Cambodian Inspectors examine suspected medicine in a crowded market along Thai-Cambodian border during an inspection July 23, 2010 in Pailin province, Cambodia. Photo: Getty Images
Show Hide image

Unregulated fake medicines are threatening the fight against diseases like malaria

There is currently no international law or body that can organise the detection and prevention of fake medicines - and it's a critical threat to our ability to fight deadly diseases.

In the UK, when horsemeat – which is not life threatening – turned up in a supermarket burgers that claimed to be made of beef, it was a national scandal. Imagine that a similar situation emerged, but this time instead of beef products, it was life-saving medicine that contained unlabeled, unsafe ingredients. You’d rightly expect the full weight of the law to come down on the manufacturers. And in the UK, that would likely be the case. You might be surprised, then, to find out that there is in fact no international law to prevent the trade in falsified medicines, and in many parts of the world without similar regulatory systems in place, these ‘medicines’ – packets labeled as a drug, but in fact containing none of the active ingredients - are big business.

In June 2012 a shipment of loudspeakers arrived in a container in the Luanda docks having travelled by sea from Guangzhou to Angola. Nothing unusual in that, given the burgeoning trade between China and Africa. However, all was not what it seemed.

Within the loudspeakers were 1.4 million packets of falsified medicine, mostly labeled as a key life-saving antimalarial drug: artemether-lumefantrine. Detailed analysis by scientists confirmed that the packets contained no active drug and would have had no beneficial affect for malaria – no more than listening to music through the loudspeakers.

There were also packets that claimed to contain the deworming medicine mebendazole. Not only did they not contain any of the active ingredient stated on the label, they did contain a drug called levamisole, a deworming medicine that has been withdrawn from human use in many countries due to severe side effects, including bone marrow failure. There has recently been an epidemic of severe blood vessel inflammation resulting from ‘cutting’ cocaine with levamisole, suggesting links between criminals producing cocaine and these falsified medicines.

Had the falsified malaria tablets got into the supply chain they would inevitability have increased death and sickness. Worse still, they could increase malaria parasites’ resistance to the real drugs which save millions of lives in sub Saharan Africa each year.

On their own, falsified medicines, containing no antimalarial, will not risk antimalarial resistance, as there is no drug in the patients’ blood for any resistant parasites to survive attack from and multiply. However, in the many countries with inadequate regulation of medicine both falsified medicines and substandard medicines commonly occur together. Substandard medicines result from errors in production and not fraud, and usually contain less than the stated amount of antimalarial compound. If patients develop very high concentrations of parasites in their blood through taking falsified antimalarials that have no effect, and then take substandard medicines, susceptible parasites in the blood are killed but the resistant ones multiply – and are sucked up by mosquitos to spread to the next unwitting patient.

This risks catastrophe for the spread of resistance to these front line drugs. If resistant parasites spread to Africa, as has already happened across Southeast Asia, the death toll will be enormous: potentially millions of lives and billions of dollars.

Over the last few decades there has been much high level debate about malaria, given the toll on lives, livelihoods and societies. The scandal is that there has been remarkably little action to ensure the quality of antimalarials. It is not regarded as a sexy subject in international public health and seems to be viewed as intractable. It is not intractable. The seizure in Angola illustrates some of the major problems in improving the global medicine supply but, as I and others have outlined in Lancet Global Health this week, there are solutions.

At the most basic level, we need a global system for mandatory reporting, assessment, and appropriate dissemination of information on suspicious medicines. The seizure in Angola was first brought to public attention on Facebook after five months and then in the Wall Street Journal after eleven months.

Although such reporting is commendable, it is grossly inadequate for public health. What proportion of African malaria patients and their families read Facebook and the Wall Street Journal? Until recently no nation had legislation requiring the pharmaceutical industry to inform the national medicine regulatory authority of drug falsification. It is extraordinary that, in 2014, such systems are widely in place for fake aircraft parts but not for medicines.

Medicine falsification, unlike money counterfeiting, is not currently regarded as an international crime, making extradition and prosecution of criminals, such as those trading in falsified medicines between China and Angola, extremely difficult. We need an international public health convention that enshrines the crime in international law, allowing extradition, and helping countries to combat criminal networks. It could also provide a financing mechanism for supporting the many countries with insufficient capacity for the regulation of medicines. Indeed, the WHO has estimated that 30 per cent of countries have no drug regulation or a capacity that hardly functions. Functional national medicine regulatory authorities are essential for the interventions needed, and to ensure that the benefits of increased accessibility to internationally financed medicines and inexpensive generics are translated effectively into improved public health.

The enormous investment in increasing global accessibility of essential medicines without investing in checking and ensuring their quality is profoundly illogical. We cannot expect the world’s medicine supply to improve without coordinated functional national regulatory systems.

We need much more vigorous and urgent action to promote Access to Good Quality Medicines or the promise of beating malaria and other endemic diseases will be squandered.

