DAR ES SALAAM, 15 January 2009 (IRIN) - The busy Kariakoo market in the Tanzanian capital is stocked with knock-off merchandise - from imported car parts to handbags – and traders from across Africa come to buy cheap imports to sell at home.

But the most dangerous counterfeits are the imitation medicines sold to unwitting consumers. In Tanzania and across the developing world, the business of fake drugs is booming. A 2006 report by the World Health Organization (WHO) estimated that in developing countries in Africa, and in parts of Asia and Latin America, up to 30 percent of medicines on the market are counterfeit.

"People are interested in getting a profit, but this is a human rights issue," said Edith Ngirwamungu, president of the Medical Association of Tanzania. "The consequences of this business are really immense. Take, for example, a person with severe malaria: if he or she cannot access the genuine drug, then it means they may die."

She said that inefficacy of counterfeit pharmaceuticals also made some Tanzanians lose confidence in crucial medicines, such as antiretrovirals for people living with HIV/AIDS.

"By having these counterfeit drugs, it makes people fearful of conventional drugs and revert back to traditional drugs," Ngirwamungu told IRIN.

Counterfeit drugs are designed to fool consumers by using misleading packaging and mimicking the shape, colour, size and imprints of genuine drugs. Fake drugs sold in Tanzania's markets include knock-offs of so-called "lifestyle" drugs, such as those for erectile dysfunction and weight loss. But there are also imitations of life-saving pharmaceuticals, including anti-malarial and anti-cancer drugs. Often, counterfeits contain just trace amounts of the purported active ingredients, and sometimes no active ingredients at all. But they are usually difficult to identify without a laboratory test.

"We've found that most pharmaceuticals don't have the content and quality of the drugs we'd expected," said Hussein Kamote, director of policy and advocacy at the Confederation of Tanzania Industries (CTI), a trade group that issued a report lambasting Tanzania's thriving counterfeit market. He said when the group recently tested a batch of anti-malaria capsules, they contained only wheat flour.

A thriving global business

Fake drugs are extremely profitable. The Center for Medicine in the Public Interest  projects that fake drugs will generate US$75 billion in revenues by 2010, nearly double that of 2005. Global counterfeit syndicates use evolving consumer technologies that make it ever easier to imitate legitimate drugs.

Developing countries are particularly vulnerable, in part because regulatory officials often lack the capacity or political will to curb the distribution of fake goods. And because legitimate drugs can be expensive, poor consumers also fuel demand by knowingly or unwittingly turning to cheaper counterfeit versions.

"We are trying to tell people in Tanzania that counterfeits are dangerous products, they kill people," said John Mponela, head of the anti-counterfeits department at Tanzania's Fair Competition Commission. "They are not working for poor people, they work against poor people."

The CTI estimates between 15 and 20 percent of all merchandise circulating in the country is counterfeit, earning Tanzania a reputation as a dumping ground for imitation goods, including fake drugs. Officials say suppliers from China, India, Europe and the USA have used the country as a gateway into Africa.

"These drugs come from abroad, and those who supply them know we need these drugs," Mponela told IRIN. "When they supply them, they supply them in parallel with the genuine drugs. They get more profit – for nothing."

Crackdowns

It is difficult to punish the vendors of fake drugs in Tanzania, because fakes are so hard to identify. In Dar es Salaam, one pharmacist pointed to receipts showing where he sourced the medicines in his shop, and insisted he only purchased drugs from wholesalers that worked with the Tanzania Pharmacy Board.

"I have to trust my suppliers," he said. "We get these from the right suppliers, who have passed through the proper channels. Those are the people we deal with."

However, he admitted: "I know that 10 percent of the drugs in this place are probably fake, but I'm not about to kill 90 percent of my business because of it."

That reality is what authorities are trying to fight. In October, INTERPOL, WHO and local officials tested drugs sold in local pharmacies and markets in Tanzania. Authorities searched nearly 200 pharmacies and illegal markets, confiscated more than 100 different fake medical products, and closed down 22 businesses. The investigation was the first INTERPOL-led operation conducted in Africa under the WHO's International Medical Products Anti-Counterfeiting Taskforce (IMPACT), launched in 2006.

The government is also boosting local efforts to respond to its illicit counterfeit market. It established the Fair Competition Commission (FCC) to crack down on those importing or selling counterfeit goods. A new law gives authorities more power to search private businesses and to destroy fake merchandise. It also makes it easer to slap big fines on offenders.

Humanitarian crisis risks

Despite efforts to reduce the prevalence of fake drugs in Africa, specialists warn that they continue to pose major risks for public health, especially in a humanitarian crisis.

"Counterfeit drugs on the market might amplify any humanitarian disaster," said Jonathan Lucas, regional representative of the UN Office on Drugs and Crime, Southern Africa.

Lucas said the poorest were most likely to suffer from the lack of legitimate medication in such a crisis. "It's really access to services at the end," Lucas said. "The producers are making a profit, while exploiting the limited availability of health services to the poor."

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