|The proceedings from the conference on “How to fight falsified medicines” organized on October 15, 2010 by the Mutualité française, in partnership with the Fondation Chirac and the Pierre Fabre Foundation are now available in French.|
In twenty pages, this summary report allows the reader to clearly grasp the implications in fight against the traffic of falsified medicines, which entails reforms not only at the structural level of health systems, but also at the distribution level, the health governance level, the cost of the production of medicines and inter-State cooperation.
For example the Mutualité française, listed the following actions to be undertaken by political leaders and international and inter-governmental organizations:
- Improvement and safety reinforcement of distribution channels
- The systematic creation of national quality control laboratories for medicines
- Expert level training for laboratory personnel
- The promotion of South-South collaboration between quality control laboratories
- The developmentthe production of generic medicines
- The harmonization of legislation by the 47 member states of the Council of Europe
- The harmonization of standards for the market entry of medication and customs regulations, thanks to stronger regional political integration of developing countries
Mr. President of the Mutualité Française, dear Jean-Pierre Davant,
Your Excellency of the Ministry of Health of Gabon,
Members of Parliament,
Ladies and Gentlemen,
Thanks to your initiative, Mr. President, the search for innovative financing is underway and is greatly developing; most notable are the tax on airfare and the anticipated tax on bank exchanges, UNITAID, which is efficiently chaired by Philippe Douste-Blazy. The naysayers who doubted its effectiveness are now forced to recognize that the Chirac tax is a success. Why? Because it funds access to essential medicines in the poorest countries; it is an essential part of the process to provide access to healthcare for those who are excluded from the usual healthcare circuits.
This is fundamental progress towards the Millennium Development Goals (MDGs), and this, we owe you.
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Launched by Jean-Pierre Davant, with the support of the Fondation Chirac and the Pierre Fabre Foundation, this morning’s debates were rich in ideas and exchanges. It is now clear that we must consider three new issues that arise from opportunities offered by innovative financing. Let us examine them together.
• First, can medicines be considered a commodity, on par with other merchandise?
• Then, in our perverse society where money is king, how can fragile states organize and ensure the safety of the drug supply chain in the current political context?
• Finally, how can we reduce the cost of medication so that the mere pursuit of healthcare, for millions of banished individuals, stops being an unattainable undertaking or a dangerous and even deadly gesture?
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Medicines are not truly a consumer product and health cannot be reduced to a mere exchange of money for remedies.
Falsified medicines are products sold to trusting patients. Overdosed or under-dosed active ingredients, sometimes toxic or containing unexpected additives (gypsum, lime, coolant,…), falsified medicines not only do not cure but they can cripple or kill. It can also contribute to the emergence of drug-resistance, as is already the case for malaria in Cambodia and Nigeria. This is why falsified medicines cannot be considered on the same level as a simple counterfeit handbag or fashionable watch. All our partners are well aware of this.
This public health scourge is worsening. Trafficking in counterfeit medicines increased 300% between 2007 and 2008, according to the World Customs Organization (WCO), a highly trusted partner. According to the World Health Organization (WHO), this traffic alone accounts for one fifth of the million malaria victims per year, in other words 200 000 deaths annually.
This fraud is thought to produce an annual sum of over 50 billion Euros with impunity.
The public health consequences are more serious and complex: to be resolved, they require drug quality control, the mobilization of customs’ systems, that of the police, analysis and debate on whether to socially insert or disinherit the small scale medicine dealers, “market, street, or turf pharmacists” who are forced to kill to survive.
Finally, the legal community and policy makers are essential partners in medical and health governance, which must separate the true from the false.
This observation has led to the adoption of a multidisciplinary strategy at all decisionary levels and to a large-scale consumer alert, in other words, informing public opinion, whose conversion is vital in bettering the situation and banning the murderers. Unlike a fake Rolex, nobody would buy, for himself or his child, falsified medicine. I would like to salute in particular Aline Plançon and the Pangea 3 campaign, launched yesterday by Interpol, whose primary goal is informing consumers. Loss of confidence in the reseller and doubts about his products constitute an important link in the fight against trafficking.
In our current, highly serious health context, we can no longer ignore the issue of structuring and securing the distribution circuit for medicines.
