Access to medicines for all

 “Access to medicines for all” a difficult target

Today two billion people usually do not have access to the essential medicines. The 30% of the world population - between 1.3 and 2.1 billion people do not have a regular access to the medicines they need. However, access to medicines is necessary to the development and the well-being of the populations. Very often it remains the most effective and most economic solution in the medical crises, as in treatments implying technical acts, or in serious or daily pathologies. Essential medicines are indeed fundamental to the treatment of the diseases.

To work towards “access to medicines of quality for all in Africa” - as does AEFJN - is one of the challenges of our time. Besides, this is the subject of a particular mention in the Millenium Development Objectives.

The structural adjustments, the economic reforms, the movement of liberalization and the WTO agreements on intellectual property have complicated and weakened the medical situation in the developing countries. In Africa this has been worsened by the deterioration of the terms of trade of agricultural and mining products, what has contributed to the notorious fall of the purchasing power of the populations.

The traffic of counterfeit medicines affects all!

The traffic of illicit medicines exists in Africa since the end of the eighties, but with Internet the extremely dangerous traffic of false medicines has gone beyond the borders of Africa to become an international problem of enormous proportions.

The counterfeit of medicines is a vast and very lucrative market evaluated at more than 32 billion dollars per year of benefit. The first recipients are the international mafias, then the importers and finally the small retailers for whom this sale constitutes their livelihood.

All countries, in the South as in North are touched by the illicit market of all kinds of false, badly preserved, and badly produced medicines that arrive to the market through illicit networks. A medicine over ten sold in the world would be a forgery. The counterfeited medicines would represent more than 10% of the world market1. The traffic of illicit medicines takes the place in the international crime of the traffic of drugs but it would be 25 times more profitable than the trade in heroin and 5 times more than that in cigarettes!


Counterfeit medicines in Africa

The medicines sold in Western Africa come mainly from Nigeria, where some are produced while others arrive there from India, Singapore and Malaysia. In Nigeria the orders of each tradesman are consigned in sealed trucks which enter other African countries without ever being searched since the customs formalities are carried out in a “special” way. A study carried out in 10 localities of Benin recorded 6,000 sellers of medicines, especially women: 1,500 of them in markets; while 3,500 practise an itinerant trading. The 85% of the inhabitants of Benin buy their medicines in the parallel market2. The use of counterfeited medicines causes to the State the lost of 4 to 5 billion (CFA) of revenue from taxes and 30 billion loss of earnings for pharmacies.

Counterfeit increases because it produces great benefits and the public is more concerned by the price of medicines than by their quality. Another difficulty is the fact that the counterfeit improves the packing without improving the quality of the product. There is great quality in the appearance of the copied medicines, which makes more difficult to recognize the forgery visually.

The choice of this distribution net by certain groups of the population is due to their extreme poverty, but even more to the ignorance of the dangers related to the consumption of medicines that pass no control of international standards. In the long run the illicit pharmaceutical products become much more expensive for the consumer and for the country and extremely dangerous for the customer’s health.

The problem is that medicines are expensive, but there are networks to buy medicines of quality and to make them accessible to the population.

Dangers of counterfeit medicines

The problem of counterfeit medicines sold on the street or in the markets, without safety of authenticity, nor information on how to use them, represents a serious health problem in Africa. Pills are sold at the unit, classified by colours, without packing neither expiring date, exposed to dust and sun. The success of this trade is due to the fact that is very lucrative, offers cheaper medicines than the pharmacies, and makes medicines available even where there is no pharmacy.

These medicines are obtained without prescription, neither medical consultation. It is the merchant who becomes the “improvised doctor” and advises the patient which medicine to take and in which amount.

The World Health Organisation estimates that each year, 200.000 patients with malaria die because of medicines of bad quality. This represents the tenth of deaths due to malaria! Many anti-malaria forgeries circulate in the world market. Other products, such as impure contraceptive pills and non tight condoms are the main counterfeited3.

Studies reveal that half of the counterfeited products sold on the African markets do not contain at all, or not sufficiently the active ingredient, which can cause the appearance of resistances. It is well known how infectious diseases, resistances to anti-parasites, and particularly to anti-malarias are mainly related to the fact that people take products under dosage, badly prepared or out-of-date. But when there is no control of quality there are also flows in the manufacture, impurities that can be toxic with serious consequences for the health of the consumer that may cause even death.

The cases of kidney insufficiency, intestinal perforations, heart problems, due to the side effects of these pharmaceutical products become frequent with their vital risk. A health professional4 affirms that only in one hospital, an average of 10 patients per day suffer from kidney insufficiency probably produced by these medicines. One of them dies each day.

Any medicine can be dangerous, and is effective only if it is well preserved and well used. The street medicines are source of intoxication -exposed to the sun without respecting neither the temperature, nor the expiring date and without quality controls- and constitute a public danger.

Africa and the combat against the illicit market of medicines

While the European Union (EU) is concerned with counterfeit products on Internet, Africa is mostly affected by the “street medicines”. Since this is a world problem, the EU and Africa have decided to work together to find solutions.
In Africa the illicit trade of street medicines is a plague and a sensitive subject to which attention is given. Faced with the ignorance of the public towards the possible dangers and the harmful effects of these street medicines, health professionals organize information and public awareness campaigns. In spite of these efforts the street merchants continue to sell their products. Without prevention, the population will go on using the parallel markets, because they believe the medicine is less expensive in the street, which is not always the case, though the sale of products by the unit makes them more accessible.

Though Health professionals and politicians are also accomplice in this market, many pharmacists and health professionals in Africa are engaged in the war against the street medicines. The orders of pharmacists get mobilized, create networks, and organize campaigns. The “African week to create awareness on the dangers of the illicit medicine market” is the occasion to organize vast national campaigns such as “true medicines are in pharmacy not elsewhere”, “street medicines kill” and “the pharmacist guarantees the quality of the product”. Information to detect a counterfeit is available to the pharmacist and another style of information for the general public and the patients.

Meetings and conferences organized recently, cover this subject. Thus the 8th International Pharmaceutical Forum of Lome (February 2007) had as theme “the market of illicit medicines in Africa”. The participants asked the governments to take concrete measures to bear an effective and sustainable fight against the illicit sale, the counterfeit and the smuggling of medicines. Will they be listened to? Some of the actors involved in this market that could share in the solution of the problem, have also interests in it, what makes the task more difficult. The lack of political will, join to the absence of legislation and the lack of laboratories of control reinforces the illicit sale.
The problem of the illicit medicines is complex: economic, social, health… Thus the answer must have necessarily a multisectorial character, and be the work of multiple actors must to form a common front: producers, distributors, medical personnel, pharmacists and public authorities. The harmonization of prices in the sector, the strengthening of social security systems, as well as the promotion of the essential generic medicines (EGM) can be ways towards a possible solution to the problem.

The initiative UNITAID recently established by Brazil, France, Chile, Norway and the United Kingdom – financed with the tax on plane tickets – has made it possible to mobilize the international community on the question of the permanent supply of quality medicines at accessible prices to treat malaria, HIV/AIDs and tuberculosis, the three most fatal diseases on the African continent.


1 Report of the USA Institution Food and Medicine Administration (FDA), on the false medicines sold all over the world. 
2 Direction Nationale de Protectionn Sanitaire (DNPS) du Benin
3 Data from the World Health Organisation (WHO)
4 Prosper, pharmacien à Guinkomey, Centre hospitaliaire et universitaire Hubert K. Maga de Cotonou

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