1
|
Macé C, Nikiema JB, Sarr OS, Ciza Hamuli P, Marini RD, Neci RC, Bourdillon Esteve P, Ravinetto R. The response to substandard and falsified medical products in francophone sub-Saharan African countries: weaknesses and opportunities. J Pharm Policy Pract 2023; 16:117. [PMID: 37803394 PMCID: PMC10557312 DOI: 10.1186/s40545-023-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Assuring the quality of medical products manufactured, imported or distributed in francophone sub-Saharan Africa remains a challenge, despite positive signals like the growing engagement in the benchmarking of regulatory authorities and -particularly- in the establishment of the African Medicines Agency. In this short report, we describe the existing activities to prevent, detect and respond to substandard and falsified products (SF) in this region, either through African multilateral organizations and initiatives led by the World Health Organization, or through the contribution of other stakeholders, such as local universities and procurement agencies. We underline that these emerging local stakeholders may play a pivotal role to guide and inform the national regulatory authorities about the prevalence and patterns of SF medical products, complementing the market surveillance and control, and building awareness of the importance of pharmaceutical quality assurance for public health.
Collapse
Affiliation(s)
| | | | - Omar Serigne Sarr
- University of Dakar Cheikh Anta Diop, Dakar, Senegal
- Senegalese Drug Regulatory Agency, Dakar, Senegal
| | - Patient Ciza Hamuli
- Faculty of Pharmaceutical Sciences, LACOMEDA, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Djang'eing'a Marini
- CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege, Liege, Belgium
| | | | - Pernette Bourdillon Esteve
- Incidents and Substandard/Falsified Medical Products Team, World Health Organization (WHO), Geneva, Switzerland
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, 2000, Antwerp, Belgium.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| |
Collapse
|
2
|
Magnolini R, Falcato L, Cremonesi A, Schori D, Bruggmann P. Fake anabolic androgenic steroids on the black market - a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature. BMC Public Health 2022; 22:1371. [PMID: 35842594 PMCID: PMC9288681 DOI: 10.1186/s12889-022-13734-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Supraphysiologic doses of anabolic androgenic steroids (AAS) are widely used to improve body image and sport performance goals. These substances can easily be acquired over the internet, leading to a substantial black market. We reviewed literature that assessed the quality and quantity of AAS found on the black market. Methods We searched PubMed/Medline, Embase and Google Scholar for articles published before March 2022. Additional hand searches were conducted to obtain studies not found in the primary literature search. Studies were included if they report on qualitative and/or quantitative analytical findings of AAS from the black market. Primary outcomes were proportions of counterfeit or substandard AAS. Eligible articles were extracted; quality appraisal was done using the ToxRTool for in-vitro studies. We used random-effects models to calculate the overall mean estimates for outcomes. The review protocol has been published and registered in INPLASY. Results Overall, 19 studies, which in total comprised 5,413 anabolic samples, met the inclusion criteria, and passed the quality appraisal from two WHO world regions that reported findings, the Americas and Europe. Most studies were nonclinical laboratory studies (95%) and provided samples seized by authorities (74%). In 18 articles, proportions of counterfeit substances and in eight articles, proportions of substandard substances were presented. The overall mean estimate for counterfeit anabolic steroids found on the black market was 36% (95% CI = 29, 43). An additional 37% (95% CI = 17, 63) were of substandard quality. We also demonstrate that these drugs could contain no active ingredient, or in another amount than that labeled, a wrong active ingredient, as well as not all or more active ingredients than were labeled. High heterogeneity among all analyses and significant differences between geographical subgroups were found. Conclusion With this systematic review and meta-analysis, we demonstrate that substantial mean proportions of black-market AAS are counterfeit and of substandard quality. These products pose a considerable individual and public health threat, and the very wide range in proportions of fake black-market AAS puts the user in a situation of unpredictable uncertainty. There is a great need for future prevention and harm-reduction programs to protect users from these substances. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13734-4.
