China suspected as source of counterfeit drugs that are holding back fight against malaria in Africa
The life-saving medicine arrives on cargo trucks and in suitcases, crossing borders to be put on sale in pharmacies, shops and hospitals. There is just one problem: it isn’t life-saving at all.
To look at the packaging, you would never know. It is usually a dead ringer for the real thing. Only on closer inspection will you find a watermark missing or notice the crumbling edges of a tablet that to well-trained inspectors can be the telltale signs of fakery. Even health professionals are routinely fooled.
“I have taken them myself,” said Dr Mechtlida Luhaga, who has been both doctor and patient in Africa’s long battle against malaria. “I took Alu and nothing happened. I had another blood test to recheck and still had the same parasites. The drugs were fake.”
In cities and villages across Tanzania and Uganda – the countries with the highest number of malaria cases in the world – everyone knows about fake and substandard drugs. Most people know at least someone who has taken them. The overwhelming suspicion is that they, like poor quality mobile phones and cheap clothing, come from China.
Luhaga knows malaria intimately. She has had several bouts and is all too familiar with the useless pills that have infiltrated every corner of the medicines market in the Lake Victoria basin. The doctor, who oversees a regional hospital that receives about 700 patients each day in Tanzania’s Mwanza district on the shores of Lake Victoria, keeps a tidy chart on her office wall. It shows the list of illnesses that bring patients in – and malaria is always number one.
In Uganda, where the market is perhaps even more saturated with fakes making their way across porous borders into less regulated markets such as the Democratic Republic of the Congo, the situation at times seems hopeless. At Busia, a major border crossing with Kenya, trucks are lined up for hours, or even days, awaiting inspection.
“We have a big problem with all these dangerous and toxic goods so we must what? Test everything?” said Robert Kamchu, the head of the border police.
In his Kampala office, David Nahamya, the chief drug inspector for Uganda’s National Drug Authority, laid out packages of fake medicines alongside their genuine counterparts, showing that only lab tests could tell the difference.
There are fake malaria drugs, antibiotics and even emergency contraceptives. This in a country battling the world’s third highest birthrate, with five to six children per woman keeping the population mired in poverty. Some pills contain no active ingredients, some are partial strength and some the wrong formulation entirely.
“Let’s not exonerate other countries, by the way,” he added, noting that African factories had also been busted for making fakes. “But of course China is entering into the African market with everything … I think you have seen their strategy in so many of our sectors. To bring in as many of their own products as possible, in every possible level of quality, and take over.”
China’s growing influence
Beijing’s multibillion-dollar economic foray into Africa has rapidly turned into a double-edged sword, the boon in terms of growth offset by negative perceptions of its motives and actions.
“If reports from African regulators are accurate, Chinese companies are responsible for the most egregious medicines frauds and misformulations seen on the continent,” said Laurie Garett, senior fellow for global health at the US Council on Foreign Relations.
“Nobody has a head count, or a body count, on numbers of Africans that have died as a result. But China’s role certainly has been dreadful … Even within China’s own official media, you can find reports of dumping, drugs/medicines found substandard or fraudulent, causing harm to Chinese, are relabeled and dumped on Africa,” she added.
International bodies have put pressure on China to acknowledge its growing economic clout and involvement in Africa by joining global efforts to improve health. In turn, Beijing has sent aid, increasing the ranks of Chinese government-sponsored doctors, building hospitals and sending equipment and medicines.
According to one report, China contributed £467m in health aid to Africa between 2007 and 2011. That’s a drop in the ocean compared with global health spending in Africa, but a major effort for a country which, despite its power and new status as the world’s second largest economy, has struggled to revamp its own healthcare system. Huang Yanzhong, another Council on Foreign Relations health policy specialist, said China’s aid had mainly targeted infrastructure and medical teams and equipment.
“Certainly China, with its rapid economic growth, economic prowess, accompanied by international pressure, wants to take more responsibility,” he said. “We expect China to play a bigger role in global health, but in the meantime China is making it very clear that the number one priority is the needs and demands of its own people.”
While the efforts are trumpeted in state-run media at home, there is rarely such goodwill or acceptance among people in Africa. Even those who benefit directly from China’s new philanthropy are sceptical. The Ugandan director of a $10m Chinese-funded hospital in Kampala doesn’t take the aid at face value.
