FAKE MEDICINE – AFRICA’S SCOURGE
Imagine giving your seriously ill child life-saving antibiotic drugs only to see the youngster deteriorate and die and then to find out, later, that the drugs administered were fakes.
Well, for thousands of families in Nigeria that’s precisely the heartbreaking reality. However Elizabeth Tadic reports that the Nigerians, led by one dynamic and particularly outspoken doctor, are fighting back against the criminals involved in the fake drug racket.
REPORTER: Elizabeth Tadic
In the children’s emergency ward in Nigeria’s Calabar University Hospital, the doctors are fighting Africa’s biggest child-killer – malaria.
DR MARTIN MEREMIKWU, PAEDIATRICIAN: In the emergency room we have children who have been transfused yesterday, some of them have been convulsing and we’ve not had any deaths in the last 24 hours, which is strange, really, because usually a couple die each day and most of them, and this is not exaggerating, would be from malaria.
Experts believe the disease is killing between 1 million and 3 million people a year in Africa, 90% of them children under the age of 5. Yet 30 years ago, the disease had almost disappeared. So what’s causing Africa’s devastating resurgence of malaria? Dr Martin Meremikwu is one of Nigeria’s leading paediatricans. His assessment has shocked many people.
DR MARTIN MEREMIKWU: The source of the problem is fake drugs. And this is not hypothesis, this is a real-life situation – this happens every hour. In working here, the fake drugs is an issue, you know, because the parents would have given some drugs and they would have tried several things, some of which would have been ineffective because they are fake.
Dr Meremikwu is not alone in his belief that many, if not most, malaria deaths are the result of children being given useless medicines. Yet this racket in fake pharmaceuticals, has until recently has been largely ignored by governments, major drug companies and the media, at a terrible human cost.
DR DORA AKUNYILI, HEAD OF NAFDAC: We had about 80% of drugs in circulation that’s fake, people were dying like rats, out healthcare delivery system was losing credibility, our doctors were confused and it was a total disaster. The incidence of fake drugs is one of the greatest atrocities of our time – it is mass murder! Honestly, it is a form of terrorism against public health.
Dr Dora Akunyili is the head of the Nigerian Food and Drug regulation body, known as NAFDAC. This London-trained pharmacist was one of the first people to act and speak out to save patients from the hidden dangers of fake drugs.
DR DORA AKUNYILI: They hide the drugs inside various commodities. We have some T-shirts here – these are babywear – there are drugs hidden inside the babywear and we had millions of shirts with many, many billions of the drugs.
REPORTER: What kind of drugs are they?
DR DORA AKUNYILI: They had everything down to insulin, anti-snake venom, multivitamins, antibiotics.
Doctor Akunyili’s passion to stop the use of fakes is driven by personal tragedy.
DR DORA AKUNYILI: My sister was a diabetic and she was taking rubbish insulin. Her blood sugar could not be controlled. She eventually died. Even before she died she had an injection – the antibiotics she was getting were all fake and she just slowly, slowly died. That was in 1988. The doctors were all confused, we were confused. I’m a pharmacist, my husband a medical doctor, yet we were just looking at her dying.
But waging her war on the racketeers became a very dangerous business.
DR DORA AKUNYILI: The first thing the drug counterfeiter does is to have discussions on how you can work together.
REPORTER: And you couldn’t be bribed?
DR DORA AKUNYILI: Nobody can bribe me, by the grace of God. Why should anyone bribe me? You know how many millions of people have died from using fake drugs. My own sister died. That is blood money.
Unable to bribe her, the fake drug gangs tried to kill her. She was attacked in a hail of gunfire while she was on the road.
DR DORA AKUNYILI: So many assassination attempts in this country have happened in traffic jams.
A bullet pierced her headscarf, grazed her skull and eventually killed a bus driver who pushed into her convoy.
DR DORA AKUNYILI: Because the man wanted to be part of my convoy, he took the bullets.
Now she travels the busy streets of Lagos in a bulletproof car with full police escort.
DR DORA AKUNYILI: This is one of the busiest parts of Lagos, you cannot just walk here with your camera. Women are less prone to corruption than men. Even in NAFDAC, we no longer post men to some positions. Like, we no longer post men to take charge of the ports or to take charge of registration. No, we don’t do that anymore because we run into a lot of problems. I don’t believe that men being easily compromisable is an African problem because even in your country, Australia I don’t know how many men in your country can be offered millions of your currency and the man will say no, but some women will reject it, yes. Elizabeth, this is my director of enforcement. He is rare – he’s a man, but he’s not corrupt. But he’s a man. I said men are more susceptible to corruption.
NAFDAC DIRECTOR: That’s general all over the world, it’s not peculiar to Nigeria.
DR DORA AKUNYILI: Why are you more susceptible to corruption?
NAFDAC DIRECTOR: We’re more exposed than women, we have to struggle generally for the survival of the world, including women and children.
