Kanchan Srivastava writes that counterfeit medicines and vaccines have been threatening public health, but the epidemic has caused a surge in global black market sales.

When the World Health Organization flagged the danger of fake covid-19 vaccines in August, 1 Mumbai and Kolkata police had prosecuted more than a dozen people for allegedly participating in “fake vaccination campaigns” conducted in May and June. In Kolkata, 500 out of 500 people were vaccinated with fake Covishield (the Indian version of AstraZeneca vaccine), one of whom was Mimi Chakraborty.

China has been cracking down on counterfeit products of its domestic vaccines. 2 Mexico and Poland have reported that some people have provided people with fake vaccines from Pfizer at a price of US$1,000 per bottle. 3 Mexican customs officials also seized counterfeit Sputnik V vaccine vials destined for Honduras. 4 An operation carried out by Interpol in Southern Africa in July and August resulted in the identification of 179 suspects and the seizure of US$3.5 million worth of goods, including vaccines, masks and forged covid-19 test certificates . 5

Interpol Secretary-General Jürgen Stock (Jürgen Stock) told Time magazine: “I have never seen such a dynamic situation before, 6” “Liquid gold in 2021 is a vaccine, and we have already seen a vaccine. The supply chain is increasingly becoming the target [counterfeiters]."

Interpol defines counterfeit or substandard drugs as drugs that are different from genuine vaccines:

Contain too much or too little one or more ingredients, or contain different ingredients

Claim different properties or side effects

Have different shapes, sizes, tastes or colors

Not marked correctly or not marked at all

Expired or missing expiration date

Does not include information on how to store medicines

The packaging looks poorly structured, is marked with spelling or grammatical errors, or appears to be disturbed

WHO estimates that as much as 1% of medicines in high-income countries may be counterfeit, but this number has risen to 10% globally. In Africa, 18.7% of samples were found to be counterfeit or substandard. 7 A 2017 report by PricewaterhouseCoopers estimated that the counterfeit drug market is worth 200 billion U.S. dollars and is growing by 20% every year.

According to a report by the Anti-Counterfeit Drug Alliance, the drug black market has grown by more than 400% in the past year. The alliance is a multi-stakeholder non-profit organization that aims to combat the proliferation of counterfeit and substandard drugs. In contrast, the real COVID-19 vaccine market is estimated to be worth 150 billion U.S. dollars. 9

The chaotic information, panic, and unfair vaccines during the pandemic have created a mature market for criminals. Oksana Pizk, who led the infectious disease outbreak of the University College London’s Global Citizenship Project, said the “trickle drop” of vaccine donations from rich countries made it easy for populations in low- and middle-income countries-especially health workers- Some people get infected and give vaccines to unlicensed suppliers.

The WHO warned that organized criminal groups continue to exploit the vaccine fairness gap to profit as they switch from personal protective equipment and diagnostics to vaccines.

Counterfeit goods have existed in the pharmaceutical trade for centuries-for example, they were rampant during the great plague pandemic in the 17th century. 10

Alok Dhawan, director of the Lucknow Biomedical Research Center in India, said: “Counterfeit medicines and vaccines are part of a parallel and illegal industry that is thriving in developing countries, where most products are available over the counter, while medical stores often Lack of qualified pharmacists..."

The globalization of the pharmaceutical industry has spread counterfeit and substandard products worldwide. The active ingredients may come from China, and the product may be manufactured in India and packaged in a third country before shipping through Dubai. It may then be repackaged and shipped to another country to take advantage of the exchange rate. These many steps provide a venue for fraud to occur.

The usual practice is to purchase empty vials and refill them with saline solution or substandard products. Dhawan said that counterfeit products containing lower concentrations of active pharmaceutical ingredients than official drugs are also common. He added: “Small pharmaceutical companies, especially those that outsource work for large companies, often ignore good manufacturing practices to reduce costs.”

Health economist Eric Feigl Ding stated that counterfeit and inferior products “may contain harmful ingredients, less active ingredients, wrong medications, wrong concentrations, or expired medications, leading to poor results and unexpected side effects, which may have serious health effects.” "

"More importantly, these products give patients an illusion of protection or cure-if the disease is an infectious disease, it may further endanger themselves and others," he told BMJ.

Counterfeit products are marketed through spam and social media. Maharashtra Police (Cybercrime) Special Inspector General Yashasvi Yadav stated that consumers should “be wary of emails with spelling errors and grammatical errors, missing physical addresses of medical products, or offering unprescribed medical products at low prices. prescription."

Yadav said that sales are also conducted through the dark web (a hidden network in the Internet), and it is almost impossible to track. The ratio of genuine or counterfeit products is unknown. According to Israeli cybersecurity company CheckPoint, dark web advertisements for covid-19 vaccines (including AstraZeneca, Johnson & Johnson, Sinopharm, and Sputnik V, at US$500-1000 per dose) have increased by more than 300% in the past three months. 11

Pyzik says that better authentication is needed. "At the macro level, key anti-counterfeiting strategies need to be adopted to protect the supply chain by further developing local manufacturing capabilities and investing in new technologies to reduce the number of imported drugs."

But Pyzik said that technology alone is not enough. "If there is no common global strategy and political will to increase the availability of medicines, improve education and training on counterfeit and substandard medicines, strengthen the regulatory capabilities of low- and middle-income countries, and pass legislative reforms to prevent criminal activities, the black market will Continued to flourish and the number of poor-quality production bases proliferated."

She said that this trade indirectly funds other criminal activities, from human trafficking to financing of terrorism.

"Due to high profits, difficult testing, and low penalties or fines, counterfeiting drugs is a perfect crime."

According to Interpol, looking for the "six Ps" is the starting point for identifying counterfeit medical products:

Location-Do not buy drugs from unknown websites or markets. If you are not sure about the supplier’s qualifications, please check the list of registered pharmacies from your local health regulatory agency

Prescription drugs-buy only prescription drugs prescribed by your doctor or healthcare professional. When buying online, make sure that the website requires you to show a prescription. Do not purchase from websites that provide prescriptions based on the questionnaire or do not have a pharmacist to contact

Promises-be wary of pharmacies that offer "unbelievably good" promises. The false promises to be aware of are "cure all types" of major diseases, "money-back guarantee", "risk-free" or "limited supply-purchase in advance"

Price-check the price against the products you usually buy or with reputable suppliers. If it’s much cheaper, it’s probably fake

Privacy-Transactions of counterfeit medical products are related to credit card fraud and identity theft. Except for appropriate medical details, do not disclose any personal information

Products-compare the medicine with your usual prescriptions

Conflict of interest: I have read and understood the BMJ's declaration of interest policy and have no relevant declaration of interest.

Provenance and peer review: commissioned; no external peer review.

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