The swamping of South-east Asia with fake antimalarials is a massive threat to health that is likely to spread to Africa, says Dr Paul Newton of the Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration in Laos. This illegal and pernicious trade could be responsible for thousands of deaths, as fake drugs often contain no active ingredients, subtherapeutic levels of active ingredient and even toxic substances.

Dr Newton has worked with colleagues in South-east Asia, Europe and the USA to raise awareness of this growing threat. At least eight of the 14 main types of antimalarial drug are being counterfeited, including artesunate, a highly efficacious treatment for potentially fatal falciparum malaria and a key component of ACT (artemisinin combination therapy).

A shopkeeper in Kenya. Many people in Africa obtain antimalarial drugs from local stores, and there are worries that they could be a route by which fake medicines are sold. Credit: Caroline Penn

Recent studies have found that about half of all 'artesunate' packs bought in South-east Asia are fake, with the majority sampled in some research containing no artesunate.

The situation is exacerbated by increasingly sophisticated counterfeits, with highly realistic holograms on the fake packaging. High prices, high demand and a shortage of raw material mean that an epidemic of fake artesunate in Africa is highly likely.

The World Health Organization is set to launch IMPACT (International Medical Products Anti-Counterfeiting Taskforce), which is expected to work with pharmaceutical manufacturers to make drugs harder to fake, and easier to trace from factory to consumer. IMPACT will also tackle the under-reporting of fake drugs by consumers, healthcare providers and pharmaceutical companies.

Dr Newton and colleagues hope to set up a network to detect and analyse counterfeit antimalarials, to assist drug regulatory authorities and to pinpoint where fakes were made.

Image credit: C Penn

External links

• Newton PN et al. Counterfeit anti-infective drugs. Lancet Infect Dis 2006;6(9):602–13.
• Newton PN et al. Manslaughter by fake artesunate in Asia – will Africa be next? PLoS Med 2006;3(6):e197.