This multidisciplinary approach should guide our approach at all levels. Mr. President, you reminded us in your speech to the Council of the World Customs Organization, on June 24 in Brussels that Customs officers have the mission to “achieve the optimal balance of preventing illegal medicines from crossing borders without prejudicing the legitimate trade of both licit and generic drugs”. In my opinion, such a task is inconceivable without the support of health professionals in pharmacies and State health authorities.
The Cotonou Declaration, launched October 12, 2009, commits all signatory countries to politically take on this booming, new traffic that will develop for many years to come if it encounters no resistance. The Cotonou Declaration, a political advocacy campaign, designed to mobilize leaders and to encourage health professionals, encourages the establishment of specific governance to counter this dramatic falsification. It is indeed by bringing together health, judicial, customs, and police officials that governments can focus their public policy in terms of medicines, track down counterfeiters, and put an end to their deadly trade.
On a technical level, this declaration also suggests the systematic implementation of a national laboratory for drug quality control. One such laboratory was launched by the Pierre Fabre foundation in Cotonou, a few years ago; it has recently been reinforced with support from the Fondation Chirac. These laboratories are the surest way to ensure that the official market remains healthy. It is also a tool that can confound counterfeit “vendors”, rogue dealers, and potential killers. This scientific base is essential.
The problem though is not national; traffickers know no borders. They too, in their own way, are border-less. They easily get around the political, economic, and health strata represented by the police, customs officials, and health authorities. The fight must be brought to the regional level. In Africa, the various States are organized into economic communities, which should enable the establishment of a large, more sophisticated, quality control laboratory, working for the sub-regional level in question. This would be an excellent start.
The regional economic community level is the best to improve the overall structure of distribution systems. The demand for medicines is on the rise and we need to harmonize marketing standards for health products. Trade is increasing: customs codes must be harmonized to allow for testing of medicines upon their entrance into a community’s territory.
Finally, public powers and international funding agencies must attribute the necessary sums for these projects. The purchase of medicines also requires the mastery of distribution channels.
It is towards this goal, dear Michele Rivasi, that the European Parliament, within the new framework of the Treaty of Lisbon, must be able to take a full part in these efforts, to convince the European Development Fund (EDF). As you know, you can count on the support of Louis Michel, former European Commissioner for Development and Humanitarian Aid, who has also signed the Cotonou Declaration.
Alongside the European Union, the Council of Europe has prepared MEDICRIME, a Convention criminalizing the trade of falsified medicines, which will be opened for signature by its 47 member states and beyond, in March 2011.
However, we all know that these proposals cannot ignore the need to reduce the cost of medicines. Without such efforts, despite risks to their health, the most vulnerable populations will continue to buy off the streets and in the marketplace.
We must obviously continue to lower the sale cost of drugs. Initiatives by the Global Fund, the GAVI Fund, and the Global Business Coalition for HIV / AIDS, tuberculosis, and malaria greatly facilitate the work of centralized drug purchasing systems.
However, as recommended by the Cotonou Declaration, we must continue and intensify our efforts to expand the availability of generic drugs, and extend the possibility to as many individuals as possible.
The answer also lies in the development of drug manufacturing that remains ever more closely tied to issues. With Cinpharm, Celestin Tawamba shows us how an entrepreneur has managed to offer Cameroon, through partnerships and innovative technology transfer, a manufacturing plant for essential medicines that will hopefully meet the demand of Cameroon and its neighboring states.
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And finally, social protection and welfare I would like to commend the President of Mutualité Française, Jean-Pierre Davant, who has shown us today how cooperative efforts and organization are affected by the problem of falsified medicines. In developing countries, healthcare is the second largest household expenditure after food. In most cases, no health coverage or social protection is offered to the population.
Developing cooperative healthcare systems would diminish these expenditures. It would be the assurance of real medical care and the promise of a better future.
In the coming months, several major international events will allow us to advance our project. Certainly, the Francophonie Summit in Montreux, Switzerland on October 22 and the European Development Days in Brussels on December 6 and 7, and perhaps even the 2011 G20 in France, will be opportunities to work together with colleagues from emerging nations on this devastating topic that is falsified medicines.
With the hope that soon, the member states of the UN will mandate the Economic and Social Council, to seize falsified medicines and provide an appropriate legal response, in the form of an international convention. So that the death penalty incurred by the poorest patients may be abolished.