Collapse
Affiliation(s)
- Raphael Magnolini
- Arud Centre for Addiction Medicine, Schützengasse 31, 8001, Zurich, Switzerland. .,Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Luis Falcato
- Arud Centre for Addiction Medicine, Schützengasse 31, 8001, Zurich, Switzerland
| | - Alessio Cremonesi
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
| | - Dominique Schori
- Department of Social Welfare, Drug Information Centre 'DIZ', City of Zurich, Zurich, Switzerland
| | - Philip Bruggmann
- Arud Centre for Addiction Medicine, Schützengasse 31, 8001, Zurich, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Fimbo AM, Maganda BA, Mwamwitwa KW, Mwanga IE, Mbekenga EB, Kisenge S, Mziray SA, Kulwa GS, Mwalwisi YH, Shewiyo DH. Post marketing surveillance of selected veterinary medicines in Tanzania mainland. BMC Vet Res 2022; 18:216. [PMID: 35681204 PMCID: PMC9178830 DOI: 10.1186/s12917-022-03329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Veterinary medicines have been widely used for the prevention and treatment of animal diseases. Globally, the veterinary medicine industry is growing. However, there is a significant increase of concern on the quality of veterinary medicines in various developing countries' legal markets. Poor-quality medicines are associated with treatment failure, development of drug resistance, increased healthcare cost, and death. These reasons warrant a need for monitoring the quality of the medicines circulating in the Tanzania Mainland. METHODS This was a survey study and veterinary medicines samples were collected from 9 out of 26 regions of Tanzania mainland between 2014 and 2017. Veterinary medicines were sampled from wholesale pharmacies, retail pharmacies, veterinary clinics and Veterinary Accredited Drug Dispensing Outlets (ADDO-vet). All sampled medicines were subjected to product information review and full quality control testing at the Tanzania Medicines and Medical Devices Authority-World Health Organization prequalified laboratory. RESULTS A total of 238 samples of veterinary medicines were collected. Out of these, 97.1% (231/238) were subjected to full quality control testing and product information review. All sampled veterinary medicines conformed to visual appearance, clarity, pH, solubility and sterility tests. Also, of the sampled veterinary medicines 97.8% (226/231) and 89.2% (206/231) passed identification and assay tests, respectively. As well as, the majority of the collected samples 92% (219/238) failed to comply with product information requirements. The most observed deficiencies on product information were inadequate information on the package insert 94.1% (224/238), inappropriate storage conditions 55.5% (132/238) and lack of Tanzania registration number 27% (64/238). CONCLUSION Veterinary medicines with poor quality were found circulating in the legal markets of Tanzania. This can potentiate treatment failure and the development of drug resistance in animals and humans. Post marketing surveillance program will continue to be implemented to ensure that only good quality, safe and efficacious medicines are circulating in the Tanzania Mainland market.
Collapse
Affiliation(s)
- Adam M. Fimbo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Betty A. Maganda
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania
| | - Kissa W. Mwamwitwa
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Itikija E. Mwanga
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Engelbert B. Mbekenga
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Seth Kisenge
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Sophia A. Mziray
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Gerald S. Kulwa
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Yonah H. Mwalwisi
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| | - Danstan H. Shewiyo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 77150, Dar es salaam, Tanzania
| |
Collapse
|
4
|
Hertig JB, Jochem JM, Long AM. Pharmacists' perceptions and attitudes toward drug importation into the State of Florida. J Pharm Policy Pract 2021; 14:101. [PMID: 34857043 PMCID: PMC8638520 DOI: 10.1186/s40545-021-00381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Department of Health and Human Services and the Food and Drug Administration released the Safe Importation Action Plan in July 2020 detailing methods to import medicines from Canada to combat increasing drug costs. In November 2020, Florida became the first state in the United States to create and propose an importation plan from Canada. This study examines the proposal submitted by Florida, Florida pharmacists' perceptions of the program on patient safety, and Florida pharmacists' thoughts on the pharmacy operational impact. METHODS This was a cross-sectional study utilizing an electronic questionnaire sent to pharmacist members of the Florida Pharmacy Association. The survey incorporated closed-ended and open-ended questions. The results from the study were reported and analyzed through descriptive statistics, qualitative and quantitative data. RESULTS Two-hundred and forty-four pharmacists responded to the survey. Of those respondents, 25% stated they had no knowledge about Florida's drug importation plan. Less than 12% of respondents stated they would trust the safety and quality of imported medicines. Seventy percent of pharmacists expressed concerns regarding the changes required in pharmacy operations to increase medicine safety. About half of the respondents questioned whether this plan would promote cost-savings as intended. CONCLUSION Florida pharmacists believe the drug importation plan does not address all aspects of patient and medicine safety and expressed concerns regarding logistical operations of a pharmacy. This article highlights those concerns and acts as a summons to action.
Collapse
Affiliation(s)
- John B Hertig
- Butler University College of Pharmacy & Health Sciences, 4600 Sunset Ave., Indianapolis, IN, 46208, USA.
