- The Washington Times - Saturday, March 4, 2006

Bird flu is on the wing in Asia, Africa and Europe. It is only a matter of time before it arrives in North America. Yet the supply of effective drugs everywhere is undermined by a plague of counterfeits for which governments are to blame.

The deadly H5N1 strain of the virus may not mutate into a form that can be transmitted between people, but people are right to be worried. The best drugs we have may be rendered useless by counterfeiters and complicit officials.

Fake drugs are a booming business in many poorer parts of the world, worth about $35 billion a year and making up 10 percent of all medicines. The U.N. warned this week that criminals are selling increasing amounts of avian flu drugs over the Internet. As well as lining criminals’ pockets, these counterfeits could completely undermine treatment of victims in a pandemic.

Counterfeit drugs can make genuine, branded drugs useless. If they contain too little of the active ingredient, they can act like an “inoculation” to the virus, bacterium or parasite they are designed to kill. They could help the bird flu virus mutate into new, drug resistant strains, rendering existing treatments useless. In an avian flu pandemic, we really do not want the best current treatment, Tamiflu, to be redundant.

This is a very real and frightening prospect: It is already happening with malaria. Counterfeiters around the world have cashed in on the massive demand for the latest and most effective antimalarial drug, artemisinin. Over half the drugs sold in Southeast Asia contain incorrect levels of the active ingredient. Drug resistance to antimalarials is becoming a deadly problem — more than 100,000 people die each year from fake antimalarials in Southeast Asia alone.

The same is true for the antiretroviral drugs used to treat HIV-AIDS. Even the latest drugs are undermined by drug-resistant forms of the HIV virus — largely due to counterfeits.

In time the same fate will befall treatments for avian flu, as demand for Tamiflu grows and people turn to the black market. The Internet is awash with spurious Tamiflu. Consignments have been discovered as far apart as New York and Beijing.

These fake drugs are now penetrating the U.S. supply through the Internet and through unscrupulous wholesalers both at home and abroad. Parallel importation of drugs into the U.S. booming with some 20 million packages containing pharmaceuticals arriving in the U.S. every year. It is impossible for customs officials to search every one.

So how what can be done? To start, it is essential to understand the problem stems largely from government actions in the countries where fakes are manufactured.

The governments stimulate demand for cheaper fakes by artificially driving up the price of legitimate drugs through taxes and tariffs. It cannot be a coincidence that the two countries with the highest levels of counterfeit drugs — Pakistan and Nigeria — also top the league for medicine taxes.

Governments also incentivize counterfeiters by corrupting the legal system. In many countries, gangsters have little difficulty persuading authorities to turn a blind eye, through bribery or intimidation, because they know there is no legal recourse. China has a particularly poor track record in clamping down on the racketeers for this reason.

Weak rule of law also means companies cannot protect their trademarks, or “brands,” which are the main means by which they signal the quality of their product to consumer. When consumers cannot tell the difference between a fake and the real thing, counterfeiters get a free ride.

Finally, in countries where the rule of law prevails, those harmed by counterfeits can obtain redress in the courts. But in most poor countries, cases can take years to progress through corrupt and under-resourced courts.

Last week the World Health Organization gathered officials and regulators from around the world in Rome to discuss “a mechanism for concerted international action against counterfeit medicinal products.” But there are plenty of laws already, perhaps even too many; the problem is the laws that matter are not applied fairly and uniformly.

Rather than wait for the United Nations to come up with a grandiose plan, governments in countries where fake Tamiflu is manufactured should act immediately to improve the situation. First, they can remove the unfair and discriminatory tariffs and taxes on medicines. Second, they can stop interfering in the free and fair functioning of the courts of law.

Governments that do not take this seriously are complicit in thousands of deaths. In the event of a bird flu pandemic, they will be responsible for many thousands more.

Philip Stevens is health program director for the International Policy Network in Great Britain.

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