Article review - “Manslaughter by Fake Artesunate in Asia – Will Africa be Next?”

by Paul N. Newton*, Rose McGready, Facundo Fernandez, et al; (published in PloS Medicine, June 2006, Volume 3, Issue e197)

The authors warn of counterfeit (fake) “artesunate” tablets (containing no artesunate) in Asia. Examples of fake artesunate samples collected in various parts of Africa including Cameroon and Tanzania are also provided. According to the article, fake drug (dihydroartemisinin 60 mg per tablet, Cotexcin) was found in Tanzania in 2001, labeled as made by Beijing COTEC New Technology Corp and was found to have no dihydroartemisinin or other active drug when analysed. The packaging of the counterfeit Cotexcin found in Tanzania was smaller than the genuine pack. More striking, while the genuine Cotexcin pack had a diagram of mosquito, the fake one didn’t have. According to the authors, fake artesunate do not always lack active drug, e.g. in 2005 in Burma, fake artesunate labeled as made by Guillin Pharmaceutical (Guangxi, Peoples Republic of China) was found to have paracetamol as the main drug and artesunate content was 10mg per tablet instead of 50 mg (as in the genuine product). And in 2005 fake artenunate tablets mimicking Arsumax (50mg per tablet, Sanofi Synthelabo, Bridgewater, New Jersey, United States) were found in Cameroon, labeled as Arsuman, manufactured by Sanofi Synthelabo, and on analysis was found to have the correct amount of artesunate, 50mg per tablet.

The authors explain why people do make fake artesunate. The artemisin derivatives are known to be remarkably effective in their antimalarial effect and are well tolerated. Therefore the demand for these medicines is high. But since they are expensive, the relatively cheaper versions would be attractive amongst the poor and the most vulnerable – hence the conterfeiters target this group.

The dangers of fake artesunate are many. There are documented cases of deaths from malaria in endemic areas due to treatment with fake artesunate. The travelers and tourists from non-malarious areas, may buy such drugs for self-medication are also at high risk. Other dangers of fake artesunate with lower drug content include the risk of selection and spread of artermisinin resistant parasites, which will lead to loss of effective antimalarial drug and subsequent failure of malaria control initiatives.

Unfortunately, the simple screening tests used in various parts of Africa for quality of drugs such as colour reaction tests may not easily detect all fake drugs. Therefore, the results of such tests may provide the users of fake artesunate with false sense of confidence.

The authors propose some ways for preventing the rapid spread of fake artesunate in Africa. Control of medicines importation is a good attempt but difficult to maintain due to porous borders. Provision of subsidized genuine artesunate containing drugs through the public facilities shall ensure the drugs are sourced from reputable sources and are made available at reduced prices and there would be no financial advantage of buying from other sources. While this option is attractive, there are many cases of malaria that are treated via private clinics / hospitals. Such private clinics / hospitals including Church facilities should be included in the Government subsidy programme, so that they do not become a potential target for fake artemisinin containing drugs.

*The article was summarized with permission from Paul N. Newton.