From Drug Safety to Drug Security: A Contemporary Shift in the Policing of Health

Sub-standard or Sub-legal? Distribution, Pharma Dossiers, and Fake-talk in India

In this article, I look at Indian pharma 'dossiers'-the bundles of paperwork that testify to pharmaceutical quality and adherence to regulatory standards-and how they illustrate a wider and ongoing shift from a paradigm of drug safety to one of drug security. By examining how dossiers enact and enable claims of 'quality', I argue that it is in a drug's paperwork-rather than its chemical composition-that quality or fake-ness is produced. Based on interviews with Indian traders and officials, and an examination of how their work has changed over time in accordance with the regulatory shift to drug security, I show that in many instances the paperwork has come to be more important than the pill itself. This analysis contests the dominant pharmaco-regulatory notion of fake-ness, which privileges chemical composition above all else. In this way, my analysis of the dossier shows that drug security is itself a powerful form of fake-talk, one that informs the entire market and the conditions of possibility of international commerce today.

Do doctors have a responsibility to help patients import medicines from abroad?

Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are not subsidised by insurers or if copayments are high. As medicine prices and out-of-pocket healthcare spending continue to climb, the online marketplace provides an important alternative for individuals in high-income countries to source medicines. In this article, I argue that doctors have a responsibility to help patients access medicines online and I propose a framework that can be used to facilitate responsible personal importation.

Do Fakes Exist? Trade and Consumption of Sex Enhancers in Harare's Avenues

After the ban of over-the-counter sex enhancers in 2013 by the Medical Control Authority of Zimbabwe (MCAZ), the streets of the inner city area of Harare called The Avenues became a haven for illegal traders in sex enhancers. This article explores how products that are banned by the state acquire their own agencies. From the traders' perspectives, the point of departure to understanding efficacy is not the sex enhancers, but their clients' needs and their body systems. Thus, the authenticity of the products ceases to be a point of reference. The trade and consumption of sex enhancers amongst Zimbabweans is itself intricately intertwined with the broader political economy of the country. A deteriorating economy has engendered a crisis of masculinity which has contributed towards increased trade and consumption in sex enhancers. The article argues that drug efficacy is a complex phenomenon, whose conceptualisation and manifestations are fluid and not always pharmacological. The research documents six months in The Avenues as research "field", enriched by both online and traditional ethnographies. The analysis aims to understand perceptions of and dynamics around the efficacy of sex enhancers sold in Harare's urban streets.

"A passion to change the landscape and drive a renaissance": The mRNA Hub at Afrigen as decolonial aspiration

In global conversations about COVID-19 vaccine access, Africa has overwhelmingly been characterized as a site of lack. However, the successful reverse engineering of the Moderna vaccine by Afrigen at the mRNA Hub in Cape Town marks a more hopeful path forward. This paper introduces the mRNA Hub and puts it into context of broader decolonial aspirations for African futures in the face of rich countries' disregard. Highlighting ways in which Afrigen's Managing Director's articulations of the endeavor resonate with historical and contemporary calls to dismantle the unequal global order, we argue that the mRNA Hub provides an example of the potential for decolonial solidarity in the post/pandemic period.

The ghost in the data: Evidence gaps and the problem of fake drugs in global health research

For the past several decades, global health research and policy have raised the alarm about the growing threat of counterfeit and low-quality drugs (henceforth 'fakes'). These high-profile and regularly-repeated claims about 'fake drugs' pepper scholarly publications, grey literature, and popular writing. We reviewed much of this work and found that it shares two characteristics that sit awkwardly alongside one another. First, it asserts that fake drugs constitute an urgent threat to lives. Second, it reports trouble with 'gaps' in the evidence on which their claims are based; that data is weaker and less conclusive than anticipated. Given the ubiquity of and urgency with these claims are made, we found this juxtaposition perplexing. To understand this juxtaposition better, we undertook a close reading of the strategies authors employed to negotiate and overcome data and evidence 'gaps' and asked questions about the cultures of scholarly publishing in global health research. We argue that a scholarly commitment to studying fakes despite--rather than because of-the evidence functions to support the continuation of similar research. It also works against asking different questions-for instance regarding the lack of easy access to pharmacological data that might make it possible to know fakes differently.

The case of the 'Spurious Drugs Kingpin': shifting pills in Chennai, India

This paper recounts the tale of a 'Spurious Drugs Kingpin' and his scandalous business empire of relabelling and recirculating expired medicines in the south Indian city of Chennai. At the time the story broke, in the first half of 2010, questions of drug safety dominated media headlines and public discussion. However, a closer investigation suggests a more complicated picture. While relabelling expired medicines was certainly a crime, it is far from clear if their relabelling and subsequent redistribution constituted a public health danger. If actually existing unsafe drugs did not fuel this drug safety scandal, what did? I argue this case illuminates two things: (1) the illusory nature of certainties about drug safety and (2) how ambiguity about the safety of expired drugs facilitates policing not of relations within the pharmacological world, but instead of social and economic relations. This episode matters because it illuminates how, within apparent attempts to police the safety of circulation of drugs, drugs themselves are neither subject nor object, but instead the ground upon which market battles are waged.