A Prescription for When the Cure Is Worse than the Illness
By Sara Cardelle, USAID
Imagine rummaging through your medicine cabinet for a vital prescription. Once found, you pop the lid and tap out a few pills into your palm. If you live in a country that strictly regulates pharmaceutical production and distribution, you assume the pills are safe and take them without a second thought.
But what if these protections were not provided? What if you were stricken by an illness that required medication that you couldn’t be sure was safe or effective? What if you learned too late that this medication contained no active ingredient, was degraded, or mixed with toxic components?
For millions of people in developing countries, these questions are all too real.
In 1995, a meningitis epidemic hit Niger, in West Africa. Although the Government of Niger carried out an efficient vaccine program, more than 50,000 people were administered fake vaccines that contained no active ingredient, resulting in 2,500 deaths. The vaccines, donated by a country that thought they were safe, had been bottled and labeled to look like true vaccines.
Similar incidents continue to occur worldwide. Counterfeit drugs, which are estimated to be as high as 30 percent of all drug sales in the developing world, can cause severe side effects or death or, because they often don’t contain the correct amount of active ingredients, can allow for disease progression and cause drug resistance. Globally, more than 100,000 people die every year as a result of these dangerous drugs and this likely represents a significant underestimation. High profit margins and minimal risk, along with lack of political commitment and weak medicines regulation and enforcement drive the counterfeit market.
A parallel problem exists with substandard medicines, whether imported or produced locally. In these cases, drugs are not produced in accordance with accepted good manufacturing practices or shipped or stored properly, rendering them ineffective at best. In 2012, a contaminated cardiovascular medicine was linked in Pakistan to the death of more than 200 patients in just a few days and was responsible for sickening 1,000 after lethal amounts of an antimalarial drug were accidentally mixed with the medicine during manufacturing.
This is the dire and sometimes fatal scenario that a promising and innovative new device called PharmaChk is hoping to prevent. PharmaChk, a fast, easy and inexpensive screening technology for counterfeit and substandard medications, is being developed at Boston University to help combat the perils of poor quality drugs in the developing world.
Several programs at USAID, including Saving Lives at Birth: A Grand Challenge for Development, have backed this effort.
“Our goal is to comprehensively address the limitations of current technologies and provide detailed information on drug quality at all points in the supply chain,” says Muhammad Zaman, an associate professor at Boston University and the lead researcher developing the device.
Zaman, who teaches biomedical engineering, has both a professional and personal interest in combatting counterfeit drugs in the developing world. He grew up in Pakistan and remembers that his “mother would take us all across the town so we could get our medicines and vaccines at a reputable place.” Those long treks would eventually inspire him to tackle the counterfeit and substandard medicine crisis.
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