The Fatal Consequences of Counterfeit Drugs

In Southeast Asia, forensic investigators using cutting-edge tools are helping stanch the deadly trade in fake anti-malaria drugs

Many medicines are too costly for Asia's rural poor (Cambodia's Leng Bo with her five children), who unknowingly turn to counterfeits. (Jack Picone)
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China's Ministry of Public Security launched its own investigation (it had also arranged for Mildenhall to analyze the samples' pollen). Finally, the authorities arrested three individuals—two buyers and a seller —in southern China for their roles in trafficking 240,000 blister packs of fake artesunate into Myanmar. They were all convicted: two of them were sentenced to one year and nine months imprisonment and one was sentenced to five months imprisonment.

But the manufacturers of the counterfeit artesunate were never found. And only one-tenth of the 240,000 blister packs were seized. The rest disappeared inside Myanmar, where nearly half of all malaria-related deaths in Asia occur, according to the Johns Hopkins Bloomberg School of Public Health.

With only three convictions, was it all worth it? Yes, says Mildenhall, who notes that the number of counterfeit antimalarial tablets entering Southeast Asia dropped the following year. "Just saving a few lives would have made it worthwhile," he adds.

Newton says he was "absolutely delighted" with the Chinese government's response. "We're not suggesting that's the end of the problem," he adds. "Police action will suppress [the trade] but won't eliminate it." And while the Jupiter Operation has emerged as an effective model for investigations into counterfeit drugs, such efforts require political focus as well as money, equipment and unique scientific expertise—all of which tend to be in short supply in developing countries.

In the meantime, Newton says a number of steps could stanch the distribution of counterfeit medicines: cheap, high-quality antimalarials must be made widely accessible; medical authorities in poor countries must be given the financial and human resources to inspect supplies; and health workers, pharmacists and the public must be made aware that drug quality is a matter of life and death.

Assistance from pharmaceutical companies will also be crucial. "They're often the first people to identify fakes, but there's a disincentive for them to declare that because it destroys their market," says White. "So they hush it up."

In 2005, White and Newton wrote to 21 major drug manufacturers, asking what their policy would be if they learned that any of their products were being counterfeited. Only three companies replied that they would contact drug regulatory authorities.

Newton praised Guilin Pharmaceutical for taking part in the Jupiter Operation. Still, confidence in Guilin-made artesunate appears to have been shattered. I spoke to the owners of a dozen mom-and-pop drugstores in Pailin, Cambodia, and none stocked Guilin's artesunate. "I don't dare sell it," says Ruen Mach, whose small shack in Cheav village brims with sun-faded packets of medicine.

Local residents once claimed they could tell the real thing by the quality of the packaging, or by the steepness of the mountain peak that makes up the Guilin logo. Not any more.

In another malaria-stricken area of Cambodia, I showed a medic named Rous Saut a photo of the two blister packs that Ouk Vichea had shown me.


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