Fake drug danger for SA

Syndicates driving sales of counterfeit medicine to desperate patients a huge public health concern

ORGANISED crime networks are doing a roaring trade in counterfeit pharmaceutical products smuggled into the country and into the hands of desperate or unsuspecting consumers whose lives could be at risk.

This trade came into sharp focus in research by Dr Trevonia Nihal, who recently graduated with a PhD in Criminology and Forensics Studies from the University of KwaZulu-Natal.

Nihal’s investigations showed that the illicit medical products brought into the country via land borders and ports included knock-offs of prescription drugs.

A recent study by the World Health Organization showed that 20% of Africa’s medicines were not genuine.

Also startling for her was how well presented the counterfeit medication was, which easily duped users into believing it was the real deal, oblivious to its dangers.

“That was one of the scariest discoveries I made. It presents a huge public health concern,” said Nihal.

To extract first-hand knowledge of the supply chain operations of counterfeit pharmaceutical syndicates, Nihal’s sample group consisted of 25 seasoned policemen well versed in and dedicated to busting drug rings.

She learnt how illegal medicines changed hands in shops and stalls around Durban’s CBD and other places. It is also sold on social media platforms and online.

Some of the items sold included Grandpa products, Movate creams, Viagra, birth control pills, antibiotics and diabetes medication.

While the poor were impacted the most, Nihal found it was not exclusive to this group because well-off people were also prone to self-medicate to reduce living expenses.

Her research showed that accredited pharmacies generally remained “clean” provided their supply chain management was effective and monitored.

The South African Health Products Regulatory Authority (SAHPRA) referred to the recent WHO study confirming that substandard or falsified medication was a global problem.

SAHPRA communication and public relations manager Madimetja Mashishi said they were concerned about the proliferation of counterfeit medicines and had dedicated resources, used legislative frameworks and collaborated with other authorities in exercises to keep a lid on the situation.

The SAHPRA primarily controls the importation of medicines and other health products at official sea, air and land ports of entry.

“We have not detected counterfeit medicine within the legal pharmaceutical supply chain; however, we continue to empower our investigative resources to ensure we have a robust surveillance programme.”

Mashini said through their engagements with law enforcement authorities, they also noticed that illicit products were sold locally via social media and other informal channels.

Illustrating one of its successes, Mashini said: “During the Covid-19 pandemic, there was only one fake vaccine detected and seized. SAHPRA was part of that operation and conducted the testing that confirmed it.”

Nihal said the motivation for her research project was borne out of the pandemic.

“During lockdown we didn’t have easy access to medicines, but neighbours were trading with neighbours and others. Somehow people were getting drugs like Ivermectin when everything was shut.”

With Nihal and some of her family members relying on chronic medication, she said the feared running out of medicine and being unable to visit the pharmacy because of the lockdown.

Another concern was whether medication on pharmacy shelves were genuine.

Those issues prompted her research effort.

Nihal looked at cross-border transportation and realised the loophole.

As the lockdown levels eased she noticed more frequent news on police raids finding counterfeit medication, N95 masks and vaccines.

While considering legislation on counterfeit pharmaceuticals, she became curious about law enforcement agencies, policies and policy makers’ roles.

She also questioned what public interventions were in place to educate people about the dangers.

“I wanted to know whether people were told that it was unsafe to consume such products, also for children.”

Nihal figured that working closely with policemen dedicated to these types of crimes would be most effective, and accepted that she would be “tramping on some toes”.

“I handpicked officers from specialised units with five or more years of experience working with counterfeit pharmaceuticals and had been on raids before.”

Walking through the streets of Durban’s CBD to interview her respondents in their offices was one of the challenges she embraced to win their confidence and do effective research.

While the officers were efficient in their duties and understood the relevant legislation on counterfeit pharmaceuticals, she found almost all were “not aware of a single public health intervention that was available to help people on this matter”.

“It shocked me. They did not advise people who had used such products to have tests done at a general practitioner or suggest any other form of help that was available” if it was needed.

Nihal believed that while the officers were excellent policemen, they needed more resources and to collaborate with the Department of Health, especially to disseminate information on available public health intervention programmes.

“It’s not the SAPS’ job to educate the public, the DoH should be doing that,” she said.

Nihal said the unavailability of affordable medicine was one of the major factors contributing to the proliferation of counterfeit pharmaceuticals.

“Desperation is a big factor, some had no other choice.

“It’s worse in rural areas where counterfeit pharmaceuticals and substandard medication are concepts that many have not heard about before, and under-pressure doctors don’t have the time to educate every patient.”

South African Pharmacy Council registrar and CEO Vincent Tlala said a pharmacist must report suspicious medication to the SAHPRA or other competent authorities.

“The purchase, possession, sale, supply or dispensing of an unregistered medicinal product, is considered unprofessional conduct and subject to disciplinary action.”

Tlala said some of the possible outcomes from disciplinary action was termination of membership and recommendations on the way forward were then handed to the SAHPRA.

Based on their findings, the SAHPRA could pursue criminal charges.

The Independent on Saturday made several appeals over three days for comment from the Department of Health and the SAPS, but neither had responded by last night.