By Allyn Gaestel
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| Scientists collect drug samples to perform quality tests. Counterfeit and substandard medicines have contributed to a rise in drug resistant strains of malaria in Cambodia. (Photo Credit: Christopher Raymond, USP) |
6 May 2010 [MediaGlobal]: Growing numbers of Cambodians are dying from malaria even while taking anti-malarial medicines. Increasing instances of drug-resistant malaria have worried public health officials over the last year, and the problem has grown from slowed recovery to fatalities even when people follow proper treatment guidelines.
Cambodians have been able to buy anti-malarial drugs over the counter for the past decade, and substandard and counterfeit medicines have inundated the market. Sub-standard medicines and unregulated consumption, such as when people do not properly take the full drug regimen, can strengthen strains of malaria, contributing to increased fatalities.
The Cambodian government is responding to the issue in partnership with United States Pharmacopeia (USP), a non-governmental organization dedicated to monitoring standards and quality of medicines and food around the world.
It is particularly worrisome that patients are increasingly resistant to Artemisinin-based combination therapy (ACTs), as these are the frontline drugs. Dr. Patrick Lukulay, Director of the Promoting the Quality of Medicines (PQM) program at USP, told MediaGlobal “This is really the pressing issue now. To make sure that the problem is not worsening, and if it is, developing therapies that would aid the ACTs because they are right now the only best therapies available in the market.”
Over the last five months, the government has shut down 65 percent of illegal pharmacies. The number of illegal pharmacies has decreased from 1,081 in November 2009 to 379 in March 2010.
USP has been conducting post-market surveillance, testing medicines from a myriad of sources to determine the origin of the problem. Illegal pharmacies were found to be a significant source of sub-standard medicines. In addition to anti-malarials, poor quality anti-retrovirals to combat HIV, antibiotics, and anti-tuberculosis medicines were also found.
Thus far, only the anti-malarials have led to measured drug resistance, but the closures will also help ensure that other substandard medicines are kept out of the market to avoid resistant strands of HIV, tuberculosis, and bacterial infections.
The illegal pharmacies facing closure are large-scale pharmaceutical depots. Cambodians have used these resources because they are local, accessible, and they are not aware of the dangers of buying medicine from unregulated sources.
The closures have been accompanied by a dramatic public service announcement video showing the chain of events that link counterfeiters, dealers, and victims. The video aims to raise awareness of the dangers of buying from unregulated sources.
Yet steps still need to be taken to inform Cambodians of which pharmacies are safe. Some illegal pharmacies have been legalized if the vendors go through a training process to learn to discern which suppliers are reliable and what medicines are high-quality.
But Lukulay told MediaGlobal, “Because you have both [legal and illegal pharmacies] operating, its hard for people to understand which ones they should seek medicines from. And so we are continuing to stress that there should be a way that people can recognize, either with a mark or some clear sign which depots have been authorized and which have not.”
USP continues to work with the Cambodian government to ensure access to quality medicines. USP has provided testing equipment and trained Cambodian government workers to perform their own tests.
Cambodia also needs to address other sources of sub-standard medicines. Lukulay acknowledged the possibility that closed pharmacies can relocate and reopen, and said that street vendors operating outside the structure of large-scale pharmaceutical depots need to be traced and shut down.
The only way to combat sub-standard medicines in the long term is by bolstering the government’s own pharmacological vigilance program to continue to monitor the quality of medicines on the market and shut down sources of poor quality medicines.
Access to high quality also needs to be scaled up. While some illegal pharmacies have been legalized, the vast majority have simply been shut down.
Nonetheless, Lukulay emphasized the positive benefits of the closures. “I would think that it is better to have fewer that sell better medicine than to have a lot that are selling medicines that compromise the effectiveness of the drugs. Its better to take nothing, than to take a poor quality medicine.”
Cambodians have been able to buy anti-malarial drugs over the counter for the past decade, and substandard and counterfeit medicines have inundated the market. Sub-standard medicines and unregulated consumption, such as when people do not properly take the full drug regimen, can strengthen strains of malaria, contributing to increased fatalities.
The Cambodian government is responding to the issue in partnership with United States Pharmacopeia (USP), a non-governmental organization dedicated to monitoring standards and quality of medicines and food around the world.
It is particularly worrisome that patients are increasingly resistant to Artemisinin-based combination therapy (ACTs), as these are the frontline drugs. Dr. Patrick Lukulay, Director of the Promoting the Quality of Medicines (PQM) program at USP, told MediaGlobal “This is really the pressing issue now. To make sure that the problem is not worsening, and if it is, developing therapies that would aid the ACTs because they are right now the only best therapies available in the market.”
Over the last five months, the government has shut down 65 percent of illegal pharmacies. The number of illegal pharmacies has decreased from 1,081 in November 2009 to 379 in March 2010.
USP has been conducting post-market surveillance, testing medicines from a myriad of sources to determine the origin of the problem. Illegal pharmacies were found to be a significant source of sub-standard medicines. In addition to anti-malarials, poor quality anti-retrovirals to combat HIV, antibiotics, and anti-tuberculosis medicines were also found.
Thus far, only the anti-malarials have led to measured drug resistance, but the closures will also help ensure that other substandard medicines are kept out of the market to avoid resistant strands of HIV, tuberculosis, and bacterial infections.
The illegal pharmacies facing closure are large-scale pharmaceutical depots. Cambodians have used these resources because they are local, accessible, and they are not aware of the dangers of buying medicine from unregulated sources.
The closures have been accompanied by a dramatic public service announcement video showing the chain of events that link counterfeiters, dealers, and victims. The video aims to raise awareness of the dangers of buying from unregulated sources.
Yet steps still need to be taken to inform Cambodians of which pharmacies are safe. Some illegal pharmacies have been legalized if the vendors go through a training process to learn to discern which suppliers are reliable and what medicines are high-quality.
But Lukulay told MediaGlobal, “Because you have both [legal and illegal pharmacies] operating, its hard for people to understand which ones they should seek medicines from. And so we are continuing to stress that there should be a way that people can recognize, either with a mark or some clear sign which depots have been authorized and which have not.”
USP continues to work with the Cambodian government to ensure access to quality medicines. USP has provided testing equipment and trained Cambodian government workers to perform their own tests.
Cambodia also needs to address other sources of sub-standard medicines. Lukulay acknowledged the possibility that closed pharmacies can relocate and reopen, and said that street vendors operating outside the structure of large-scale pharmaceutical depots need to be traced and shut down.
The only way to combat sub-standard medicines in the long term is by bolstering the government’s own pharmacological vigilance program to continue to monitor the quality of medicines on the market and shut down sources of poor quality medicines.
Access to high quality also needs to be scaled up. While some illegal pharmacies have been legalized, the vast majority have simply been shut down.
Nonetheless, Lukulay emphasized the positive benefits of the closures. “I would think that it is better to have fewer that sell better medicine than to have a lot that are selling medicines that compromise the effectiveness of the drugs. Its better to take nothing, than to take a poor quality medicine.”
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