On a radio programme recently, I heard a teaser on an advertisement indicating that a substantial amount of anti-malarial medicines on the Ghanaian market were counterfeits.
Unfortunately, the statement is true. I do recall having done some articles in this paper on counterfeit medicines.
I still believe that there is a lot the pharmacist can do to curb the proliferation of counterfeit medicines in the West African sub-region. Once, I was asked by a colleague pharmacist how this could be done.
Assuming that we are able to seal our sea and air ports from counterfeit medicines, can we do the same for our land borders with the ever expanding trading activities between countries in the sub-region?
Drug counterfeiters usually target high value, high volume, high demand or high turn-over medicines. A typical example is the Artemisinine Combination therapy (ACT) approved under the Global Fund for the treatment of malaria.
It is important as a pharmacist to know the approved distributors or wholesalers of these ACTs and source your stocks of anti-malarials from them to prevent the supply of counterfeit/fake medicines to your consumers.
There are three main types of pharmaceuticals on the market.
There are the innovator products, branded generics and generic products. The innovator products are referred to as ethical pharmaceuticals - because they are products originated by specific pharmaceutical concerns.
Such products are covered by patents and are usually high value because of the years (and high cost) of research and development in producing an innovator product. These products or their innovators have designated outlets in Ghana for their sale and distribution. It is highly unlikely for a locally designated distributor (or wholesaler) to be supplied with counterfeit/fake medicines from these innovator companies.
The in-house processes of manufacture make such occurrences non-existent. Product defects are quickly subjected to recalls which are to a large extent initiated by these innovator companies. Product defect is different from counterfeit medicine which is a deliberate action to deceive and profit from the deception.
Unfortunately, some people yield to the temptation of lower priced “innovator products” offered by unapproved vendors and risk being supplied with counterfeit/fake medicines.
The other category is the branded generic which though not an innovator product, mimic some of the structures of innovators in the sale and distribution of such products in the country. There are therefore, approved sources for such products in the country.
An approved distributor/wholesaler of such products would find it very difficult to yield to offers of other vendors because of the costs associated with such arrangements with the principals of these branded generics. This is yet another way that pharmacists can curb the proliferation of counterfeit medicines in the country.
The third category is the generics which can be traded by everyone on the market. There is a lot we can still do as pharmacists using our in-house Drugs & Therapeutics Committee. You can separate these generics into two: locally manufactured generics and imported generics.
Product selection can be done based on the disease condition under consideration, the reputation of the company, the country of origin (being guided by developments in counterfeit medicines on the global market), preparedness to allow local clinical trials and preparedness to submit products for periodic testing.
It is not out of place for a company to submit good samples for registration by the regulatory authorities and later introduce “something else” unto the market with time. The regulatory authority does its best to do post-marketing surveillance and indeed some manufacturers have been “caught in the web” as a result.
A number of times a chunk of such products may have already been used by the consumer. It is therefore, important for the pharmacist to use his expertise (and training at the tax payer’s expense) to assist in the fight against counterfeit medicines in the country.
Recently, I had a very interesting interaction with a retiree client of Cocoa Clinic in Accra. He had heard about our Disposal of Unused/Unwanted Medicines Programme (DUMP) and had brought to the clinic ‘plenty’ medicines from home.
He is diabetic and hypertensive and has relations outside the country who send him medicines in addition to the ones we supply him from the clinic. His question was whether he could take the medicines his relations had been sending him from abroad?
I told him there were regulations governing the acquisition of medicines from abroad. Secondly I could not vouch for the sources of the medicines he had brought and how they were transported (storage during transit) into the country. I asked him “uncle, your blood sugar and blood pressure have been controlled all these years with the medicines from Cocoa Clinic, why do you want to change them?”
Well, he didn’t have any convincing response; so he decided that he would continue to rely solely on the drugs he collects from our outfit.
We (pharmacists) have a unique role to play in the fight against counterfeit medicines in the country. Promoting the Safe Use of Medicines is part and parcel of our calling as pharmacists.
The writer is Chief Pharmacist at Cocoa Clinic in Accra.