“There is a hidden agenda,” said Edward Naddumba, who runs the newly opened Naguru hospital. “What is their hidden agenda? We do not know, but they are our friends anyway.”
Global strategy needed
That even doctors are unable tell real malaria drugs from fake is testament to just how complex the situation has become in Tanzania and Uganda, which together accounted for 20m of the 94m malaria cases reported globally in 2010.
Estimates vary, but some recent studies suggest that as many as a third of malaria drugs in the two countries are fake or substandard, and most are believed to have originated in China.
“We have little reliable data on the problem, which makes it difficult to come up with a good global strategy to address it,” said Andreas Seiter, senior health specialist and expert on pharmaceutical policy at the World Bank. The World Health Organisation is working on such a survey, he added.
“Countries like India and China, with their large export industries in the pharmaceutical sector, have recognised the damage to their export business from perceived quality problems and are making efforts to strength domestic oversight of their industries,” he said.
Seiter said international organised crime rings were a more dangerous and difficult threat to counter, as they could move operations as needed.
When artemisinin derivatives were approved as a first-line treatment in Tanzania in 2006, they were supposed to revolutionise the war on malaria, the biggest killer of children in sub-Saharan Africa. The subsequent flood of fake and substandard pills has diluted the drug efficacy, potentially set back life-saving gains and, experts warn, opened the doors to new dangers, including drug-resistant parasites.
The task of healthcare providers, already struggling with a lack of equipment, has grown exponentially. They have been put in a position of guessing which drugs might work, which are useless and which might actually do harm.
Genuine artemisinin combination therapy is highly effective, curing up to 95% of malaria cases.
Economic interests are deeply ingrained on all sides. China isn’t talking about the problem, its African trading partners have entrenched financial interests and even NGOs are unwilling to lay the blame. As a result it’s difficult for investigators trying to protect public health to tie drugs to their source.
Patients and healthcare professionals in Africa don’t much care where the drugs are made. They are more concerned with the deadly consequences.
“Patients usually do not know it when they take the counterfeit medications,” said Appolinary Mzinza, a pharmacist who runs a small and trusted clinic in Tanzania’s Mwanza district. “We only know it from the reaction of the treatment, when it is the best drug you can give and the reaction is very poor.”
Mzinza has been dispensing drugs and medical advice to the rural poor for decades. The flood of drugs that don’t work has made it into an imprecise science based largely on intuition and experience. “I can say that malaria is not going away because we are getting fake treatment,” he said. “If you take medication and you are not cured, you get bitten by mosquitoes and you get it again. It’s a continuous thing.
“It is helping us to die more with malaria than anything else.”
Circle, which took over Hinchingbrooke hospital in Cambridge earlier this year, may put profits over jobs, unions warn
The first private company to take over an NHS hospital could make a profit of £31m in the next decade in a deal that the government’s spending watchdog warns would rely on unprecedented levels of savings.
Circle Healthcare, founded by former Goldman Sachs banker Ali Parsa, runs four private treatment facilities and one NHS treatment centre and took over Hinchingbrooke hospital in Cambridge in February. Before being handed over to Circle, the hospital had been in trouble, losing five chief executives in as many years and building up £40m of debt.
The National Audit Office reveals that Circle has already missed its own financial target, generating a deficit of £4m by September – £2m behind where Circle said it would be. The company admitted that on current projections it would end up bearing £3.5m in losses this year, which it would fund.
The report warns that “Circle’s projected savings of £311m over 10 years are unprecedented as a percentage of annual turnover in the NHS… Circle’s bid did not fully specify how it
I’m critical of Obama’s presidency, but my medical emergency convinced me that for Obamacare alone we must re-elect him
Under the influence of the painkiller Dilaudid, and dog-tired after another day of fighting for my life with my private health insurance company, I glimpsed Mitt Romney and his running-mate, Paul Ryan, entering my Los Angeles hospital room dressed in surgical gowns with scalpels in their hands ready to fatally operate on me.
It was a drug-induced hallucination, of course. But the mirage made me sit bolt upright in bed and, fully awake, start to rethink my previous, bitterly dissenting view of Barack Obama.
