USP Helps Cambodia, Southeast Asia Build Arsenal To Combat Counterfeit Drugs

BEIJING - In the latest moves aimed at fighting counterfeit medicines being sold to patients with malaria or other potentially lethal diseases, the United States Pharmacopeial Convention is training Cambodian scientists to test drugs for quality and authenticity, expanding a new system to track adverse events, and producing television spots to educate the public about the dangers of fake drugs. The USP is conducting a similar offensive against counterfeit drugs throughout Southeast Asia under a cooperative agreement with the United States Agency for International Development.

Counterfeit drugs apparently manufactured abroad have infiltrated the Cambodian capital and other cities, according to Patrick Lukulay, director of USP's Drug Quality and Information Program, who just returned to the organization's headquarters in Rockville, Maryland from a trip to Cambodia.

"These counterfeit drugs are being sold on street corners and back alleys" that crisscross Cambodia, said Lukulay, whose program's mission is to track down and wipe out substandard and counterfeit medicines in developing countries in Asia, Africa, and Latin America.

The World Health Organization estimates that counterfeits account for between 10 and 30 percent of all medicines in the developing world; Lukulay says that 10 to 15 percent of the medicines currently circulating in Cambodia are likely fake.

That spells danger and possibly death for sufferers of malaria, TB or other life-threatening diseases who happen to have the compounded ill fortune to purchase counterfeit treatments containing too little or no active pharmaceutical ingredients.

"Malaria kills 800,000 to one million people every year," explained Lukulay, and "about 80 percent of these are children."

"When children are exposed to counterfeit medicines," he added, "it is more catastrophic for them."

The children of Cambodia and of other "tropical developing countries" where malaria is endemic, he said, face dire consequences when life-saving access to immediate treatment is blocked by the unknowing purchase of counterfeit drugs.

Medicines being sold in the backstreets by "unauthorized traders" are up to 10 times cheaper than those sold in government hospitals or private pharmacies, so impoverished patients often take a chance on these "illicit markets," said Lukulay.

"Generally these medicines are imported - from China, but also from India," he explained (Also see "Counterfeit Drugs Produced In China Still Threaten Chinese, U.S., Global Consumers" - Scrip, 14 May, 2009.). This may be due to Cambodia's proximity to these countries.

Packaging containing Chinese characters "often imitates the real product," and, except for those who have received special training, it is extremely difficult to spot the fakes.

To help remedy the situation, USP operates a series of surveillance programs in which medicines are purchased on the market and tested; the group has also set up "sentinel sites" in Cambodia, along with Laos, Vietnam and Thailand, to test drugs.

These programs are gradually being expanded across Southeast Asia, Lukulay said. In the Cambodian capital, he added, USP now gathers drugs from hospitals, drug stores, and the black market, and conducts quality tests on these samples.

Inside Cambodia, he said, USP has started training chemists working in government laboratories, along with medical students and other scientists, to conduct these tests.

One year ago, USP joined forces with the World Health Organization to set up a basic system in Phnom Penh to monitor and record adverse events triggered by drugs.

"Before that, there was zero tracking of adverse events" in Cambodia, Lukulay noted.

"Now this center [and its tracking equipment] only covers Phnom Penh," he said, but USP aims to expand the capacity to monitor adverse events to more Cambodian cities by October of next year, and eventually to build a national database.

Meanwhile, USP recently produced a series of public service announcement videos to educate the citizens of Cambodia and neighboring countries about the existence and dangers of counterfeit medicines.

The Cambodian government is also cooperating on the project, and in other USP/USAID activities, in joint efforts to reduce the presence of counterfeit and substandard medicines in the country. The videos are expected to begin airing on Cambodian television soon.

- Kevin Holden ([email protected])