Quack pharmacists make a killing

Most chemists in the country are unregistered and in most cases sell counterfeit drugs. This is putting patients at risk , writes ISAIAH ESIPISUOne in every four pharmacies in Kenya is fake, manned by quarks and in most cases selling counterfeit drugs. Of the 4000 operating pharmacies here, the Pharmacy and Poisons Board has registered only 1000.

This was the main message sent out by pharmacists after a weeklong pharmacy awareness campaign, which climaxed with the opening of a medical camp in Kirinyaga last Saturday.

“We have tried to expose these outlets, but there has been no political goodwill to support us,” Prof Isaac Kibwage, the chairman of the Pharmaceutical Society of Kenya says. 

The fake drugs range from dangerous products to totally ineffective ones as told by a clinician from Kinango Hospital, Kwale District.

Talking to Horizons at the Kirinyaga camp, the clinical officer who requested anonymity told of how in 1991 the hospital used a very popular product to treat a two-year-old boy suffering from febrile convulsions, but even after giving the boy five times over the normal dose there was no response.

Under normal circumstances, a child with such convulsions should be given a dose of 2.5gms of the said product. But the dose can be increased if the response is slow. After giving the first dose, the child did not respond, prompting the doctors to increase it. They finally dispensed five doses but with no success.

On investigation, said the clinical officer, it was discovered that the drug did not have any active ingredients.

Experts are blaming the proliferation of counterfeit drugs on the liberalisation of the economy, where people are allowed to import and export goods and products freely.

“We warned the government against including medical drugs among the commodities to be traded freely through the Pharmaceutical Society of Kenya (PSK), but the ministry of Health turned a deaf ear to us,” says Dr E K Kamamia, the then chief pharmacist and a former UN consultant. “Now the problem is working against the whole country. Drugs are now being hawked in the streets like other commodities, which is a direct avenue for counterfeits,” he adds.

But according to the World Health Organisation (WHO), medicine counterfeiting is a global problem. It represents 10 per cent of total medicine traded globally.

In Kenya, though no proper statistics have been put in place, the trade is rampant and lucrative, thus attracting criminal networks. Most common especially in many illegal pharmacies are anti-malaria drugs, lifestyle drugs, toothpastes, analgesics and a wide range of antibiotics among others.

“It is not easy to differentiate the fake from real drugs,” says Kibwage. “The packaging is deceitful and sometimes even more attractive than the real product,” he adds

The biggest difference in the drugs is in their active ingredients. Sometimes, some of the medicines have expired but have been re-packaged for marketing. “This is extremely dangerous for patients since they can’t tell the difference. The drugs can worsen their condition or lead to resistance of the particular drug by the patient,” adds Kibwage, who is also a don at the School of Pharmacy, University of Nairobi.

Analysis by WHO show that of 771 incidents of counterfeit drugs in 1999, 325 analysed had 60 per cent with no active ingredient, 17 per cent had incorrect amounts of active ingredients, 16 per cent had wrong active ingredients and seven per cent had the right amount of active ingredients.

Experts say that patients opt for such drugs because they are cheaper than real drugs of similar nature and get convinced by the appearance of the packaging, which looks real.

“The problem starts from training,” says the University don. “It is only the University of Nairobi that is able to train pharmacists. Other colleges train students in pharmaceutical technology, where the graduates are supposed to practice pharmacy to a certain level, defined by the type of drugs they are supposed to dispense,” adds Kibwge.

The professor, however, adds that Kenya has only seven colleges authorised to train people in pharmaceutical technology. Yet the market is full of pharmacy practitioners who masquerade as pharmacists from unrecognised colleges.

“These are the people who form cartels of medicine hawking from chemist to chemist,” says Kibwage.

Last week, police seized fake degrees and related certificates purportedly from prominent universities in East Africa. Though some people have been arrested concerning the saga, it is believed that people masquerading as pharmacists are using some of them.

According to shopkeepers in some of the sprawling estates in Nairobi, most drugs sold across the counter, which include pain killers, anti-malaria drugs, lifestyle drugs among others are supplied to them by hawkers, some who claim to be promoters from given drug manufacturing companies. 

“Sometimes we can doubt the packaging thus avoid it. But in some cases they look so real. However, after selling them to customers, some come back to complain that they did not work,” says Thomas Mutinda, a shopkeeper in Dandora, Nairobi.

Pharmacists in the same area, who admit that dealers from bigger pharmaceutical outlets in the city supply some of their drugs, have echoed similar complaints.

There are several factors believed to be favouring the trade on counterfeit drugs.

The global trend towards free international commerce makes it easier for counterfeiters to move drugs from one region to another in briefcases. Experts are also blaming legal systems in different regions for not being serious on fighting counterfeits.

“The penalties for such a criminal act are in most cases inadequate,” says Dr W Mwatu, Medical and Regulatory Affairs director, East Africa – GlaxoSmithKline Ltd.

Regulatory oversight by pharmacists is also ineffective, leading to poor channels of distribution of the medicines.

To curb drug counterfeiting in Kenya, the Pharmacy and Poisons Board has issued circulars regarding importation of medicine, distribution and drug registration. Experts are optimistic that the move could finally control the fake medicine influx in the country.

“We are currently seeing an increase in the hawking of medicines from pharmacy to pharmacy by unauthorised persons. We need to ensure that we sell drugs to authorised persons and buy only from authorised persons, if we have to stop counterfeits,” says Mwatu.