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Fake Malaria Pills Could Cause an Epidemic

Fake antimalarial pills sold on the black market have helped create a drug resistant malaria strain. We look at who's selling them and the problems they're causing.

by Caitlin Reid
Mar 27 2015, 2:20pm

Back in the 60s and 70s, hundreds of scientists in China were tasked with screening thousands of traditional medicines, some of them centuries old. The project yielded a list of game-changing substances including the antimalarial drug, artemisinin. Fast acting and well tolerated by the human body, artemisinin kills malaria parasites at the first stage of transmission and is considered one of the most effective treatments for the disease. But none of this helps you if the antimalarial drugs you're taking are fake.

Every year hundreds of thousands of avoidable deaths are caused by fake antimalarial tablets. Counterfeit antimalarials can come in the form of chalk pills, repackaged expired products, or different drugs entirely. A study in 2012 found a massive 30 percent of all antimalarial medications in South East Asia and Sub Saharan Africa were counterfeit, a figure that has only increased in recent years. Gangs have taken advantage of increasing rates of malaria by selling fake medication on the streets, with poorer rural areas of Cambodia, Myanmar, and Laos becoming a focus of the trade.

Beyond exploiting people who can't afford treatment, the fake pills are giving rise to drug-resistant malaria strains that specialists fear could trigger an epidemic. The appearance of the new forms of the illness coincides with an expected decline in foreign aid aimed at combatting the disease over the next few years. Also compounding the situation are growing numbers of insecticide-resistant mosquitoes.

Malaria can be caused by one of four different mosquito-born parasites. Up to 1.2 million deaths occur worldwide due to the disease every year, and those infected with the P. Falciparum parasite can suffer organ failure, shock, blood clot complications, and death.

Fake pills offer no relief from symptoms, but pills containing diluted levels of antimalarials can also help build resistance to the drugs. Say your pill contains small amounts of the active ingredient Artemisinin. This will kill susceptible parasites in your blood stream, but it leaves the resistant ones to multiply. Once these multiply, they're passed on to other people by mosquitoes.

Experts say antimalarial resistance could be catastrophic if it spreads. Artemisinin resistance has caused a critical situation in the Greater Mekong Subregion in South East Asia. If drug-resistance spreads to Bangladesh and India, the Asia Pacific Leaders Malaria Alliance say it would be "a major regional and global setback to progress in malaria control efforts over the last decade."

Despite early blame being placed on Chinese drug companies, Chinese and Vietnamese criminal gangs are thought to be the main source of fake antimalarials. Roger Bate, an American Enterprise Institute researcher, says small-time criminals have a lot to gain by posing as legitimate companies, adding "the most expensive things to buy are the packing machines."

To counter, Interpol launched Operation Jupiter in 2007 and a handful of arrests were made. A detained Southern Chinese man was alleged to have enough counterfeit artemisinin to " treat" almost a quarter of a million adults. The Chinese Ministry of Public Security reported almost 200,000 of the blister packs were sold at border crossings between China and Myanmar.

This operation exposed complex and hard to track networks between Myanmar, Malaysia, and China. John Newton, a senior investigator with Interpol told the BBC "because they know each other, they're very difficult to infiltrate. They have established networks in the various countries. It makes it difficult for us to counter."

The good news is Melbourne researchers may be on the verge of creating a Malaria vaccine. This month Professor James Beeson from the Burnet Institute published research into the recruitment of antibodies and proteins that combat the infection before it infiltrates red blood cells. He says it's actually the replication of the infection in the body's red blood cells that makes the disease harmful, not the initial transmission from mosquitos. "We're hoping that this new knowledge opens up a new strategy to generate or develop highly effective vaccines," he said.

Image via Flickr user hitthatswitch

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