In a survey of antimalarial drugs from 21 countries in
sub-Saharan Africa and seven countries in Southeast Asia, many were of poor
quality or fake. Researchers, therefore, suggest the need for a multifaceted
approach to address this issue.
“Despite a dramatic rise in reports of
poor-quality antimalarial drugs over the past decade, the issue is much greater
than it seems because most cases are probably unreported, reported to the wrong
agencies, or kept confidential by pharmaceutical companies,” Gaurvika
Nayyar, BS, of the Fogarty International Center at the NIH, said in a press
Nayyar and colleagues pooled data from published and
unpublished studies, including chemical analyses and assessments of packaging
of antimalarial drugs in sub-Saharan Africa and Southeast Asia. From Southeast
Asia, there were 1,437 samples from five classes of drugs evaluated. In
sub-Saharan Africa, analysis was available for 2,634 samples from six classes
Among the drugs from Southeast Asia, 35% failed chemical
analysis, 46% failed packaging analysis and 36% were considered fake. Among the
drugs from sub-Saharan Africa, 35% failed chemical analysis, 36% failed
packaging analysis and 20% were considered fake, according to the study
“More than 3 billion people are at risk for
malaria, which is endemic in 106 countries,” Nayyar said in the press
release. “Between 655,000 and 1.2 million people die every year from
Plasmodium falciparum infection. Much of this morbidity and mortality
could be avoided if drugs available to patients were efficacious, high quality
and used correctly.”
In an accompanying editorial, Michael Seear, MD,
of the British Columbia Children’s Hospital in Vancouver, Canada, called
for more research to clarify the extent and cause of poor drug quality.
“Drug quality is dependent on the overlapping effects of poor
manufacturing standards, criminal counterfeiting, adulteration with inactive or
toxic fillers, relabeling of time-expired drugs, and degradation during
storage,” Seear wrote. “Reliable research concerning counterfeiting
is limited, and almost no information is available about the other four
- Nayyar GML. Lancet Infect Dis. 2012;12:488-496.
- Seear M. Lancet Infect Dis. 2012;12:428-429.
- Ms. Nayyar and Dr. Seear report no
relevant financial disclosures.