We wrote about the early efforts at DDT control, ad nauseum; but learned that our efforts to add historic perspective do little more than draw out life of the party commenters.
Thankfully, there are plenty of forward looking people who are willing to work at getting malaria incidence rates down, and, hopefully, many others who will be inspired by the following tale of scientific rationalism.
A fake version of the anti-malarial drug, artesunate, was being widely distributed though Southeast Asia, and had been putting lives at risk for nearly a decade. Thankfully, a recent collaboration between an international team of scientists and the Chinese authorities is making things right. Kudos to the team.
Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, and concerns that artemisinin resistance might be engendered.
Methods and Findings
With evidence of a deteriorating situation, a group of police, criminal analysts, chemists, palynologists, and health workers collaborated to determine the source of these counterfeits under the auspices of the International Criminal Police Organization (INTERPOL) and the Western Pacific World Health Organization Regional Office. A total of 391 samples of genuine and counterfeit artesunate collected in Vietnam (75), Cambodia (48), Lao PDR (115), Myanmar (Burma) (137) and the Thai/Myanmar border (16), were available for analysis. Sixteen different fake hologram types were identified. High-performance liquid chromatography and/or mass spectrometry confirmed that all specimens thought to be counterfeit (195/391, 49.9%) on the basis of packaging contained no or small quantities of artesunate (up to 12 mg per tablet as opposed to ∼ 50 mg per genuine tablet). Chemical analysis demonstrated a wide diversity of wrong active ingredients, including banned pharmaceuticals, such as metamizole, and safrole, a carcinogen, and raw material for manufacture of methylenedioxymethamphetamine (‘ecstasy'). Evidence from chemical, mineralogical, biological, and packaging analysis suggested that at least some of the counterfeits were manufactured in southeast People's Republic of China. This evidence prompted the Chinese Government to act quickly against the criminal traders with arrests and seizures.
An international multi-disciplinary group obtained evidence that some of the counterfeit artesunate was manufactured in China, and this prompted a criminal investigation. International cross-disciplinary collaborations may be appropriate in the investigation of other serious counterfeit medicine public health problems elsewhere, but strengthening of international collaborations and forensic and drug regulatory authority capacity will be required.
God bless children, science, bald eagles, and the growing recognition that unfettered capitalism poses real risks.
Via::PLOS Medicine, "A Collaborative Epidemiological Investigation into the Criminal Fake Artesunate Trade in South East Asia" Image credit::Centers For Disease Control, "Counterfeit and Substandard Antimalarial Drugs" AND GPHF, "Fake Artesunate In Southeast Asia"