Understanding and fighting the medicine counterfeit market

Flexible Physical Unclonable Functions Based on Non-deterministically Distributed Dye-Doped Fibers and Droplets

The development of new anticounterfeiting solutions is a constant challenge and involves several research fields. Much interest is currently devoted to systems that are impossible to clone, based on the physical unclonable function (PUF) paradigm. In this work, a new strategy based on electrospinning and electrospraying of dye-doped polymeric materials is presented for the manufacturing of flexible free-standing films that embed simultaneously different PUF keys. The proposed films can be used to fabricate novel anticounterfeiting labels having three encryption levels: (i) a map of fluorescent polymer droplets, with random positions on a dense yarn of polymer nanofibers, (ii) a characteristic fluorescence spectrum for each label, and (iii) the unique speckle patterns that every label produces when illuminated with coherent laser light shaped in different wavefronts. The intrinsic uniqueness introduced by the manufacturing process encodes enough complexity into the optical anticounterfeiting tag to generate thousands of cryptographic keys. The simple and cheap fabrication process as well as multilevel authentication makes such colored polymeric unclonable tags a practical solution in the secure protection of goods in our daily life.

Addressing forensic science challenges with nuclear analytical techniques - A review

We review the application of Nuclear Analytical Techniques (NATs) to forensic problems for the first time. NATs include neutron activation analysis (NAA), carried out in nuclear reactors for elemental analysis; accelerator-based techniques, mainly Ion Beam Analysis (IBA) for elemental and molecular analysis; and Accelerator Mass Spectrometry (AMS) for dating of traces of forensic interest by "radiocarbon dating" and other related methods. Applications include analysis of drugs of abuse, food fraud, counterfeit medicine, gunshot residue, glass fragments, forgery of art objects and documents, and human material. In some applications only the NATs are able to provide relevant information for forensic purposes. This review not only includes a wide collection of forensic applications, but also illustrates the wide availability worldwide of NATs, opening up opportunities for an increased use of NATs in routine forensic casework.

Nondestructive Measurement Technique for Substandard Amoxicillin Based on Thermal Approach

In this study, we introduce a new nondestructive measurement technique based on a thermal approach for the determination of substandard amoxicillin. The quality control of amoxicillin is critical for patient safety, and one of the essential parameters for its evaluation is the content of the active ingredient. Traditional methods for assessing amoxicillin content are defined by their time-consuming nature, reliance on skilled personnel, and frequent necessity for specific reagents. The proposed device aims to provide a rapid and low-cost alternative that can accurately measure the amoxicillin content without damaging the sample. The method validation results indicate coefficient of determination (R2) exceeding 0.99, with percent recoveries falling within the range of 98.70-103.40%. The calculated values for limit of detection and limit of quantitation were determined to be 28.11 and 85.17 mg/L, respectively. Our experiments employed amoxicillin samples with predetermined concentrations, all of which were below the standard quality. It was observed that the proposed analytical device effectively quantifies the amoxicillin content in aqueous solutions. Each measurement took no more than 10 min, underscoring the efficiency of the analysis process. The experiments were validated through independent testing at the Government Pharmaceutical Organization in Thailand and the department of engineering science in Oxford, which provides strong evidence for the effectiveness and robustness of the technique. Overall, this study demonstrates the feasibility of using a thermal approach for the nondestructive measurement of substandard amoxicillin.

Drivers of vulnerability to medicine smuggling and combat strategies: a qualitative study based on online news media analysis in Iran

BACKGROUND

Medicine smuggling poses a serious public health threat, limiting patients' safe and timely access to this essential resource. Thus, this study aims to identify the factors contributing to the vulnerability to medicine smuggling and propose effective strategies to combat this issue in Iran.

METHODS

An analysis of news media was conducted using qualitative content analysis. News text items related to medicine smuggling were retrieved from various online news sources between March 21, 2017, and May 21, 2023. To select health-oriented and general online news stations, news agencies, and newspapers, the purposeful sampling method with a maximum variation strategy was used. The selected sources included Mehr News Agency, Khabar Online, Islamic Consultative Assembly News Agency (ICANA), Islamic Republic News Agency (IRNA), Iranian Students News Agency (ISNA), Hamshahri, Donya-e-Eqtesad newspapers, Webda, Sepid Online, and Iran's Food and Drug Administration News Agency (IFDANA). All data coding was manually done using Microsoft Excel software version 2016.

RESULTS

A total of 277 news articles were found to meet the established criteria for inclusion. The analysis revealed four main themes, each with several sub-themes, that shed light on the factors that drive vulnerability and the strategies to combat medicine smuggling. These themes are the economic environment, government and stewardship, information technology systems, and socio-cultural factors. The economic environment emerged as the most significant theme, encompassing medicine selection, reimbursement, and procurement, all of which affect the smuggling of pharmaceuticals in Iran.

CONCLUSION

To combat medicine smuggling, it is important to adjust policies based on the identified vulnerabilities. Effective strategies to reverse pharmaceutical smuggling include capacity building of pharmaceutical manufacturing companies, implementing regulated and enhanced supervisory and rulemaking policies, strengthening health insurance, improving e-infrastructure, and increasing public awareness through collaborative approaches involving various stakeholders within and outside the health system.

2D Information Security System Based on Polyurethane Inverse Photonic Glass Structure

Information security has become a major global problem in recent years. Thus, people continue to exert much effort in developing new information security technologies based on encryption and storage. In this study, a 2D information security technology based on polyurethane optical devices with inverse photonic glass structure (PU-IPG) is introduced. Based on 1) the swelling and plasticizing effects of various solvents on PU-IPG and 2) the capillary force that can produce geometric deformation on micro/nanostructures when solvents evaporate, a 2D information security system with two modules of decryption (structural color information display) and anticounterfeiting (structural color transformation) is successfully constructed. The spraying method adopted can be simple and fast and can provide a large area to build photonic glass templates, which greatly improves the capacity and category of information in the encryption system. The prepared PU-IPG optical devices can produce large-area multicolor output capability of information. These devices also have excellent mechanical properties, strong cycle stability, environmental friendliness, and low price. Therefore, the preparation strategy has great reference value and application prospects in the field of information security.