Until her arrival in 2001, NAFDAC, like many other government organisations in Nigeria, was corrupt. Drug importers simply paid a bribe to get their products on the market. But Dr Akunyili changed all that. The counterfeiters fought back hard, burning down NAFDAC labs and facilities, including these headquarters.
DR DORA AKUNYILI: Fire started at all corners at the same time. These used to be our offices. My offices were from that end to here, everything burnt down. I had lots of important documents here belonging to NAFDAC.
REPORTER: Do you know who did this?
DR DORA AKUNYILI: Of course, everybody knows, not just me, drug counterfeiters. It was syncronised bombing. In one week, many of our facilities across the country. The presiding judge released them after a year and a half, he said he had no jurisdiction to hear the case.
Despite Dr Akunyili’s campaign, there are still no severe penalties for drug counterfeiting. It’s considered nothing more than a copyright infringement.
DR DORA AKUNYILI: You see, because the laws against drug counterfeiting are weak and at the same time it is as lucrative as other criminal activities, criminals are now shifting from gun-running and carrying of cocaine, heroin and other hard drugs to counterfeiting of medicines.
It’s very hard, even for healthcare professionals, to tell the difference between genuine and fake medicines.
DR DORA AKUNYILI: This here is the original Halfan tablet and this is the fake ones. If you look at the packaging closely you can hardly tell the difference.
While the outside packaging can be a perfect copy, the tablets are often no more than chalk or rice starch. Life-saving vaccines and syrups are nothing but polluted water.
DR DORA AKUNYILI: Another fake product, it is manufactured in China. It is chloroquin injections.
MC: The special guest of honour and chairperson for this morning’s program. The only man of the year anywhere in the world who is a female.
Dr Dora, as she is known to millions of Nigerians, is now a national hero.
MC: Nigerians were asked to name four people who could lead Nigeria after OBJ and she came up very prominently as one, so those of us in NAFDAC, we have to encourage her.
She set about cleaning up corruption and issuing vital public warnings to Nigerians about which drugs to avoid.
DR DORA AKUNYILI: It has been causing havoc, killing people, maiming people, we continued using it out of ignorance.
Later that day, Dr Dora’s NAFDAC enforcement officers scour the streets of Lagos on the look-out for hawkers selling fakes.
NAFDAC DIRECTOR: Many of the people we are likely to catch now do not know that NAFDAC enforcement officers don’t have any hours of work, we can work at any time.
They’re heading to one of the city’s most popular beaches.
NAFDAC DIRECTOR: OK. There’s one, there’s one!
The officers swoop on this man. He’s selling a range of counterfeit medicines from multivitamins to antibiotics.
NAFDAC DIRECTOR: We are trying to see if we can catch them relaxing and selling to beach users. OK, from our surveillance, many of the hawkers retire here in the evening hours to be patronised by the users of the beach. So we hope to catch more of them.
After the sun goes down, they raid a nearby market. Under the cover of night, the hawkers are more confident selling fakes.
OFFICER (Translation): Do you know you’re doing wrong? Do you know what you’re hawking is fake?
HAWKER (Translation): Please have mercy.
OFFICER: We’re not catching these people because we don’t like their faces.
In less than an hour, the NAFDAC officers make another three arrests.
OFFICER: Put him into the vehicle.
They’re taken back to the NAFDAC headquarters for interrogation.
OFFICER: Why are you selling fake drugs and they harm people? Would you like to be harmed yourself?
HAWKER: They are not fake, sir.
OFFICER: Where did you buy them from? But why are you doing it?
HAWKER: For our children. I need to prop up their condition. I don’t know what I would do, else.
OFFICER: You want to kill people?
HAWKER: Only yesterday I started.
OFFICER: You had opportunity to do legitimate business, but it’s greed and avarice that is pushing you to sell fake drugs to kill people. Am I correct?
The NAFDAC team has a hard time getting any information out of these small-time crims. The racket is now a vast global black market worth about $40 billion a year. According to the WHO, around 10% of all the world’s medicines are now counterfeit. Yet as the deadly trade grows, so too does the secrecy that surrounds the business.
DR DORA AKUNYILI: It is hard to speak out about counterfeit drugs without affecting legitimate business, that is the reason for the silence. And it is this silence that is largely encouraging drug counterfeiting.
Dr Dora was part of an Oxford University investigation into the fake drug cover-up. She published her results in an influential US science journal. The results were staggering. It was claimed that pharmaceutical companies and governments did not want to go public with the fake drug issue for fear of hurting profits.
JOURNAL READING: “…the justification for secrecy is to avoid any alarm that could prevent patients taking their genuine medicines….this secrecy, and the subsequent lack of public health warnings, is harming patients.”
REPORTER: So all these deaths that have occurred from fake drugs could have been prevented had government and companies
DR DORA AKUNYILI: Cooperated. All these deaths from fake drugs would have been prevented if governments came out to fight it the way the Nigerian Government is fighting now and if companies also came out to collaborate with government it would have been stopped a long time ago and it wouldn’t have lasted for almost 30 years. That’s ridiculous, almost 30 years. In Nigeria, fake drugs have been killing people from the early ’70s.
