The World Health Organisation estimates that counterfeit drugs constitute 10 % of the global market, and up to 25 % of the total medicine supply in less developed countries (LDCs). In Africa and South East Asia, more detailed sampling found that between 30 and 60 % of medicines were substandard. Fake medicines are also highly prevalent in Latin America and other parts of Asia. The largest producers of fake medicines seem to be India and China [1]. These figures have major implications for the Pharmeceutical drug industry, which losses up to $75 Billion a year to counterfeit drugs [2]. According to the WHO, types of counterfeit medicines can be grouped into six categories:
- Products without active ingredients, 32.1%;
- Products with incorrect quantities of active ingredients, 20.2%;
- Products with wrong ingredients, 21.4%,
- Products with correct quantities of active ingredients but with fake packaging, 15.6%;
- Copies of an original product, 1%; and
- Products with high levels of impurities and contaminants, 8.5%. [3]
The International Policy Network's 2009 study, Keep it Real, notes that fake drugs pose three direct threats to patients:
- Failure to provide effective treatment. As fake drugs usually contain insufficient bioavailable active ingredient, a patient who believes he is addressing his disease is in fact going untreated. The disease thus progresses, often leading to death, especially in children and the elderly. They estimate that approximately 700,000 deaths from malaria and tuberculosis are attributable to fake drugs.Products without active ingredients, 32.1%;
- Adulteration with toxic chemicals, often leading to death or injury. There have been numerous deaths due to consumption of cough syrup contaminated with anti-freeze, including 84 children in Nigeria in 2008. In 2008 contaminated Heparin from China killed 62 people in the US.
If a drug contains some active ingredient but too little to kill all the disease agents, it can lead to the emergence of drug resistant strains of disease. This is a serious problem with tuberculosis, Extremely Drug Resistant strains of which are now found in 49 countries, as well as malaria, with parasites in much of Africa and Asia now resistant to most drugs, except those based on Artemisinin – but there are worrying signs of emerging resistance to these drugs too. Resistance is also a serious problem for HIV medications.
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