Professor Paul Newton is the director of the Lao-Oxford University-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao PDR

Show Hide image

Brexit confusion is scuppering my show – what next?

My week, from spinning records with Baconface, Brexit block and visiting comedy graves.

I am a stand-up comedian, and I am in the process of previewing a new live show, which I hope to tour until early 2018. It was supposed to be about how the digital, free-market society is reshaping the idea of the individual, but we are in the pre-Brexit events whirlpool, and there has never been a worse time to try to assemble a show that will still mean anything in 18 months’ time.



A joke written six weeks ago about dep­orting eastern Europeans, intended to be an exaggeration for comic effect, suddenly just reads like an Amber Rudd speech – or, as James O’Brien pointed out on LBC, an extract from Mein Kampf.

A rude riff on Sarah Vine and 2 Girls 1 Cup runs aground because there are fewer people now who remember Vine than recall the briefly notorious Brazilian video clip. I realise that something that gets a cheer on a Tuesday in Harrogate, or Glasgow, or Oxford, could get me lynched the next night in Lincoln. Perhaps I’ll go into the fruit-picking business. I hear there’s about to be some vacancies.



I sit and stare at blocks of text, wondering how to knit them into a homogeneous whole. But it’s Sunday afternoon, a time for supervising homework and finding sports kit. My 11-year-old daughter has a school project on the Victorians and she has decided to do it on dead 19th-century comedians, as we had recently been on a Music Hall Guild tour of their graves at the local cemetery. I wonder if, secretly, she wished I would join them.

I have found living with the background noise of this project depressing. The headstones that she photographed show that most of the performers – even the well-known Champagne Charlie – barely made it past 40, while the owners of the halls outlived them. Herbert Campbell’s obelisk is vast and has the word “comedian” written on it in gold leaf, but it’s in the bushes and he is no longer remembered. Neither are many of the acts I loved in the 1980s – Johnny Immaterial, Paul Ramone, the Iceman.



I would have liked to do some more work on the live show but, one Monday a month, I go to the studios of the largely volunteer-run arts radio station Resonance FM in Borough, south London. Each Wednesday night at 11pm, the masked Canadian stand-up comedian Baconface presents selections from his late brother’s collection of 1950s, 1960s and 1970s jazz, psychedelia, folk, blues and experimental music. I go in to help him pre-record the programmes.

Baconface is a fascinating character, whom I first met at the Cantaloupes Comedy Club in Kamloops in British Columbia in 1994. He sees the radio show as an attempt to atone for his part in his brother’s death, which was the result of a prank gone wrong involving nudity and bacon, though he is often unable to conceal his contempt for the music that he is compelled to play.

The show is recorded in a small, hot room and Baconface doesn’t change the bacon that his mask is made of very often, so the experience can be quite claustrophobic. Whenever we lose tapes or the old vinyl is too warped to play, he just sits back and utters his resigned, philosophical catchphrase, “It’s all bacon!” – which I now find myself using, as I watch the news, with ­depressing regularity.



After the kids go to sleep, I sit up alone and finally watch The Lady in the Van. Last year, I walked along the street in Camden where it was being filmed, and Alan Bennett talked to me, which was amazing.

About a month later, on the same street, we saw Jonathan Miller skirting some dog’s mess and he told me and the kids how annoyed it made him. I tried to explain to them afterwards who Jonathan Miller was, but to the five-year-old the satire pioneer will always be the Shouting Dog’s Mess Man.



I have the second of the final three preview shows at the intimate Leicester Square Theatre in London before the new show, Content Provider, does a week in big rooms around the country. Today, I was supposed to do a BBC Radio 3 show about improvised music but both of the kids were off school with a bug and I had to stay home mopping up. In between the vomiting, in the psychic shadow of the improvisers, I had something of a breakthrough. The guitarist Derek Bailey, for example, would embrace his problems and make them part of the performance.



I drank half a bottle of wine before going on stage, to give me the guts to take some risks. It’s not a long-term strategy for creative problem-solving, and that way lies wandering around Southend with a pet chicken. But by binning the words that I’d written and trying to repoint them, in the moment, to be about how the Brexit confusion is blocking my route to the show I wanted to write, I can suddenly see a way forward. The designer is in, with samples of a nice coat that she is making for me, intended to replicate the clothing of the central figure in Caspar David Friedrich’s 1818 German masterpiece Wanderer Above a Sea of Fog.



Richard Branson is on the internet and, just as I’d problem-solved my way around writing about it, he’s suggesting that Brexit might not happen. I drop the kids off and sit in a café reading Alan Moore’s new novel, Jerusalem. I am interviewing him about it for the Guardian in two weeks’ time. It’s 1,174 pages long, but what with the show falling apart I have read only 293 pages. Next week is half-term. I’ll nail it. It’s great, by the way, and seems to be about the small lives of undocumented individuals, buffeted by the random events of their times.

Stewart Lee’s show “Content Provider” will be on in London from 8 November. For more details, visit:

This article first appeared in the 27 October 2016 issue of the New Statesman, American Rage