For the past year, I’ve been in a death spiral without knowing it. The occasional fainting spell, sprawls on the street and a dramatic weight loss were shrugged off as merely a cost of doing a writer’s business. Denial is a most powerful analgesic. Even when paramedics first rushed me to the hospital, I angrily argued with the doctors.
But when a lightning-bolt sciatica pain, triggered by a car accident, brought me down like a bull under the matador’s sword, more or less paralyzing the left side of my body, the health gods decided it was time to shut down my hubris. Like something out of the TV’s “House” or “General Hospital”, suddenly there were midnight ambulances, emergency room traumas, drip feeds, oxygen tubes up my nose, renal failure, suspected meningitis, pneumonia and a minor heart attack.
Thankfully, working as a team at my local Cedars-Sinai hospital, whole platoons of neurosurgeons, cardiologists, nurses, infectious disease experts, radiologists, physical therapists, pulmonologists and hospitalists (whatever they are) dragged me back from the edge. Emergency surgery in a special spinal unit was successful, and today I’m back on my feet – I’m a product of American medicine at its best.
Ah, if only the doctors were free to do their jobs!
My private insurance company, a subsidiary of Wellpoint Inc – America’s largest “managed healthcare”, for-profit company – interfered at almost every stage of my treatment. They were aggressive and shameless. At my most vulnerable, with tubes sticking out of me, they phoned my hospital room – kicking my anxiety level sky-high – to let me know that Wellpoint’s profit-seeking radar had targeted me. The anonymous voice warned, with a kind of smiling threat, that they were on my case: meaning, some bureaucrat – was he or she even medically competent, or just an IT geek – in a far-off, distant corporate office believed that my treatment was violating a mysterious insurance algorithm.
Here in California, Wellpoint and its member plans are notorious, as Reuters reported, for “using a computer algorithm that automatically targeted [women] and every other policyholder recently diagnosed with breast cancer … the insurer then [allegedly] canceled their policies based on either erroneous or flimsy information.”
The practice is called rescission. To put it bluntly, the company collects your money when you’re healthy, but cancels if you get sick. In the case of another insurance company, Health Net Inc, employees were actually paid bonuses based on how many cancellations were carried out; at other insurers, like Wellpoint, staff were praised in performance reviews. Wellpoint’s California subsidiary, Anthem Blue Cross, has raised premiums capriciously by as much as 39%. Politically, Wellpoint is, in effect, a rightwing “political action group” that lobbies hard against healthcare reform – even calling upon employees to do their share. In other words, it’s the ogre in the medicine cabinet.
Perversely, none of the bad stuff would have come down if my primary insurance had been traditional, government-paid Medicare, the closest America has to a single payer. But a quirk in my union benefits put me in the sweaty hands of Wellpoint. I wasn’t threatened with recission, but almost daily, and sometimes several times daily, my doctors were interrogated about practically every measure they took to keep me alive. Again and again, I saw caregivers, even the most skilled and courageous, retreat with an embarrassed, impotent shrug of resignation that said, “what can I do; it’s ‘the system’?”
So I – and my courageous tiger wife – fought, wangled, yelled, protested until I ultimately squeezed past the algorithm. The surgeon of my choice skillfully removed the whatsit that was pressing on an inflamed nerve that had been beating up my spine, and I even won a little rehab time before the insurance computer forced my early discharge. Along the way, anguish over near-daily arguments with the faceless insurance hanging judges almost gave me another heart attack.
Need it be this way?
Obamacare – also known as the Affordable Health Care Act – isn’t medical heaven, or single payer, or anything like the “socialized” NHS that kept me well for the 30 years I lived in the UK. The new law, an obvious compromise with the corporate sickness industry, still keeps us in the hands of private insurance companies. But when the law fully kicks in for the first time, all Americans – regardless of income and “preexisting medical conditions” – must have health coverage. Individuals up to the age of 26 are covered by their parents’ plan. Low-income Americans will get subsidies to help them buy insurance, and doctors and hospitals will be paid for outcomes not “procedures”. Starting in 2014, insurers are forbidden to deny coverage to anyone who has no workplace – the jobless and freelancers will be able to get a government-mandated, insurance plan; indeed, they must or pay a “fine”. And under the new law, “federal parity” means mental healthcare will be more accessible to more people.
