Hiding in Plain Sight

It is well known in the pharma industry – and among law enforcers – that counterfeit drugs are a growing problem, but Western consumers remain blissfully unaware for the most part. Despite a few high profile cases – for example, fake Avastin given to US cancer patients – the main burden falls on developing countries. Frequent shortages of life-saving drugs force doctors to turn to unofficial ‘gray market’ sources, while illegal (and potentially dangerous) fakes are sold direct to consumers in markets or on the street. Just this week, the press reported that an INTERPOL swoop in South Africa had seized 150 tons of fake medicines, arrested 550 people and closed 20 pharmacies. The World Health Organization (WHO) estimates that 100,000 deaths a year in Africa are linked to the counterfeit drug trade. That said, counterfeit medicines are not always inactive or dangerous – some are simply generics, mislabeled as brand-name drugs. Critics have argued that pursuing these ‘harmless’ counterfeits takes resources away from combating the real danger of falsified medicine (1). But it is hard to draw a clear distinction between the two – and is it unlikely that those already engaged in an illegal activity will feel compelled to stick to the stringent quality and safety standards of licensed drug manufacturers.

It’s perhaps no surprise that enterprising criminal gangs have turned to counterfeit or falsified medicines – it is big business.And to make the activity even more attractive, penalties for breaking the law are limited. Why take on the risks of dealing in heroin, when fake medicines bring in more money with a much lower chance of jail time?

Currently, there is no large-scale universal, coordinated effort towards stamping out counterfeit drugs, but new serialization initiatives and tracking technologies make the supply chain more secure, and verification services make it easier for consumers to play their part. Drug makers have also welcomed the Council of Europe’s Medicrime Convention (2).

But perhaps the ultimate solution is hiding in plain sight, just like the counterfeits. Faced with serious illness, most of us would probably choose counterfeit drugs over no medicine at all. And while that choice remains, it will be exploited. Increasing access to drugs in the developing world, by preventing drug shortages and cutting costs, is the only way to reduce demand for fake medicines in the long term.