Drug Running: Bust nets suspects in counterfeit antimalaria trade

Over the past decade, researchers have documented the sale of fake antimalaria tablets in Southeast Asia. A new report traces the source of some of these drugs to southern China, and police there have located an illicit drug “factory” and arrested multiple suspects accused of trafficking the pills. Authorities in Burma (Myanmar) have also nabbed two suspects.

The busts mark the first time that the World Health Organization (WHO) has teamed with Interpol and physicians, pharmacists, and scientists working in Southeast Asia to analyze and track packages of anti-malaria pills. The investigators found that many fake tablets, which have been linked to deaths, were visual mimics of legitimate pills made and packaged by the Chinese company Guilin Pharmaceutical. In 2006, the investigators informed the Chinese government.

In addition to making arrests, Chinese police seized 24,000 packets of counterfeit artesunate pills. Artesunate is made from sweet wormwood leaves. When combined with another drug, it has a remarkable success rate against malaria (SN: 2/7/04, p. 94; (SN: 6/16/07. p. 381).

The illicit factory in Yunnan province in southern China has been “found, searched and shut down,” says John Newton, intellectual property rights program manager at Interpol in Lyon, France.

The action may have disrupted the trafficking of some fake pills in Burma, Thailand, and parts of Laos, the international team reports in the February PLoS Medicine. But there may be another southbound traffic route supplying Vietnam, Cambodia, and southern Laos.

Fake artesunate first cropped up in Southeast Asia in 1999, says study coauthor Paul Newton, an infectious disease physician at the University of Oxford and the Wellcome Trust who works in Laos. Since then, he and others have documented cases in which malaria patients died after receiving counterfeit pills. That work ultimately triggered a secret meeting with WHO and Interpol in Manila, Philippines, in 2005.

The ensuing investigation revealed a highly sophisticated enterprise, Paul Newton says, with holograms on packages designed to look like Guilin products. Pollen was also detected on some pills from plants in southern China, leading to talks with Chinese officials.

“This is a tour de force combining many disciplines,” says David Sullivan, an infectious disease physician at Johns Hopkins University in Baltimore. “Pharmaceutical counterfeiting is usually tough to track. It took a team effort [that] can now be duplicated elsewhere.”

In developing countries, many prescription drugs are obtained over the counter with little regulation. “Two surveys that our group has done suggested that one-third to one-half of artesunate bought [in Southeast Asia] is counterfeit,” Paul Newton says.

Some of the fake pills collected in the new investigation showed traces of active artesunate or related compounds. Such amounts invite the development of resistant malaria strains and can shorten the useful life span of a drug, says Terrie Taylor, an osteopath at Michigan State University in East Lansing and scientific director of the Blantyre Malaria Project in Malawi.

To date, no tests have established any resistance to artesunate, Sullivan says.

Meanwhile, fake medication “can diminish faith in the drug,” Sullivan says. Some of the fake pills contained banned pharmaceuticals, including one known carcinogen.

Taylor notes that drug subsidies for anti-malaria pills would bring down their prices and put some counterfeiters out of business by hurting profitability.

This year, Interpol plans to investigate whether fake drugs are moving from Asia to Africa, says John Newton.