Terahertz Spectroscopy and Imaging Techniques for Herbal Medicinal Plants Detection: A Comprehensive Review

Herbal medicine (HM), derived from various therapeutic plants, has garnered considerable attention for its remarkable effectiveness in treating diseases. However, numerous issues including improved varieties selection, hazardous residue detection, and concoction management affect herb quality throughout the manufacturing process. Therefore, a practical, rapid, nondestructive detection technology is necessary. Terahertz (THz) spectroscopy, with low energy, penetration, and fingerprint features, becomes preferable method for herb quality appraisal. There are three parts in our review. THz techniques, data processing, and modeling methods were introduced in Part I. Three primary applications (authenticity, composition and active ingredients, and origin detection) of THz in medicinal plants quality detection in industrial processing and marketing were detailed in Part II. A thorough investigation and outlook on the well-known applications and advancements of this field were presented in Part III. This review aims to bring new enlightenment to the in-depth THz application research in herbal medicinal plants.

Screening method for the characterization of anabolic steroids seized in Brazil using paper spray mass spectrometry and chemometric tools

This paper reports the use of paper spray mass spectrometry (PS-MS) combined with chemometric models to analyze seized samples of anabolic steroids. Because many forensic laboratories typically demand high-throughput analysis for this type of sample, we developed a quicker and simpler alternative analytical method for routine analysis with minimal sample preparation. Oily samples (n = 39) resulting from seizures carried out by Brazilian Federal and State Police units were selected for this study. These samples were analyzed by PS-MS in the positive ion mode and full scan (50-1000 m/z), providing spectra containing patterns of the respective active ingredients present in each product. A principal component analysis (PCA) model was built, which discriminated samples mainly according to their active ingredients and allowed to detect and characterize some cases of product counterfeiting. The variable selection method ordered predictors selection was employed jointly with PCA to improve sample cluster separation and to provide model simplification. The final PCA model was built with three principal components and using only 28 spectral variables. This model accounted for 69.82% of the variance and discriminated samples according to their specific active ingredients.

Surveillance for substandard and falsified medicines by local faith-based organizations in 13 low- and middle-income countries using the GPHF Minilab

This study evaluates the use of the Global Pharma Health Fund (GPHF) Minilab for medicine quality screening by 16 faith-based drug supply organizations located in 13 low- and middle-income countries. The study period included the year before the COVID-19 pandemic (2019) and the first year of the pandemic (2020). In total 1,919 medicine samples were screened using the GPHF Minilab, and samples showing serious quality deficiencies were subjected to compendial analysis in fully equipped laboratories. Thirty-four (1.8%) of the samples were found not to contain the declared active pharmaceutical ingredient (API), or less than 50% of the declared API, or undeclared APIs, and probably represented falsified products. Fifty-four (2.8%) of the samples were reported as substandard, although the true number of substandard medicines may have been higher due to the limited sensitivity of the GPHF Minilab. The number of probably falsified products increased during the COVID-19 pandemic, especially due to falsified preparations of chloroquine; chloroquine had been incorrectly advocated as treatment for COVID-19. The reports from this project resulted in four international WHO Medical Product Alerts and several national alerts. Within this project, the costs for GPHF Minilab analysis resulted as 25.85 € per sample. Medicine quality screening with the GPHF Minilab is a cost-effective way to contribute to the global surveillance for substandard and falsified medical products.

A feasibility study on the use of a pocket-sized NIR spectrometer and multivariate algorithm to distinguish expired drugs from unexpired ones

An onsite technique for determining drug integrity in sub-Saharan Africa is needed to ensure drug integrity and enhance public health. This current study presents the application of handheld NIR spectroscopic and multivariate techniques for the accurate identification of unexpired drugs from expired ones. A total of 150 drugs comprising 75 drug samples each of antimalarial (40 unexpired and 35 expired) and antibiotics (40 unexpired and 35 expired) were used in the study. Principal component (PC) analysis was used to extract relevant information from the spectral fingerprint and pre-processed using different techniques comparatively to observe the best cluster trends. The performance of three multivariate algorithms: RF, SVM, and PLS-DA were compared after optimization by cross-validation. The results revealed that SVM and PLS-DA were superior with an identification rate for both antimalarial and antibiotic authenticity prediction above 98% at 5 PCs in both the prediction set and calibration set. For simultaneous prediction of expired and unexpired drugs, we achieved a 100% identification rate. Generally, the results show that handheld NIR spectrometers coupled with smartphone devices could successfully be used to identify unexpired antimalarial and antibiotic drugs from expired antimalarial and antibiotic drugs for effective quality assurance in poor-resource countries. This offers positive feasibility for an affordable and user-friendly approach to reducing drug fraud in Africa.

Emerging Antimicrobial Drug Resistance in Africa and Latin America: Search for Reasons

Medicine quality and methods for its assessment play a major role in the effectiveness of therapies and the treatment of many infectious diseases. However, poor-quality and/or falsified products are circulating in huge amounts in many low- and middle-income countries and are one of the major reasons why more and more resistant bacteria emerge. The development of resistance is additionally triggered by a plethora of antibiotic medicines which is easily available through pharmacies and unofficial sources. The uncontrolled overuse of these products is a huge problem not only in single countries but worldwide. In this review, we aim to demonstrate the factors which are involved in an emerging resistance development and how strong regulatory authorities, routine quality control by means of proficiency testing, and post-marketing surveillance as well as training personnel and patients can be combined to curb the problem.

Comparison of genuine, generic and counterfeit Cialis tablets using vibrational spectroscopy and statistical methods

The dubious online market in phosphodiesterase type 5 inhibitors is growing on a global scale. Counterfeit medical products can represent health issues for the user and cause medical mistrust. Within this work, genuine Cialis containing the active pharmaceutical ingredient (API) tadalafil, its generics available in the Czech Republic and the Cialis tablets from questionable online pharmacies were analysed. The methods of infra-red and Raman spectroscopy were used for the identification of the counterfeit tablets and for the verification of their API and excipients. All 9 tablets from online pharmacies were counterfeit with 2 of them even containing a different API (sildenafil, vardenafil). In addition, Raman mapping was used to determine the API and excipients' distribution and, in combination with multivariate data analysis, to separate similar tablets in clusters and to identify the outliers. Scanning electron microscopy of the samples revealed that the process of a wet granulation of micronized API was used during the formulation of the tablets. This comprehensive approach of analysis can be used for advanced exploration of the dubious samples of various medical products.

