As much as half of a crucial anti-malarial drug sold in five Southeast Asian nations, including Cambodia, may be fake, a new report has found.
The report, published this week by PLoS Medicine scientific journal, detailed a collaboration between medical researchers and the international police body Interpol to investigate the incidence and origin of fake artesunate, a critically important drug used to treat malaria.
The report confirmed that all counterfeit specimens contained little or no artesunate and were made up of a wide variety of ingredients, including banned pharmaceuticals and even the raw material for making ecstasy.
Among the biggest concerns the report raised was that the drugs with low levels of artesunate would lead to a more resistant strain of malaria.
“Resistance is created by incomplete medication,” said World Health Organization Cambodia Country Representative Dr Michael O’Leary, who described artesunate as “one of our final lines of defense [against malaria].”
“Over time the resistant strain can become dominant, and the drug becomes useless,” he said.
Forty-eight of the 391 drug samples tested were from Cambodia. Approximately half of the samples region-wide were counterfeit, though the report did not give a country-by-country breakdown.
The new report also highlighted the sophistication of many of the copies, with the packaging in some cases even containing fake holograms, with only tiny differences to expose them as counterfeit.
The report traced the origin of some of the counterfeit supply to Southern China, where Chinese authorities have arrested a suspect in Yunnan Province and seized a consignment of drugs as a result.
However, the origin of the drugs on the trade route that supplied Vietnam, Cambodia and Laos remains unknown, according to the report, which concluded that strengthening international collaboration and the capacity of forensic and drug regulatory authorities may be required to deal with the problem.
O’Leary said that tackling the issue here presented a major policing challenge, as the fake drugs were more widespread in rural areas. He added that availability of cheap fakes and the high profit margins earned by selling them feed the problem in Cambodia.
Dr Tol Bunkea, chief of epidemiology at the National Center for Parasitology, Entomology and Malaria Control, said it is difficult to get hard data on how many people here are using fake drugs, but agreed it would be a “serious problem,” if a malaria strain resistant to artesunate became common.
“Strategies are in place to try to combat [the fake drug] problem,” he said, adding that the Health Ministry needs to continue its battle to reduce the number of unlicensed pharmacies selling illegal drugs.
In 2006, 396 malaria deaths were recorded in Cambodia, but numbers appear to have dropped in 2007, though the total has not yet been fully compiled, he said.
And though there has been some success in reducing the number of malaria fatalities, the national malaria infection rate remains very high, Tol Bunkea said.
Approximately 100,000 Cambodians were infected with malaria in 2006, according to the National Malaria Center.
Minister of Health Nuth Sokhom acknowledged Tuesday that between 10 and 13 percent of all drugs sold in Cambodia are counterfeit, adding that he based his information on a 2003 WHO study. He referred further questions to the Department of Drugs, Cosmetics and Food.
The department’s deputy director, Dr Chroeung Sokham, said the government was aware of the fake artesunate problem.
“We have done a lot of work educating the public,” he said. “We have also put stickers on the drugs that name the country of origin and registration to try and stop the spread of the bad drugs.”
Chroeung Sokham added that the sophisticated packaging used on many of the fake drugs made it unlikely that any had been produced in Cambodia, where the technology needed to produce them does not exist.
Two committees have been set up by his department to tackle the problem, and a legislation revision made last year gave authorities additional powers to fine those who distribute fake drugs, Chroeung Sokham added.
“Often the owners of pharmacies who sold these drugs would run away, so it is difficult to crack down effectively,” he said.
