Combating the trafficking of counterfeit medicines is a source of continual trouble in Botswana. According to the World Health Organisation (WHO), counterfeit drugs are the world’s most lucrative counterfeit goods, with a global market worth approximately $200billion, and Africa accounts for over 40% of the world’s cases. The health agency also notes that counterfeit drugs are responsible for thousands of deaths, especially in developing countries and vulnerable communities.
In the Global Surveillance and Monitoring System for Substandard and Falsified Medical Products report prepared by WHO, the health agency highlighted that constrained access to quality, safe and effective medical products creates a vacuum that is too often filled by substandard and falsified products.
The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) expressed concern over the shortages highlighting that “these shortages ranges from medications, which provide pain relief such as Paracetamol to medications, which regulate chronic illnesses such as asthma, diabetes and high blood pressure among others.” BONELA also notes that these shortages have had ripple effects in that citizens are now opting to use “alternative medication” which has “proven to be less effective”.
The ministry of health (MoH) has also admitted to these shortages. The permanent secretary in the ministry of health, Dr Christopher Nyanga indicated that the production and supply of drugs and medical supplies which had been interrupted by Covid-19 would soon improve.
“As already indicated the challenge has been the delayed delivery of drugs and other medical supplies, as a result of the Covid-19 pandemic which has slowed down the supply chain of all products and commodities, including medical supplies,” he said.
At the onset of Covid-19, the Botswana Medicines Regulatory Authority (BOMRA) whose mandate is to ensure that all medicines and related substances used in Botswana are in conformity with established criteria of quality, safety and efficacy warned consumers to desist from buying unproven products which claim to treat diseases or cure serious illnesses. The regulatory authority warned that counterfeit drugs could lead to “delays in getting proper diagnosis and treatment of potentially serious diseases and conditions.”
However, such warnings have not stopped degenerate drug traders who sell everything from fake pain relief medications to fake medication which regulates asthma and high blood pressure. The fact is these drug shortages have given rise to the dark world of counterfeit trading which further exposes citizens to health complications. Apart from counterfeit drugs other fake drugs being sold and circulating across Botswana include anti-malaria pills, weight loss pills, abortion pills, Viagra and sexual performance drugs; some of which are now being produced locally.
In Botswana, abortion is illegal and severely restricted. It is only allowed if the abortion will save the woman’s life, if the pregnancy gravely endangers the woman’s physical or mental health, or if the pregnancy is as a result of rape or incest. But so brazen are some of these fake unlicensed pharmaceutical dealers that they are now openly advertising their contraband on social media without fretting too much over law enforcement.
The discovery that counterfeit versions of Cytotec drugs are being widely circulated in Gaborone has raised concerns that the lucrative industry now has a foothold in the country. These findings were also confirmed years ago in a review prepared by Stephanie S. Smith prepared entitled “Reproductive Health and the Question of Abortion in Botswana”. The review stated that “complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the foetus to term and abandon the infant at birth.”
Cytotec is often used to induce labour and slow post-partum bleeding (the period just after delivery). However, it is increasingly being used for self-induced abortions in Botswana’s underground abortion market, especially first trimester abortions. The current Cytotec tablets being sold on the black market are reported to be sophisticated counterfeits, often having the appearance of the original product. This has added a new and complex dimension and placed heightened concern on Botswana’s underground abortion market.
One of the dealers who sells Cytotec tablets spoke to this publication and indicated that most Batswana women used to travel to South Africa pre Covid-19 to procure an abortion. However, Covid-19 and the resultant border closures have attracted some rogue dealers who are now illegally importing phony medicines. “Covid-19 has resulted in women tracking down local underground providers and this has caused a surge in demand,” says the woman who only identified herself as Kagiso. Although she is aware that her line of business is illegal, she gave a vague answer when we inquired if her contraband is genuine.
Another dealer who spoke to The Telegraph indicated that he sells authentic pills and is simply capitalising on an unmet need for safe, legal and accessible abortion in Botswana. “The pills I sell are original and are smuggled through the border from South Africa,” said the dealer who would not disclose his name for obvious reasons. This publication could not verify his insinuations as he chose to withhold information regarding his sources.
The World Health Organisation (WHO) which is the specialised agency of the United Nations (UN) responsible for international public health says in Africa the statistics are acute and stark. One in 10 medications sold in Africa are either fake or substandard. At the Indo-African health summit held a few years ago, it was revealed that most of the imported fake and substandard drugs sold in Africa originate from India, China, Pakistan and Indonesia. The African continent also accounts for between 40-45% of all counterfeit medical products.
Public health experts encourage consumers to avoid buying any form of medication whose origins they do not know. They also say using fake drugs could result in a person’s system failing to respond to authentic drugs as a result of resistance induced by previous intake of counterfeit drugs.