Identifying the most relevant tablet regions in the image detection of counterfeit medicines

This paper proposes a novel image-based approach to detect counterfeit medicines and identify the most relevant regions of the tablet in the task of classification. Images of medicine tablets undergo an initial pre-processing step which (i) removes the background to find the region of interest, (ii) clusters individual pixels into super-pixels, and (iii) extracts features containing color and texture information. The classification relying on Support Vector Machine (SVM) defines the class the respective image will be inserted into. The task of identifying the relevant regions of the tablets for counterfeiting detection is performed using the concept of support vectors, generating a heat map that indicates the regions that contribute the most to the classification purpose. Two datasets containing images of authentic and counterfeit tablets of Cialis and Viagra were used to validate our propositions, achieving correct classification rates of 100% on both datasets. Regarding the task of identifying the most relevant regions, our proposition outperformed the traditional LIME (Local Interpretable Model-agnostic Explanations) method by yielding more robust explanations.

Contribution to the Detection of Poor Quality Sildenafil Drugs in Burkina Faso Using High-Performance Thin-Layer Chromatography

In substandard drugs enforcement, there is a need to develop reliable, fast, and inexpensive analytical methods. Due to its very characteristics, HPTLC offers opportunities for the development of methods that meet these requirements. This technique was used to develop and validate a method for the determination of sildenafil in pharmaceutical formulations from the licit and illicit supply chain in Burkina Faso. Taking into account optimization parameters such as measurement wavelength and mobile phase composition, the best elution quality is found at the maximum signals of spots on silica plates at 305 nm, using a mixture of dichloromethane-methanol mixture 9 : 1 (v/v) proportions. The method developed under these conditions was validated using the accuracy profile as a decision tool. The establishment of the response function curves allowed the choice of the polynomial function applied to the peak areas. This mathematical model provides a validity range between 0.4 and 0.6 mg/mL. The application of the developed and validated method to collected samples allowed the detection of two substandard drugs and confirmed the poor quality of drugs in the illicit market. More data using this approach in a variety of drug molecules could lead to the establishment of databases of counterfeit drugs in Burkina Faso.

Substandard and falsified medical products: bibliometric analysis and mapping of scientific research

Objective

Substandard and falsified (SF) medical products are a global public health threat. The presence and spread of SF drugs negatively affect (1) patients’ safety and health outcomes, (2) national economy, (3) public trust in the healthcare system, and (4) the international fight against serious health challenges such as malaria and antimicrobial resistance. The objective of the current study was to investigate and provide a snapshot analysis of the evolution and developmental patterns of global research publications on SF products.

Methods

A bibliometric approach was adopted using terms such as fake, falsified, counterfeit, substandard, and others. No language restriction was made. The study period was from 1900 up to 2020. The search strategy was validated and implemented using Scopus database.

Results

The search strategy retrieved 978 documents authored by 2861 researchers from 100 different countries and published in 421 different journals. The retrieved documents received 11,237 citations (11.5 citations per document) with an H-index of 53. The 978 documents retrieved from Scopus were published from 1961 to 2020, giving an average of 16.6 publications per year. The present study indicated that research on SF medical products: (a) has experienced a steep growth from 2001 to 2012 followed by a steady-state growth; (b) was disseminated in a wide range of journals, mainly in the fields of the pharmaceutical industry, analytical chemistry, public health, infectious diseases, and internal medicine; (c) was published by scholars with diverse and distant geographical backgrounds; (d) was mainly produced in the United States, United Kingdom, and Germany; (d) has fragmented research networks and a limited number of researchers per network; (e) has limited cross-country collaboration except for that between the US and the UK in one hand and countries in the Mekong region in the other hand; (f) emphasized on medications related to malaria and sexual stimulants; and (g) received relatively inadequate funding.

Conclusions

Research on SF medical products is important and should remain a priority to ensure good quality of medications. Research activity in the field needs to be encouraged in world regions such as Africa and the Middle East where drug regulations are unsatisfactory and cross-border trade of illegal medications is common.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00766-5.

Unclonable Micro-Texture with Clonable Micro-Shape towards Rapid, Convenient, and Low-Cost Fluorescent Anti-Counterfeiting Labels

An ideal anti-counterfeiting label not only needs to be unclonable and accurate but also must consider cost and efficiency. But the traditional physical unclonable function (PUF) recognition technology must match all the images in a database one by one. The matching time increases with the number of samples. Here, a new kind of PUF anti-counterfeiting label is introduced with high modifiability, low reagent cost (2.1 × 10^-4 USD), simple and fast authentication (overall time 12.17 s), high encoding capacity (2.1 × 10⁶²³ ), and its identification software. All inorganic perovskite nanocrystalline films with clonable micro-profile and unclonable micro-texture are prepared by laser engraving for lyophilic patterning, liquid strip sliding for high throughput droplet generation, and evaporative self-assembling for thin film deposition. A variety of crystal film profile shapes can be used as "specificator" for image recognition, and the verification time of recognition technology based on this divide-and-conquer strategy can be decreased by more than 20 times.

Toward Blockchain-Enabled Supply Chain Anti-Counterfeiting and Traceability

Existing product anti-counterfeiting and traceability solutions across today’s internationally spanning supply chain networks are indeed developed and implemented with centralized system architecture relying on centralized authorities or intermediaries. Vulnerabilities of centralized product anti-counterfeiting solutions could possibly lead to system failure or susceptibility of malicious modifications performed on product records or various potential attacks to the system components by dishonest participant nodes traversing along the supply chain. Blockchain technology has progressed from simply being a use case of immutable ledger for cryptocurrency transactions, to a programmable interactive environment of developing decentralized and reliable applications addressing different use cases globally. Key areas of decentralization, fundamental system requirements, and feasible mechanisms of developing decentralized product anti-counterfeiting and traceability ecosystems utilizing blockchain technology are identified in this research, via a series of security analyses performed against solutions currently implemented in supply chain industry with centralized architecture. The decentralized solution will be a secure and immutable scientific data provenance tracking and management platform where provenance records, providing compelling properties on data integrity of luxurious goods, are recorded and verified automatically across the supply chain.