| | - Jade M Jochem
- Butler University College of Pharmacy & Health Sciences, 4600 Sunset Ave., Indianapolis, IN, 46208, USA
| | - Allissa M Long
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| |
Collapse
|
5
|
Mziray S, Maganda BA, Mwamwitwa K, Fimbo AM, Kisenge S, Sambu G, Mwalwisi YH, Bitegeko A, Alphonce E, Khea A, Shewiyo DH, Kaale E. Quality of selected anti-retroviral medicines: Tanzania Mainland market as a case study. BMC Pharmacol Toxicol 2021; 22:46. [PMID: 34446094 PMCID: PMC8390223 DOI: 10.1186/s40360-021-00514-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/26/2021] [Indexed: 08/29/2023] Open
Abstract
Background Antiretroviral drugs (ARVs) have significantly reduced morbidity, mortality and improved the quality of life of people living with HIV infection. Poor quality ARVs may result in harmful consequences such as adverse drug reactions, treatment failure and development of drug resistant strains and sometimes death, which in turn may undermine the healthcare delivery system. To ensure optimal treatment outcomes, medicines quality control must be undertaken regularly. This study was aimed at evaluating the quality of ARVs circulating on the Tanzania Mainland market. Methods This was a survey study. ARVs samples were collected in 20 regions of Tanzania Mainland, between 2012 and 2018. All sampled ARVs were subjected to screening testing using the Global Pharma Health Fund® Mini-Lab kits. Sampled ARV’s that failed screening test or yielded doubtful results and 10 % (10 %) of all that complied with the screening test requirements were selected for full quality control testing. Quality control testing was conducted at the Tanzania Medicines and Medical Devices Authority (TMDA) laboratory a World Health Organisation prequalified. Samples collected from the medicine distribution outlets were also, subjected to product information review. Results A total of 2,630 samples were collected, of which 83.7 % (2200/2630) were from port of entry (POEs). All sampled ARVs were screened and conformed to the specifications, except of the fixed dose combination (FDC) lopinavir/ritonavir 0.27 % (7/2630) and lamivudine/zidovudine/nevirapine 0.27 % (7/2630) that failed the disintegration test. Out of the 100 samples selected for full quality control testing, 3 % of them failed to comply with the specifications, of which FDC stavudine/lamivudine/nevirapine failed disintegration and assay tests 2 % (2/100) and 1 % (1/100), respectively. Samples failing the assay test had low content of stavudine (86.6 %) versus specification limits (90 -110 %). Out of the 430 samples which were subjected to product information review, 25.6 % (110/430) failed to comply with the TMDA packaging and labelling requirements. Conclusions The quality of majority of ARVs circulating on the Tanzania Mainland market was good, even so, significant deficiencies on labelling and packaging were observed. These results call for continuous monitoring of quality of medicines circulating on the Tanzania Mainland market.
Collapse
Affiliation(s)
- Sophia Mziray
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Betty A Maganda
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania.
| | - Kissa Mwamwitwa
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Adam M Fimbo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Seth Kisenge
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Gerald Sambu
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Yonah H Mwalwisi
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Adonis Bitegeko
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Emmanuel Alphonce
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Akida Khea
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Danstan H Shewiyo
- Tanzania Medicines and Medical Devices Authority, P.O BOX 75150, Dar es salaam, Tanzania
| | - Eliangiringa Kaale
- Pharm R&D Lab, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania.,Department of Medicinal Chemistry, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania
| |
Collapse
|
6
|
Shiferie F, Kassa E. The scourge of substandard and falsified medical products gets worse with COVID-19 pandemic. Pan Afr Med J 2021; 37:344. [PMID: 33738032 PMCID: PMC7934180 DOI: 10.11604/pamj.2020.37.344.26322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
Although health professionals, communities, governments and global institutions work closely to halt the spread of COVID-19 and mitigate its societal impact, COVID-19 remains a challenge to many countries around the world. In addition to its direct health, economic and social consequences, the pandemic has also resulted in unforeseen consequences in Africa especially in East African countries. COVID-19 might increase the demand and consumption of Substandard and Falsified (SF) medical products in three major ways. The first way is due to the inability of vulnerable segment of the population to access healthcare services as they used to do before. The second way people get exposed to SF medical products is due to fear of being quarantined, isolated and traced. Yet another way is related to import permits for medical products. Concerned regulatory bodies shall intervene aggressively in ensuring the safety, quality and effectiveness of medical products before we face a parallel pandemic from SF medical products.
Collapse
Affiliation(s)
- Fisseha Shiferie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Eden Kassa
- Defense Health Science College, Debre Zeit, Ethiopia
| |
Collapse
|
7
|
Rahman MS, Yoshida N, Tsuboi H, Maeda E, Ibarra AVV, Zin T, Akimoto Y, Tanimoto T, Kimura K. Patient safety and public health concerns: poor dissolution rate of pioglitazone tablets obtained from China, Myanmar and internet sites. BMC Pharmacol Toxicol 2021; 22:12. [PMID: 33653417 PMCID: PMC7923830 DOI: 10.1186/s40360-021-00478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor quality medicines have serious implications for public health. The aim of this study was to explore the quality of the antidiabetic pioglitazone, using samples collected in China and Myanmar, and samples purchased online. Methods In this cross-sectional study, we examined samples (n = 163) collected from hospitals in Shanghai, China in 2012 (n = 44), products purchased via the internet and imported into Japan in 2013 (n = 59), and samples purchased in shops in Yangon, Myanmar in 2015 (n = 60). Collected samples were subjected to visual inspection, authenticity investigation and quality testing (potency, content uniformity and dissolution test) by high-performance liquid chromatography. Samples were rated as compliant or non-compliant based on the relevant pharmacopoeial acceptance criteria. Results Visual inspection of all samples revealed compliant products. However, responses from manufacturers during authenticity investigation were poor. Among the n = 44 samples from China, one was non-compliant in the potency test. Among the n = 59 samples personally imported into Japan, 38% of generic samples were found to be non-compliant. In Myanmar, 13.3% of samples were non-compliant. Non-compliant samples predominantly failed in the dissolution test. All non-compliant samples were generic. Conclusions Despite the apparent satisfactory outcome on the samples from China, pioglitazone samples collected in Myanmar and purchased online for personal import into Japan included many substandard products, which failed quality assessment predominantly because of poor dissolution. Internet providers did not comply with Japanese regulations in various respects. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00478-x.
