Earlier this year, Mussarat, a 35-year-old Karachi woman, was pregnant with her fourth child when doctors advised her to start taking injectable iron for her anemia. She purchased those injections from a local pharmacy and brought them to the hospital to have them administered.
As she was being injected, Mussarat (who asked that her last name not be used) began feeling a burning sensation in her arm and broke out into a rash. She complained of having sharp pain in her chest and difficulty breathing. After looking into it, the hospital staff found that others who had taken those iron injections had similar reactions and had not improved. The injections were counterfeit.
Unfortunately, Mussarat’s story isn’t novel. Every year, millions of Pakistanis think they are buying legitimate medicine only to purchase fakes that contain potentially lethal substances like rat poison, paint and tar.
Now, one Karachi-based startup is trying to combat the problem by offering a free service called ProCheck that will allow anyone with a cellphone to verify the drug's authenticity.
The idea behind ProCheck is simple: text the code printed on the medication packet to ProCheck’s number and get an almost instant verification response.
It's part of a broader effort to combat the global problem of counterfeit drugs. An estimated 10 to 30 percent of medicines sold in developing countries are counterfeit as compared to 1 percent in the developed world, according to the Centers for Disease Control and Prevention. A study published in the American Journal of Tropical Medicine and Hygiene reported that counterfeit and substandard malaria medicine contributed to the deaths of more than 100,000 children in Africa in one year alone. Interpol found that many drugs in the developing world, such as antibiotics or malaria tablets, contained less active ingredients or none at all.
PharmaSecure, based in New Hampshire, offers a similar service in India, Nigeria and Pakistan. Patients can text the distinct alphanumeric code on the drug packet, and they will get a response in about 10 seconds verifying the authenticity of the drug.
Sproxil, located just outside of Boston, allows patients in Ghana, Kenya and India to check drugs by verifying the one-of-a-kind code on their medicine packets through a website, text message or call center.
And much like the other services, MPedigree, based in Ghana, allows local users to text a 12-code to its number for an instant response about the medication’s authenticity.
A loss of time, money and lives
In a country like Pakistan, rampant poverty and lack of access to health care go hand in hand. Pakistan has a population of 185 million. According the World Bank, in 2014, over 50 percent of the population in Pakistan lived below the poverty line if the poverty line is set at $2 per day.
Fake pharmaceutical drugs not only pose serious health risks to patients, they waste consumer time and income — time that could be spent earning money that is extremely limited. If the drug doesn’t kill the patient, it worsens the patient’s condition so he or she has to take the time to return for additional treatment and spend more money. This further impoverishes the already poor consumer.
It is difficult to know how much money is spent on fake drugs every year as estimates vary greatly.
“Counterfeit medicines come with a huge cost to everyone — the patient, the doctors, the government. We often don’t even have enough resources to meet the existing demands of patients, let alone these needs which can easily be prevented,” says Kinza Waseem, a doctor at the Combined Military Hospital in Karachi.
Saim Siddiqui, the founder of ProCheck, says the problem of fake medicine in Pakistan is extensive. “Sometimes the pills people are taking are made up of sugar and water, but in some cases the pill will contain brick dust, concrete or tar, and it’s just really bad,” he said.
Fake drugs are often made in “small, makeshift, home-grown factories” and underground labs, explains Siddiqui. They are later dispensed at unregistered pharmacies, often loosely or with no packaging at all. Fake medication in liquid form is even harder to detect. In other cases, expired medication is repackaged and sold.
ProCheck launched in June 2015 and has since protected 2 million medicines. To expand its reach, the company recently signed a deal with Ferozsons Laboratories Ltd., a leading manufacturer of pharmaceuticals in Pakistan, to print codes on up to 35 million units of medicine using its service.
In 2012, Siddiqui, who grew up in Pakistan, heard about an incident in which fake antihypertensive medicine killed 120 heart patients in Lahore. “I became obsessed with the crisis and knew I had to do something,” says Siddiqui. Soon after, with private funding almost secured, Siddiqui quit his job in Toronto, packed his bags and moved to Karachi.
But Pakistani lives, time and money can’t be protected unless people know about the service. Getting the word out about mobile authentication services can be a challenge, but a government mandate seems to be one way of doing it.
Drug companies pay services like Procheck to print-code their medication packets, though many are reluctant. “No one wants to spend money on things they don’t have to,” says Laurence Huntley, vice president of Sproxil. But if a country’s government requires sterilization, then drug companies have no choice but to do it if they want to do business there.
In Nigeria, the fight against fake drugs is led by the National Agency for Food and Drug Administration and Control. In 2012, this government agency required anti-malaria drug manufacturers to serialize all medication. According to the Nigerian government, counterfeit anti-malaria drugs fell from 19.6 percent in 2012 to 3.6 percent in 2015.
When people know about a service, they use it. “Our call centers in Nigeria get 1,000 calls a day,” says Huntley.
Bejon Misra, founder of Partnership for Safe Medicines (PSM) India, a public health group dedicated to protecting consumers against counterfeit, substandard or otherwise unsafe medicines, says that a sustainable solution to address counterfeit drugs cannot be achieved in isolation. “We need the cooperation of the government, the regulators, the pharmaceutical industry, the chemists and patients groups who have the common goal of protecting health and safety in consumers.”
Samar Warsi is a lawyer and journalist based out of Toronto. Follow her on Twitter: @swarsi