Corruption and Substandard Medicine in Latin America
It is hardly news to say that corruption is a problem in Latin America. However, its impact on health is often underestimated. One World Bank scholar suggests that about $28 billion are stolen or diverted from health systems per year in Latin America. Sometimes the problems are high profile, such as in Honduras, where the vice-president was charged with having links to a company that embezzled the state by selling poor quality medicines at inflated prices. But most problems never make the press, since they seem mundane. After all regulatory violations are boring; yet they can be lethal.
Bribes paid to government officials to prevent or avoid regulations are arguably the greatest problem, especially leading to high-priced and inferior medicines. The problems with fake and substandard medicines are well known among specialists, but largely ignored by political leaders. The total death rate is unknown but one peer review estimate is that over 100,000 children die every year just from inferior malaria medicine. Yet even though so many die, there have been almost no assessments of medicines in Latin America.
Over the past decade, as part of our research, we have collected over ten thousand samples of medicines from 22 cities in emerging markets, but the only one from the Latin region was Sao Paolo in Brazil. We have now rectified this gap, at least for one critical medicine, the broad spectrum antibiotic ciprofloxacin. Our paper “Corruption and Medicine Quality in Latin America: A Pilot Study” was published last week.
We sampled 518 treatments of Cipro from pharmacies in ten Latin American cities and conducted a very basic test for active ingredient content. About 7 percent failed this test, and most of these were substandard - medicines made by legal companies that simply cut corners and failed to make the drug properly. About 2 percent were fake medicines, made by criminal groups, not companies with products registered in any country. As we conduct more exacting tests on a subset of these medicines we are finding more substandard medicines (but no more fakes). It seems reasonable to assume that up to ten per cent of the Cipro will end up being substandard.
When NBC’s Tom Brokaw said “In Cipro we trust” he was referring to the belief that Cipro would save American lives from anthrax or smallpox after September 11th. And as one of the more powerful antibiotics it is only used when people are in real need. Substandard Cipro is obviously a worry for those patients who have serious bacterial infections. But it also should worry us all because substandard medicines drive resistance, so that even good quality Cipro will become less effective over time. And resistance in Latin America can quickly be transmitted to North America.
The best way to ensure good quality medicines in the region is for local regulators to monitor quality problems, identify the problem suppliers and shut them down. They should work with police and other law enforcement to try and prevent bribery of regulators and public officials, since this affects procurement processes for drugs and allow dubious producers to supply low quality drugs without facing the consequences. And of course they must combat criminal groups selling fake medicines – even though this is a smaller problem than legal producers selling poor quality medicines.
Our study finds that corruption is strongly correlated with poor quality drugs, with less corrupt countries having better quality drugs. To understand the exact sources of inferior medicines requires more detailed research into producers, traders, and other intermediaries. But for now our results suggest a significant problem exists. And it is one most physicians and patients in the region are ignorant about. That is the first thing that needs to change.