Michelle argues that the rampaging Ebola epidemic may be further exasperated by the proliferation of counterfeit medication used to treat Ebola symptoms. Vigilance by national governments and the international community, including the WHO, is necessary to stem the rise of counterfeit drugs in West Africa.
In late August, a 10 year-old Liberian boy, Saah Exco, was removed from a Monrovian holding cell for suspected Ebola patients, when it was taken over by a mob. Some time later, local residents found the boy, naked and alone. They clothed him and brought him to an alleyway, where he was left abandoned since residents feared to hold or even touch him. Efforts were made to take the boy to a local clinic but the clinic refused to treat him. Saah Exco’s story is not unusual. It touches on the issue of social stigmas and fears around Ebola and raises the question of what interventions are being used to treat patients in West Africa.
The current Ebola outbreak, primarily located in the West African countries of Liberia, Guinea, Nigeria and Sierra Leone, has resulted in more than 8,300 confirmed and suspected cases, and more than 4,000 deaths. Several anti-viral drugs including ZMapp and Chimerix have been used on an emergency basis to treat Ebola patients in the U.S. In Liberia, lamivudine, an HIV drug, has been tried with some success. That said, according to the World Health Organization (WHO), there are currently no licensed vaccines or cures for the Ebola virus. Ebola can only be treated through early supportive care of the symptoms.
It is at this moment, in the face of the ever-spreading Ebola virus, that the risk of proliferation of counterfeit medications should be paramount on our minds. Counterfeit medications are medicines that have the wrong ingredients, have no active ingredient, have insufficient active ingredients or at times contain harmful chemical compounds. Estimates for the global value of counterfeit goods range from a $250 billion to $1.7 trillion a year industry, the latter of which is over 2% of the world’s current economic output. There exists no reliable estimates for the global economic value of counterfeit medicines.
Counterfeit goods and fraudulent medicine pose a serious risk of ravaging the medical supply chain in West Africa. It is during times of instability, when there is a high demand for medications, and a low supply, that criminals put fake goods into the supply chain and gain wealth from this scheme. Antibiotics, pain-killers and cough medications are amongst those which the WHO has said are vulnerable to counterfeit. These are just a few of the medications that may be required to treat the symptoms and infections that result from Ebola.
The African pharmaceutical market has had a long history in the battle against fraudulent medicines. The WHO has said that fraudulent pharmaceuticals amount to as much as 30 percent of the African market. While we don’t know the number of counterfeit medicines that may have been used to treat Ebola symptoms, we do know that one third of malaria medicines used in East Africa and sub-Saharan Africa are fraudulent.
What is necessary now is vigilance. The countries most affected by Ebola have acceded or ratified the United Nations Convention against Transnational Organized Crime (UNCTOC). The UNCTOC commits its members to fight organized crime, including illicit trafficking of counterfeit goods, by ensuring that their national laws criminalize this conduct. Strong implementation and enforcement of national laws will deter counterfeiters from engaging in more prolific schemes since they will fear prosecution by national authorities. In order to effectively reduce the counterfeit market, national authorities, including health workers, law enforcement and the judiciary, must prioritize investigations and sanctions of this conduct.
The current outbreak of Ebola has ignited debate and critiques concerning appropriate medical interventions. For Saah Exco, the medical interventions were ineffective. Saah was eventually taken to John F. Kennedy Memorial Hospital in Monrovia. Like his mother before him, Saah died of Ebola. We will never know whether Saah was treated with authentic medications. The challenge looking forward is to ensure that future deaths from counterfeit medications are prevented.
Michelle Ratpan works as a Litigation Specialist for the Integrity Vice Presidency of the World Bank. Michelle is an LLM graduate from Georgetown Universities Global Health Law Program.
The views expressed in this article are solely those of the author and do not express the views of the World Bank, its Board of Executive Directors or the Governments they represent.