WOODRUFF: Now, a glimpse into the vast, global, and criminal business of fake pharmaceutical
drugs.
Special correspondent Fred de Sam Lazaro reports on how some medical providers in Kenya are
trying to ensure patients receive genuine prescription drugs. It`s part of his series,
"Agents for Change".
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FRED DE SAM LAZARO, PBS NEWSHOUR SPECIAL CORRESPONDENT: Catherine Karimi has been a nurse for 30 years.
But for the last nine, she`s also been a businesswoman. She owns a franchise in Nairobi of a CFW Clinics,
owned by a U.S.-based group called the Health Store Foundation.
So business is very good? Very busy then?
CATHERINE KARIMI, CFW CLINICS FRANCHISE OWNER: Yes, I can`t complain.
DE SAM LAZARO: Much like a fast- food chain, health store supplies Karimi and all franchisees
with lab equipment, training, marketing and standardized procedures. Perhaps most importantly,
it also supplies clinics with genuine drugs, containing what`s on the original label.
KARIMI: They feel that our drugs are original. That`s why they come here.
DE SAM LAZARO: Twenty-three-year-old Edah Mokua (ph) came here after the drugs she bought
at a nearby pharmacy failed to cure a urinary tract infection.
UNIDENTIFIED FEMALE: They did not work at all.
DE SAM LAZARO: So-called fake pharmaceuticals are a multi- billion dollar problem around
the world. They are made and packaged to look like real drugs, but contain a fraction of
the active ingredients need to be effective, sometimes containing nothing but chalk.
Thomas Woods, a consultant to the World Bank, worked on this issue while serving in the
George W. Bush administration.
THOMAS WOODS, CONSULTANT, WORLD BANK: These are major global crime syndicates with far
reach. These guys are killers. They`re murdering people and taking something that we all rely
on and they`re callously and cynically putting out fake medicines.
DE SAM LAZARO: A newly-released report by the World Health Organization found that one
in ten medical products in developing countries is substandard or falsified. A Lancet Medical
Journal study found that 20 percent of malaria drugs were fake.
James Owour is with Kenya`s pharmacy and poisons board which regulates drugs. He complains
his agency is hampered by too few inspectors, only 16 for the entire country, and no legal
muscle.
There`s no law against a pill made out of chalk?
JAMES OWOUR, KENYA PHARMACY AND POISON: Not in our acts.
DE SAM LAZARO: It must be a real frustration?
OWOUR: Sure it is. The other challenge is porous borders. People smuggle things including
medicine through places that are not manned by inspectors and such.
DE SAM LAZARO: In response, many providers have developed their own methods to ensure
quality, inspections are regularly conducted at CFW Clinics, for example.
Abraham Orare explained what he looks for.
ABRAHAM ORARE, INSPECTOR, CFW CLINICS: We`re looking at the source. I`m looking at the
stock card and also checking the delivery sheet to make sure this is exactly what is
being supplied.
DE SAM LAZARO: Their supplier is a not-for-profit group called MEDS, Mission for Essential Drugs
and Supplies. It was founded 30 years ago by faith-based groups, which are major health
care providers in Kenya. MEDS now distributes 40 percent of all drugs in Kenya from its
giant warehouse on the edge of Nairobi.
JANE MASIGA, MEDS DIRECTOR: We have more than 1,300 items which pass through here.
DE SAM LAZARO: Some of the most commonly prescribed are also most commonly counterfeited, says
MEDS director Jane Masiga.
MASIGA: Antibiotics, painkillers and medicines for chronic diseases. Because they know that`s
a regular supply, patients will continue taking those medicines.
DE SAM LAZARO: Before they reach its Nairobi labs, MEDS begins its process by inspecting
the factories where the drugs are made, in Kenya and also in India and China -- two of
the biggest sources of pharmaceuticals, both legitimate and counterfeit.
Stephen Kigera is in charge of quality assurance for MEDS.
STEPHEN KIGERA, QUALITY ASSURANCE DIRECTOR, MEDS: So, we`re able to pick out the non-conformities
that are found in some of these factories.
DE SAM LAZARO: MEDS randomly tests the drugs that it buys. Those that fail are destroyed
to insure that only genuine products leave this warehouse for clients` shelves. But Kigera
says there are other complications. Many small, storefront pharmacies buy from unauthorized
distributors, and are staffed by unqualified people dispensing drugs without any pharmacy
training or a prescription.
KIGERA: Those pharmacies and chemists run by quacks or non- professionals, those are
the chemists where there is a high likelihood that fake medicines will actually be sold.
DE SAM LAZARO: Does the average patient have any awareness that this is a problem?
KIGERA: Chances are no, because, assuming I`m from a poor neighborhood, if I see somebody
standing behind the counter and wearing a white lab coat, I assume the person is a professional.
DR. MERCY MAINA, MOI TEACHING AND REFERRAL HOSPITAL: Pop open a capsule.
DE SAM LAZARO: Technology may provide some answers -- everything from bar coding to chemical
markers to weed out fakes. Here at the Moi hospital in Eldoret, a team from Purdue and
Notre Dame Universities is in the early testing phase of a chemically coated paper strip.
It`s cheap, just 50 cents a card, and easy to use by a clinic for instance to test its
drugs supply. Spread it on the card strip, dip in water and check for color changes.
MAINA: If there are any differences between the image and the control image, you can say
it`s suspicious.
DE SAM LAZARO: Suspicious means it doesn`t contain the active ingredient or has only
a tiny fraction of it, as often happens, says Dr. Mercy Maina.
MAINA: Counterfeiters are smart. They know you`re going to run a qualitative test to
just test a presence of the active pharmaceutical ingredient. They will make sure that some
of it is available for it to pass the test, right, to get away with it.
DE SAM LAZARO: The new test should be able to detect products with those smaller doses
of active ingredient, which he says are a giant threat to public health, especially
with antibiotics which the bacteria learn to resist.
MAINA: You`re increasing superbugs. So we will run out of antibiotics because you`re
being always exposed to lower quantity of medication than you should. That has consequences.
DE SAM LAZARO: Thomas Woods agrees.
WOODS: I think it`s a system failure if we are not able to equip partners in places like
Africa with some of the same tools that we use to protect ourselves: technology, field-based
technology, stronger laboratories, rapid authentication devices, things that our Food and Drug Administration
has at its regular disposal. Let`s put them in the hands of African regulators so that
we can save African lives.
DE SAM LAZARO: Part of his job at the World Bank is to convince rich countries to step
up such efforts. It`s not just African lives at stake, he says, but the safety of the global
supply of pharmaceutical drugs.
For the PBS NEWSHOUR, this is Fred de Sam Lazaro in Eldoret, Kenya.
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WOODRUFF: Fred`s reporting is a partnership with the "Undertold Stories Project" at the
University of St. Thomas in Minnesota.