Yesterday Reuters reported a story of fake drugs produced in China that was subsequently carried by the Independent. Although three types of drugs were mentioned, it was the fake Viagra that captured the headline. Not surprisingly fake bird flu and malaria medicines did not attract as much attention in a story geared to the western press. This falls on the heels of other discoveries of fake or adulterated products from China ranging from pet food to toothpaste, again products of greater interest in the western world.
Still, more people are likely to die or be harmed by fake malaria drugs than fake Viagra. Other fake drugs from China have over the past years killed children in Nigeria and Panama. There is real concern because China is one of the world’s major suppliers of malaria drugs, especially the newer artemisinin-based drugs developed from a Chinese herb that are being adopted as first line treatment in endemic countries.
Three steps by the World Health Organization may help. WHO recommends artemisinin-based combination therapy (ACT) as first line treatment. These combinations include artemisinin and another drug for which there is no parasite resistance. The second step is coming out clearly and stating that monotherapy artemisinin drugs should be withdrawn from use to prevent the spread drug resistance and increase the useful life of the new artemisinin-based medicines. Finally, WHO has a program for pre-qualification of drugs that focuses on quality issues. The main ACT recommended on that list is artemisinin-lumefantrin (AL), which is produced by one company and has tight quality controls. AL is the drug favored by major donor and NGO programs.
Where dangers may arise is within the commercial pharmaceutical sector where monotherapy artemisinin drugs (see picture) are still available and where ACTs that have not received pre-qualification status are sold. Each malaria endemic country has some form of a food and drug authority that should license and regulate drugs. If these agencies are empowered to do their job, the public will also be protected from fake or inappropriate malaria drugs on sale in shops and private clinics.