The next time you're tempted to buy Viagra, Lipitor or some other medication online, ponder this: there's a high likelihood that what you buy will be fake. The pill or vaccine may contain a much smaller dosage than stated, or it may lack any active ingredient whatsoever. Worst of all, it could be toxic. According to the World Health Organization (WHO), more than 50% of drugs sold online have either been falsified or altered in some way. And Internet sales are just the tip of a much bigger problem. Falsified medicines are especially prevalent in developing countries; the WHO estimates that up to 30% of drugs sold in parts of Africa, Asia and Latin America are fake, including ones used to fight diseases like malaria and tuberculosis.
The issue has long been a preoccupation of major pharmaceutical companies, which lose as much as $75 billion in business every year to counterfeit-drug makers, according to WHO estimates. In 2002, the industry set up a Washington-based agency called the Pharmaceutical Security Industry, run by Thomas Kubic, a former FBI deputy assistant director, to try to tackle the problem. And four years later, the WHO launched an international task force dedicated to the issue. But so far, such efforts have merely highlighted the growing trade. The Pharmaceutical Security Industry tracked more than 1,800 incidents of drug-counterfeiting around the world last year, 10 times the number when it first started monitoring seven years ago. Getting governments and law enforcers around the world to work more effectively to counter the problem has proved hard.
But that may be starting to change. On Monday, the Presidents of two African countries, Thomas Boni Yayi of Benin and Blaise Compaoré of Burkina Faso, will be among a cluster of international dignitaries and industry experts who will make an international call for action against counterfeit drugs in Cotonou, Benin. The initiative is the brainchild of Jacques Chirac, the former French President, who wants to make the Cotonou declaration the first step of a worldwide campaign aimed at raising awareness of the problem and persuading governments to impose tougher penalties and improve routine testing of medications. The larger goal is to establish an international convention on counterfeit drugs as early as next year. Marc Gentilini, a French medical professor and expert on tropical diseases who is advising Chirac, says the problem is urgent. The lack of clear international rules governing counterfeit medicines, he says, means that trafficking them is currently "less risky and more lucrative than trafficking narcotics."
Certainly, there's now an abundance of evidence of brazen criminal activity. More than 80 babies in Nigeria died earlier this year from teething medicine that contained the toxic coolant diethylene glycol. In July, authorities in Bangladesh seized supplies of a poisonous acetaminophen syrup that had killed 24 children. In Argentina, several women died in 2004 after receiving injections of a falsified iron-based medicine to treat anemia. And in 2006 more than 100 people in Panama died after taking medicines made with fake glycerin. Many times, the counterfeit drugs just don't work. This leads to a large number of preventable deaths, particularly in the developing world.
The problem is not limited to poor countries, however. When Pfizer recalled 120,000 packs of its cholesterol drug Lipitor in Britain in 2005 after it discovered a counterfeit version, it found that 60% of all the returned packs were fakes. Jacques Franquet, who heads security operations for the French drugmaker Sanofi Aventis, says his teams routinely find fake versions of about 15 of the company's drugs worldwide.
The major pharmaceutical companies have been at the forefront of the campaign to crack down on the problem. All have growing security divisions that track illegal medicine-trafficking and gather evidence to give to law-enforcement agencies to help them take action. Pfizer has also started experimenting with safer packaging. For example, all its Viagra blockbuster packs in the U.S. now have a radio-frequency-identification tag. Merck, meanwhile, is funding the distribution of minilabs to developing countries to improve detection of fake ingredients in drugs used to combat malaria, HIV and tuberculosis.
But experts say governments also need to step up enforcement of laws in order to effectively tackle the problem. The U.S. and Britain have special police units to deal with falsified medication, but most other countries lag behind, Franquet says. Kubic says that political efforts to fight the problem have flagged in recent years, mainly because countries like India and Brazil fear that the large amounts of generic drugs they produce legally may be mistakenly targeted in a global crackdown on fake-drug-trafficking.
The Chirac initiative is treading carefully at the start. Organizers make clear that the Cotonou declaration isn't aimed at generics. And they avoid using the word counterfeit since this term is often associated with intellectual-property issues and could lead some to believe that the initiative is aimed at protecting pharmaceutical companies' profits, not safeguarding public health. Franquet says it's important for public opinion to be mobilized against fake medicines, and he believes that given the sometimes tragic consequences, this should be easy to accomplish. "This is one of the rare areas where the public is on our side," he says.