Fake antimalarials and public health

Santé & Médecine Business

Conference on Health and Social Protection: Meeting the needs of the poor, 09-10 October 2008 www.povill.com

[object Object],[object Object],[object Object],[object Object],Fake antimalarials and public health

Recent Reports of Fake Antimalarials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Not faked ? * Artemether-lumefantrine * Atovaquone-proguanil * iv/im artesunate

Definitions ,[object Object],[object Object],[object Object],[object Object]

Fake Cinchona Bark 17 th C Europe Fake Quinine London 1829 Physicians chastising a drug seller 13 th C Arabia

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CONSEQUENCES of FAKE DRUGS

Artesunate ,[object Object],[object Object],[object Object]

Fake artesunate in mainland SE Asia ,[object Object],[object Object],[object Object],[object Object],[object Object],There are ~ 2 x 10 6 cases of P. falciparum /year in WPRO - in ‘untreated’ non-immunes the excess mortality will be considerable

Genuine Hologram Fake Artesunate ‘Type 8’

Genuine Hologram Fake Artesunate ‘Type 10’

Traces of artesunate ,[object Object],[object Object]

Fake artesunate ‘wrong’ ingredients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

An under appreciated Asian public health disaster * Malaria remains a problem in SE Asia, but we have the tools for control * Counterfeit artesunate MUST be a major risk for death and an impediment to malaria control * Despite 6 years of awareness - situation deteriorating and little action despite severe danger to public health * How many additional deaths - thousands ?

INTERPOL/WPRO Investigation ,[object Object],[object Object]

Debris, including Juglans pollen charcoal fragments

Valid batch numbers, stickers, multiple wrong AIs, calcite Invalid batch numbers, holograms, subtherapeutic artesunate

[object Object],[object Object],[object Object],WANTED

Genuine Hologram Fake Artesunate ‘Type 15’ Similar to Type 10 - found only in N Burma and N Laos (Westerly trade route)

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What can be done ? ,[object Object],[object Object],[object Object],[object Object]

Acknowledgements The laboratories and their staff The Government of the People’s Republic of China Food and Drug Quality Control Centre & Food & Drug Department, Lao PDR Guilin Pharmaceutical Co. Ltd, China The Natural History Museum, London and Wolfson College, Oxford, UK David Pizzanelli, Mayfong Mayxay, Bryan Watt, Arjen Dondorp, Frank Smithuis, François Nosten, Lucy Paiphun, Aung Pyae Phyo, Khin Mg Lwin, Rose McGready, Shunmay Yeung, Chongkham Phonekeo, Christopher Curtis, Sue Lee, Nicholas Day, Nicholas White and anonymous collectors for their help and advice Funded by Wellcome Trust of Great Britain, the participating institutions and the United States Agency for International Development through US Pharmacopeia

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