There are severe but neglected problems with poor medicine quality globally, but especially for anti-infective medicines in the tropics which have important but under-recognised impact on public health. Poor quality drugs have clear importance for individual patients, in terms of death, treatment failure, prolonged sickness, excess health expenditure, and lost income. Poor quality drugs also have far reaching consequences for society, resulting in loss of confidence in efficacious medicines and health systems, and economic losses to patients, health systems, their employment, and the pharmaceutical industry. We are conducting random sampling of medicines to objectively estimate the prevalence of counterfeit and sub-standard drugs, evaluating new rapid assessment techniques for medicine quality and advocating that much more is done to improve the quality of the medicine supply. We host the coordination for the new Anti-Malarial Quality module of WWARN to tabulate, map, disseminate and discuss global data on the quality of antimalarial medicines.
We work with the Food and Drug Department and Food and Drug Quality Control Centre, Government of the Loa PDR, in collaboration with Dr Michael Green, CDC-USA, on the quality of the drug supply in Laos.
Together we conducted the first randomised country-wide survey of the prevalence of substandard and counterfeit antimalarials was conducted, supported by the British Embassy, Bangkok, and this gives the first objective estimate of the prevalence of poor-quality drugs in the country.
We also act as a coordinating centre for samples of suspected counterfeit antimalrials. We analyse the packaging and send samples for chemical analysis by our chemist collaborators Professor Facundo Fernandez, of Georgia Tech and Dr Green. We produce a warning sheet which describes the different types of counterfeit artesunate found (Fake Artesunate Warning Sheet). This has been translated into Lao and Burmese languages.
We helped coordinate a large collaboration of INTERPOL, scientists, doctors, Chinese police and WHO to trace the origin of the epidemic of fake artesunate. When the chemical and botanical (pollen) evidence suggested that the fakes were coming from southern China, the Chinese Government launched their own criminal investigation and arrested some of those responsible.