance of civil law in deterring counterfeiters - in many countries, the rule of law is so weak, and political corruption so great that civil proceedings are simply not viable). In 2006 Pfizer surveyed the fakes market in Russia, finding an unusually high standard of counterfeit drug production (which is not, of course, to say that the drugs are good). All indicators point towards a very professional class of counterfeiters, in league with the political elite.

For these reasons, one must be extremely cynical when leading political figures (including Medvedev and Putin) pledge to "protect" their people from counterfeit drugs.  Rather than looking for political saviours we should be looking for political culprits, and ensuring they're accountable for their crimes.

Trading Away Access to Medicines?

Coinciding with another controversial seizure of medicines in the EU (Paris, this time) a group of NGOs have released a joint statement criticising EU trade policy.  Oxfam, HAI, and MSF have attacked the European Commission for its support of intellectual property (IP), which they claim “benefits…IP holders at the expense of Access to Medicines for millions of people, particularly in poor countries.”

The document is essentially an anti-IP polemic, in which the signatories rail against the alleged “deficiencies” of the patent system of “leaving a research gap” and neglecting diseases. We have argued against these claims in the past but they’re tangential to the enormous health threat that everyone else (Time magazine, Jacques Chirac, the WHO, UN head Ban Ki-moon, the Gates Foundation…) is talking about—the danger of drug resistant diseases, induced by counterfeit drugs.  Rather than conflating many issues and ideologically opposing all IP, health activists should take a more practical view on how IP laws can be shaped to help poor people in less developed countries (LDCs).

Access to medicines is an insufficient goal in global health. We should be aiming for access to high quality medicines. Substandard drugs (especially counterfeits) cause more harm than good, injuring patients and burdening poor countries and healthcare resources with new waves of drug-resistant disease.

When counterfeiters fake a product, they often fake a trademark too—it’s part of their deception, to leech off the good reputation of others. Stopping these fakes is one of the simplest means of protecting the poor from bad medicines and should be acceptable to opponents of other forms of IP. Even MEP Christian Engström of the Pirate Party agrees, stating last week: “The primary function of trademarks is to act as consumer protection ... The Pirate Party has no objections in principle to combating counterfeit goods or upholding the existing trademark laws.”

EU seizures of pharmaceutical goods in 2008 were almost entirely (93 per cent) for trademark infringement—ie. on suspicion of being fakes. Only 6 per cent were for patent infringement. By focusing on a minority of cases (for patent-infringement), groups like Oxfam, HAI and MSF are ignoring the main threat to patients in LDCs; and by conflating the issues and seemingly opposing all IP, they risk damaging measures that safeguard the poor from fake drugs.

Perhaps I’ve missed statements from these groups regarding the seizures of fake drugs (rather than generics), but given the severity of the situation they should be making more noise and making clear their views. Do they really think medicines with fake trademarks should be released into poor country markets? One hopes not. It’s time we stopped obfuscating this issue with squabbles over other areas of IP and found consensus in the fight against fakes.

UN confirms bed-nets not slept under, used for fishing

The UN continues to boast of millions of dollars of public money being spent on bed-nets, this time on a project in Tanzania costing $111 million.

However, the inefficiency of such schemes is infamous. Some factors are now confirmed by Ray Chambers, the UN's special envoy for malaria, who admits that people often use the nets "to catch fish".

He also confirms that "one out of two people will not sleep under a net". This blog has previously noted how people find nets uncomfortable, or simply not much use when their living conditions are particularly poor. Furthermore, they often need to be retreated with insecticides every few months.

It is no myth that they are often sold on to make fishing nets or wedding dresses.

Amusingly this story comes just days after the news that a team of peacekeepers avoided malaria entirely by - shock horror - killing as many mosquitoes as possible. The team used housefly killing machines to protect them from mosquitoes, and remarkably the infection rate plummeted all the way down to zero.

Presumably it's too late to reinvest that $111,000,000.

Mosquitoes to carry insecticides

The innovation of getting mosquitoes to carry insecticides to their own larvae is proving hugely effective, according to an article in magazine SciDev.