Plasmonic Anticounterfeit Tags with High Encoding Capacity Rapidly Authenticated with Deep Machine Learning

Counterfeit goods create significant economic losses and product failures in many industries. Here, we report a covert anticounterfeit platform where plasmonic nanoparticles (NPs) create physically unclonable functions (PUFs) with high encoding capacity. By allowing anisotropic Au NPs of different sizes to deposit randomly, a diversity of surfaces can be facilely tagged with NP deposits that serve as PUFs and are analyzed using optical microscopy. High encoding capacity is engineered into the tags by the sizes of the Au NPs, which provide a range of color responses, while their anisotropy provides sensitivity to light polarization. An estimated encoding capacity of 270ⁿ is achieved, which is one of the highest reported to date. Authentication of the tags with deep machine learning allows for high accuracy and rapid matching of a tag to a specific product. Moreover, the tags contain descriptive metadata that is leveraged to match a tag to a specific lot number (i.e., a collection of tags created in the same manner from the same formulation of anisotropic Au NPs). Overall, integration of designer plasmonic NPs with deep machine learning methods can create a rapidly authenticated anticounterfeit platform with high encoding capacity.

Current challenges in the detection and analysis of falsified medicines

Falsified medicines affect public health all around the globe. Complex distribution routes, illegal online webshops and reuse of packaging materials make them hard to detect. In order to tackle this problem, detection methods for the recognition of suspicious medicines and subsequent confirmation of falsification by analytical techniques is required. In this review, we focus on the developments and challenges that existed in the last five years (2015-2020) in the detection and analysis of falsified medicines. These challenges might have not been solved yet or arisen with new types of falsifications, new analytical techniques or detection strategies. Detection of suspicious medicines starts with visual inspection of packaging materials. However, re-use of packaging materials and high-quality imitations complicate visual inspection. Recent developments in the analysis of packaging by microscopic and spectroscopic techniques such as optical microscopy, X-ray fluorescence, infrared spectroscopy and Raman spectroscopy or microscopy, in combination with multivariate analysis show promising results in the detection of falsified medicines. An ongoing big challenge in the analysis of falsified medicines is the affordability of analytical devices. Yet, recent reports showed that lower cost devices, such as Counterfeit Drug Indicator or Counterfeit Detection device version 3 show promising use in the detection of falsified medicines. Furthermore, combining the outcomes of different low-cost analytical techniques, such as Minilab, colorimetry and Counterfeit Drug Indicator significantly increased selectivity and sensitivity in the detection of falsified medicines. Also, recent developments make it possible to link a low-cost technique, such as TLC, to mobile phones. Proper training of personnel has shown room for improvement and remains a challenge, even for relatively simple techniques. With an increased use of analytical fingerprints, an upcoming challenge is the accessibility of the growing pool of data. There is also the need of validated reference libraries on both national and international levels. Developments of the last few years bring us a step closer in the fight against falsified medicines, however challenges remain in the worldwide accessibility of affordable, easily operable and sensitive techniques.

Forensic analysis of anabolic steroids tablets composition using attenuated total reflection Fourier transform infrared microspectroscopy (µATR-FTIR) mapping

The use of falsified and unregistered drugs is a worldwide public health problem. Because these global market products usually do not follow the Good Manufacturing Practices required by health legislation, its composition may be completely different from the original or may contain relevant concentrations of impurities and toxic contaminants. Since anabolic steroids are among the main irregular therapeutic classes seized in Brazil, here we propose a new methodology for analyzing these products, in tablets form, using Attenuated Total Reflection Fourier Transform Infrared Microspectroscopy (µATR-FTIR) mapping. Spectra were acquired from solid tablets by attenuated total reflection, through point mapping methodology. In data processing, a characteristic absorption band for each Active Pharmaceutical Ingredient (API) was integrated and plotted to create its distribution map. This technique was applied in an unprecedented way for the forensic analysis of anabolic steroids and proved to be effective in distinguishing falsified products based on the detection of their APIs. It was possible to detect APIs in 26 out of 30 samples, five of which were classified as falsified only through µATR-FTIR analysis. We were able to create distribution maps of the detected substances associating the microspectroscopic results with characteristic band integration method, which can be used to detect substances and to study samples' homogeneity. We concluded that this methodology is promising for the analysis of anabolic steroid tablets, and can be used in a complementary way with techniques already consolidated in forensic laboratory routine for a better classification of questioned samples between authentic and falsified ones.

Counterfeit formulations: analytical perspective on anorectics

Purpose

This paper examines the scope of anorectics in counterfeit weight-reducing formulations and provides insight into the present state of research in determining such adulterants. Analytical techniques utilised in profiling adulterants found in slimming products, including limitations and mitigation steps of these conventional methods are also discussed. The current legal status of the anorectics and analogues routinely encountered in non-prescription slimming formulations is also explored.

Methods

All reviewed literature was extracted from Scopus, Web of Science, PubMed, and Google Scholar databases using relevant search terms, such as, ‘counterfeit drugs’, ‘weight loss drugs’, ‘weight-reducing drugs’, ‘slimming drugs’, ‘anorectic agents’, and ‘counterfeit anorexics’. Legislation related to anorectics was obtained from the portals of various government and international agencies.

Results

Anorectics frequently profiled in counterfeit slimming formulations are mostly amphetamine derivatives or its analogues. Five routinely reported pharmacological classes of adulterants, namely anxiolytics, diuretics, antidepressants, laxatives, and stimulants, are mainly utilised as coadjuvants in fake weigh-reducing formulations to increase bioavailability or to minimise anticipated side effects. Liquid and gas chromatography coupled with mass spectrometric detectors are predominantly used techniques for anorectic analysis due to the possibility of obtaining detailed information of adulterants. However, interference from the complex sample matrices of these fake products limits the accuracy of these methods and requires robust sample preparation methods for enhanced sensitivity and selectivity. The most common anorectics found in counterfeit slimming medicines are either completely banned or available by prescription only, in many countries.

Conclusions

Slimming formulations doped with anorectic cocktails to boost their weight-reducing efficacy are not uncommon. Liquid chromatography combined with mass spectrometry remains the gold standard for counterfeit drug analysis, and requires improved preconcentration methods for rapid and quantitative identification of specific chemical constituents. Extensive method development and validation, targeted at refining existing techniques while developing new ones, is expected to improve the analytical profiling of counterfeit anorectics significantly.