Granted, that all depends on this upcoming election day. If Romney and Ryan win – the latest polls tell us this is a real possibility – they, a vengeful Republican Congress and their insurance lobby allies have sworn to sabotage healthcare-for-all. As for repeal and replace, Mitt’s prescription for uninsured folks is that emergency room care is a good enough substitute:
“We do provide care for people who don’t have insurance … If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.”
Here and elsewhere, I have written bitterly attacking Obama’s serial betrayals. He’s no street-scrapper, our Barack. Prior to falling sick, I pined for a third-party candidate, and seriously thought about not voting. But a drug-induced vision of a Romney/Ryan medical hell changed my mind. On 6 November, I’m pulling the lever for Obama: my arrogant, self-sabotaging, drone-happy, compromise-addicted war president.
I never want to see Dr Romney in my hospital room again. Damn it, I want to live.
Professor Tim Evans must live in an ivory tower (Shut one in three hospitals to improve care, says top doctor, 22 September). Most medical staff are just coping with the workload now, and opening hospitals for full services all weekend would necessitate more staff. These hospital closures are about increasing opportunities for privatisation.
The evidence is very clear that if you want to save lives you need to have hospitals near to patients. Death rates rise 20% for every seven miles a patient travels. For two days this year when flash floods hit Gateshead, no one was able to travel far. If we had only had a casualty department in Newcastle rather than Gateshead itself, it is difficult to imagine what might have happened.
Later this year Queen Elizabeth Hospital Gateshead is going to stop providing 24-hour inpatient care to children, and it has just been announced that there will be no overnight emergency care. For patients who use public transport this is a problem and for those who have to drive and who fall ill during rush hour this will mean at least an hour more on their journey time. It would be helpful if innovation was based on evidence rather than political expediency.
Dr Helen Murrell
Newcastle upon Tyne
• Go into the red and you haven’t got enough money to pay for staff and services. Achieve a surplus, and you are hoarding cash. NHS organisations can’t win, so it is high time we got away from a simplistic debate about how many NHS and foundation trusts break even each year (NHS has cash reserves of £4bn, report shows, 20 September).
Foundation trusts are now the majority of hospital providers, have the freedom to run their own affairs, and can generate a surplus to reinvest in patient care. Unlike other NHS trusts they are also allowed to run a short-term deficit, and this can sometimes be a sensible way of managing their finances. Of the 21 foundation trusts operating a deficit in 2011-12, 13 planned to be in deficit, nine are planning to return to surplus in 2012-13, and five had deficits of below £1m (on average less than 0.3% of turnover).
It is therefore misleading to use the number of foundation trusts in deficit as an indicator for assessing the NHS as a whole. As the independent regulator of foundation trusts, we use a more sophisticated risk rating which indicates that 11 foundation trusts are currently in some financial difficulty – fewer than one in 10 – and those with the most acute difficulties are receiving specialist help.
• When procuring the contract for the out-of-hours GP service in Cornwall the PCT would have specified a level of service and bidders would have extrapolated their costs from the staff numbers required to support that level of service (Serco provided false data hundreds of times on GP service, 21 September). The fact that Serco subsequently skimped on their staffing levels suggests that they had undercut other bids that had been prepared more realistically.
The PCT’s statement that despite failing to meet service targets and lying about it Serco’s service was “fundamentally safe and effective” is bizarre. We can only presume that the PCT was profligate with public money in pitching its service levels too high in the first place.
- Ladner Storm girls’ under ten soccer team wins $125,000 for a field refurbishment
- Selects Whitecaps FC game for team trip
- Makes donation of $5,000 to BC Children’s Hospital Foundation
Original post: REPEAT-MEDIA ADVISORY/PHOTO OPPORTUNITY-Ladner Community Celebration Planned for BMO Team of the Week National Champions
Staff wages and benefits eroded through privatisation is nothing compared to what is in store for patients
Under the government’s franchise plan for the NHS, shareholders and equity investors will use the service’s logo as a Trojan horse to prise open the budgets of other countries’ health systems and to front up their unethical, fraudulent and inequitable activities. However, prospective customers will be buying neither NHS services nor the NHS model of care.