Researchers spread an insecticide among adult mosquitoes who then transported it back to their breeding sites.

The results were startling:

Placing the insecticide in just 3 - 5 per cent of resting areas resulted in 95 - 100 per cent of larvae dying in aquatic breeding sites.

The development offers great hope in the ongoing battles against vector-borne diseases such as dengue and malaria, especially given the stifled markets for new insecticides.

Defending the indefensible

The Indian government is to launch a campaign in South Africa this week, desgined to "counter the multinational companies' (MNCs) propaganda against Indian generic drugs in African countries."

But what "propaganda" is this?

The report states: "generic drugs are not counterfeit drugs as is being spread by the MNCs."

Of course generic drugs are not necessarily counterfeits, but vast amounts of seized drugs coming from India are counterfeits.

Last week the EU released new data showing that yet again most fake drugs are coming from India.

Over half the medicines stopped at EU borders for intellectual property infringements were from India.

The most high-profile examples of these seizures have been those committed in the Netherlands over alleged patent infringements. Certain groups have cried incessantly about the injustice of these seizures, accusing the EU of endangering lives.

Yet these seizures are in the minority - only 6% of seizures in 2008 were for patent infringement, while 93% were for trademark infringements.

And another word for a faked trademark is "counterfeit."

Packaging with fake trademarks will likely contain fake drugs. People receiving these fakes can have no confidence in the medicines they're taking, and it is their lives that are being endangered far more than any the EU is supposedly responsible for.

Let's hope delegates in South Africa bear that in mind more than propaganda from any side.

The Gates Foundation: help or hindrance?

I'm on the BBC World Service today discussing the Gates Foundation, and whether or not it is skewing efforts to improve global health. 

Check it out here: http://www.bbc.co.uk/iplayer/console/p0038yg4

Medicinas falsificadas matan 700.000 personas al año

Our fake medicine study has been translated into Spanish and is now available for download here.

We've also garnered some good international coverage, here and here.

Here's the press release:

Un nuevo informe del International Policy Network detalla el impresionante impacto de las medicinas falsificadas en los países menos desarrollados. Se estima que solamente las medicinas falsificadas para la malaria y la tuberculosis matan alrededor de 700.000 personas al año. Esto equivale a la caída de cuatro aviones tipo “jumbo” llenos de pasajeros  cada día.

El informe revela el creciente problema de las medicinas falsificadas y sub-stándar. Se estima que en Colombia el 5 por ciento del mercado es de medicinas falsificadas, mientras que las autoridades en la República Dominicana sospechan que el 10 por ciento de sus fármacos son falsificados. En el mercado Peruano se estima que las ventas de medicinas falsificadas ha crecido de $40 millones en 2002 hasta $66 millones en 2006. Estas medicinas falsas causan muertes innecesarias y mayores niveles de resistencia a los fármacos.

• En otras partes del mundo el problema es aún más severo. El informe establece que:
• Casi la mitad de las medicinas vendidas en Angola, Burundi y el Congo son sub-stándar,
• Aproximadamente las dos terceras partes de las medicinas contentivas de artesanato (anti-maláricas) en Laos, Myanmar, Camboya y Vietnam poseen cantidades insuficientes de ingredientes activos,
• La mayoría de las medicinas falsficadas provienen de la China y de la India.

Los esfuerzos para enfrentar el problema en base a regulaciones más severas y castigos a los criminales no combaten  la raíz de las falsificaciones. Peor aún, muchos países tienen sistemas legales y regulatorios corruptos, los cuáles son aprovechados por los falsificadores de tal forma que la aparición de nuevas reglas incrementa la corrupción.

Los gobiernos también excacerban el problema a través de tarifas e impuestos que hacen más costosas las medicinas genuinas.

El informe enfatiza la necesidad de establecer mecanismos efectivos para permitirle a los compradores de medicinas asegurarse de que lo que están comprando es genuino. Los sistemas de protección de identidad de origen mediante el uso de códigos verificables por un sencillo mensaje de texto ofrecen una posible solución. También pueden ser de utilidad  sistemas más efectivos de protección de patentes.

