Asia Pacific has made broad progress against malaria, but the gains are fragile. Without intervention, the massive trade in fake or substandard medicines throughout the region puts a malaria-free future at risk, write Benjamin Rolfe and Lelio Marmora.
The dream of an Asia Pacific region free of malaria is within our grasp as steady progress brings most countries in the region to the brink of elimination. In less than 20 years, most Asia Pacific countries have managed to reduce malaria by more than 75 percent; 11 of them are heading towards complete elimination by 2025; and 22 have committed to end the disease by 2030.
However, a booming trade in fake* drugs is holding the region hostage.
Globally, one in ten medicines are fake in low- and middle-income countries, including many countries in Asia Pacific. In Southeast Asia alone, one-third of all antimalarial drugs are reported to be of poor quality, contributing to an alarming rise in resistance to antimalarial drugs across the region. Antimalarials are just one of a broader range of drugs that are becoming ineffective. Antimicrobial resistance already accounts for 700,000 deaths worldwide every year, and could cause up to 10 million deaths per year, and cost $100 trillion by 2050, according to some estimates.
Why has this come about?
Fake drugs are big business
Outside the formal health system, pharmaceutical crime permeates all levels of society, with sales ranging from $163 billion to $217 billion per year globally. According to the Pharmaceutical Security Institute, Asia accounts for the biggest share of the fake drug trade, ranging from sophisticated organized crime groups to informal networks, that ply their trade even in remote villages.
Everyone deserves good medicines wherever they are
We are also failing to reach those in need through our health care structure. Undocumented migrant workers, for example, hesitate to connect with the public health clinics. For reasons of ease of access or affordability, they are more likely to purchase drugs from unlicensed private vendors, fueling a robust underground market for smugglers.
Are we encouraging fake medicines to flourish?
Fake or poor-quality drugs thrive in markets where authorities lack the resources and capacity to enforce international standards for quality medicines. Porous borders further compound the problem and facilitate smuggling of fake and sub-standard medicines between countries.
There are no easy solutions but there are a few good places to start.
Last week in Phnom Penh, global and regional leaders made a commitment to tackle this dangerous trade at the Regional Conference Combating Falsified and Substandard Medicines. Discussions highlighted the need: to strengthen border controls to cut off the most common supply routes for smugglers; to ensure quality drugs reach marginalized populations; and to build capacity enabling regulatory authorities to intervene to pull fake medicines from circulation.
Cambodia, which hosted this high-level meeting, has already shown its commitment to a brighter future by utilizing the World Health Organization’s reporting system to track the scale of the illicit drug trade and identify concrete measures to stamp it out. The country has also pioneered a cross-ministry approach, bringing multiple arms of government together, including law enforcement and public health bodies, in order to ensure a single, coordinated effort.
To support countries in the region, the Asia Pacific Leaders’ Malaria Alliance (APLMA) and Unitaid partnered earlier this year to accelerate access to quality innovations, including medicines, which bring us closer to a malaria-free Asia Pacific by 2030. As part of this commitment, we are working with regional leaders to build stronger regulations to ensure quality medicines reach vulnerable communities in need.
Indeed, Asia Pacific has made broad progress against malaria, but the gains are fragile. Without intervention, the massive fake drug trade throughout the region puts a malaria-free future at risk.
Facing down the challenge extends well beyond malaria. When we ensure equal access to high-quality medicines, we strengthen our health systems, reinforce our commitment to equitable healthcare, and benefit other disease elimination and public health efforts in the process.
Shutting down the fake drug business will help us to achieve a malaria-free and healthy Asia Pacific.
*Fake medicines in this article refers to Substandard and Falsified (SF) medical products. For more information please go to: https://www.who.int/medicines/regulation/ssffc/en/
Dr Benjamin Rolfe is chief executive officer of the Asia Pacific Leaders’ Malaria Alliance (APLMA) and Lelio Marmora is Unitaid’s executive director. To learn more and get involved, visit https://medswecantrust.org