Criminals in Africa are producing harmful anti-malarial counterfeits with severe public health consequences, a recent investigation has found.
The study, that used direct ionization mass spectrometry, among other methods, found that the quality of artemisinin-derivative based combination therapy (ACT) and removal of artemisinin monotherapies must be addressed quickly to deter major public health problems, with possible intervention from the International Health Regulations.
Seven collections of artemisinin erivative monotherapies, ACT and halofantrine anti-malarials of suspicious quality were collected in 2002 to 2010 in eleven countries and in Asia en route to Africa. The results found counterfeit artesunate containing traces of several counterfeit elements, such as counterfeit DHA-piperaquine containing sildenafil, counterfeit artemether-lumefantrine containing pyrimethamine, counterfeit halofantrine containing artemisinin, and substandard/counterfeit or degraded artesunate and artesunate+amodiaquine had passed into the continent.
Pollen analysis was consistent with manufacture of counterfeits in eastern Asia.
The presence of artesunate monotherapy, substandard and/or degraded and counterfeit medicines containing sub-therapeutic amounts of unexpected anti-malarials will engender drug resistance.