Blockchain technology is also revolutionizing supply chains in the pharmaceutical industry, in the process, helping track fake medicines. 



From genomics to robotics, technology is truly revolutionizing
the healthcare sector. And while it’s easy to become consumed by exciting,
futuristic trends like artificial intelligence (AI) diagnosis, digitized
patient records and 3D-printed medical tools, technology is also transforming
the pharmaceutical industry. How medication is prescribed, dispensed and
administered is big business with McKinsey predicting the value of Africa’s
pharmaceutical industry to be $65 billion in 2020.



But fake drugs are an ongoing and complex issue – they can
cause death, have unknown side-effects, fail to treat illnesses, and sometimes
even add to the spread of disease. According to World Health Organization (WHO)
statistics, 42% of detected cases of falsified (or substandard) pharmaceuticals
occur in Africa – reports estimate that between 72,000 and 169,000 children die
each year from pneumonia because of counterfeit antibiotics while fake malaria
drugs cause an additional 64,000 –158,000 deaths every year in sub-Saharan
Africa. Both antimalarials and antibiotics sit among the most commonly-reported
counterfeited drugs.



“Fake medicine distribution is rampant because business
processes are siloed between the various industry stakeholders, which puts the
industry at risk of fraud,” explains Heidi Patmore, a marketing consultant
specializing in technology that’s changing consumer behavior. 



“One solution to this would be cross-company process
automation which could easily be enabled by a blockchain data interchange. This
creates an open information system that all players can use to verify the
authenticity of medication because it can track and trace it from when it’s
manufactured to when it is dispensed to the patient.”



Companies such as IBM and SAP are working on blockchain
solutions to weed out Africa’s counterfeit medication network. When medicine is
returned to pharmaceutical manufacturers, for example, it is often re-sold
instead of being destroyed. How can a small local pharmacy ensure what is
returned is authentic? SAP are working with their existing client base – Merck,
GSK, Ingelheim, McKesson and others – on a blockchain project to verify that
any returned drugs are original. 



IBM Research’s solution for Africa (currently in development
in Haifa, Israel) includes a mobile interface and permissioned blockchain
backend that enables each certified and authorized party in the network to
initiate action, finish their transaction, and track its progress. 



“It also includes the monitoring of temperature to ensure
compliance with the proper conditions for transportation and asset transfer,”
adds Inna Skarbovsky, a blockchain architect from IBM Research – Haifa.
“Blockchain ensures full provenance for each medicine package, uniquely
identified with a barcode or a serial number. This makes it possible for all
authorized parties to track the drugs through the entire supply chain and the
drugs’ life-cycle.”



This also allows significant cost reductions by eliminating each participant’s need to manage a separate system for traceability of its components. “It also improves procedural efficiency for change-of-hands, make it much harder for counterfeit drugs to be introduced into the supply chain and to be distributed to end-users,” says Skarbovsky.



<figure class="wp-block-image size-large"><img decoding="async" loading="lazy" width="768" height="1024" src="https://www.forbesafrica.com/wp-content/uploads/2020/01/IMG_20190927_124217-1-768x1024.jpg" alt="" class="wp-image-42537"/><figcaption> Towett Ngetich, CEO of Uthabiti Health, a Kenya-based pharmaceutical company </figcaption></figure>



Towett Ngetich is the CEO of Uthabiti Health, a Kenya-based pharmaceutical company that has implemented blockchain to bring transparency and accountability back to a country where statistics show that 30% of medicines sold are counterfeit. Uthabiti, which means ‘verify’ in Swahili, was started after Ngetich’s first-hand experience with the effects of fake health products: “Back in university, a significant number of students fell victim to unplanned pregnancies and unsafe abortions. With deep research, it was uncovered that there had been a supply of fake contraceptives and backstreet abortion pills into the student market,” explains Ngetich. More findings showed the presence of fake antibiotics, antiretrovirals (ARVs) and non-communicable diseases (NCD) medicines in the Kenyan pharmaceutical supply chain. 



“Pharmaceutical science is the center of healthcare – one
mistake in any drug composition or formulation has the risk of endangering a
significant number of people. The need to access safe, affordable and quality
health products in its simplest form means life and death in diagnosed health complications.
Blockchain gives patients the ability to track and trace products using
attached IDs – it also gives Uthabiti Health the ability to know where all our
health products sit within each supply chain,” he says. Uthabiti Health
procures medicines from different pharmaceutical manufacturers. Once received,
they go to an internal laboratory for quality testing and are then labeled with
the product’s safety lab report – attached in their codes is a unique
blockchain ID. The medicines are then passed on to their partnering retail
points, ensuring that the medicines dispensed to patients can be verified with
something as simple as a text message. 



“This brings in consumers in safe-proofing the supply chain
of pharmaceuticals,” adds Ngetich. 



The proliferation of fake drugs throughout Africa is complex
– on average, medicine changes 30 hands before reaching the destined pharmacy –
but blockchain technology has great potential to help stop counterfeit medicine
distribution because it brings traceability and trackability to the entire
pharmaceutical supply chain, ensuring the immutability of information.&nbsp; 



<h4 class="wp-block-heading">Blockchain ethics?</h4>



<figure class="wp-block-image size-large"><img decoding="async" loading="lazy" width="709" height="1024" src="https://www.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-709x1024.jpg" alt="" class="wp-image-42533" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-709x1024.jpg 709w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-300x433.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-600x867.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-208x300.jpg 208w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-768x1110.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC-1063x1536.jpg 1063w, https://cms.forbesafrica.com/wp-content/uploads/2020/01/CandicedC.jpg 1329w" sizes="(max-width: 709px) 100vw, 709px" /><figcaption>Candice De Carvalho</figcaption></figure>



While blockchain is still a relatively niche technology, it is slowly changing how organizations operate. Blockchain promises better security and transparency, but not necessarily for the customer, in the case of drug allocation: “Where blockchain technology could likely increase efficiency and simultaneously decrease the abuse of medicines, customers benefit. The pharmaceutical and related industries are unique however, in that the ‘consumer’ is also a patient – a vulnerable group with special needs and rights,” explains Candice De Carvalho, the founder of Easy Ethics CPD.



