By the time the teenage boy was standing in front of Bernice Bornmai, feverish and delirious, it was too late.
It was not just the malaria that was killing the 17-year-old, it was the time that he had wasted taking fake medicine. The anti-malarials did nothing to stop the disease marching through the young Ghanaian’s body: His organs were already shutting down.
“He died waiting to be taken to a larger teaching hospital for dialysis,” said Bornmai, senior medical officer of a small hospital in Accra. “It was one of my saddest cases, but I have lost other patients who would have survived, too, because of fake medicines.”
Illustration: June Hsu
It is not just ineffective malaria medication that can prove fatal.
Bornmai’s patients have sometimes taken counterfeit antibiotics that not only do not fight the illness, but also increase bacterial resistance to effective medicines.
“Sometimes I just throw up my hands when I see the results showing which antibiotics have a chance of working — often they are not readily available or too expensive,” the doctor said. “It makes my work frustrating and it means patients have to stay here longer while I investigate.”
When it comes to trying to stop fake medicines getting into the hands of sick patients, experts describe a difficult task where they are constantly trying to stay one step ahead of counterfeiters.
Law enforcement and legislation are needed, strong pharmaceutical regulation has to be in place and well-trained healthcare professionals are essential, said Cynthia Genolet, an Africa policy expert at the International Federation of Pharmaceutical Manufacturers. “You can’t focus on one specific dimension to be successful in this fight — it has to be a holistic effort.”
Genolet is a member of Fight the Fakes, a campaign group launched in 2010 to raise awareness of the problem among pharmacists and industry.
One tool that campaigners hope would have an effect is the harnessing of emerging technologies such as blockchain and artificial intelligence (AI), which have the potential to help in dealing with the complexity of the task at hand.
A handful of new start-ups are focusing on tracing medications on blockchain-type technologies, as well as arming consumers with instant information about what they have bought.
For example, the Nigerian start-up RxAll has created a handheld scanner that can assess the compound of a drug in real time. The device connects to a cloud-based database of information of what the drugs should contain, which then feeds back that information.
“The information collected is a spectral signature of the drug, and once checked, the database sends back information to an app on your phone,” cofounder Adebayo Alonge said.
The vast information database is updated using an AI algorithm.
“The app also shows you the other parts of your city that the drug has been tested in, meaning that you can see where bad patches and bad suppliers are,” Alonge said.
Alonge and his colleagues in October last year launched Rxall and have launched it in countries such as Ghana, Cambodia and Kenya. It has been in use commercially in Myanmar and has been sold to a large Nigerian teaching hospital and to the Nigerian National Agency for Food and Drug Administration and Control, whose officials have begun training to use it.
It is a personal cause for Alonge, who nearly died at the age of 15 after taking what turned out to be fake Ventolin for his asthma. The toxic tablets put him in a coma for 21 days, and it took six months for him to completely recover. That experience motivated him to train as a pharmacist himself before starting RxAll.
Raja Sharif, chief executive officer of the UK-based data company FarmaTrust, was also motivated by personal experience. He began researching the problem after he found out that a relative had taken fake medicines.
FarmaTrust offers a way to trace data about medicine moving through the supply chain on blockchain, a technology originally created for the purpose of buying and selling bitcoin without going through a server belonging to a bank or government that could be hacked.
“The issue with fake medicines is that they usually enter the middle of the supply chain, not at the top at the point of manufacturing,” Sharif said. “The useful thing about blockchain is that it creates an incorruptible record. Once you’ve made a record, you can’t make it again or alter it.”
Another benefit of this technology is that information can be shared between pharmaceutical companies about what is going on in their supply chains on a need to know basis, he said.
As they are siloed and competing with each other, vital information that could root out fakes might not be shared.
Blockchain looks as though it can become an effective tool, said Oksana Pyzik, a senior lecturer at University College London’s School of Pharmacy and a campaigner for Fight the Fakes.
“I think based on the fact that the FDA [US Food and Drug Administration] is already piloting blockchain in the pharma supply chain in the US suggests that it’s a way forward to get the highest quality track and trace, and the cost is not as prohibitive as it was once,” said Pyzik, who organized a panel on the topic of technology and fake medicines at the WHO’s World Health Assembly in May.
“Technology alone is not enough. However, it’s a very effective tool — but we also still need to talk about human behavior and corruption,” Pyzik added.
A much simpler tech solution pioneered by Ghanaian company mPedigree offers a different approach. The company founders began by placing serial numbers under scratch card surfaces on medicine bottles at the point of manufacture, and consumers can then check the text to see if it matches their database before taking it.
“The company has grown because the counterfeiters grew,” said Selorm Branttie, who co-founded the company with social entrepreneur Bright Simmons. “We’ve studied where breaches happen in the supply chain and we counteract them.”