Since 1948, the NHS has been the model for universal heathcare on the basis of need and free at the point of use. In 2012, parliament in England passed a law effectively ending the NHS by abolishing the 60-year duty on
Government suggests service could learn from the lucrative success of US firms which have established themselves abroad
Hospitals are to be encouraged by the government to sell their services abroad, setting up clinics with the famous NHS brand to pull in much-needed cash for the health service from overseas.
The scheme – which has been put together by the Department of Health (DH) and the UK Trade and Investment department (UKTI) – attracted immediate criticism from the Patients Association, concerned that in times of financial stringency at home, establishing overseas clinics would be a distraction too far and could undermine standards at home.
But the government points to clinics that already exist, run by big-name NHS trusts with a reputation around the world, such as Moorfields Eye Hospital and Great Ormond Street children’s hospital in the Middle East. The government thinks there could be lucrative possibilities for NHS-standard healthcare services in growing markets such as India and China.
It also points to work that has already been undertaken in Libya by an NHS ambulance trust, which is helping to set up emergency services, while Virgin healthcare, with NHS GPs, is in discussions with Abu Dhabi about the provision of primary healthcare services.
UKTI and the DH think that the NHS could learn from the success of some of the major American brands, such as the private Mayo clinics and Johns Hopkins in Baltimore, which have established themselves abroad.
The health minister Anne Milton said the NHS would benefit and not suffer from the diversification.
“This is good news for NHS patients, who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate,” she said.
“This is also good news for the economy, which will benefit from the extra jobs and revenue created by our highly successful life sciences industries as they trade more across the globe.
“The NHS has a world class reputation and this exciting development will make the most of that to deliver real benefits for both patients and taxpayers.”
But critics of the healthcare reforms, already alarmed at the increased opportunity for private companies to take over parts of the NHS, are unlikely to feel comfortable about NHS hospitals drumming up private custom overseas.
Katherine Murphy, chief executive of the Patients Association, told the Independent: “The guiding principle of the NHS must be to ensure that outcomes and care for patients comes before profits.
“At a time of huge upheaval in the health service, when waiting times are rising and trusts are being asked to make £20
Women performing apartheid-era toyi-toyi dance condemn mine company as they wait for news of victims of police shootings
Nosisieko Jali’s husband is missing. She has heard a rumour that a bullet hit him in the head, yet he survived. One witness said all his clothes were torn. “I don’t know where he is,” said Jali, numb with anxiety. “The hospital wouldn’t let me come inside. I am hurting.”
Jali is among scores of wives at the Lonmin platinum mine in Marikana still waiting to discover if their husband is in a jail, hospital or mortuary after one of the bloodiest days in South Africa since apartheid.
Thirty-four people were killed and 78 injured on Thursday when police with automatic rifles, pistols and shotguns opened fire on the strikers, many of whom were armed with spears, machetes and clubs as they demonstrated for higher wages. The shocking images, beamed to TV viewers around the world, provoked comparisons with massacres by the white minority regime of the country’s past.
On Friday, next to the killing field, wives took the place of their dead and wounded husbands to stage an angry, emotionally charged demonstration. The women raged against police brutality, mine exploitation and a lack of official information that has left them agonisingly in the dark.
“How can we know whether people are dead or missing?” demanded Nowelcime Bosanathi, 35. “My husband went to the protest with a stick. I worried he might be dead. Then he called last night to say he’s in a police van and he doesn’t know where he’s going. Now his phone is on voicemail.”
Waving sticks, whistling and ululating, the women performed the apartheid-era toyi-toyi dance up and down a dirt road. They sang songs, some mournful, some defiant, warning: “When you strike a woman, you strike a rock” and invoking the memory of heroes of the anti-apartheid struggle such as Oliver Tambo. They joined hands in a circle for a soulful rendition of Nkosi Sikelel’ iAfrika, the national anthem and originally a hymn. They kneeled before police armed with shotguns and sang “What have we done?” in the Xhosa language.
The group of about 100 women also brandished homemade cardboard placards with handwritten slogans condemning the police. “Police stop shooting our husbands and sons,” one said. Another, referring to the new national police commissioner, Riah Phiyega, read: “Piega you celebrating your position by blood of our families.”
