Around one in every eight essential medicines in lower income countries may be of low quality, or an outright fake. This was the conclusion of a review and met-analysis performed on relevant studies in five databases, including Pubmed and Embase, which allowed researchers to examine over 350 previous studies, which between them tested more than 4,000,000 drug samples.
“I recently transitioned to the School of Pharmacy at the University of North Carolina at Chapel Hill, where it struck me how important medicine quality is for protecting population health. Ensuring that medicine is doing what it’s intended to do is critical to a trusted healthcare system. We wanted to know how large of a problem poor quality medicines is,” says Sachiko Ozawa, first author of the review (1).
Substandard and fake drugs don’t just fail to treat disease – they can prolong illness, and heighten the risk of treatment failure, poisoning and drug interactions. They can also contribute to antimicrobial resistance, posing a threat to the effectiveness of future treatments, explains Ozawa. “In addition, poor quality medicine can diminish people’s trust in medicines, healthcare professionals, and the healthcare system itself,” he adds, “and there are also economic impacts, from wasted resources and treatment of additional complications, to decreased economic productivity resulting from prolonged illness.”
In a meta-analysis of studies that tested 50 samples or more, the researchers found that the overall prevalence of substandard and falsified medicines was 13.6 percent for antibiotics. Data on the estimated economic impact were limited and focused mainly on market size, but ranged from $10–200 billion – a substantial number for low and middle income countries, even by the conservative estimate.
The team is urging pharma to help. “The pharmaceutical industry has the technical know-how and screening technologies to detect substandard and falsified medicines. Greater collaboration and data sharing are needed to ensure that medicines are genuine, quality assured and trustworthy. Multi-stakeholder engagement of pharmaceutical companies with governments, international organizations, and experts are essential to ensure that medicines are safe and effective,” says Ozawa. “We have an opportunity and obligation to tackle this problem, which threatens global health security and is essential to meet the United Nations Sustainable Development Goal to achieve universal access to safe and effective essential medicines.”
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References
- S Ozawa et al., “Prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries”, JAMA Network Open, 1, e181662 (2018). doi:10.1001/jamanetworkopen.2018.1662.
