Thursday, May 8, 2008

An AFM study about low quality drugs in Africa

Dear Colleagues

The following message was recently circulated by Africa Fighting Malaria (AFM). It describes a study about the quality of drugs being distributed in various places in Africa.

The quality of the drug supply in Africa has been in question for a very long time, and surprisingly little has been done about it. The Tr-Ac-Net view of this is simply that little changes when there are financial benefits in the status quo.

This is what AFM circulated.
Dear colleagues,

AFM's study of antimalarial drug quality in six major African cities is now live on PLoS One:

Reuters India has provided a nice summary:

I'm copying the study abstract here for your information. Please feel free to contact me directly for more information.

Abstract: A range of antimalarial drugs were procured from private pharmacies in urban and peri-urban areas in the major cities of six African countries, situated in the part of that continent and the world that is most highly endemic for malaria. Semi-quantitative thin-layer chromatography (TLC) and dissolution testing were used to measure active pharmaceutical ingredient content against internationally acceptable standards. 35% of all samples tested failed either or both tests, and were substandard. Further, 33% of treatments collected were artemisinin monotherapies, most of which (78%) were manufactured in disobservance of an appeal by the World Health Organisation (WHO) to withdraw these clinically inappropriate medicines from the market. The high persistence of substandard drugs and clinically inappropriate artemisinin monotherapies in the private sector risks patient safety and, through drug resistance, places the future of malaria treatment at risk globally.

Philip Coticelli
Africa Fighting Malaria
My own observations of drug distribution in Africa go back to the early 1980s. Originally I did not give much credence to the "stories" about the dumping of out of date drugs in African markets ... so over the course of many months I took every opportunity I had to visit store rooms in hospitals and clinics to see for myself. The outcome of this was that I rarely found any drug that was within date ... and in general the drugs, many of which were labelled "store in a cool place" were in store rooms where the temperature was around 100 degrees F.

It is now 20 years later ... and for all practical purposes the situation is as bad as ever. There is a problem not only in the fact that there are unsatisfactory drugs being distributed, but that there is a dysfunctional system that has allowed this to go on for a very long time, and still not much happening to end the bad practices.

This, of coure, is the raison d'etre for the Transparency and Accountability Network ... to help get important changes made so that there can be sustainable progress ... and to deploy Community Impact Accountancy so that the socio-economic outcomes of profitable bad practices can be part of a universal set of performance metrics.


Peter Burgess