Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Counterfeit Drugs* ; Developing Countries* ; Drug and Narcotic Control*; Antimalarials/*standards; Adult ; Africa/epidemiology ; Antimalarials/therapeutic use ; Child Mortality/trends ; Child, Preschool ; Humans ; Infant ; Malaria/drug therapy ; Malaria/mortality

Background: Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone.
Discussion: Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made.
Conclusion: There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

Am J Trop Med Hyg. 2015 Jun;92(6 Suppl):95-104. (PMID: 25897062)
Expert Rev Anti Infect Ther. 2015 Apr;13(4):505-9. (PMID: 25683870)
Expert Rev Anti Infect Ther. 2016 Jun;14 (6):531-3. (PMID: 27187060)
Am J Trop Med Hyg. 2015 Jun;92 (6 Suppl):113-118. (PMID: 25897060)
Lancet Glob Health. 2014 Sep;2(9):e509-e510. (PMID: 25304415)
Am J Trop Med Hyg. 2015 Jun;92(6 Suppl):75-86. (PMID: 25897065)
Trends Pharmacol Sci. 2010 Mar;31(3):99-101. (PMID: 20117849)
PLoS One. 2015 May 27;10(5):e0125577. (PMID: 26018221)
Lancet Infect Dis. 2012 Jun;12(6):488-96. (PMID: 22632187)
Malar J. 2013 Jun 28;12:220. (PMID: 23809666)
Am J Trop Med Hyg. 2015 Jun;92(6 Suppl):8-16. (PMID: 25897066)
BMC Pharmacol Toxicol. 2016 Oct 28;17 (1):48. (PMID: 27788677)
Am J Trop Med Hyg. 2015 Jun;92 (6 Suppl):51-58. (PMID: 25897070)
Am J Trop Med Hyg. 2008 Apr;78(4):552-5. (PMID: 18385347)
Am J Trop Med Hyg. 2015 Jun;92 (6 Suppl):127-132. (PMID: 25897071)
Malar J. 2012 Jun 15;11:203. (PMID: 22704709)
PLoS Med. 2009 Mar 24;6(3):e52. (PMID: 19320538)
Malar J. 2014 Apr 08;13:139. (PMID: 24712972)
Malar J. 2014 Jun 02;13:209. (PMID: 24888370)
Mediterr J Hematol Infect Dis. 2012;4(1):e2012027. (PMID: 22708042)
Am J Trop Med Hyg. 2017 May;96(5):1124-1135. (PMID: 28219993)
Trans R Soc Trop Med Hyg. 2017 Feb 1;111(2):90-96. (PMID: 28460126)
PLoS Med. 2006 Jun;3(6):e197. (PMID: 16752952)
J Vector Borne Dis. 2012 Sep;49(3):131-9. (PMID: 23135006)
Am J Trop Med Hyg. 2015 Jun;92(6 Suppl):39-50. (PMID: 25897063)
Am J Trop Med Hyg. 2014 Nov;91(5):920-4. (PMID: 25266348)
J Pharm Biomed Anal. 2018 Jan 5;147:612-623. (PMID: 28549854)
Am J Trop Med Hyg. 2015 Jun;92 (6 Suppl):119-126. (PMID: 25897068)
Am J Trop Med Hyg. 2015 Jun;92 (6 Suppl):105-112. (PMID: 25897069)
Malar Res Treat. 2014;2014:806416. (PMID: 25400975)
Malar J. 2016 Jun 01;15:302. (PMID: 27251199)
Lancet. 2012 Sep 22;380(9847):1120. (PMID: 22998721)
Malar J. 2011 Dec 13;10:352. (PMID: 22152094)
Malar J. 2017 May 15;16(1):197. (PMID: 28506234)
PLoS One. 2014 May 14;9(5):e96810. (PMID: 24828338)

Keywords: Antimalarial; Counterfeit; Malaria; Poor-quality; Substandard

0 (Antimalarials)
0 (Counterfeit Drugs)

Date Created: 20180517 Date Completed: 20190604 Latest Revision: 20190604

20240628

PMC5952616

10.1186/s12889-018-5521-7

29764407