Collapse
Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan.
| | - Naoko Yoshida
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Hirohito Tsuboi
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Erina Maeda
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | | | - Theingi Zin
- Department of Food and Drug Administration (FDA), Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Yoshio Akimoto
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Tsuyoshi Tanimoto
- Pharmaceutical and Medical Device Regulatory Science Society of Japan, 150-0002, Osaka, Japan
| | - Kazuko Kimura
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| |
Collapse
|
8
|
Jackson KD, Higgins CR, Laing SK, Mwila C, Kobayashi T, Ippolito MM, Sylvia S, Ozawa S. Impact of substandard and falsified antimalarials in Zambia: application of the SAFARI model. BMC Public Health 2020; 20:1083. [PMID: 32646393 PMCID: PMC7350731 DOI: 10.1186/s12889-020-08852-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries are striving to become malaria-free, but global reduction in case estimates has stagnated in recent years. Substandard and falsified medicines may contribute to this lack of progress. Zambia aims to eliminate their annual burden of 1.2 million pediatric malaria cases and 2500 child deaths due to malaria. We examined the health and economic impact of poor-quality antimalarials in Zambia. METHODS An agent-based model, Substandard and Falsified Antimalarial Research Impact (SAFARI), was modified and applied to Zambia. The model was developed to simulate population characteristics, malaria incidence, patient care-seeking, disease progression, treatment outcomes, and associated costs of malaria for children under age five. Zambia-specific demographic, epidemiological, and cost inputs were extracted from the literature. Simulations were run to estimate the health and economic impact of poor-quality antimalarials, the effect of potential artemisinin resistance, and six additional malaria focused policy interventions. RESULTS We simulated annual malaria cases among Zambian children under five. At baseline, we found 2610 deaths resulting in $141.5 million in annual economic burden of malaria. We estimated that elimination of substandard and falsified antimalarials would result in an 8.1% (n = 213) reduction in under-five deaths, prevent 937 hospitalizations, and realize $8.5 million in economic savings, annually. Potential artemisinin resistance could further increase deaths by 6.3% (n = 166) and cost an additional $9.7 million every year. CONCLUSIONS Eliminating substandard and falsified antimalarials is an important step towards a malaria-free Zambia. Beyond the dissemination of insecticide-treated bed nets, indoor residual spraying, and other malaria control measures, attention must also be paid to assure the quality of antimalarial treatments.
Collapse
Affiliation(s)
- Kathryn D Jackson
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Colleen R Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall, 115H, Chapel Hill, NC, 27599, USA
| | - Sarah K Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Chiluba Mwila
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew M Ippolito
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Sylvia
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall, 115H, Chapel Hill, NC, 27599, USA. .,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| |
Collapse
|
9
|
Orubu ESF, Ching C, Zaman MH, Wirtz VJ. Tackling the blind spot of poor-quality medicines in Universal Health Coverage. J Pharm Policy Pract 2020; 13:40. [PMID: 32670594 PMCID: PMC7350647 DOI: 10.1186/s40545-020-00208-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/08/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) is challenged by the prevalence of poor-quality medicines, those that either do not meet required specifications (substandard) or are outrightly fraudulent (falsified), especially in Low- and Middle-Income Countries, LMICs. Whereas poor-quality medicines are a significant burden in these countries, medicine quality still remains a neglected component of UHC programs. This article describes key barriers to quality medicines and presents five select approaches leveraging the scale-up of UHC for medicine quality assurance. MAIN BODY Barriers to medicine quality assurance, while numerous, are described in five key inter-related domains as: low political priority, weak regulatory systems capacity, poor access to accredited facilities and licensed outlets, medicine manufacturing and other supply-chain challenges, and lack of public awareness. Five select approaches for leveraging the scale-up of UHC for medicine quality assurance in LMICs are (1): political commitment (2) strengthening the capacity of regulatory authorities and investment in detection technologies as part of national security (3); licensing of medicines outlets and expanding pharmacovigilance (4); strengthening the supply-chain; and (5) public awareness and participation. CONCLUSIONS Unchecked, poor-quality medicines can jeopardize UHC. National governments in LMICs need to prioritize medicine quality assurance through enforcing policies, regulatory strengthening and investments in technologies. Healthcare facilities and insurance schemes under UHC also play critical roles through incorporating medicine quality assurance into procurement practices and by promoting awareness among beneficiaries. Tackling medicine quality with a committed systems approach will enhance progress towards UHC implementation.