Composition analysis of falsified chloroquine phosphate samples seized during the COVID-19 pandemic

The proliferation of falsified medicines can cause serious public health issues, particularly in the context of a global pandemic such as the actual COVID-19 pandemic. Our study involved eight chloroquine phosphate medicines seized in Cameroon, Democratic Republic of Congo and Niger during March and May 2020. These suspect samples were first analyzed in a screening phase using field tools such as handheld Raman spectroscopy (TruScan) and then in a confirmation phase using laboratory tools such as hyperspectral Raman imaging and High Performance Liquid Chromatography (HPLC). The results confirmed the falsified nature of the samples, highlighting the presence of metronidazole at low dose in four samples (16.6, 15.2, 15.2 and 14.5 mg/tab), too low levels of chloroquine in two samples (2.4 and 20.2 mg/tab), and substitution of chloroquine phosphate by paracetamol in one sample (255.7 mg/tab). The results also confirmed that four samples had been adulterated with paracetamol in trace amounts and two of them presented traces of chloramphenicol.

A Blockchain and Machine Learning-Based Drug Supply Chain Management and Recommendation System for Smart Pharmaceutical Industry

From the last decade, pharmaceutical companies are facing difficulties in tracking their products during the supply chain process, allowing the counterfeiters to add their fake medicines into the market. Counterfeit drugs are analyzed as a very big challenge for the pharmaceutical industry worldwide. As indicated by the statistics, yearly business loss of around $200 billion is reported by US pharmaceutical companies due to these counterfeit drugs. These drugs may not help the patients to recover the disease but have many other dangerous side effects. According to the World Health Organization (WHO) survey report, in under-developed countries every 10th drug use by the consumers is counterfeit and has low quality. Hence, a system that can trace and track drug delivery at every phase is needed to solve the counterfeiting problem. The blockchain has the full potential to handle and track the supply chain process very efficiently. In this paper, we have proposed and implemented a novel blockchain and machine learning-based drug supply chain management and recommendation system (DSCMR). Our proposed system consists of two main modules: blockchain-based drug supply chain management and machine learning-based drug recommendation system for consumers. In the first module, the drug supply chain management system is deployed using Hyperledger fabrics which is capable of continuously monitor and track the drug delivery process in the smart pharmaceutical industry. On the other hand, the N-gram, LightGBM models are used in the machine learning module to recommend the top-rated or best medicines to the customers of the pharmaceutical industry. These models have trained on well known publicly available drug reviews dataset provided by the UCI: an open-source machine learning repository. Moreover, the machine learning module is integrated with this blockchain system with the help of the REST API. Finally, we also perform several tests to check the efficiency and usability of our proposed system.

Gap-enhanced Raman tags for physically unclonable anticounterfeiting labels

Anticounterfeiting labels based on physical unclonable functions (PUFs), as one of the powerful tools against counterfeiting, are easy to generate but difficult to duplicate due to inherent randomness. Gap-enhanced Raman tags (GERTs) with embedded Raman reporters show strong intensity enhancement and ultra-high photostability suitable for fast and repeated readout of PUF labels. Herein, we demonstrate a PUF label fabricated by drop-casting aqueous GERTs, high-speed read using a confocal Raman system, digitized through coarse-grained coding methods, and authenticated via pixel-by-pixel comparison. A three-dimensional encoding capacity of over 3 × 1015051 can be achieved for the labels composed of ten types of GERTs with a mapping resolution of 2500 pixels and quaternary encoding of Raman intensity levels at each pixel. Authentication experiments have ensured the robustness and security of the PUF system, and the practical viability is demonstrated. Such PUF labels could provide a potential platform to realize unbreakable anticounterfeiting.

Raman spectroscopy and mapping technique for the identification of expired drugs

As expired medical products can be repackaged and sold by unscrupulous counterfeiters, it is essential to find a rapid and convenient method for distinguishing expired and unexpired drugs. Standard detection methods such as high-performance liquid chromatography (HPLC) and thin-layer chromatography are complex, time-consuming, and require organic solvents (that are environmentally unfriendly). Additionally, the Pharmacopoeia publications do not include information about identifying expired drugs. In this study, we proposed a novel method for identifying expired medications based on Raman spectra and verified it using >20 types of expired (Old) and unexpired (New) drugs, each type from the same manufacturer. A portable Raman spectrometer was used to collect Raman spectra of all samples and the similarities between the Old and New drugs (S_N-O) were evaluated. Drugs with S_N-O values <0.9 were classified directly as expired drugs. For drugs with S_N-O values >0.9, the content of active pharmaceutical ingredient (API) might be so low (below or around 10 wt%) that its Raman signal is largely obscured by that of the excipients. In such cases, changes in the API content are undetectable using the portable instrument. Therefore, we adopted Raman mapping technology and established a virtual imaging map to locate areas of high API content. The similarities between the Old or New spectrum and that of the API (S_O-A and S_N-A, respectively) were calculated after removing the signal from the excipients. Our novel methods provide a precise, rapid, convenient, and environmentally friendly way to identify expired drugs that is more effective than the standard HPLC assay.

Application of near-infrared spectroscopy and class-modeling to antibiotic authentication

Nowadays, counterfeit medicines have become very popular due to the extension of the Internet. Broad-spectrum antibiotics with similar effect, but different prices, provide a gold opportunity for illegal traders to counterfeit. It is found that some genuine packaging of expensive brand drugs are recycled and then used to refill other kinds of cheap antibiotic tablets. It is of great importance to establish an effective antibiotic authentication method to check whether a product with a specific claim on its label is compatible with that declaration. In the present work, the feasibility of near-infrared (NIR) spectroscopy coupled with class-modeling for antibiotics authentication, i.e., counterfeiting between different antibiotics, is investigated. A total of 591 antibiotics samples of nine classes of different dosage forms were collected. Principal component analysis (PCA) was used for exploratory analysis. An effective model-independent filter method, i.e., relief, was used for feature selection and a novel class-modeling algorithm was used to construct authentication models. Three kinds of antibiotics were used as the target classes for experiments. The results confirmed that such a scheme is feasible and can be used in the screening of fake drug.

Unintended Consequences and Hidden Obstacles in Medicine Access in Sub-Saharan Africa

Many life-saving drugs are still inaccessible and unaffordable in low- and middle-income countries, particularly in Sub-Saharan Africa. This contributes to poor health outcomes, wider health and socioeconomic inequities, and higher patient spending on healthcare. While resource limitations facing national regulatory authorities (NRAs) contribute to the problem, we believe that (1) fragmented and complex drug regulations, (2) suboptimal enforcement of existing regulations, and (3) poorly designed disincentives for non-compliance play a larger role. These "unintended consequences" that are a direct result of our current regulatory regimes limit competition, keep drug costs high, and lead to shortages and the proliferation of illegitimate and unregistered drugs. While NRAs can gain a lot from increased investment in their work, regulatory harmonization and innovation can arrest and reverse the regulatory failures we still see today and improve medicine access in Africa. Unfortunately, harmonization initiatives in Sub-Saharan Africa have made modest impact and have done so slowly. We encourage greater attention and investment in harmonization and other downstream functions of NRAs. We also urge increased participation of national governments-particularly executive agencies in health and the treasury-and patient advocacy groups in advancing harmonization across the subcontinent.