The company has offices in Nigeria, Ghana, Kenya and India, and has branched out into tackling counterfeiting in the food supply chain too.
“Happily, from when we began until now, the prevalence of counterfeiting has dropped from the estimated 30 percent of the Nigerian pharmaceutical sector to less than 10 percent today,” Branttie said.
“We are now looking into ways that we can use blockchain, too — blockchain helps to demonstrate that we are ourselves trustworthy, because it’s a permanent public ledger and therefore can show the data we have collected,” Branttie said.
The need for any solution under development to have a global reach is clear. Interpol in 2011 seized 2.4 million fake and illicit pills, and that number jumped to 20.7 million seized in 2015. A large quantity is produced in China, but India, Pakistan, Paraguay and the UK are also among the top sources for fakes.
An estimated 116,000 people die from malaria from ineffective anti-malarial drugs in sub-Saharan Africa, the London School of Hygiene and Tropical Medicine said.
The WHO estimates that 72,000 to 169,000 children might be dying each year from pneumonia due to “substandard and falsified antibiotics.”
Counterfeited medicines — thought to be the most lucrative of illegally copied goods traded — end up all over the world, but developing countries, where spending on medicine means paying out of pocket for most people, are the most vulnerable to counterfeits. Most of the cases (42 percent) reported by the WHO from 2013 to 2017 were found in sub-Saharan Africa.
The EU last year launched its track-and-trace directive to combat falsified medicines in Europe. The African Union in the same year voted unanimously to found an African medicines agency, something that has been welcomed as a move that would help strengthen regulation across the continent.
Organizations such as the Safe Medicines Foundation in Nigeria, launched earlier this year, are springing up. The foundation hopes that its medical professionals can help pharmacists recognize the signs of fake logos and learn how to store medicines correctly.
Slowly, the fightback is taking shape, but it is still a mammoth task.
Bornmai said that she noticed her patients have been asking her more questions about fake medicines.
“People are getting to know about fake medicines. They ask me if I’ve heard of a certain drug, or whether it’s safe to take,” she said.
Technology can help speed up the process of checking something — saving days or weeks that could be lost to laboratory testing, Bornmai said, but consumers ultimately still need quality medicine to reach their local markets.
“An individual could scan a medicine and find that it is fake, then go to the next shop, scan again, and find it’s fake again,” she said.
Most importantly, it is informing and educating the public that can save lives, she said.
“Giving individuals more power, through education and the right information, to choose the medication that isn’t harmful is the most important thing that I want to see. It is a universal right to choose medicine that won’t harm you,” Bornmai said.
The cancelation this week of President William Lai’s (賴清德) state visit to Eswatini, after the Seychelles, Madagascar and Mauritius revoked overflight permits under Chinese pressure, is one more measure of Taiwan’s shrinking executive diplomatic space. Another channel that deserves attention keeps growing while the first contracts. For several years now, Taipei has been one of Europe’s busiest legislative destinations. Where presidents and foreign ministers cannot land, parliamentarians do — and they do it in rising numbers. The Italian parliament opened the year with its largest bipartisan delegation to Taiwan to date: six Italian deputies and one senator, drawn from six
Recently, Taipei’s streets have been plagued by the bizarre sight of rats running rampant and the city government’s countermeasures have devolved into an anti-intellectual farce. The Taipei Parks and Street Lights Office has attempted to eradicate rats by filling their burrows with polyurethane foam, seeming to believe that rats could not simply dig another path out. Meanwhile, as the nation’s capital slowly deteriorates into a rat hive, the Taipei Department of Environmental Protection has proudly pointed to the increase in the number of poisoned rats reported in February and March as a sign of success. When confronted with public concerns over young
Taiwan and India are important partners, yet this reality is increasingly being overshadowed in current debates. At a time when Taiwan-India relations are at a crossroads, with clear potential for deeper engagement and cooperation, the labor agreement signed in February 2024 has become a source of friction. The proposal to bring in 1,000 migrant workers from India is already facing significant resistance, with a petition calling for its “indefinite suspension” garnering more than 40,000 signatures. What should have been a straightforward and practical step forward has instead become controversial. The agreement had the potential to serve as a milestone in
China has long given assurances that it would not interfere in free access to the global commons. As one Ministry of Defense spokesperson put it in 2024, “the Chinese side always respects the freedom of navigation and overflight entitled to countries under international law.” Although these reassurances have always been disingenuous, China’s recent actions display a blatant disregard for these principles. Countries that care about civilian air safety should take note. In April, President Lai Ching-te (賴清德) canceled a planned trip to Eswatini for the 40th anniversary of King Mswati III’s coronation and the 58th anniversary of bilateral diplomatic
RSS