Collapse
Affiliation(s)
- E. S. F. Orubu
- Institute for Health System Innovation & Policy, Boston University, Boston, MA USA
- Department of Biomedical Engineering, Boston University, Boston, MA USA
| | - C. Ching
- Department of Biomedical Engineering, Boston University, Boston, MA USA
| | - M. H. Zaman
- Department of Biomedical Engineering, Boston University, Boston, MA USA
| | - V. J. Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA USA
| |
Collapse
|
10
|
Schiavetti B, Wynendaele E, Melotte V, Van der Elst J, De Spiegeleer B, Ravinetto R. A simplified checklist for the visual inspection of finished pharmaceutical products: a way to empower frontline health workers in the fight against poor-quality medicines. J Pharm Policy Pract 2020; 13:9. [PMID: 32377348 PMCID: PMC7193355 DOI: 10.1186/s40545-020-00211-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Substandard and falsified medicines, mainly prevalent in low and middle-income countries (LMICs), cause avoidable morbidity and mortality, and put at stake the performance of health systems. They may be prevented by an adequate implementation of pharmaceutical Quality Assurance (QA) guidelines, but unfortunately, most guidelines address upstream stakeholders and specialized staff in the supply chain. A multi-layered approach is needed, in order to empower the health workers at the point-of-care to proactively contribute to the fight against poor-quality medicines. Visual inspection is a simple technique, suitable for field screening. The findings of a survey conducted in the Democratic Republic of the Congo (DRC) suggested that it might be a fairly good (yet partial) predictor of poor-quality, when compared to full laboratory tests. Methods and results Starting from the 68-questions checklist originally used in the survey in the DRC, we developed a simplified checklist, specifically designed to guide health workers at the point of care to rapidly identify suspect poor-quality medicines. We selected those medicines’ attributes the assessment of which does not require technical expertise, or access to regulatory information. Attributes were categorized according to a 3-level risk scale, to guide decision-making on suspect poor-quality medicines, based on an informed risk assessment. The simplified checklist contains 26 binary questions (YES/NO), grouped into four themes: packaging, identification, traceability, and physical appearance. Each non-conformity corresponds to a level of risk for patients. The user is guided towards three possible actions: A) reasonably safe for dispensing; B) dispense with explanation; C) quarantine and make a risk-benefit evaluation before dispensing. Conclusion The simplified checklist should now be implemented in real-life setting in LMICs. If proven useful in guiding health workers at the point-of-care to take rapid, transparent, patient-centred actions when facing a suspect poor-quality medicine, it could be further extended to address specific formulations. Digitalization for linkage with pharmacovigilance programs could also be considered.
Collapse
Affiliation(s)
- B Schiavetti
- 1Institute of Tropical Medicine Antwerp, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - E Wynendaele
- 2Department Pharmaceutical Analysis, DruQuaR (Drug Quality & Registration), Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | | | - J Van der Elst
- Centre for Adult Education CVO COOVI, Emile Grysonlaan 1, 1070 Brussels, Belgium
| | - B De Spiegeleer
- 2Department Pharmaceutical Analysis, DruQuaR (Drug Quality & Registration), Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - R Ravinetto
- 5Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, B-2000 Antwerp, Belgium
| |
Collapse
|
11
|
Hobeika E, Farhat J, Saab J, Hleihel W, Azzi-Achkouty S, Sili G, Hallit S, Salameh P. Are antibiotics substandard in Lebanon? Quantification of active pharmaceutical ingredients between brand and generics of selected antibiotics. BMC Pharmacol Toxicol 2020; 21:15. [PMID: 32087736 PMCID: PMC7036234 DOI: 10.1186/s40360-020-0390-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background In developing countries, brand-generic substitution is not based on validated scientific evidence that confirm the therapeutic equivalence of the generic to the originator. Rather, decisions are made based on the availability of generic medications. Substitution by inappropriate preparations applies to antibiotics, which may increase the risk of resistance in case of underdosing. This analytical study aims to dose and assess for the accuracy of labeling three oral antibiotic preparations, namely ciprofloxacin hydrochloride, amoxicillin trihydrate and amoxicillin trihydrate-clavulanate potassium, the active pharmaceutical ingredients (APIs) found in brand and generic tablets available on the Lebanese market. Methods One brand and 4 generics of ciprofloxacin tablets, 3 generic amoxicillin tablets, and 1 brand and 4 generics of amoxicillin-clavulanic acid medications, were quantified, taking 2 batches of each. According to the United States Pharmacopeia (USP) guidelines, ultra-high pressure liquid chromatography was used to measure the APIs content within tablets. The USP required assay limit of the API was taken as the main comparison criteria. Results Out of the 5 ciprofloxacin medications tested, all 5 were out of the 2% required range, thus being substandard. For amoxicillin, all 3 medications were within the 20% range. As for amoxicillin-clavulanic acid medications, 4 out of 5 medications met the 30% required range of clavulanic acid and one exceeded the claimed amount of clavulanic acid, while all 5 met the assay limit for amoxicillin. Conclusion These findings raise safety and efficacy concerns, providing solid grounds for potential correlations of antibiotic resistance/substandard antibiotics.
