Study finds substandard malaria drugs, but no fakes

By: Charles Parkinson

A new report suggests counterfeit anti-malarial drugs are far less prevalent in Cambodia than previously thought, but almost a third of the legitimate medicines are of substandard quality.

According to the study, published on Monday by the London School of Hygiene and Tropical Medicine, none of the 291 anti-malarial drug samples bought at pharmacies in Cambodia were phony, though only 69 per cent were considered “good quality”.

As the report points out, the findings contrast with the widely held notion that bogus anti-malarials are commonplace in the Kingdom, something lead author Dr Shumnay Yeung says she was unsurprised about.

“I was pretty sure we wouldn’t find anything like previous reports, I thought we might find one or two [counterfeit samples],” Yeung said in an interview yesterday. “But that was one of the reasons we did it, to kind of bust that idea.”

As well as the fieldwork carried out in Cambodia, a separate team undertook a study on anti-malarials in Tanzania, where no fakes were found and just 12 per cent of samples were substandard.

The findings are published on the back of an increase in deaths due to malaria in Cambodia between 2013 and 2014, following three consecutive years of significant reductions.

According to the director of Cambodia’s National Malaria Centre, Huy Rekol, 18 people died from the disease last year. In 2013, just 12 were reported killed, following 47 deaths in 2012 and 94 in 2011.

Between 2010 and 2013, cases of malaria plummeted from 50,000 to just over 21,000, according to a World Health Organization report published in December – a pattern attributed to the widespread distribution of insecticide-treated bed nets.

The new study focussed on documenting the quality of artemisinin-containing anti-malarials – one of the most successful forms of treatment for the disease, despite being ineffective against a deadly strain of resistant malaria found to be unique to Cambodia in 2010.

According to Yeung, that resistance could be driven by the prevalence of substandard medication – usually meaning medication with too little of the active ingredient.

“Not only do [substandard drugs] leave patients with malaria under treated, which could be fatal, but they may also contribute to the development of resistance,” Yeung said in a press release that accompanied the report.

The study attributes the lack of counterfeit drugs among the samples to the “positive impact of the country’s efforts to tackle falsified anti-malarials”, something the deputy chief of the Interior Ministry’s economic crime unit, Long Streng, said had increased since the fieldwork was undertaken in 2010 and 2011.
“There were fake anti-malarial drugs on sale in many areas four years ago and our police have done a good job investigating and cracking down on them,” Streng said yesterday. “I can say for sure that there are now no fake anti-malarial drugs in Cambodia.”
However, the World Health Organization urged caution on such a bold claim, with Dr Clive Ondari, coordinator for safety and vigilance at the WHO’s Department of Essential Medicines and Health Products, saying it was too soon to declare the country free of fake anti-malarials.

“It’s a good sign, but there needs to be continued effort and routine surveillance,” he explained.

It was a warning echoed by Yeung.

“The counterfeiters are always one step ahead, so you can’t let your guard down.”