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Ghana: Giving Fake Medicines A Free Roam?

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Ghana: Giving Fake Medicines A Free Roam?

A new system to fight counterfeit medicines that kill hundreds of thousands of people a year has hit the buffers in Ghana, mPedigree Network’s Bright Simons explains.
Stephen Gyasi Jnr reports from Accra.

Across Africa, experts estimate that more than 30% of malaria and tuberculosis medicines are fake and over 700,000 people die every year as a result of taking those counterfeit drugs. It is a menace that has to be defeated, and it is why an initiative by the Ghana-based mPedigree Network, an African social enterprise, is so important to the health of millions of Africans on the continent.

But do not mention it to the Ghana Food & Drugs Board (FDB). They are plainly not interested and did not even bother to reply to several New African queries as to why they are not involved in the new anti-counterfeit system, even though right in the Ghanaian capital, Accra, the mPedigree Network has committed itself to tackling the issue of fake medicines by empowering consumers to get involved in authenticating pharmaceutical products before they use them.

According to Bright Simons, founder and president of the mPedigree Network: “The poor areas of Africa are at the highest risk [of fake medicines] because they are where the supply chain is weakest. In places like Accra, many people get their medications at informal supply centres, which ultimately become key entry points for fake medicines. And that represents one of the biggest threats to our project’s objectives – people losing confidence in the public health system because of the criminal activities of counterfeiters.”

To fight the danger, mPedigree began talks in 2009 with Hewlett Packard (the manufacturers of HP computers) to form a collaborative relationship for the trial roll-out of a Medical Authentication System (MAS) in Ghana and Nigeria.

The first system was launched simultaneously in the two countries in December 2010, with the participation of local pharmaceutical and telecom companies, including May & Baker, Kama Group, MTN, Airtel, and several other telecom partners.

As part of the collaboration, HP provides printing, imaging and cloud computing technology, which makes the automatic authentication of malaria medication possible.

And it works this way: the pharmaceutical companies participating in the MAS programme agree to print a unique code on each package of medicine. When the consumer purchases a prescription drug, they send the text code on the packaging, free of charge, via their mobile phone, to a designated phone number.

Thanks to HP’s cloud computing technology, the code is checked against the authentic codes stored in HP’s secure cloud databank. Within 26 seconds, the consumer receives a text message reply indicating whether the medicine is authentic or fake.

If it is a counterfeit, the consumer can call the police or report the seller or pharmacy shop to the authorities.

Local agencies, including the West African Health Organisation, the West African Pharmaceutical Manufacturers Association, the Health Access Network, and the Pharmaceutical Society of Ghana have all agreed to participate in the MAS programme as advocates in an education campaign that includes billboards and adverts designed to empower consumers to take responsibility for the pharmaceutical products they buy.
The MAS programme is currently running in Ghana and Nigeria, with plans to roll it out in Kenya, Tanzania, South Africa, Uganda, Bangladesh and India.  

“Initial testing of the mPedigree technology in Tanzania and Uganda has been successful,” Simons revealed. “We have rolled out fully in Kenya, with complete regulatory support. We are now trying to engage the Kenyan pharmaceutical industry more comprehensively as opposed to a piecemeal approach. We have decided to delay our South Africa entry for a while to ensure we are not overstretched. As a new technology that requires deep integration into manufacturing practices, we have to be realistic about how we set our expansion pace.”

 “In all these countries,” Simons continued, “we need a partner at a strategic position that can drive the different stakeholders – in telecoms, the regulatory agencies, and the pharmaceuticals – to work in concert and expeditiously. While health ministries have been important allies, they clearly do not have the full force of legal or moral authority to push such a diverse range of stakeholders towards faster and deeper collaboration.”

Expansion into the Asian market is also on the cards. “We have started initial testing in Bangladesh,” Simons told New African. “We are in discussion with partners in India, which is a rather complex market and without the right strategy it can be very expensive to penetrate.”

The overall vision of the MAS programme is to extend the automated, GSM-enabled authentication capabilities across Africa, the Middle East, and Asia for many types of medications and even across different industries where counterfeiting can jeopardise citizens’ health and safety.