Express detection of expired drugs based on near-infrared spectroscopy and chemometrics: A feasibility study

Levofloxacin is a third-generation fluoroquinolone antimicrobials drug that inhibits bacterial DNA replication. Driven by huge profit, one kind of particular counterfeit, e.g., repackaged expired tablets, becomes very common especially in developing countries. The feasibility of identifying expired levofloxacin tablets by combining NIR spectroscopy with chemometrics was investigated. Five kinds of levofloxacin samples from different manufacturers were collected for experiment. Two types of expired mode were considered and a simple model-independent algorithm was used for feature selection. Principal component analysis (PCA) was used for exploratory analysis and simple discriminant analysis. Taking seventy samples as the target class, a final one-class model based on Data Driven Soft Independent Modeling by Class Analogy with abbreviation DD-SIMCA was constructed, which achieved 97% sensitivity and 100% specificity on the independent set composed of 34 unexpired and 128 expired tablets. These results confirm that the combination of NIR spectroscopy, feature selection and class-modeling is feasible for identifying the expired levofloxacin tablets. Such a method can be extended to the analysis of similar drugs.

Instrumental neutron activation analysis (INAA) and liquid chromatography (LC) coupled to high resolution mass spectrometry (HRMS) characterisation of sildenafil based products seized on the Italian illegal market

The commerce of illegal and counterfeit medicinal products on internet is a serious criminal problem. Drugs for erectile dysfunction such as phosphodiesterase type 5 inhibitor are the most commonly counterfeited medicines in Europe. The search of possible toxic chemical substances in seized products is needed. Moreover, the profiling of the material can be the source of relevant forensic information. For the first time a combined approach based on liquid chromatography (LC) coupled to high resolution mass spectrometry (HRMS) and instrumental neutron activation analysis (INAA) is proposed and tested, allowing characterisation of both authentic and illegal pharmaceuticals containing sildenafil seized in Italy. LC-HRMS allowed the detection and identification of unknown impurities not reported on labels in illegal products and the quantitation of the sildenafil. INAA showed to be suitable to provide both qualitative and quantitative information for forensic purposes on 23 elements, allowing discrimination between legal and illegal products.

Forensic intelligence on illicit markets: The example of watch counterfeiting

Counterfeit luxury fashion goods have rarely been the subject of scientific studies. Very little is known about the mechanisms of this illicit market despite the apparent prevalence and their adverse consequences. Counterfeit watches remain one of the preferred targets in the luxury goods segment. The study of marks or traces in a forensic intelligence perspective can contribute to an improved understanding of the phenomenon. The aim of our research was to highlight different types of links that can be drawn between specimens of counterfeit watches, to carry out a thorough study of the information conveyed by the revealed links, to study their complementarity and to get an understanding of the intelligence that can be produced from these pieces of information. Thirty-five counterfeit watches of a commonly counterfeit watch brand including seven popular models were studied in this research. Chemical and physical links were found that corroborated existing knowledge and also revealed new connections between different seizures or specimens. The comparison of chemical and physical features combined with spatiotemporal information on the seized watches enabled us to produce intelligence disclosing possible aspects of the structure and the organisation of production and distribution channels. We were able to reveal or confirm links between watches that were previously unknown or uncertain and demonstrated the interconnection of all watches on a chemical and/or physical level, suggesting an overhead organised network with substructures. Despite the limited set of specimens that was considered, this study illustrates that forensic intelligence on this illicit market can be used to support consistent decision-making from all the key-players involved in the anti-counterfeiting process.

Associations Between Practices and Behaviors at the Health Facility Level and Supply Chain Management for Antiretrovirals: Evidence from Cameroon, Namibia, and Swaziland

Using antiretrovirals (ARVs) as tracer products, we identified the following key practices that may affect supply chain management at the facility level: order verification, actions taken when stock is received, changes in prescription and dispensing due to ARV stock-out, actions to ensure patient adherence, and communication with other affiliated facilities and higher-level supply chain management. We propose a set of indicators to measure these practices.

Background:

While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM. This study identifies practices and behaviors that are associated with SCM of ARVs at the hospital level and proposes new indicators for measurement.

Methods:

We performed an in-depth literature review to identify facility-level practices and behaviors and existing indicators that are associated with SCM. We used the United States Agency for International Development's 2013 National Supply Chain Assessment Toolkit to define 7 supply chain function areas to frame the study. Qualitative, semistructured key informant and focus group interviews were conducted in hospitals with health professionals from Cameroon, Namibia, and Swaziland to understand facility-level practices and behaviors.

Results:

Using the results from 54 key informant and focus group interviews from 12 hospitals, we identified 30 practices and behaviors that may affect ARV SCM at the facility level. The following practice areas were particularly associated with SCM: order verification, actions taken when ARV stock is received, changes in prescription and dispensing due to ARV stock-out, actions to ensure patient adherence, and communication with other affiliated facilities and higher-level SCM. We subsequently developed measurable indicators for future research.

Conclusion:

This study characterizes facility-level practices and behaviors that can affect ARV SCM. It also identifies gaps in their measurement. While this study uses ARVs as a tracer medicine to understand gaps in practices at the facility level, many of the findings are more broadly applicable to other medicines in an integrated setting. This study provides real-world evidence and the groundwork for further research to characterize the link between 30 facility-level practices and behaviors and ARV SCM at the facility and central levels.

Management of crime scene units by Quebec police senior managers: Insight on forensic knowledge and understanding of key stakeholders

What do policing leaders think and know of forensic science? Beyond crime scene investigators or detectives, how do police senior managers perceive the role, utility and limitations of forensic science? Very few empirical studies have addressed the issue. Forensic scientsts should be concerned about the perception that law enforcement senior managers have of their discipline for two reasons. First, strategic and financial decision-makers are obviously key players in the overall administration and provision of forensic science, either as a supervisor, money provider or as a customer. Second, literature has highlighted that other actors involved in forensic science underestimate the scope and possibilities offered by forensic science, hence limiting its exploitation and potential. Following interviews with 18 police senior managers from Quebec (Canada), this study shows that they generally restrict forensic science to a reactive discipline whose role and utility is to identify offenders and support the Court. This understanding of forensic science, like that of many others including a significant share of forensic scientists, differs from the perception of other police activities in modern law enforcement agencies where proactive action is sought. Considering these findings and the growing body of literature which calls for forensic science to connect more tightly with policing and security, we advocate a more extensive education of police leaders regarding the scope of forensic science.

