Between 2000 and 2010, malaria cases declined by 25%, and deaths caused by malaria declined by an even greater 57%. Despite these tremendous accomplishments, Southeast Asian nations still face many challenges brought on by malaria. Perhaps the most pressing of these issues is the growing trend of counterfeit anti-malaria drugs emerging in Southeast Asia.
According to a recent study, over 1,400 anti malaria drug samples were analyzed from seven countries in Southeast Asia between 1999 and 2010. The results show about 35% of these anti malaria drugs were counterfeit, low quality, or incorrectly packaged. This poses many challenges to anti-malaria campaigns in Southeast Asia. First, most affected people live in poor, remote rural regions where local officials do not have the training to distinguish real and counterfeit drugs. Second, many of the counterfeit pills contain trace amounts of genuine artemisinin, an anti-malaria drug, in order to fool drug tests. This would cause the malaria parasite to develop resistance to many forms of malaria treatment while not adequately treating the disease.
According to a WHO report, in Cambodia, up to 70% malaria patients seek treatment from private vendors. Most of these patients live in poor rural areas where the only access to malaria drugs are from unlicensed and untrained vendors, who cannot distinguish between real and counterfeit malaria pills. These vendors are supplied by traveling merchants who offer unbeatable bargains. A Cambodian government research project found that over 27% of malaria drugs purchased from rural pharmacies were counterfeit.
A more pressing and alarming situation is happening along the Thai-Cambodian border. Since the 1990s, Artemisinin has been introduced around the world and is considered the best treatment against malaria. Officials noticed that around the Thai-Cambodia border, malaria parasites are starting to build a resistance to the drug. The wide majority of counterfeit malaria drugs contain traces of real Artemisinin that kills off the weaker parasites and leaves the stronger ones to multiply. In addition, this border area has a highly mobile population that moves between the two countries and spreads this parasite to other areas in Southeast Asia.
This recent discovery of resistance to Artemisinin along the Thai-Cambodian border is very concerning to health officials. This border area has longer history, with resistance to older malaria drugs such as Sulphadoxine Pyrimethamine (SP) and Chloroquine first reported at in the 1970s. Resistance to these drugs soon spread to Africa, where 91% of malaria-related deaths occur. Today, these two drugs are virtually useless against malaria. Health officials fear that if resistance to Artemisinin follows the same trends as before, the milestones made in the past decade would be reversed.
In 2005, a number of researchers, physicians, and officials met at the WHO headquarters in Manila. It was there that they launched Operation Jupiter, an operation designed to disrupt the illegal trade of counterfeit malaria medication by putting the counterfeiters behind bars. Researchers determined that they originated from China’s southeast coast along the border with Vietnam. At the end of the operation in 2006, China’s Ministry of Public Security, in partnership with Interpol, arrested three people and sentenced them to less than two years imprisonment. The program appeared to be successful, as the amount of counterfeit medication entering SE Asia dropped the following year.
Finding and prosecuting malaria drug counterfeiters may be time consuming and difficult. Therefore, it is sometimes up to the consumers to determine whether malaria drugs are real or fake. One accessible solution is to utilize the mobile phone. By the end of 2009, there were an estimated 450 million mobile phone subscribers in SE Asia. Mobile use in growing markets such as Cambodia and Vietnam are expected to be dominated by voice and text messaging usage. One way to exploit the growing access to mobile phones in Southeast Asia is to take a cue from Africa. In 2010, mPedigree launched a mobile service in Ghana and Nigeria to help detect counterfeit medication. Consumers buying medication would then scratch off a panel attached to the package. A code is revealed and the consumer texts the code to a central computer system that runs the code through a database. Finally, a reply is sent informing the consumer if the code is genuine or fake.
The future of counterfeit malaria drugs is difficult to determine. Greater access to anti-malaria nets, genuine malaria drugs, new technological innovations, and more collaboration between governments, NGOs and the pharmaceutical corporations are needed to ensure that malaria cases continue to decrease.