According to Simons: “The number of stakeholders that we brought together to invest in this programme – from government agencies, pharmaceutical companies, telecoms, partners like HP to NGOs, local pharmacists and consumers – is truly remarkable. It’s a massive undertaking that addresses one of the most retractable, complex problems facing healthcare in the developing world. The fact that we are at the forefront of the solution is exciting and provides immense motivation to move forward in protecting people’s health and saving lives.”

A global challenge

Counterfeiting is a global problem. Many goods moving through international commerce are counterfeited. Industry data show that 5% to 7% of world trade, valued at approximately $280bn, is lost to counterfeiting. It is estimated that about $20bn worth of IT products move through unauthorised channels annually.

The pharmaceutical and personal care product industries are also riddled with countless counterfeits, running into billions of dollars a year. These channels make it possible for counterfeits, expired, repackaged, and re-labelled products to be shipped internationally, sometimes with the tacit support of officials trained to check their infiltration into the market.

A WHO report has indicated that India is responsible for about 35% of the world’s fake drugs, worth about $200m annually.

Within West Africa, there is high activity in cross-border trade in pharmaceuticals. Countries such as Togo, Benin, Chad, Niger, Ghana and Cameroon buy a high volume of medicines from Nigeria because it has the biggest market in the sub-region.

As such, the situation in Nigeria naturally reflects those of the countries in the sub-region. Even though counterfeit drugs are a global phenomenon, some countries, including Nigeria, are more affected than others.

A study conducted in Nigeria in 1990 by the former deputy director general of the WHO, Adeoye Lambo, for a pharmaceutical firm in Lagos showed that 54% of drugs in the major pharmacy shops were fake, a figure that alarmingly rose to about 80% in subsequent years. In another study of 581 samples of 27 different drugs from 35 pharmacies in Lagos and Abuja, 279 (48%) did not comply with set standards.

Simons’ nightmare

The menace posed by counterfeit drugs in Africa is so scary that it beggars belief that the Ghana Food & Drugs Board (FDB), the agency charged with fighting fake drugs in the country, is not interested in mPedigree’s MAS project.

“To be entirely candid,” Simons told New African, “we have been frustrated by the Food & Drugs Board which has been scaring the pharmaceutical manufacturers away from the system, and confusing the health ministry by claiming that the FDB can develop (or are developing) a mobile laboratory system that can go around and test pharmaceuticals.

“This is of course ridiculous, considering that we have 10,000 pharmacy shops in the country and less than 100 trained inspectors for the whole country, not to talk of chemists to sit in the mobile vans and go around doing the testing.”

A visibly-pained Simons continued: “We have been in discussions with the FDB for the last three years with a view to integrating the mPedigree platform into the national regulatory system. There are challenges that have been raised regarding procedure and transparency which we believe can be addressed by the technological innovations we continue to develop. But so far, not much progress has come from the FDB.”

New African called the FDB several times over a one-week period, and the national regulatory agency did not deign to response to our queries.

Despite the frustrations, Simons remains optimistic about a successful nationwide roll-out of the system. “We acknowledge however that the motivations are very different, and it is up to us to continue figuring out the levers that can move the public sector to work in lock step with the private sector to make this platform truly successful,” he said.

“In Nigeria, the process has been considerably faster on the regulatory agency front, but the size and complexities of the market has posed its own challenges and led us to expend a considerable amount of resources to get the country to where it is today. There is a consensus amongst stakeholders in the country to adopt the technology for all anti-malaria drugs.”

Simons decries the fragmented supply chain in Africa which makes surveillance systems hard to implement. Most drug distributors and retailers have very sketchy record-keeping systems.

Moreover, government agencies have themselves not pursued significant computerisation of their own processes, making it difficult for them to appreciate the improvements that the mPedigree project can provide. Until the capacity of these agencies to handle real-time market intelligence information on fake drugs is bolstered, the transparency that the mPedigree MAS platform brings (for example, every time a fake drug is detected, there is an instant update to the record; and consignments of authentic medicines delivered into the country can be tracked to the last pack) will not be entirely useful to them.

The trouble, of course, is that those who have the most vested interests in seeing these reforms of government agencies are ordinary consumers, and unfortunately consumer advocacy in Africa is weak and dispersed.

The mPedigree system is doubtless a saviour of lives but with the frustrating administrative bottlenecks and deeply entrenched parochial interests firmly in place, it might take the personal involvement of presidents across Africa to make the implementation a reality. 

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