Evaluating the quality of antihypertensive drugs in Lagos State, Nigeria

BACKGROUND

As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables.

METHODS

We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria. We assessed drug quality based on (1) the level of active pharmaceutical ingredients (APIs), which identified falsely labeled drug samples; and (2) the amount of impurities, which revealed substandard drug samples in accordance with the international pharmacopoeia guidelines. Good-quality drugs met specifications for both API and impurity.

RESULTS

Of the 102 drug samples collected, 30 (29.3%) were falsely labeled, 76 (74.5%) were substandard,78 (76.5%) were of poor quality and 24 (23.5%) were of good quality.Among the falsely labeled drugs, 2 samples met standards set for purity while 28 did not. Among the 76 substandard drug samples, 28 were also falsely labeled. Of the falsely labeled drugs, 17 (56.7%) came from LGAs with low socioeconomic status, and 40 (52.6%) of the substandard drug samples came from LGAs with high socioeconomic status. Most of the good-quality drug samples, 14 (58.3%), were from LGAs with low socioeconomic status. Eighteen (60%) of the falsely labeled samples, 37 (48.7%) of the substandard samples, and 15 (62.5%) of the good-quality drug samples were from manufacturers based in Asia. The average price was 375.67 Nigerian naira (NGN) for falsely labeled drugs, 383.33 NGN for substandard drugs, and 375.67 NGN for good-quality drugs. The prevalence of falsely labeled and substandard drug samples did not differ by LGA-level socioeconomic status (P = .39) or region of manufacturer (P = .24); however, there was a trend for a difference by price (P = .06).

CONCLUSION

The prevalence of falsely labeled and substandard drug samples was high in Lagos. Treatment of noncommunicable diseases in this setting will require efforts to monitor and assure drug quality.

Quantitative screening of the pharmaceutical ingredient for the rapid identification of substandard and falsified medicines using reflectance infrared spectroscopy

The World Health Organization suggests that approximately 10% of medicines worldwide are either falsified or substandard with higher figures in low and middle income countries. Such poor quality medicines can seriously harm patients and pose a threat to the economy worldwide. This study investigates attenuated total reflectance-fourier transform infrared (ATR-FTIR) spectroscopy as a simple and rapid method for determination of drug content in tablet dosage forms. Paracetamol was used as the model pharmaceutical ingredient. Spectra of standard mixtures of paracetamol with different excipients formed the basis for multivariate PLS based quantitative analysis of simulated tablet content using different selected infrared absorbance bands. Calibration methods using ATR-FTIR were compared with the ATR-FTIR and conventional ultraviolet spectroscopic analyses of real tablet samples and showed that the paracetamol/microcrystalline cellulose mixtures gave optimum results for all spectral bands tested. The quantitative data for band 1524-1493cm-1 was linear (R2 ˃ 0.98; LOQ ≥ 10%w/w tablet). Global examples of paracetamol tablets were tested using this protocol and 12% of the tablet samples examined was identified as substandard. Each sample analysis was completed in just a few minutes. ATR-FTIR can therefore be used in the rapid screening of tablet formulations. The simplicity of the proposed method makes it appropriate for use in low and middle income countries where analytical facilities are not available.

Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

IMPORTANCE

Substandard and falsified medicines burden health systems by diverting resources to ineffective or harmful therapies, causing medical complications and prolonging illnesses. However, the prevalence and economic impact of poor-quality medicines is unclear.

OBJECTIVE

To conduct a systematic review and meta-analysis to assess the prevalence and estimated economic burden of substandard and falsified essential medicines in low- and middle-income countries.

DATA SOURCES

Five databases (PubMed, EconLit, Global Health, Embase, and Scopus) were searched from inception until November 3, 2017.

STUDY SELECTION

Publications were assessed to determine whether they examined medicine quality and the prevalence and/or economic burden of substandard and falsified medicines in low- and middle-income countries. Studies with a sample size of 50 or more were included in the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

The study is registered in PROSPERO and reported via the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Study quality was assessed using an adapted Medicine Quality Assessment Reporting Guidelines scoring metric. Multiple reviewers conducted the data extraction and quality assessment independently.

MAIN OUTCOMES AND MEASURES

Prevalence and/or estimated economic impact of substandard and falsified medicines.

RESULTS

Two hundred sixty-five studies that estimated the prevalence of poor-quality essential medicines in low- and middle-income countries were identified. Among 96 studies that tested 50 samples or more (67 839 total drug samples), overall prevalence of poor-quality medicines was 13.6% (95% CI, 11.0%-16.3%), with regional prevalence of 18.7% in Africa (95% CI, 12.9%-24.5%) and 13.7% in Asia (95% CI, 8.2%-19.1%). Of studies included in the meta-analysis, 19.1% (95% CI, 15.0%-23.3%) of antimalarials and 12.4% (95% CI, 7.1%-17.7%) of antibiotics were substandard or falsified. Eight approximations of the economic impact, focused primarily on market size, with poor or undisclosed methods in estimation were identified, ranging from $10 billion to $200 billion.

CONCLUSIONS AND RELEVANCE

Poor-quality essential medicines are a substantial and understudied problem. Methodological standards for prevalence and rigorous economic studies estimating the burden beyond market size are needed to accurately assess the scope of the issue and inform efforts to address it. Global collaborative efforts are needed to improve supply-chain management, surveillance, and regulatory capacity in low- and middle-income countries to reduce the threat of poor-quality medicines.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42017080266.