Primrose South, 51, was still waiting for news about Mishack Mzilikazi, 35, who lives on her property and is considered part of the family. “I last saw him at 8am on Thursday. He was going to work with his phone but now it’s off. He also had a stick and he was quiet.
“I don’t know where he is now. He could be in prison or he could be dead. I don’t know.”
She added: “We are feeling bad because the children now are crying, are hungry, are afraid even to sleep at night. The wives have no husbands now. Their husbands are lying dead in the forest.”
Whatever did happen here there is no shortage of blame – and competing accounts. The women point at the police and the Lonmin mine management.
South, who works as a mine store manager, said: “The management sent the police to kill our husbands, brothers and sons. But we will fight for our rights like them.”
Many of these women followed their husbands from Eastern Cape province or neighbouring countries such as Lesotho, Swaziland or Zimbabwe. They live in the nearby Nkanini settlement in cramped shacks with pit toilets and an intermittent water supply. Above one of one of the world’s richest platinum deposits, goats wander in adjacent scrubland strewn with discarded plastic bags and rubbish.
They denied that the workers had opened fire first and said a turf war between rival unions was a sideshow to the dispute over pay.
The unions are scrapping for members. The National Union of Mineworkers, a supporter of the ANC, had signed up to a pay deal with Lonmin. But the militant Association of Mineworkers and Construction Union (AMCU) rejected this and pushed for wages to be trebled. This comes amid a wider debate on whether the governing African National Congress (ANC) should curb mine owners’ power.
The youth league of the ANC argues that nationalisation of the country’s mines and farms is the only way to redress the injustices of the past. The youth league said: “South Africa’s exploitative mining regime, capitalist greed and the poverty of our people is the cause.”
For its part, Lonmin announced that it would provide support to all the families that have suffered loss this week. Simon Scott, its chief financial officer, said: “We have established a help desk at Lonmin’s Andrew Saffy Hospital, which will help families with the identification of bodies, assist with all the burial arrangements and offer bereavement counselling.
“Lonmin commits to provide funding for the education of all the children of employees who lost their lives. This funding will cover education costs from primary school to university.”
The company’s London-listed share price slumped 9% early yesterday, though it ended 1.3% down at 639.5p. It plunged to a nine-year low on the Johannesburg exchange, where it is also listed.
The South African Institute of Race Relations called for the immediate suspension of all police officers involved in the shootings.
It said: “There is clear evidence that policemen randomly shot into the crowd with rifles and handguns. There is also evidence of their continuing to shoot after a number of bodies can be seen dropping and others turning to run.
“This is reminiscent of the Sharpeville massacre in 1960,” it said.
The police, though, insisted they acted in self-defence, arguing that the mine workers even possessed a pistol taken from a police officer they are alleged to have beaten to death on Monday.
At least 10 other people were killed during the week-old strike at the mine,80 miles north-west of Johannesburg, including two police officers said to have been battered to death by strikers and two mine security guards.
It was into this highly charged atmosphere that President Jacob Zuma stepped, having cut short a visit to a regional summit. He announced that a commission of inquiry would be held into the tragedy. “This inquiry will enable us to get to the real cause of the incident and derive the real lessons too,” he said during a visit to Marikana.
“We’ve all been saddened and dismayed by the events of the past few days and hours around the Marikana mine. The loss of life among workers and members of the police service is tragic and regrettable.
“These events are not what we want to see or want to become accustomed to in a democracy that is bound by the rule of law and where we are creating a better life for all our people.
“Today our thoughts are primarily with the families of those who have lost their lives. As a government and as fellow citizens, we offer our sincere condolences to families who have lost their loved ones. Our thoughts are also with those who are recovering.”
He continued: “The events of the past few days have unfortunately been visited upon a nation that is hard at work addressing the persistent challenges of poverty, unemployment and inequality.
“We undertake this work in conditions of peace and stability, working with all sectors in our country.
“We assure the South African people in particular that we remain fully committed to ensuring that this country remains a peaceful, stable, productive and thriving nation, that is focused on improving the quality of life of all, especially the poor and working class.
“It is against this background that we have to uncover the truth about what happened here.”
He went on: “Today challenges us to restore calm and share the pain of the affected families and communities.
“This is not a day to apportion blame. It is a day for us to mourn together as a