The recent tragedy in Lahore, where several dozen people died and many more critically ill due to substandard medicines, highlights an ugly problem not often discussed. The tragic loss of life, due to counterfeit or substandard medicines needs to be highlighted and immediately addressed. The problem is neither new, nor limited to Lahore. There was a recent report on counterfeit medicines in Karachi and I am sure, many preventable deaths, both in urban and particularly in rural Pakistan, go unreported and accepted as isolated incidents. The problem, however, is not going to go away anytime soon unless we address it comprehensively. Counterfeit and substandard drugs not only lead to tragic loss of life, but can also result in long-term resistance to potent medicines in those who are exposed to these drugs. This affects the society as a whole and makes it even more vulnerable to epidemics.
Our response to substandard drugs is, at best, substandard itself. Growing up in Islamabad, I knew very well about the issue of substandard drugs or ‘do number dawain’ as we affectionately call them. This, coupled by the universal practice of self-medication, prescription free medicines at the pharmacy and little awareness is an epidemic time bomb that can detonate at any point. Fortunately, I was spared and never had any serious issues. The people in Lahore were less lucky. The problem continues to grow and needs to be tackled in order to combat relentless growth in this problem. We need to pursue the criminals to the fullest extent of the law. While this is obvious, it can not be overstated. Conflicts of interest, kick-backs and nepotism have longed undermined the rule of law. This is no less serious than terrorism against the state and needs an aggressive approach from all arms of our law-enforcement units.
That said, there are a number of policy and practical issues that we should also emphasise and incorporate. First, we have to raise awareness. We need not, and should not, wait for a major catastrophe like the one in Lahore to raise this issue. A massive campaign about reading labels, using trusted pharmacies and reputable sources has to start immediately at the national, provincial and municipal level. This will, of course, not solve the problem completely, but will be a start.
The awareness campaign needs to be linked with strengthening of quality control mechanisms by the government. This means not only testing the drugs that enter the market, but also tightening the supply chains. We need to have stricter control on who has the authority to provide medicines and how our medicines travel down the supply chain and reach consumers, both within the large urban centers and smaller villages. With the devolution of the ministry of health at the federal level, this problem has gotten much harder to address. Yet, this cannot be our excuse to ignore the problem or be complacent about it. It is a well known fact that once counterfeit drugs enter the market, it is very hard to get them out of the system. Thus the government needs to secure the entry of drugs in the market and access to medicines by the consumers. Pharmacies that give medicines without prescriptions should be penalised heavily and random quality control checks need to be carried out routinely. The lack of resources is no longer a good enough argument. If we can spend billions on the security of our elected officials and ministers, we can spend a few hundred thousand on securing the medicines that are supposed to save the lives of those who bring them to power!
Finally, as I have argued before, we need to emphasise the need for indigenous research to solve our problems. We need to come up with better, affordable and robust mechanisms for screening drugs and identifying bad drugs quickly. Our national labs cannot afford to rely on instruments that are prehistoric and need foreign contractors to service them. We need to encourage our researchers to address the problems of national safety and security. Ensuring that our drugs are a lifeline and not a death sentence, should be our highest priority.
Published in The Express Tribune, January 24th, 2012.