El autor del informe, Julian Harris, dice: “Muchos países pobres poseen leyes sobre patentes muy débiles, de manera que no es sorprendente que las falsificaciones abunden. Una prensa libre, tribunales autónomos y un libre intercambio comercial incrementarían la calidad de las medicinas”.

Combatting the spread of fake drugs in poor countries

This week we launched our new paper on counterfeit medicines, Keeping it Real, which highlights the shocking burden of fake drugs in less developed countries. Fake tuberculosis and malaria drugs alone are estimated to kill 700,000 people a year. That’s equivalent to four fully laden jumbo jets crashing every day.

The report lays bare the ballooning problem of counterfeit and substandard drugs, which can constitute one third of the drug supply in certain African countries. These dodgy drugs result in unnecessary death and increased levels of drug resistance.

The report highlights more shocking evidence, such as:

• Nearly half the drugs sold in Angola, Burundi, and the Congo are substandard
• About two thirds of artesunate (anti-malaria) drugs in Laos, Myanmar Cambodia and Vietnam contain insufficient active ingredient
• Most fake drugs originate from China and India

Current attempts to deal with the problem through tougher regulation and criminal penalties do not address the root causes of counterfeiting. Worse, many countries have corrupt regulatory and legal systems that are easily exploited by criminal counterfeiters, so additional rules will only increase corruption.

Governments also exacerbate the problem by making legitimate drugs more expensive through taxes and tariffs.

The report stresses that what is needed are effective mechanisms to enable purchasers of drugs to be assured that what they are buying is the real thing. Identity preservation systems using unique codes verifiable through a simple text message are one possible solution. More effective trademark systems would also help.

Report author Julian Harris said: “Many poor countries have weak or nonexistent trademark laws, so it’s no surprise that counterfeits are rife. A free press, free courts, and free trade would actually increase the quality of medicines.”

CLICK HERE FOR THE REPORT or find it at http://policynetwork.net/uploaded/pdf/keeping_it_real_2009.pdf

When home-made isn't best

Following encouragement from UNAIDS and the African Union, the Nigerian government has announced that it is to start producing antiretroviral drugs.

The announcement coincides with an article in nearby Ghana, which outlines the many problems with government-assisted pharmaceutical production.

Africa's pharmaceutical industry has grown to provide 40 per cent of the continent's drug supply, yet there are reasons why the figure is not higher, explains the author.

Many of the components required are extremely expensive and need to be imported from Europe and the USA. Furthermore, necessary conditions to produce high quality drugs are often lacking--such as a reliable power supply.

Worryingly a study last year showed that almost half African-produced drugs procured in six major African cities were substandard. Political support for such plants is therefore extremely dangerous.

If governments really want to encourage local production, they should drop the tariffs on imported components and ingredients that such facilities require.

A strong gust of hot air from the Lancet

The Lancet seems to be accelerating its mutation from respected medical journal to lefty campaigning rag.

A few months ago it was trumpteting the publication of the WHO's execrable report on the Social Determinants of Health.

This week it turns its humourless gaze onto climate change, which it alarmingly describes as "the biggest threat to health of the 21st century".

Its major new report, written in association with University College London, makes the usual tired claims about killer heatwaves, malaria moving into highland and northern areas, and increased hurricanes and other weather mayhem - unless, of course, governments intervene massively at the local and global levels.

I've written at length on the climate change / health nexus before, so I'm not going to rehearse the old arguments.  But the facts remain:

• Climate has little to do with the range of the malarial parasite, which is more down to sociological and economic factors
• Deaths from 'extreme weather events' have actually decreased by 95% since the 1920s
• Cold is far worse for health than heat, as any shivering pensioner will tell you.

Check out my article for a longer exposition on these themes.

I understand that the Lancet see itself as a catalyst of change or something equally grandiose, but it really needs to start tempering its hyperbole if it wants to continue being taken seriously by anyone outside the global public health bubble.