According to World Health Organization statistics, 42% of detected cases of substandard or falsified pharmaceuticals between 2013-2017 occurred in Africa— substantially more than on any other continent. Poor, underdeveloped countries experience a penetration rate of approximately 30% of counterfeit pharmaceuticals as opposed to less than 1% in developed countries.
In Ivory Coast, Adjame, the biggest street market of fake medicines in West Africa, alone accounts for 30% of medicine sales in Ivory Coast. No medication is spared, with counterfeiters producing a full range of fake pharmaceuticals including antibiotics, pain killers, HIV/AIDS, cancer, and diabetes treatments.
This illicit trade has dramatic consequences, namely increased bacterial resistance to effective medicines, longer hospitalisation and treatment time, and widespread loss of life. Counterfeit antimalarial medicines kill around 64 000 to 158 000 people in sub-Saharan Africa every year. In March 2019, only a few weeks after the launch of a campaign in Niger to inoculate six million children against meningitis, the health authorities warned the population to remain vigilant over a counterfeit version of the vaccine.
With the African pharmaceutical market projected value rising from $45 billion in 2020 to an estimated $56-70 billion by 2030, trade in counterfeit pharmaceuticals will become more lucrative and consequently attract a greater number of criminals. If one adds in high poverty rates, low risk of detection and prosecution, weak penalties, trusting consumers and the tolerance of a parallel pharmaceutical trade, the problems caused by counterfeit and falsified pharmaceuticals in Africa are most likely to increase over the next decade. As a collateral damage of the COVID-19 pandemic in Africa, the delivery of other health services is disrupted, resulting in a loss or interruption of access to regular medication, including antiretroviral therapy refills. As access to medications from reliable sources decreases, a significant rise in counterfeit pharmaceuticals in Africa is anticipated.
Various types of counterfeit drug detection devices are available on the market, but these are often prohibitively priced for widespread use in most African countries. Rising to the challenge, African entrepreneurs are proposing innovative technological measures that allow for a quick and cheap verification of the genuineness of a drug. With more than three-quarters of the population in sub-Saharan Africa having a mobile phone connection (747 million people), of which a third (250 million) have a smartphone, it is no surprise that many of these innovations are based on mobile technology and text message identification. Since July 2017, Malian consumers may verify the authenticity of a product by sending a verification code on their mobile phone to the phone company. In Nigeria, more than five million pharmaceutical products have scratch cards attached. Scratch-off codes are now mandatory on malaria drugs and some antibiotics. Once scratched, a one-time use code is revealed. The customer sends the code via text message to a toll-free number and immediately receives a response as to whether the drug is real or fake. If the drug is fake, the patient receives a hotline number to report the counterfeit drug. This notification system is also available in Kenya and Ghana.
Beyond the obvious benefit of text message identification to the consumer, the data collected allows pharmaceutical companies to track locations where occurrences of counterfeits are common and is used to trace offenders. Where a genuine authentication code was checked more than 1500 times in a few days, the service provider quickly identified that a genuine code had been replicated and applied to thousands of counterfeit emergency contraceptive pills. Using the contact details provided through the verification system, the service provider was able to contact every person to ascertain where the pills were bought and alerted authorities and regulators for further action.
While there have been no studies on the positive impact of those mobile technologies, in Nigeria the local food and drug administration authority responsible for the quality of products such as drugs, chemicals, medical devices and foods reported a decrease in the prevalence of counterfeit drugs from 64% to 3% after the introduction of a combination of technological means from text message identification, hand-held analysers that identify goods through sealed packaging in a matter of seconds, to radio-frequency identification tags which identify individual items and track movement through the supply chain.
With mobile technology already allowing for such impressive results, the growing interest of African entrepreneurs for blockchain technology to authenticate the supply chain is exciting news for the continent. Similarly, the technological advancements experienced in the building of COVID-19 tracing apps, to trace, identify, and notify all those who come in contact with a person infected with the coronavirus, can be harnessed and used for the identification and tracking of supply chains for counterfeit and falsified pharmaceuticals in Africa going forward.