The fake drug racket has been hidden for decades. But it was first highlighted in this 1940s film classic, ‘The Third Man’. Orson Welles played racketeer Harry Lime, selling deadly penicillin in the back streets of Vienna.
‘THE THIRD MAN’ FILM EXCERPT – JOSEPH COTTON: Have you ever seen any of your victims?
ORSON WELLES: You know, I never feel comfortable in these sort of things. Victims? Don’t be melodramatic. Look down there. Would you really feel any pity if one of those dots stopped moving forever? If I offered you can have £20,000 for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spend, free of income tax, old man, free of income tax.
After a long silence, drug companies are finally beginning to speak out about this deadly racket.
REPORTER: In the past, drug companies have been very secretive about this problem. Could you tell me why?
COLIN CUMMINS, SWISS PHARMA NIGERIA MANAGING DIRECTOR: I think that’s obvious, the reason it’s secretive is that you don’t want to tell people that there’s a product out there that looks like your product but is not your product. You have to balance the publicity of a product being faked and the damage that it can do to your product. Obviously, in the past a lot of big companies wouldn’t say anything about it because they didn’t want their original product to be damaged by a fake, if it was that close.
REPORTER: But then the consequences of these fake drugs have been many deaths?
COLIN CUMMINS: I don’t know how you would equate that, I have no idea on figures.
REPORTER: Because of fake drugs there’s been a resurgence of malaria over the years.
COLIN CUMMINS: That one I don’t know, I don’t think that is really the case. I don’t know if the fake drugs has caused that, or whether it’s the malaria parasite that’s mutating and getting used to the products that are there.
DR DORA AKUNYILI: The fake drug racket and the silence associated with it have led to the resurgence of malaria especially chloroquim-resistant malaria, which is a greater problem now than malaria itself.
REPORTER: Why’s that?
DR DORA AKUNYILI: Chloroquin-resistant – that is, malaria that is now resistant to a normal dose of chloroquin, because the malaria parasite had been kind of trained with small small doses of chloroquin previously taken by malaria patients. When you take small doses of chloroquin or antibiotics what you are actually doing is training the micro-organism to get used to the chemical. The chemical eventually becomes food for the micro-organism, so that when you now have the right dose of chloroquin the malaria will no longer respond, that is the problem now.
DR MARTIN MEREMIKWU: When we lost chloroquim, we also lost millions of lives with chloroquim because the drugs don’t work then the children are going to die from it.
In Swiss Pharma’s high-tech plant, legitimate anti-malarials are being produced. But a series of malarial drugs have failed due to resistance. According to the World Health Organisation, Africa’s last hope, a new anti-malarial drug called artesunate, is already showing signs of premature resistance. The WHO has warned that without an effective treatment Africa’s 500 million malaria sufferers face a disaster. But it will take 10 years to develop a new drug if artesunate fails. Public attention is, at last, being drawn to Africa’s malaria victims.
Microsoft billionaire Bill Gates has spent hundreds of millions of dollars in developing new anti-malarial drugs.
BILL GATES: That can reduce the burden of malaria quite significantly.
Gates says it’s a disgrace that the world ignored malaria for 20 years. Yet in all the publicity surrounding Gates’ investment in new drugs, there’s no mention of the role of fakes. And Dr Dora says it’s not worth developing new malaria drugs until the racket is properly addressed.
DR DORA AKUNYILI: All those drugs will not help us because the counterfeiters are always moving to be ahead of us. They will go and produce fake artesunate and fake whatever higher drugs we want to replace chloroquin with and the problem will be worse. When we get artesunate-resistant malaria, where do we go from there?
Today, Dr Dora’s NAFDAC team is continuing its war on fakes. They’re about to burn $2.5 million worth of counterfeit medicine.
NAFDAC DIRECTOR: They’re made up of products seized during enforcement activities.
A public display with the local media invited to help sell the message. But even here, the problem won’t go away. A gang of thieves has apparently sneaked in the night before to try and pilfer the stockpile.
MAN: These useless people.
REPORTER: Do you realize fake drugs kill people?
THIEF: I’m not a dealer of drugs.
NAFDAC DIRECTOR: These are fast-moving products that they targeted and were removing. For them to target fast-moving products means they’re conversant with this business.
THIEF: All of them have run away.
NAFDAC DIRECTOR: That means there are many of you! Make us a statement, you link all the people who can be linked because all the people who are going to interview you are experienced police investiigators.
THIEF: Help us, we are human beings, I have never sinned in my lifetime. I am doing this to earn my daily bread.
These thieves are just small fry. Catching the producers requires full cooperation from governments and companies around the world. With the problem ignored for so long, how many more years and how many more lives will be lost, before real action is taken?