Is your pharmacy free of fake medicines?

Paidamoyo Chipunza Senior Health Reporter
A couple of weeks ago, the Zimbabwe Republic Police (ZRP) in conjunction with Interpol recovered about 420 000 tablets including antiretroviral drugs and cough syrups during an operation of which 90 percent were from Harare and Mashonaland West province. Smuggling and selling of medicines – a majority of which are fake – on the informal market is on the increase, putting the lives of thousands of patients at risk. While most of these medicines are sold secretly along the streets in the central business district, by individuals in high density suburbs and in buses at Mbare Msika, disturbing revelations of the recent police haul were a bogus doctor in Karoi and unlicenced pharmacies.

The apparent presence of unregulated medicines in spaces that people would normally consider as safe has left people wondering how safe they are when buying medicines even from licenced health facility outlets. Medicines Control Authority of Zimbabwe spokesperson Mr Richard Rukwata said that the revealed cases are the exception rather than the rule and the public should retain their trust in the system.

“The Authority ensures that medicines in pharmacies are safe by controlling the whole supply chain, from the manufacturer, through the wholesaler down to the retailer and this process ensures that by the time a patient gets their medicine, that medicine conforms to the specifications approved by the Authority,” he said.

He said in a few cases such as the pharmacies that were closed in the last operation, some people are found wanting and breaking the law, but emphasised that MCAZ always takes stern action when such incidents come to its attention. “We are always imploring members of the public to avoid buying medicines from informal markets for the simple reason that such medicines are very likely to be fake.

“We are very appreciative of the recent efforts by the police, which we were a part of, and we hope that we will continue working on similar projects to help bring awareness to the people of Zimbabwe of the dangers inherent in supporting the informal trade in medicines,” said Mr Rukwata. He attributed the increase in smuggling and selling of medicines on the informal market to the presence of “a ready market”.

“For as long as there is a market for smuggled and fake goods, someone will attempt to fill that market space. “As long as members of the public have an appetite for these dangerous substances, then all enforcement efforts will have limited success,” he said. He said apart from being fake, medicines should not be sold from unapproved facilities because they are very sensitive to moisture, heat and have other specific storage conditions.

“Informal traders have absolutely no conception of these issues, and we know that they handle medicines worse than they handle foodstuffs, so it is very confusing why anyone would entrust their health to someone who cannot take any responsibility whatsoever,” he said.

He said all licenced pharmacies were obliged by law to display their licences issued by MCAZ, failure of which is an offence. Mr Rukwata said the pharmacist must also be licenced and display his or her licence for the public to see. In addition, pharmacists must only buy approved medicines from approved sources and such transactions must be traceable.

“If an inspector asks a pharmacist about the source of medicines, whether they are approved or not, and doesn’t get a satisfactory answer, then the person responsible for procuring those medicines is liable for an offence,” said Mr Rukwata. Adding that this was just an example of the controls in place as provided for by the Medicines and Allied Substances Control Act (Chapter 15:03).

A snap survey by The Herald Review to try and establish why people are opting to buy their medicines from the informal market instead of approved pharmacies showed that the common belief was that the informal market is always cheaper and more convenient. “Buying from the streets is cheaper compared to pharmacies where they would have factored in other costs such as rentals and utility bills and the informal market is always convenient,” said Mrs Mary Makoni of Mbare.

However, further investigations showed that in most instances the actual cost of most medicines was similar at both pharmacies and on the informal market. For instance, oral contraceptives commonly known as family planning tablets cost $1 for two packets both in pharmacies and on the streets. Yet many women still buy these tablets from places like Mupedzanhamo.

She said with the underground traders one does not have to divert their route in search of a pharmacy. Asked if she knew of the dangers of buying medicines on the streets, she said she always checks the expiry dates. An unidentified male in his thirties who was buying pain-killers in Mbare said that the black market operators do not ask any questions and do not need prescriptions as consultation fees push up the cost of healthcare.

“To get antibiotics that cost $3,50 in a pharmacy I need a doctor’s prescription and that will cost me $20. That is too much. So if I know what my problem is I simply get the antibiotics from the dealers,” he said. The MCAZ however, dismissed the point of easy access saying Zimbabwe has one of the best health delivery infrastructures per capita in Africa.

Health and Child Care Minister Dr David Parirenyatwa also said people were at much higher risk of getting fake medicines from underground markets rather than licenced outlets. According to World Health Organisation, fake drugs may contain an inadequate amount of active ingredients, and are sometimes completely devoid of any active ingredients, which can cause major adverse effects and complications for a consumer.

If a drug contains too low of a dose of the active ingredients, not all bacteria, parasites and viruses are killed. These pathogens can therefore become resistant to the drug, allowing them to multiply and spread, leading to worsening of conditions and possible fatalities.

It is estimated that 100 000 people die every year in Africa because of counterfeit drugs. Sometimes, counterfeit drugs can contain a number of harmful or poisonous chemicals, such as boric acid, floor polish, nickel, leaded highway paint, heavy metals, brick dust and arsenic, to name a few. In November 2008, 34 Nigerian children, aged between four months to three years, died and more than 50 were hospitalised with severe kidney damage after their mothers, wishing to alleviate their children’s teething pains, unknowingly gave them a counterfeit drug.

Although the recent operation by the police revealed that fake medicines were coming from neighbouring countries, MCAZ said counterfeit medicines come from all over the world and there is nothing much Government can do beyond keeping in place systems that protect its people.