Collapse
Affiliation(s)
- Eva Hobeika
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Joanna Farhat
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Joseph Saab
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Walid Hleihel
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Samar Azzi-Achkouty
- School of Engineering, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Georges Sili
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
| |
Collapse
|
12
|
Rasheed H, Hoellein L, Bukhari KS, Holzgrabe U. Regulatory framework in Pakistan: situation analysis of medicine quality and future recommendations. J Pharm Policy Pract 2019; 12:23. [PMID: 31528352 PMCID: PMC6737614 DOI: 10.1186/s40545-019-0184-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality issues in pharmaceuticals are identified as a huge global and public health problem, especially with reference to low- and middle-income countries like Pakistan. The 2011 "Fake Drug Crisis" acted as a driving force to reform the regulatory structures of the country and for establishing the autonomous "Drug Regulatory Authority of Pakistan". Despite the fact that Pakistan possesses a huge pharmaceutical industry, there is a severe dearth of published literature and scientific evidence for the country regarding medicine quality and the prevalence of counterfeit and low-quality products, respectively. AIMS AND OBJECTIVES This narrative review covers relevant features of the regulatory framework for pharmaceuticals in Pakistan, its national pharmaceutical industry, as well as a compilation and analysis of published literature for documentation of the country's situation regarding the overall quality of medicines. METHODS Available data including scientific publications on the quality of pharmaceuticals in peer reviewed journals, research reports, notifications, and alerts issued by the World Health Organization and other agencies were accessed and compiled. Post graduate dissertations were used to represent unpublished research data and drug safety alerts issued from the local Pakistan authority were analysed to assess the type and number of quality failures reported for pharmaceuticals. RESULTS It could be clearly shown that there is negligible scientific data available on the issue of medicine quality in Pakistan. The anticipated number of 40-50% of poor-quality drugs in Pakistan cannot be defended by data available from the literature. Accessible technologies and strategies used in recent years at global level, especially in developing countries, were also reviewed and recommendations are devised for Pakistan to combat the fight against poor-quality medicines. CONCLUSION The case reports, investigations, and general data listed for Pakistan suggest the need of strengthening regulatory systems for premises and GMP inspections, analytical laboratories, as well as an overall capacity building in the field of unravelling and controlling substandard and falsified medicines. It is proposed that well-planned and properly funded studies need to be carried out for collecting critical statistics regarding the prevalence of substandard and falsified medicines in Pakistan.
Collapse
Affiliation(s)
- Huma Rasheed
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ludwig Hoellein
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| | - Khalid Saeed Bukhari
- USP Promoting the Quality of Medicines (PQM) Program, U.S. Pharmacopeial Convention, 12601 Twinbrook Parkway, Rockville, MD 20852-1790 USA
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| |
Collapse
|
13
|
Ozawa S, Evans DR, Higgins CR, Laing SK, Awor P. Development of an agent-based model to assess the impact of substandard and falsified anti-malarials: Uganda case study. Malar J 2019; 18:5. [PMID: 30626380 PMCID: PMC6327614 DOI: 10.1186/s12936-018-2628-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Global efforts to address the burden of malaria have stagnated in recent years with malaria cases beginning to rise. Substandard and falsified anti-malarial treatments contribute to this stagnation. Poor quality anti-malarials directly affect health outcomes by increasing malaria morbidity and mortality, as well as threaten the effectiveness of treatment by contributing to artemisinin resistance. Research to assess the scope and impact of poor quality anti-malarials is essential to raise awareness and allocate resources to improve the quality of treatment. A probabilistic agent-based model was developed to provide country-specific estimates of the health and economic impact of poor quality anti-malarials on paediatric malaria. This paper presents the methodology and case study of the Substandard and Falsified Antimalarial Research Impact (SAFARI) model developed and applied to Uganda. RESULTS The total annual economic impact of malaria in Ugandan children under age five was estimated at US$614 million. Among children who sought medical care, the total economic impact was estimated at $403 million, including $57.7 million in direct costs. Substandard and falsified anti-malarials were a significant contributor to this annual burden, accounting for $31 million (8% of care-seeking children) in total economic impact involving $5.2 million in direct costs. Further, 9% of malaria deaths relating to cases seeking treatment were attributable to poor quality anti-malarials. In the event of widespread artemisinin resistance in Uganda, we simulated a 12% yearly increase in costs associated with paediatric malaria cases that sought care, inflicting $48.5 million in additional economic impact annually. CONCLUSIONS Improving the quality of treatment is essential to combat the burden of malaria and prevent the development of drug resistance. The SAFARI model provides country-specific estimates of the health and economic impact of substandard and falsified anti-malarials to inform governments, policy makers, donors and the malaria community about the threat posed by poor quality medicines. The model findings are useful to illustrate the significance of the issue and inform policy and interventions to improve medicinal quality.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599 USA
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | | | - Colleen R. Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599 USA
| | - Sarah K. Laing
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall 115H, Chapel Hill, NC 27599 USA
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makarere University School of Public Health, Kampala, Uganda
| |
Collapse
|
14
|
Walker EJ, Peterson GM, Grech J, Paragalli E, Thomas J. Are we doing enough to prevent poor-quality antimalarial medicines in the developing world? BMC Public Health 2018; 18:630. [PMID: 29764407 DOI: 10.1186/s12889-018-5521-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone. DISCUSSION Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made. CONCLUSION There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.
