Producing and selling falsified medicines—fake drugs deliberately labeled as real and sold to consumers—has been described by the Institute of Medicine as “the perfect crime.” The industry tops $200 billion annually and in Africa alone is responsible for 100,000 deaths each year. The WHO identifies corruption as one of the biggest challenges to keeping these drugs off the market, but the number of access points all along the supply chain—at the point of manufacturer, in customs offices, at distribution centers or individual pharmacies—make reining in corruption a gargantuan task. Governments may squeeze one area—say stricter regulation of customs offices—only to find distribution centers being turned into drug swap shops.
We may, however, be witnessing a shift in how governments approach these issues, moving from confronting corruption head on—which has met with mixed results—to simply circumventing it. The Nigerian experience is noteworthy. Nigeria’s National Agency for Food and Drug Administration (NAFDAC) has teamed up with Sproxil, a product verification company, to allow consumers to individually verify the authenticity of their drugs. NAFDAC is effectively crowdsourcing its falsified medicines anti-corruption efforts, and with some very positive results.
It’s a simple idea. Sproxil affixes a scratch-off panel to individual drug packets. After purchasing the drug, consumers scratch off the panel to reveal a unique, single-use code and text the code, free of charge, to the country office. Within seconds they receive a reply letting them know if the product is real or fake, and providing additional information if necessary. While not the only company offering crowdsourcing verification technologies (mPedigree and PharmaSecure are other examples), Sproxil’s exponential growth is indicative of the buy-in this approach is garnering. It took Sproxil two years to hit one million text-in verifications, one year later they were at five million, less than a year after that ten million (real time number of verifications can be found here). Nor is the idea’s buy-in limited to patent-holding Western pharmaceuticals or countries frequently on the receiving end of falsified medicines. Companies in China and India—each major sources of fake drugs but also home to legitimate generic manufacturers providing affordable drugs to much of the developing world—are starting to partner with companies which use product verification technologies similar to Sproxil’s.
Individual verification systems are proving so effective for two reasons:
- They empower the right people—authentic manufacturers and consumers—and cut out the rest. Every fake pill purchased is lost revenue for authentic manufacturers; every fake pill consumed puts the consumer’s health at risk. Both groups have a strong incentive to participate in the system. Furthermore, the costs of participation are distributed to incentivize broad participation (i.e. consumers text-in for free).
- Implementing the system does not require direct suppression of corrupt activities–which can be difficult, resource-intensive, and politically sensitive. Product verification simply circumvents the customs officials who take bribes, the wholesalers who divert drug supplies, and the pharmacists who switch pills.
It is important to recognize, however, that while consumer verification systems are proving an important tool in the fight against falsified medicines, they are still basically a rear-guard action; they only come into play after falsified drugs have already invaded the market. Governments can and should use the success of these crowdsourcing technologies to build their capacity to fight corruption head on. I have three recommendations:
- First, NAFDAC and Sproxil (or similar partnerships) are gathering a lot of information that could be used to figure out which drugs are easiest to fake, and which are in the highest demand. This information could be used by law enforcement authorities and authentic manufacturers to allocate resources to the highest-priority risks.
- Second, and building on the first point, if verification systems become widespread enough, and there is enough public buy-in, in addition to texting in the scratch-off code, consumers could be encouraged to text in their region, town and the pharmacy from which they purchased the medicines (along with any other pertinent information). This data could be used to generate a real time “heat map” of fake drugs, which could be used both for law enforcement purposes, and to design better regulatory regimes to cut out the supply of fake drugs.
- Third, and this is more controversial, aggregated information collected through crowdsourcing technologies should be made available to the communities which text-in. Releasing this information is tricky because, so the argument goes, knowledge of the prevalence of falsified medicines within a community may lessen confidence in all available medicines, which may in turn erode public health overall. In a nutshell, the concern is that if people think the medicines they purchase may not be effective, when they get sick they may decide not to bother seeking treatment at all. Despite this risk, I would argue, making this information available at the community-level is important because it incentivizes change. If consumers are aware that a particular retailer and/or town has a higher incidence of falsified drugs, they’ll shop somewhere else. It’s possible that the final retailer had no knowledge of the falsified drugs (and so would be punished for a harm for which they bore no responsibility), but retailers are better positioned vis-à-vis consumers to maintain supply chain integrity. Releasing this information to the public incentivizes those with the ability to restrict access points and/or ensure that medicines entering at all points are authentic to do just that.