Covid crisis boosts India’s trade in fake medicines

As India is engulfed by a second wave of coronavirus infections, which is swamping big cities, its people have rushed to the black market to buy drugs for treatment.

Neighbourhood WhatsApp groups in the capital city of New Delhi buzz with urgent pleas for sellers of everything from oxygen to remdesivir, an antiviral used in India to treat Covid-19.

In Pune, a city in the hard-hit state of Maharashtra, four people were arrested this month for selling fake vials of remdesivir for Rs35,000 ($464), far above the official Rs2,000 ($27) price cap for the genuine product.

Police said the men had sold at least seven vials filled with liquid paracetamol to a relative of a coronavirus patient. Further south, in Mysuru, in the state of Karnataka, a nurse at a private hospital was arrested for selling remdesivir vials that had been refilled with antibiotics and saline solution.

“In times like these, where you see high numbers for tocilizumab — an arthritis drug — and remdesivir, this is a ripe area for people to make up this stuff and slap labels on,” says Dinesh Thakur, a former pharma executive who works as a public health activist in the US.

An estimated one in 10 medical products in low- and middle-income countries is substandard or falsified, according to the World Health Organization. Unregulated websites, which allow people to buy drugs without a prescription, make these products available worldwide.

Countries that have weak governance or are affected by war bear the brunt of the consequences. Counterfeit malaria drugs in Africa, the continent with the highest proportion of fake or substandard medicines, hamper efforts to control the disease, according to a 2017 study published in The Lancet, a medical journal.

Narendra Modi, India’s prime minister, has declared that India is playing the role of “pharmacy to the world” because of its extensive production of drugs and vaccines to combat coronavirus. But India is also the world’s leading producer of fake drugs, according to research by the OECD and the EU Intellectual Property Office.

We’re already starting to see falsified Covid products, but the real danger is vaccines

Covid-19 has presented a unique opportunity for the trade to flourish. In the first week of March 2020, Interpol reported an 18 per cent increase in seizures of unauthorised antiviral medication and a 100 per cent rise in seizures of unauthorised chloroquine, the antimalarial medicine endorsed by former US President Donald Trump.

“We’re already starting to see falsified Covid products, but the real danger is vaccines,” says Nakul Pasricha, chief executive of Pharma Secure, a company that offers drug verification technology to pharmaceutical companies in India. “Scarcity breeds falsification and counterfeiting, that’s just a fact.”

India and Turkey have large illegal medicine distribution networks, says Todd Ratcliffe, chief executive at the Pharmaceutical Security Institute, a non-profit trade association set up to tackle the problem of counterfeit medication.

Ratcliffe, who worked for more than two decades in the FBI, says the networks span continents. “We find an Indian seller [and] a buyer that sends payments to Hong Kong, then the order will be fulfilled from a product bought in a Turkish market that is then shipped out through a New Delhi location,” Ratcliffe says. “It’s pretty complicated.”

He adds that while China is still a significant producer of fake drugs, its law enforcement is receptive to tips and usually acts on them, in contrast with India where “we don’t see as many enforcements”.

Mahesh Zagade, a former food and drugs commissioner in Maharashtra, says that although India’s supply chain of legitimate drugs is robust, one problem is checks and controls when patients go to buy them. Zagade says that, when he was in office, he prioritised the use of prescriptions at pharmacies. “At these shops, there were no bills or receipts,” he explains. “At the level of patient compliance, many things were lacking.”

As well as fake drugs, substandard drugs with toxic contaminants or insufficient active ingredients are a serious danger to public health, Thakur warns. Last year, 12 children died in the northern region of Jammu after taking cough syrup that contained diethylene glycol — an anti-freezing agent that causes renal failure.

“As a country, we don’t have a very good vigilance system,” Thakur says.