Counterfeit Anti-malarial Drugs Sold in Shan State

The Irrawaddy News
Friday, February 8, 2008
By Withaya Huanok
Kengtung, Burma

The central market in Kengtung, the capital of eastern Shan State, is a beehive of commercial activity in the mornings, reflecting the cultural kaleidoscope of Burma’s frontier.

Although most people speak Tai Khün, which is closely related to northern Thai, you can hear smatterings of Chinese, Thai, Burmese and other languages among the stalls that sell all manner of goods, mostly from China: food, books, clothing, bags, toys, electronics and, frequently, medications.

Stalls selling the latter offer a range of multi-colored pills in clear plastic bags arranged on wooden trays or in plastic baskets with no indication of what they are, where they were produced, instructions for their use or warnings—or an expiration date.

Others medicines are sold in their manufacturers’ packages, complete with labels detailing the standard, prescribed information and seals of authenticity. However, these medicines may be just as dangerous as the unlabeled variety.

Two different batches of the drug artesunate, now a standard treatment for Plasmodium falciparum malaria, the most dangerous type of malaria, were recently obtained in Kengtung and sent to the United States Center for Disease Control and Prevention in Atlanta, Georgia.

The agency tested the drugs for safety and quality in January 2008. The analysis of both batches confirmed them to be counterfeit, containing no active drug. Although fake artesunate has been discovered in Burma, with one analysis documenting that over one-fifth of such drugs in Burma were fake, this was the first time these counterfeit drugs have been confirmed in Kengtung.

The analysis report said, “They [the tablets] contained no measurable amount of the active ingredient artesunate. The tablets weighed much more than the comparable genuine Guilin tablets… [and were] much harder to manually split in two… these samples are definite fakes. It is almost impossible to distinguish fakes from genuine based on package appearance.”

The source of these fake drugs is not known, and they have also been discovered for sale along the Thailand-Burma border.

Many physicians say the Burmese health system has collapsed, another casualty of the successive military governments that have ruled the country for decades.

The current Burmese junta, the State Peace and Development Council (SPDC), spends 40 US cents per person per year on health (Thailand’s equivalent figure is $61) which, in conjunction with isolation, censorship and widespread human rights abuses, “have rendered Burma’s health care system incapable of responding effectively to endemic and emerging infectious diseases,” according to “The Gathering Storm,” a report published by the University of California (Berkeley) and Johns Hopkins University in 2007.

Malaria, in particular, is a top cause of morbidity and mortality in the region, and 70 percent of Burma’s population live in malaria-endemic areas, overwhelmingly along the country’s frontiers, and almost 75 percent of Burma’s reported cases of malaria are due to Plasmodium falciparum.

Moreover, Burma is an epicenter for multi-drug resistant strains of malaria that require a combination therapy with artesunate to be treated effectively. According to World Health Organization figures, almost 90 percent of Burma’s total health expenditures are borne privately, usually paid for out-of-pocket, making visits to healthcare services a luxury for most Burmese, particularly given the worsening poverty and runaway inflation which, at 35 percent a year, is the highest in Asia.

“People have to buy all their drugs and pay for investigation charges,” noted a Burmese physician, forced into exile in Thailand after participating in the Saffron Revolution in September 2007.

“They have to pay for the services of hospital staff like dressings, injections, wheelchairs and even the unofficial entrance fee… [the] majority of people in Burma rely on betel shops, drug stores, quacks and traditional healers and as a result, there are unnecessary morbidities and mortalities.”

Lack of regulatory oversight and widespread corruption continue to fuel the production and sale of counterfeit drugs such as artesunate, packaged almost identically as the genuine product, increasing unnecessary sickness and death. And, with these fakes being sold more cheaply than the authentic drug amidst an economy that continues to deteriorate, the counterfeit drugs remain popular.

“The tragedy with these fake drugs is that Burmese people will use their limited resources to buy them for themselves and their families and still get no relief—and falciparum malaria can be rapidly fatal,” noted Dr.

Chris Beyrer of the Johns Hopkins University. “This form of criminal forgery can lead to loss of life, and it can lead to the generation of resistant malaria strains which could threaten the health of people across the malaria zones of Asia. The government of Myanmar and its partners should be addressing this problem with due diligence.”

The author is a physician based in Chiang Mai who works on the Thailand-Burma border.