The priorities of the major pharmaceutical corporations mean that health systems of poor countries are often supplied with substandard and faulty medicines, argues John Clarke

Research conducted at Bahir Dar University in Ethiopia has produced some horrifying findings, with regard to the quality of medicines that are available in Africa. Researchers examined 27 studies that had been conducted ‘and found, of the 7,508 medicine samples included, 1,639 failed at least one quality test and were confirmed to be substandard or falsified.’ ‘Substandard medicines refer to those that are authorised but do not meet quality standards, whereas falsified medicines are those that deliberately misrepresent their identity, composition or source.’

Responding to these findings, Claudia Martínez, the head of research at the Access to Medicine Foundation in Amsterdam, noted that if ‘patients are getting medicines that are substandard or outright fake, it can result in their treatment failing or even preventable deaths.’ Indeed, estimates ‘published last year by the UN Office on Drugs and Crime put the human cost of falsified and substandard medicines at up to 500,000 deaths a year in sub-Saharan Africa.’

The World Health Organisation (WHO) has found that ‘antibiotics and antimalarial products [are] the most falsified medicines in Africa.’ Such flawed antibiotics ‘can contain incorrect dosages or the wrong active ingredients, leading to ineffective treatments and survival of resistant strains. The WHO said such products were likely to be fuelling an increase in antimicrobial resistance.’

Global inequality

It is readily apparent that this appalling situation is but one expression of global inequality and the impact that this has on populations in the Global South. ‘Pharma supply chains in many low- and middle-income countries are often complex, inefficient and fragmented; the region relies heavily on a limited number of suppliers for essential medicines, and many countries face significant challenges in procuring products in time and effectively policing the quality of products in the market.’

In this context, ‘the role of multiple middlemen in the distribution of products on the continent made it easier for substandard or falsified medicines to infiltrate the supply chain.’ It is important, however, not to allow the odious behaviour of locally based agents to obscure the reality that Western pharmaceutical companies and governments carry the greatest share of blame for the lack of access to safe and effective medicines, as I shall show.

The issue of compromised supplies of medicines, while it is particularly severe in Africa, must be viewed as a worldwide issue that takes a disproportionate toll on the countries of the South. A study undertaken in 2022 looked at a range of international examples and discovered some shocking results. In Ghana, 66.38% of antibiotic samples were substandard and the same was true of ‘26.7% of 90 samples of cardiac medicines from the Democratic Republic of Congo.’ At the same time, 10.1% of drug samples tested in Mongolia were substandard.

The study concluded that the ‘total deaths documented due to counterfeit medicines are thought to be underestimated.’ Nonetheless, available evidence gives a strong indication of the appalling impacts that flow from this situation. It is believed that ‘in Africa, about 169,000 children could die annually from pneumonia treated with substandard and falsified medicines.’ Meanwhile, ‘cough syrup adulterated with diethylene glycol became a global concern, resulting in 109 deaths in Nigeria, 236 deaths in Bangladesh, 26 deaths in Argentina and 85 deaths in Haiti.’

The WHO raised this issue in 2017 when it reported that ‘1 in 10 medical products in developing countries are substandard or falsified.’ It pointed out that ‘people are taking medicines that fail to treat or prevent disease. Not only is this a waste of money for individuals and health systems that purchase these products, but substandard or falsified medical products can cause serious illness or even death.’ The WHO made clear that the evidence it had uncovered was ‘likely just a small fraction of the total problem and many cases may be going unreported.’

WHO Director-General, Dr Tedros Adhanom Ghebreyesus, offered a powerful comment on the implications of this situation. ‘Imagine a mother who gives up food or other basic needs to pay for her child’s treatment, unaware that the medicines are substandard or falsified, and then that treatment causes her child to die. This is unacceptable. Countries have agreed on measures at the global level – it is time to translate them into tangible action.’ It is clear that, seven years later, such action has not been taken.

Big Pharma

The impact of fake and substandard medicines is so dreadful in poor countries because they are denied the means to acquire or manufacture adequate supplies of safe and effective medicines. In this regard, the stranglehold of the major Western pharmaceutical companies, so-called Big Pharma, is the decisive question. This powerful group, with its patent rights, subjects research, manufacture and the allocation of medicines to its profit needs, with consequences that are particularly severe in the Global South.

The global supply of insulin for people with diabetes is a case in point. As an article in Al Jazeera this May pointed out, there are now ‘long and anxious waits for essential insulin products in many countries.’ Two companies, ‘Eli Lilly and Novo Nordisk control some 75 percent of the global insulin market.’ At the time the article appeared, ‘several essential formulations of insulin produced by leading drugmaker Eli Lilly [had] been out of stock for weeks due to what the company described as “brief delay in manufacturing”.’ At the same time, ‘Novo Nordisk … announced plans to stop production of a widely used long-acting insulin injection by the end of the year, seemingly opting to bolster its profit-raking weight loss drugs over its off-patent and price-controlled insulin products.’

It is well established that drug-resistant strains of bacteria are emerging that could render antibiotic treatment ineffective on a massive scale. Despite this, ‘not a single new class of antibiotic has been invented since the 1980s. And this is a choice made by Big Pharma.’ In such a situation, ‘not every country has the means to feed corporate greed. What happens to patients in countries that cannot afford the ever-increasing price tag? The horrific “vaccine apartheid” we witnessed at the height of the COVID-19 pandemic is perhaps the best demonstration of how such a strategy plays out on a global stage.’

The article draws the conclusion that ultimately, ‘we need to end Big Pharma’s control over our lives and future.’ We need to ‘completely dismantle the financialised drug-production system that is leaving diabetes patients without access to insulin and exposing us all to the dangers of “superbugs”.’

The lack of access to effective medical treatment in the Global South is becoming an ever greater source of death and hardship, as the weight of other factors increases the health impacts of poverty. The cost-of-living crisis that followed the pandemic has had an effect in the South that is far more dreadful than in wealthy countries. The dislocation, displacement and destruction that climate impacts inflict have a shattering effect on poor countries with healthcare systems that are already overstretched and inadequate. A crushing international debt burden ensures that ‘low-income countries see only one reality: that of public investment, education and healthcare, which are clearly declining.’

Under such dire conditions, the proliferation of substandard and falsified medicines is disastrous for hard-pressed populations that are already struggling to survive. It undermines the ability to provide the most basic standard of healthcare in some of the poorest countries on earth.

Compromised supplies of medicines are but one expression of the deep inequalities and fundamental injustices of the imperialist world order that must be challenged and overcome. This includes ensuring that medical treatment in the Global South is no longer dominated by the profit needs and ‘intellectual property rights’ of the major pharmaceutical companies.