Collapse
|
15
|
Rahman MS, Yoshida N, Tsuboi H, Keila T, Sovannarith T, Kiet HB, Dararth E, Zin T, Tanimoto T, Kimura K. Erroneous formulation of delayed-release omeprazole capsules: alert for importing countries. BMC Pharmacol Toxicol 2017; 18:31. [PMID: 28468688 PMCID: PMC5415780 DOI: 10.1186/s40360-017-0138-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Poor drug quality is a matter of serious concern, especially in countries where drug regulation and law enforcement are constrained by limited resources. This study was carried out to investigate the cause of quality failure of omeprazole in Cambodia in 2010 and Myanmar in 2014. Methods We conducted pharmacopoeial quantity, content uniformity and dissolution tests of 156 samples of omeprazole capsules collected in Cambodia in 2010 and Myanmar in 2014. High failure rates were found, especially in dissolution testing, and detailed investigation of several unacceptable samples was carried out by means of in-vitro dissolution profiling, scanning electron microscopy (SEM) and X-ray computed tomography (X-ray CT) to identify the cause of failure. Results Dissolution profiling with and without the acid stage showed that acid caused premature omeprazole release, indicating that the enteric coating of the omeprazole granules was ineffective. SEM examination of two failed samples revealed cracked and broken granules mixed with apparently intact omeprazole granules in the capsule. X-ray CT examination indicated that some granules of failed samples completely lacked enteric coating, and others had incomplete and non-uniform enteric coating or malformation. Conclusions Omeprazole capsules collected in Myanmar and Cambodia showed high failure rates in pharmacopoeial tests, especially dissolution tests. Some samples were found to have ineffective or absent enteric coating of the granules, resulting in premature dissolution and degradation in acidic conditions. This is a potentially serious public health issue that needs to be addressed by regulatory authorities in Cambodia and Myanmar, possibly through a collaborative initiative with manufacturers.
Collapse
Affiliation(s)
| | - Naoko Yoshida
- Drug Management and Policy, Kanazawa University, Kanazawa, Japan
| | - Hirohito Tsuboi
- Drug Management and Policy, Kanazawa University, Kanazawa, Japan
| | - Tep Keila
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh, Cambodia
| | - Tey Sovannarith
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh, Cambodia
| | - Heng Bun Kiet
- Department of Drugs and Food, Ministry of Health, Phnom Penh, Cambodia
| | - Eav Dararth
- Department of Drugs and Food, Ministry of Health, Phnom Penh, Cambodia
| | - Theingi Zin
- Department of Food and Drug Administration, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Tsuyoshi Tanimoto
- Faculty of Pharmaceutical Sciences, Doshisha Women's University, Kyoto, Japan
| | - Kazuko Kimura
- Drug Management and Policy, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
16
|
Bassat Q, Tanner M, Guerin PJ, Stricker K, Hamed K. Combating poor-quality anti-malarial medicines: a call to action. Malar J 2016; 15:302. [PMID: 27251199 PMCID: PMC4888506 DOI: 10.1186/s12936-016-1357-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/24/2016] [Indexed: 12/04/2022] Open
Abstract
The circulation of poor-quality medicines continues to undermine the fight against many life-threatening diseases. Anti-malarial medicines appear to have been particularly compromised and present a major public health threat in malaria-endemic countries, negatively affecting individuals and their communities. Concerted collaborative efforts are required from global, regional and national organizations, involving the public and private sectors, to address the problem. While many initiatives are underway, a number of unmet needs deserve urgent and increased multisector attention. At the global level, there is a need for an international public health legal framework or treaty on poor-quality medicines, with statutes suitable for integration into national laws. In addition, increased international efforts are required to strengthen the governance of global supply chains and enhance cooperation between national medicine regulation authorities and law enforcement bodies. Increased investment is needed in innovative technologies that will enable healthcare teams to detect poor-quality medicines at all levels of the supply chain. At the regional level, a number of initiatives would be beneficial—key areas are standardization, simplification, and reciprocal recognition of registration processes and development of quality control capacity in regional centres of excellence that are better aligned with public health needs; improved surveillance methods and creation of a framework for compulsory and transparent reporting of poor-quality medicines; additional support for national medicine regulation authorities and other national partner authorities; and an increase in support for regional laboratories to boost their capabilities in detecting poor-quality medicines. It is vital that all stakeholders involved in efforts against poor-quality anti-malarial medicines extend and strengthen their actions in these critical areas and thus effectively support global health development and malaria elimination programmes.
