Rwanda: a model for fighting falsified medicines?

With sub-Saharan Africa seemingly under assault by fake and substandard drugs, it is remarkable that Rwanda appears to be bucking the trend, according to a new study.

The scale of the problem has been exemplified by recent studies showing high levels of antimalarial and tuberculosis drugs that failed quality testing - almost 17 per cent of samples in Africa - and showed evidence of deliberate falsification in around 7 per cent of cases.

Tests on samples from Rwanda failed however to reveal any falsified products, according to the authors of the study, which is published in the public access journal PLOS Medicine.

The secret of the country's success has been the introduction of a coordinated programme to shore up the security of its supply chain for malaria and TB medicines, for example by insisting that these drugs are only sourced from drugmakers accredited by the World Health Organization (WHO) and distributed through a dedicated supply chain, with routine inspections of medicine imports at the border.

In the case of TB, the country has brought control primarily into the publicly-funded health system rather than relying on the private sector. It also trains healthcare workers who handle the medicines how to spot and report substandard and falsified products.

The authors - who include Rwandan health minister Agnes Binagwaho - are calling for a global treat that would "guarantee sustainable progress towards higher quality medicines by bringing regulatory, technical, legal, and financial mechanisms to bear together".

The World Health Organization should take the lead on this with "transparent and visionary leadership", they note, adding: "the world loses ground with each passing day that WHO delays".

The WHO has adopted a cautious stance on counterfeit and substandard medicines since being accused of being unduly influenced by the drug industry in the context of the International Medical Products Anti-Counterfeiting Taskforce (IMPACT).

The WHO's executive board adopted a resolution last year to set up a member state 'mechanism' to tackle the trade in substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC) medicines from a public health perspective and without any consideration of intellectual property (IP) issues.

A few weeks ago at the World Health Assembly a deadlock on progress with the new mechanism was alleviated after WHA member states agreed to rotate chairmanship of the steering committee driving the project.