An "epidemic" of counterfeit therapeutic drugs is sweeping south-east Asia, costing hundreds of thousands of lives as victims take them under the mistaken belief that they are receiving vital treatment for their illnesses. A British doctor working in the Laotian capital, Vientiane, found that most of the anti-malarial medicines tested in a sample were sophisticated fakes, often displaying holograms on the packaging, originally aimed at making counterfeiting difficult.
The World Health Organisation (WHO) estimates that 200,000 of the 1m malaria deaths each year would be prevented if all the drugs taken were genuine.
But the epidemic goes far beyond anti-malarials. Bogus drugs have been found across the spectrum of life-threatening diseases. Anti-retrovirals for HIV-Aids and medicine for tuberculosis, meningitis, typhoid, pneumonia and even avian flu have been the target for highly organised criminals.
Up to 50% of the drugs sold in Asia and Africa are fakes, in a trade estimated by the US Food and Drug Administration to be worth between $35bn and $44bn (£18.5bn-£23.1bn) annually. WHO maintains that 30% of the world's countries have no drug regulation, or a capacity that is barely functional.
The fear is not only that many people are dying needlessly, but that diseases will become resistant to treatments as parasites survive and mutate, because "sub-therapeutic" doses - ineffective amounts of the active ingredient - are sometimes used in the fake drugs to fool patients into thinking that the treatment is working.
Dr Paul Newton, of the Oxford University Centre for Tropical Medicine, working in Vientiane, and colleagues say the scale of the bogus anti-malarials and their sophistication point to production on an industrial scale by unscrupulous manufacturers. Experts maintain that the trade is based in China, a focus for all manner of counterfeiting.
In December, according to the Chinese news agency Xinhua, three senior Chinese officials were arrested on charges of taking bribes to approve drugs. The distribution networks mirror the old heroin networks, flowing to Thai distributors with financing and money-laundering arranged in Hong Kong.
"We make no apology for the use of the term manslaughter to describe this criminal lethal trade," Dr Newton said. "Some might call it murder. Somewhere, people are directing a highly technical and sophisticated criminal trade. [They] are making these fakes in the full knowledge that their ineffective product might kill people who would otherwise survive their malaria infection."
A particular target of the criminals is the new malaria wonder-drug, artemisinin, a chemically derived plant extract. The active ingredient, known as artesunate, has proved especially effective against malaria whereas older remedies such as chloroquine have long-ago failed as the parasite has become resistant.
Dr Newton and his team highlighted their discovery that the largest manufacturer of artesunates, the Chinese company Guilin Pharma, was a victim of the attacks by the bogus drug makers. Anti-forgery holograms and the firm's packaging were painstakingly reproduced, along with a logo only visible under ultra-violet light. In all, 12 different fake drugs were sold as the Guilin brand's artesunate pills.
The team spotlighted the dangers of a loss of confidence in the cure. They cited the case of 23-year-old man in eastern Burma who was treated in hospital with artesunates labelled Guilin Pharma. He was transferred to several larger hospitals but died of cerebral malaria. The original hospital tested its batch of artesunate and found that the whole stock was fake. "The village committee, which had clear idea of what was responsible for the man's death, was so angered ... that they collected all the artesunate, fake and genuine, that they could find in local shops and destroyed it on a public bonfire," Dr Newton wrote.
