Smuggling in the Sahel: fake drugs, real deaths
In the summer of 2022, 70 Gambian babies and children died of kidney failure after ingesting illegal cough syrup. The World Health Organisation (WHO) issued a global alert reporting that four children's health products from India were contaminated.
From faulty disinfectant gel to fake malaria pills, the UN and partner countries in Africa's Sahel region are meticulously combating an illicit trade that grew during the COVID-19 pandemic in 2020.
According to a report by the UN Office on Drugs and Crime (UNODC), substandard or counterfeit medicines, such as smuggled children's cough syrup, kill nearly half a million sub-Saharan Africans annually.
The report explains how the nations of the Sahel, a 6000-kilometre-wide strip stretching from the Red Sea to the Atlantic and home to 300 million people, are joining forces to stop counterfeit medicines at their borders and hold perpetrators accountable.
While this struggle is taking place, the people of the Sahel are engaged in an unprecedented struggle: conflict and violence have displaced more than 2.9 million people, and attacks by armed groups have led to the closure of 11,000 schools and 7,000 health centres.
Disparity between medical supply and demandFalsified medicines
This violent scenario is compounded by poor regional healthcare with one of the highest incidences of malaria in the world, in a region where infectious diseases are a leading cause of death.
"The gap between supply and demand for health care is at least partly filled by illegally obtained medicines," the report says, explaining that street markets and unauthorised vendors, especially in rural or conflict-affected areas, are sometimes the only sources of medicines and pharmaceuticals.
More than 200,000 deaths
The study shows the high cost of the illegal trade in medicines, in terms of health care and human lives.
Fake anti-malarial drugs kill 267,000 people annually in the Sahel, while some 170,000 children die each year from unauthorised antibiotics used to treat severe pneumonia.
Treating people who have used counterfeit or substandard medical products to treat malaria in sub-Saharan Africa costs up to $44.7 million a year, the World Health Organisation estimates.
Corruption in supply chains
Customs and law enforcement officials prevent huge quantities of cocaine from entering the markets of destination countries.
Corruption is one of the main reasons why this trade is allowed to flourish.
It is estimated that about 40 per cent of these products, reported in Sahel countries between 2013 and 2021, land in legal supply chains, the study reveals. These medicines often come from exporting countries such as Belgium, China, France and India, and some reach the shelves of pharmacies.
Those involved in these schemes are pharmaceutical company workers, civil servants, law enforcement officers, health agency workers and street vendors, all motivated by potential financial gain.
Although medicine trafficking in the Sahel is often associated with terrorist groups and non-state armed groups, it mainly revolves around the consumption of medicines or extortion, disguised as so-called 'taxes', on shipments in areas under their control.
Cutting supply, meeting demand
Against this backdrop, efforts are being made to adopt a regional approach to the problem, involving all countries in the region. With the exception of Mauritania, all Sahel countries have ratified a treaty to create an African Medicines Agency and an African Medicines Regulatory Harmonisation initiative.
According to the agency's data, all Sahel countries have legal provisions on trafficking of medical products, but some of them are outdated. The agency recommended, among other things, revising legislation and improving coordination among stakeholders.
Measures taken by states
It also noted that police and judicial operations should prioritise the protection of the legal supply chain, and highlighted that regional authorities seized some 605 tonnes of counterfeit medicines between 2017 and 2021.
Thus, Operation Pangea, coordinated by UN partner INTERPOL in 90 countries, targeted the online sale of pharmaceuticals. As a result, seizures of illegal antivirals increased by 18% and seizures of unauthorised chloroquine, a drug to treat malaria, increased by 100%.
The office's executive director, Ghada Waly, recalled that "transnational organised crime exploits gaps in national regulation and oversight to sell substandard and counterfeit medical products".
"We need to help countries increase cooperation to close loopholes, strengthen law enforcement and criminal justice expertise, and raise public awareness to keep people safe," she added.
Following the deaths of 70 children in The Gambia in 2022, the World Health Organisation identified four contaminated paediatric medicines in the West African nation.
Initiatives
In support of States, the UN has launched several initiatives to combat drug trafficking and protect public health.
- The World Health Organisation launched the Global Surveillance and Tracking System, which works in collaboration with a mechanism of Member States on substandard and counterfeit medical products, monitors products and issues alerts to its 194 members.
- The International Telecommunication Union (ITU) and WHO partnered in a focus group on the health-related use of artificial intelligence.
- The United Nations Interregional Crime and Justice Research Institute (UNICRI) is studying counterfeit products and their impact on consumer health and safety.
- The United Nations Office on Drugs and Crime's Strategic Vision for Africa 2030 includes enhanced protection against counterfeit medical products, and its Good Legislative Practices to Combat Counterfeit Medical Products Crime supports countries in enacting legislation and protecting public health.
- The World Customs Organization (WCO) and UNODC launched a container control programme in 70 countries to help authorities share information and ensure supply chain security.