Paper-Based Enzyme Competition Assay for Detecting Falsified β-Lactam Antibiotics

Falsified and substandard antibiotics are a growing worldwide problem that leads to increased patient mortality and decreased trust in healthcare, and contributes to antimicrobial resistance. Monitoring falsified antibiotics is difficult because most falsified pharmaceuticals are most commonly found in developing countries, where detecting the active ingredient is difficult due to lack of access to complex instrumentation. Herein, we describe the development and optimization of a microfluidic paper-based analytical device (μPAD) to detect the active ingredient in the most falsified class of antibiotics, β-lactams. The assay is based on enzyme competition, making it the first demonstrated competitive enzyme assay reported in paper-based devices. The assay uses nitrocefin, a chromogenic substrate, to compete with β-lactam antibiotics in a reaction with β-lactamase. A yellow color indicates legitimate drugs, while a color change from yellow to red indicates falsified drugs. In addition to testing for the active ingredient, another section of the device was added to test the sample pH to further verify results and identify common falsified ingredients like aspirin or baking soda. Calibration curves for four different antibiotics, including cefazolin, have been generated making it the first paper-based device capable of detecting both cephalosporin and penicillin antibiotics. The μPAD has also been tested with common falsified ingredients and four antibiotics in tablet or injectable form, demonstrating its potential for in-field falsified antibiotic testing.

Drug Quality in South Africa: A Field Test

To assess drug quality and pharmaceutical care in South Africa, "mystery" (i.e., anonymous) customers collected 316 samples from July to September 2016. Solid dosage forms containing amoxicillin alone or in combination with clavulanic acid as well as analgesics containing paracetamol alone or in combination with other drugs were sampled in a randomized fashion from the formal market (pharmacies) and by convenient sampling from the informal market. Visual inspection, uniformity of dosage units, and dissolution testing were performed to evaluate adherence to pharmacopoeial quality standards and to identify counterfeit, degraded, or substandard drugs. Although no counterfeited products were identified, only 55.4% (173/312) of samples were able to fulfill all pharmacopeial requirements for quality. Most of the 139 samples that failed were unable to pass the visual inspection due to inappropriate labeling and packaging. In addition, several substandard products were identified: 17 (5.4%) samples failed dissolution testing and 15 (4.8%) failed the content uniformity test. To improve drug quality and the quality of pharmaceutical care, better education of pharmaceutical professionals and monitoring of the pharmaceutical supply chain in South Africa are needed. Further field studies are necessary to evaluate risks and quality issues for other drug classes and distribution channels.

Survey to Identify Substandard and Falsified Tablets in Several Asian Countries with Pharmacopeial Quality Control Tests and Principal Component Analysis of Handheld Raman Spectroscopy

The World Health Organization has warned that substandard and falsified medical products (SFs) can harm patients and fail to treat the diseases for which they were intended, and they affect every region of the world, leading to loss of confidence in medicines, health-care providers, and health systems. Therefore, development of analytical procedures to detect SFs is extremely important. In this study, we investigated the quality of pharmaceutical tablets containing the antihypertensive candesartan cilexetil, collected in China, Indonesia, Japan, and Myanmar, using the Japanese pharmacopeial analytical procedures for quality control, together with principal component analysis (PCA) of Raman spectrum obtained with handheld Raman spectrometer. Some samples showed delayed dissolution and failed to meet the pharmacopeial specification, whereas others failed the assay test. These products appeared to be substandard. Principal component analysis showed that all Raman spectra could be explained in terms of two components: the amount of the active pharmaceutical ingredient and the kinds of excipients. Principal component analysis score plot indicated one substandard, and the falsified tablets have similar principal components in Raman spectra, in contrast to authentic products. The locations of samples within the PCA score plot varied according to the source country, suggesting that manufacturers in different countries use different excipients. Our results indicate that the handheld Raman device will be useful for detection of SFs in the field. Principal component analysis of that Raman data clarify the difference in chemical properties between good quality products and SFs that circulate in the Asian market.

Recent advances in the applications of vibrational spectroscopic imaging and mapping to pharmaceutical formulations

Vibrational spectroscopic imaging and mapping approaches have continued in their development and applications for the analysis of pharmaceutical formulations. Obtaining spatially resolved chemical information about the distribution of different components within pharmaceutical formulations is integral for improving the understanding and quality of final drug products. This review aims to summarise some key advances of these technologies over recent years, primarily since 2010. An overview of FTIR, NIR, terahertz spectroscopic imaging and Raman mapping will be presented to give a perspective of the current state-of-the-art of these techniques for studying pharmaceutical samples. This will include their application to reveal spatial information of components that reveals molecular insight of polymorphic or structural changes, behaviour of formulations during dissolution experiments, uniformity of materials and detection of counterfeit products. Furthermore, new advancements will be presented that demonstrate the continuing novel applications of spectroscopic imaging and mapping, namely in FTIR spectroscopy, for studies of microfluidic devices. Whilst much of the recently developed work has been reported by academic groups, examples of the potential impacts of utilising these imaging and mapping technologies to support industrial applications have also been reviewed.

Global landscape assessment of screening technologies for medicine quality assurance: stakeholder perceptions and practices from ten countries

BACKGROUND

The spread of substandard and falsified (SF) medical products constitutes a growing global public health concern. Some countries use portable, handheld screening technologies (STs) in the field to accelerate detection of SF medicines and reduce the number of medicine samples that undergo costly and time-consuming confirmatory analysis.

METHODS

A multi-country, multi-stakeholder landscape assessment utilizing qualitative methodology was used to examine practices and perceptions related to the use of STs. Qualitative interview guides were designed using the results of a literature review and comprised of open-ended questions with the study participants, who were from national medicine regulatory authorities, pharmaceutical manufacturers, pharmacies, and distributors. Ten geographically and economically diverse countries were selected: Argentina, China, Egypt, India, Jordan, Mexico, Nigeria, Philippines, the United States, and Zimbabwe. Of the completed 53 interviews, 32 were in-person, 16 were phone interviews, and 5 were via written questionnaires.

RESULTS

Data analysis shows a wide variation in understanding and usage of STs in different sectors. Virtually all of the study participants indicated a lack of objective, accessible information on STs to advise them on what technologies would be beneficial for their needs. Study participants also described their ideal capabilities of the next generation of STs, including shareable spectral libraries, lower acquisition costs, lesser training requirements, and in-country maintenance and technical support.

CONCLUSION

The results and recommendations presented in this article can be used to help regulators communicate and justify their needs to acquire and invest in new STs. There is a need for additional standardized, trustworthy and scientifically sound evaluations of STs, and to support regulators to effectively deploy the most promising technologies. ST manufacturers can take into account some of the limitations of the technologies the interviewees identified in this article, such as a dearth of technologies, which provide quantitative information about the active ingredient, and take steps to address them to better serve their customers. These results and recommendations, can catalyze research and actionable interventions into the development, review, application, and use of STs.