Counterfeit pharmaceuticals continue to pose a significant threat to public health in a number of countries around the world, particularly in African countries that account for the majority of their customers. The rise in the threat of drug counterfeiting has been attributed to a variety of factors, including lax penalties for drug counterfeiters, the rise of internet commerce, ignorance, and a lack of effective collaboration between drug regulatory agencies and law enforcement agencies, among others. According to the World Health Organisation (WHO), counterfeit drugs are the most profitable counterfeit goods in the world, with a global market worth approximately $200 billion, and Africa accounts for more than 40% of all cases. The WHO also claims that counterfeit medications are to blame for thousands of deaths, particularly in developing countries and vulnerable populations.
Botswana and several other countries are currently experiencing a medicine shortage due to manufacturing issues. Zambian hospitals are reported to be operating at less than half of the WHO’s internationally accepted standards. Some antibiotics and children’s medications are also in short supply in Ireland, Canada and Australia due to manufacturing issues. It is believed that these pharmaceutical shortages exacerbate the problem by allowing counterfeit drugs to enter the market as providers seek out drugs in short supply.
The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) issued a warning that these medicine shortages have ripple effects in that citizens are now opting to use “alternative medication” which has “proven to be less effective”.
Although the Ministry of Health (MoH) has stated that they are working around the clock to end the crisis, some unscrupulous dealers are taking advantage of the shortages by importing subpar medications, such as phony painkillers and fake asthma and high blood pressure medications. Other fake medicines widely sold in Botswana, in addition to Viagra, are sex performance drugs, bogus anti-malaria medications, weight-loss and abortion medications.
A dealer who sells unregistered medical products as well as birth control and Cytotec abortion pills claims he is simply capitalising on an unmet need in Botswana. “The pills I sell are sourced from South Africa,” the dealer told The Telegraph in a brief interview. Although this publication was unable to verify the veracity of his claims, he stated that he also illegally sells pain killers.
The widespread distribution of counterfeit Cytotec in Botswana has raised fears that the lucrative industry has established a foothold in the country. In Gaborone, social media is flooded with advertisements for people selling abortion pills as well as fake viagra.
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.”
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.”
In January, the Botswana Police Service (BPS) announced that they had arrested 18 suspects in connection with various offences among others importation, sale, storage and advertising of unregistered medical products. In a statement issued on its Facebook page, they warned the public to avoid purchasing medicines from unlicensed vendors, particularly at the Gaborone bus rank. “The public is therefore warned to desist from buying goods from unlicensed individuals….,” read part of the statement.
Statistics compiled by WHO show that 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.
In January, the minister of health and wellness, Dr. Edwin Dikoloti said the lack of pharmaceutical manufacturing locally was forcing Botswana to import all our medical commodities. He also blamed the local procurement regulatory framework for medicine shortages. “I need also to mention the local procurement regulatory framework that does not support efficient procurement of medicines and medical commodities,” he said.
While Botswana is employing numerous ways to reduce the threat posed by counterfeit pharmaceuticals, public health experts advise consumers to avoid purchasing any medication whose origins they do not know. They also warn that using counterfeit drugs may cause a person’s system to fail to respond to genuine drugs due to resistance induced by previous use of counterfeit drugs. However, in order to completely eradicate the crime, further stringent measures still need to be taken.