Dawood Tareen Shah (Pakistan) is making a documentary about the distressing problems caused by counterfeit medicines in his country. Glo.be met him while he was working as a journalist-in-residence at the Institute of Tropical Medicine in Antwerp.
What do you understand by the term fake or falsified medicines?
We are primarily talking about counterfeit pills without active ingredients. An organised mafia ensures that they look exactly like the originals by using colouring agents and imitating the packaging. They then sell these pills at a low price, and in doing so, they deceive the poor, with disastrous consequences.
There are also sub-standard medicines containing active ingredients of inferior quality that may aggravate a disease.
How significant is the problem?
Very significant! In Pakistan alone, thousands of people fell victim to these practices. In 2012, for example, more than 100 people died after using fake medicines against heart disease. In my own region too, the National Accountability Bureau (editor’s note: which detects corruption) exposed a huge scandal. It arrested officials and doctors who commercialized low-cost stents of inferior quality as high-quality stents. These stents failed to keep the blood vessels open to a sufficient degree, with disastrous consequences for the heart patients. We’re talking about a well-organised mafia here, involving both officials and doctors.
When a state does not function properly, hundreds of private hospitals and pharmacies are established without any control. Someone who has been working in a pharmacy for some 6 months knows the names of the medicines and can pretend to be a pharmacist. You cannot trust 60 or 70 percent of the pharmacies in Pakistan. Karachi, a megacity of 20 million inhabitants, has only 2 or 3 inspectors for medicines control and they are corrupt!
Many people who claim to be a doctor or a specialist have been insufficiently trained. There are nurses, for example, who claim to be doctors and cause enormous damage, which leads to complications in hundreds of births, among other things. Many well-trained doctors do exist, but they often do not behave correctly because they are mainly interested in money. According to a BBC documentary, no doctor in Pakistan prescribes medicines according to the standards.
In Pakistan, we also have the problem of non-registered medicines. India has slightly better medicines that are imported illegally into Pakistan. The smugglers, however, treat them with negligence and expose them for example to sunlight and heat, which is normally not allowed. These medicines are not fake, but they are often damaged and can make the patients even more ill.
In my region of Qabailistan, close to Afghanistan, many Afghans come to the doctor and insist on getting medicines for 6 months or a year at once. Many people also prefer doctors who prescribe a lot of medicines and those doctors behave as if they were specialized in everything. Some even use preprinted prescriptions. They do not even examine the patient and get well paid in private clinics.
According to a BBC documentary, no doctor in Pakistan prescribes medicines according to the standards.
Is the government doing anything about that?
Only partly, for example by providing 'health cards' that allow people to go to certain hospitals, but this is not really helpful. One weakness is that the penalties for the drug mafia are minimal, even though they commit serious crimes! They should be punished as drug criminals. That is the difference between a developed and a developing country: in the latter, you cannot rely on the state. Taxpayers’ money goes to corrupt people. If the state doesn’t intervene, there can be no progress.
Is the situation in Africa comparable to that in the rest of Asia?
It is certainly a common problem for the whole of southern Asia. The countries concerned have a large population, highly corrupt governments and medical inspectors who accept bribes from the mafia.
Actually, this is a theme for all developing countries, with a large majority of the population (60 to 90 percent) falling victim to these practices. The best proof: the wealthy citizens do not trust their own healthcare system. They travel to London, the US or Europe for medical care.
What is the World Health Organisation (WHO) doing?
They formulate recommendations, but ultimately action is needed at the level of each individual state. They are the first players. However, the WHO can push the countries. If a country with nuclear weapons can be isolated internationally, why is it not possible for a country with a lamentable healthcare system? Maternal mortality or complications during childbirth, people who die from cancer due to a lack of treatment, dilapidated hospitals, ... These are definitely serious problems that you cannot leave in the hands of corrupt governments, can you?
If a country with nuclear weapons can be isolated internationally, why is it not possible for a country with a lamentable healthcare system?
Does the documentary you are currently working on deal with the whole problem?
Exactly, I am comparing the supply of medicines in Pakistan to that in Belgium. That way, I want to inform the population, but also encourage my government to finally tackle the abuses. The documentary will be shown on social media and various TV channels.
What is it like to work as a journalist in Pakistan?
It is difficult! Where I live, in a region situated close to Afghanistan that is rich in mineral ores, many separatists are active. International players such as China and the US are interfering too. It is therefore very dangerous for journalists, and more than 20 have already been murdered. They are caught between two fires: the state does not want them to talk about the militant movements, but the militants do want to be talked about.
Personally, I focus on social issues, but even then it remains risky to address taboo issues. I guess that is just part of the job I want to do.
Dawood Tareen Shah is a freelance documentary maker from Pakistan. He has already made documentaries about climate change, water, terrorism and security. He is currently tackling the issue of fake medicines. Thanks to the Journalist-in-Residence Programme, he spent one week in Antwerp to attend the International Congress for Tropical Medicine, organised by the Institute for Tropical Medicine, where he got the opportunity to consult experts about fake medicines and work on his documentary.
Journalist-in Residence is an initiative of the Institute of Tropical Medicine (ITG). Four journalists from Africa, Asia and Latin America are given the opportunity to deepen their knowledge of a subject related to tropical medicine or global health. The ITG is an essential partner of the Belgian Development Cooperation.
Belgium is committed to good quality medicines
Belgium is the first bilateral donor to commit itself to guaranteeing the quality of medicines in its programmes. The implementing partners (BTC, medical NGOs, BIO) also ensure that only high-quality medicines are used. At the international level (EU, WHO), our country advocates the use of quality medicines. In addition, it has a law requiring pharmaceutical companies to produce medicines of guaranteed quality, including those intended for export. Not all EU Member States have achieved this so far.