According to researchers fake and poor quality anti-malarial drugs are threatening efforts to control the disease in Africa and could put millions of lives at risk. These counterfeit medicines could harm patients and promote drug resistance among malaria parasites, warns the study, funded by the Wellcome Trust.
Malaria killed 655,000 people in 2010, many of them African children, the World Health Organization said. Pregnant women are also at high risk from the mosquito-borne disease. Some of the fake tablets are said to have originated in China. The Asian origin of the fake drugs was identified using traces of pollen found in some of the tablets. The researchers, from the Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration, published their work in the Malaria Journal.
They examined fake and substandard anti-malarial drugs that were found on sale in 11 African countries between 2002 and 2010 and discovered that some counterfeits contained a mixture of the wrong pharmaceutical ingredients which would initially alleviate the symptoms of malaria but would not cure it. Some of the ingredients in the tablets could cause potentially serious side effects, the study found, especially if they were mixed with other drugs a patient might be taking, like anti-retrovirals to treat HIV.
The malaria parasite can, after a period of time, develop resistance to the drugs being used to treat it. This has happened in the past with medicines such as chloroquine and mefloquine. The researchers warn that the fake drugs could lead to the same effect on artemisinin, one of the most effective drugs now being used to treat malaria. They say small quantities of artemisinin derivatives are being put in some of the counterfeit products to ensure that they pass authenticity tests. However, at the level it is present, these drugs are unlikely to rid the body of malaria parasites, but could enable them to build up resistance to artemisinin, the study warns.
Professor Alan Cowman from the Walter and Eliza Hall Institute in Victoria says counterfeit anti-malarial drugs are not only potentially harmful to the individuals who consume them, but may also help the malaria parasite develop an immunity to artemisinin. “What the counterfeiters have done is basically watered down the level of drug in the tablet and then they've added in other things that will have no effect against that malaria parasite,” said Professor Cowman, one of Australia's leading malaria researchers. “The parasite will be able to grow but it'll be in a lower concentration of drug, not enough to kill it, but enough to enable it to get used to that level of drug and therefore it makes it more likely that it will develop resistance to that drug.”
The lead researcher on the study, Dr Paul Newton, called for urgent measures from African governments to tackle counterfeit anti-malarials. “The enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure…Failure to take action will put at risk the lives of millions of people, particularly children and pregnant women…The enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure,” he said. “It's very difficult to give accurate numbers of the scale…It's substantial, with hundreds of thousands of packets of fake anti-malarials circulating,” he added.
Dr Newton added that his study looked at their pollen content and chemistry make-up and have handed this information onto authorities. “We've been using that information to inform governments so they will be able to do their own criminal investigations…That work is being done in collaboration with Interpol and it has succeeded in cutting at least some of the trade in South East Asia.”
Unfortunately, Australia is not immune to the counterfeit drug market. Australian Pharmacy Guild national president Kos Sclavos says that with the growth of online shopping, the use of counterfeits is on the rise. “The reason it's on the rise is as people feel more comfortable with internet shopping, it is expected that we'll see a rise in prescription shopping,” he said. “There are items that are not on the PBS, such as private prescriptions, generally drugs for lifestyle, drugs such as erectile dysfunctions or medications that sadly patients are fully aware that they're not through the normal supply chain. We're aware in the past where body-building steroids and the like have been intercepted through the supply chain.” Mr. Sclavos says consuming counterfeit drugs is like playing Russian roulette.
Study finds artemisinin resistance in African children with severe malaria