The cost of Ivory Coast's fake medicine industry

In Ivory Coast, fake medicine is sold widely in the streets, markets and bus stations. Though the police carry out frequent operations targeting vendors of the unregulated medicine, it is difficult to disband the networks behind it. Moreover, awareness campaigns rarely reach the public. Our Observers are worried about the long-term effects of this trade on health and are calling on the government to do something about it.

In the streets of Ivory Coast, you can easily buy vaccines, antibiotics or counterfeit malaria medicine. In May 2017, Ivorian authorities incinerated close to 40 tonnes of fake medicine seized in Adjamé, a neighbourhood in Abidjan, which has the largest market for “street medicine” in West Africa. Purchases made in this neighbourhood represent 30% of all medicine sales in the Ivory Coast. But despite the mass police operation, there is no sign that this illegal trade will dry up anytime soon.

Ivorian blogger Rita Dro recently visited a bus station in Mahapleu, a city in the west of the country, where she noticed that children were running small makeshift pharmacies. She says that this trade in unregulated and fake medicine is widespread but few people know the extent of the risks.

Rita Dro holds up “antibiotics”. The child vendor told her the red and yellow ones were amoxicillin. Photo by Rita Dro.

“The vendors sell these products in front of everyone, with total impunity!”

In the station, there are a few small pharmacies. I noticed that one of these pharmacies was being run by a 13-year-old boy. He explained that he had been selling medicine since he was nine years old and that the products came from Guinea. When someone came up to him, he asked the person about their symptoms, offered the person some tablets and even explained the dosage. I didn’t recognize all the medicines that he was selling but he told me that he sold antibiotics, among other products.

Maybe he is selling real medicine, but I am not going to try it. Even if this medicine is cheaper, it is left in the sun all day and can get wet or covered with dust.

I have relatives who buy this kind of medicine in the Roxy market in Abidjan, which has a wide selection. My relatives think that this medicine is exactly what you find in pharmacies – just cheaper. For example, a packet of antibiotics might cost around 1,200 CFA francs (about €1.80) in the pharmacy, but in the street, you can get two packets for just 100 CFA francs (about 15 euro centimes). I think that these people aren’t really aware of the risks. And even if they know that it is probably better to go to the pharmacy, people see buying medicine in the street as normal. Vendors sell these products in front of everyone, in total impunity.”

This medicine is all being sold on the street. You can find medicine to treat malaria (amodiaquine hydrochloride), antibiotics (penicillin and amoxicillin) beside other substances that are difficult to trace. (Photo by Rita Dro).

"There are laboratories in our country that manufacture fake medicine"

In September 2017, the pharmaceutical group Sanofi launched a mass campaign against the sale of fake medicine in Abidjan. An information bus spent four days traveling to ten different cities to raise awareness about the dangers of fake medicine or medicine sold by unlicensed providers. But, according to Charles Boguifo, the president of the Ivorian Order of Pharmacists in Ivory Coast, only universal healthcare could stem this flow. In the meantime, the health and safety consequences of this market are more and more worrying.

It’s very difficult to carry out awareness-raising campaigns or policies of repression because we let the mafia establish itself. The illegal sale of medicine is bigger and more profitable than drug trafficking here.

Some of the medicine sold in the street is real, it has just been stolen or is mislabeled. Most of the counterfeit medicine comes from Asia.

The vendors are ready to do anything to sell their products. It is easy to falsify the expiration dates, for example. Moreover, if you buy medicine that isn’t properly packaged, you have no guarantee that you are buying good medicine. There are also labs in our country that manufacture fake medicine [Editor’s note: In March 2017, the ministry of health closed a Chinese factory that was manufacturing fake medicine].

I think that we need studies carried out to improve our awareness-raising campaigns. We know, for example, that people can die from malaria if they are treated with fake medicine.

We also know that the sale of uncontrolled antibiotics can lead to resistance against antibiotics or kidney failure. We need financing to carry out good investigations and really establish the impact of this fake medicine [Editor’s note: According to the WHO, at least 100,000 people die each year in Africa from fake medicine].

Because you can buy one tablet at a time in the street, it feels like you are spending less. However, this is just an illusion. At best, the benefits are just in the short-term. In the long-term, it will end up just as expensive because it is likely that you won’t be cured.

I think also that people don’t really know how pharmacies work. Much has been done to make medicine more accessible. Now, you only have to buy the number of tablets you need for your treatment. It is also important to know that generics are actually good medicine but they cost less. Now, we hope that the government will establish universal healthcare to reimburse costs. That is the only thing that would definitely slow the trend of unregulated medicine [Editor’s note: Launched in 2014 by President Alassane Ouattara, universal healthcare is still in a trial phase].

Police seized this fake medicine in a home in Cocody, a municipality of Abidjan, in March 2017. (Photo sent to the FRANCE 24 Observers by Charles Boguifo.)

Police seized this fake medicine in the Roxy market in Adjamé. (Photo sent to the FRANCE 24 Observers by Charles Boguifo.)

A transnational offensive against the traffic of fake medicine

When contacted by FRANCE 24, the Board of Medical Pharmacies and Laboratories (in French, Direction de la pharmacie du médicament et des laboratoires, or the DPML), a body connected to the ministry of health, maintained that they were carrying out actions to fight against the trafficking of medicine, especially through enforcing security around customs and carrying out police raids.

“However, the most important thing is to dismantle networks and that’s a transnational problem, so, for that, we are going to adhere to the Council of Europe’s Medicrime Convention,” said Diallo Lacine Nouhoun, who is responsible for the fight against fake medicine at DPML.

On February 28, the Council of Ministers agreed upon the adhesion of Ivory Coast to this international convention that criminalises both the traffic itself and drug dealers. And on February 26, the Ivory Coast joined about a dozen other African nations in the signing of a resolution with the aim to reinforce efforts to combat the trade of fake medicine.