Collapse
Affiliation(s)
- Quique Bassat
- Centro de Investigação Em Saúde Da Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
| |
Collapse
|
17
|
Khurelbat D, Dorj G, Bayarsaikhan E, Chimedsuren M, Sanjjav T, Morimoto T, Morley M, Morley K. Prevalence estimates of substandard drugs in Mongolia using a random sample survey. Springerplus 2014; 3:709. [PMID: 25525570 PMCID: PMC4265637 DOI: 10.1186/2193-1801-3-709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/17/2014] [Indexed: 11/11/2022]
Abstract
To determine the prevalence of substandard drugs in urban (Ulaanbaatar) and rural (selected provinces) areas of Mongolia, samples of 9 common, therapeutically important drugs were collected from randomly selected drug outlets in Ulaanbaatar and 4 rural provinces by “mystery shoppers”. Samples were analyzed by visual inspection, registration status, and biochemical analysis. Samples failing to meet all Pharmacopeia quality tests were considered substandard. In the rural provinces, 69 out of 388 samples were substandard, giving an estimated prevalence of substandard drugs of 17.8% (95% CI: 14.1-22.0). There were 85 unregistered samples, giving a prevalence estimate of unregistered drugs of 21.9%. (95% CI: 17.9-26.3). In the urban Ulaanbaatar districts, 112 out of 848 samples were substandard, giving an estimated prevalence of substandard drugs of 13.2% (95% CI: 11.0-15.7). There were 150 unregistered samples, giving a prevalence estimate of unregistered drugs of 17.7% (95% CI: 15.2-20.4). In the rural provinces, 35 out of 85 (41.2%) unregistered samples were substandard; whereas 34 out of 303 (11.2%) registered samples were substandard. (p < 0.0001) In the urban districts, 18 out of 150 (12.0%) unregistered samples were substandard, whereas 94 out of 698 registered were substandard. (13.5%) (p = 0.6). The prevalence of substandard and unregistered drugs is higher in rural provinces. There is a significant association between substandard and unregistered drugs in the provinces but not in the urban districts. The underlying causes for substandard drugs need to be further investigated in order to help formulate strategies to improve pharmacovigilance and the drug supply quality in Mongolia.
Collapse
Affiliation(s)
- Daariimaa Khurelbat
- School of Pharmacy and Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gereltuya Dorj
- School of Pharmacy Curtin University of Technology, Perth, Western Australia
| | - Enkhtuul Bayarsaikhan
- School of Pharmacy and Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Tsetsegmaa Sanjjav
- Ministry of Health, Fourth Health Sector Development Project, Ulaanbaatar, Mongolia
| | - Takeshi Morimoto
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Michael Morley
- Department of Ophthalmology, Harvard University, Boston, MA USA
| | | |
Collapse
|
18
|
Keizers PHJ, Vredenbregt MJ, Bakker F, de Kaste D, Venhuis BJ. Chemical fingerprinting of silicone-based breast implants. J Pharm Biomed Anal 2014; 102:340-5. [PMID: 25459933 DOI: 10.1016/j.jpba.2014.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Abstract
With millions of women worldwide carrying them, silicone-based breast implants represent a large market. Even though silicone breast implants already have a history of use of more than 50 years, the discussion on their safety has not yet come to an end. To improve safety assessment, regulatory authorities should have the availability of a set of tests to be able to determine parameters of implant identity and quality. Therefore, the gels and envelopes of various brands and types of silicone-based breast implants have been subjected to infrared, Raman and NMR spectroscopy. We show that by using a combination of complementary spectroscopic techniques breast implants of various origins can be distinguished on typical chemical hallmarks. It was found that typical silicone-based implants display a surplus of vinyl signals in the gel, cyclosiloxane impurities are tolerable at low levels only and a barrier layer is present in the implant envelope. The techniques presented here and the results obtained offer a good starting point for market surveillance studies.
Collapse
Affiliation(s)
- Peter H J Keizers
- National Institute for Public Health and the Environment, PO Box 1, 3721 MA, Bilthoven, The Netherlands
| | - Marjo J Vredenbregt
- National Institute for Public Health and the Environment, PO Box 1, 3721 MA, Bilthoven, The Netherlands
| | - Frank Bakker
- National Institute for Public Health and the Environment, PO Box 1, 3721 MA, Bilthoven, The Netherlands
| | - Dries de Kaste
- National Institute for Public Health and the Environment, PO Box 1, 3721 MA, Bilthoven, The Netherlands
| | - Bastiaan J Venhuis
- National Institute for Public Health and the Environment, PO Box 1, 3721 MA, Bilthoven, The Netherlands.
| |
Collapse
|
19
|
Abstract
OBJECTIVE To determine the extent of substandard and falsified medicines in the UK. DESIGN A retrospective review of drug alerts and company-led recalls. SETTING The Medicines and Healthcare Products Regulatory Agency (MHRA) website search for drug alerts issued between 2001 and 2011. ELIGIBILITY CRITERIA Drug alerts related to quality defect in medicinal products. MAIN OUTCOME MEASURE Relevant data about defective medicines reported in drug alerts and company-led recalls, including description of the defect, type of formulation, year of the alert and category of the alert. RESULTS There were 280 substandard medicines of which 222 were recalled. The two most frequent problems were contamination (74 incidents) and issues related to packaging (98 incidents). Formulations for parenteral administration (117 incidents) were the formulation most frequently affected. There were 11 falsified medicines, as defined by the MHRA, reported over the 11-year period. The number of defective medicines reported by the MHRA increased 10-fold from 5 in 2001 to 50 in 2011. CONCLUSIONS Substandard medicines are a significant problem in the UK. It is uncertain whether the increasing number of reports relates to improved detection or an increase in the number of substandard medicines.
Collapse
Affiliation(s)
- Tariq Almuzaini
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | | | | |
Collapse
|