Although overall transparency in the supply chain increases
through the use of blockchain, and this confers patient benefits, these must be
weighed against patient privacy and confidentiality.&nbsp; 



“With emerging technologies more freely available, we’ve
observed an interesting shift in patient behavior, where data privacy is
regarded less as an absolute by patients, in favor of a kind of sliding scale,
where privacy itself is a currency that purchases medical benefits along the
way,” adds De Carvalho. “Patients, for the right benefits, are perhaps more willing
to part with some privacy privileges.”



De Carvalho questions the genuine knowledge that patients
have of any exposure they experience through their use of novel medical device
or systems innovations. The key drivers for the business are not necessarily
unified with the total needs of the patient. However, the more the technology
owners protect and balance the patient’s need for confidentiality and consent,
the more they will ultimately see business benefit.&nbsp; 



“In the context of a doctor-patient relationship, the doctor has a positive duty to enhance patient understanding so that the patient enjoys a truly informed consent. Does this then mean that technology providers are now responsible in the same way that medical health workers are?” she ends.



-Tiana Cline

GettyImages-1056482262

Cure For Counterfeit Drugs?

It’s a familiar scene on a hot day in Accra, the capital of Ghana. The alleys are packed with women, carrying children on their backs, selling vegetables and fake Louis Vuitton bags while men sell anything they can get their hands on. Here, you could be sold a drug that could kill you.
The danger is counterfeit drugs that masquerade as healers but threaten to do the opposite.
Victoria Amponsah claims fake drugs almost robbed her of her unborn child like a thief in the night. The day she was diagnosed with malaria she also learned she was two months pregnant. She went to the nearest pharmacy, in Accra, and bought prescribed anti-malarial drugs she thought would save her and her child.
“That evening, I took the medicine. After about two to three hours, I started shaking and vomiting. I felt weak. I called a cotenant and showed her the drug and she said ‘I know this drug, its ok’. But when she [took out the pills from the box] she said ‘this is not the drug that is supposed to be in this box,’” Amponsah told the NGO, United States Pharmacopeia (USP).
&nbsp;
<div id="attachment_5209" style="width: 310px" class="wp-caption alignleft"><img aria-describedby="caption-attachment-5209" decoding="async" loading="lazy" class="size-medium wp-image-5209" src="/wp-content/uploads/2017/05/Bright_Pharmacy_Lonart_Phone_2015_hi-res-300x200.jpg" alt="" width="300" height="200" />Bright B. Simons is the brain behind mPedigree, a technology that&#8217;s used to counter counterfeiting of pharmaceutical products, wax prints and other products that are prone to piracy. Accra, Ghana.</div>
She was rushed to the hospital where a doctor confirmed the drug she took was fake. She managed to complete her pregnancy, but this was not the end of her struggle.
Near the end of her pregnancy, she almost died from a fake version of oxytocin, disguised in convincing packaging. Within 30 minutes of administration, Amponsah was sweating, shaking, vomiting and bleeding.
“I was bleeding so bad. [The doctors] were scared and didn’t want me to move,” she says.
She nearly lost her baby and was hospitalized for two days. For months later, she had to return to the hospital often, for checks.
“Sometimes I hear stories of a person who was fine, gave birth and the next minute the person has died and you find that they gave the person an injection and they died from it. I didn’t know it was that bad,” says Amponsah.
It is the poor, like Amponsah, that suffer. According to the Dutch Malaria Foundation, malaria is responsible for the death of one child dies every 45 seconds, but a third of malaria drugs sold in Africa are fake.
“My son was my biggest present; the center of my life. He is all I have… I am hoping that globally people understand that our lives are more important than the little money they will make out of bringing a fake drug out. [I hope] people will understand that it’s not all about money. It’s about life… the smallest thing, like just a tiny drug which is bad can cause so much damage in one’s life,” she says.
Amponsah and her son Denzel are among the few lucky ones. Over 30% of antimalarials in Africa contribute to nearly 450,000 preventable deaths each year, according to a report in the medical journal The Lancet. Fake tuberculosis and malaria drugs kill an estimated 700,000 people a year, according to the International Policy Network.
The manufacturers of this fake medicine make it look like the real thing. Mario Ottiglio, the Director of Public Affairs, Communications and Global Health Policy of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), says fake medicine thrives in countries with weak regulation.
“In areas of infectious disease, like malaria and tuberculosis, fake products with incorrect dosage of ingredients can result in antimicrobial resistance to genuine treatments. At a global level, analysis of reports over a five-year period, from 2005 to 2010, indicates that incidents of fake medicine increased by 122 percent, while diversion and theft increased by 66 percent,” says Ottiglio.
In 2009, 84 Nigerian children were killed by toxic chemicals that were laced with teething medications for babies. In 2012, Angolan custom agents busted counterfeiters importing what turned out to be one of the largest fake medicine imports in history, when containers shipped from China to Luanda, the capital of Angola, were filled with over 1.4 million packets of a fake version of the antimalarial drug, Coartem.
“In 2013, the World Health Organization (WHO) launched a global surveillance and monitoring system… Thus far, 48 percent of cases reported [to the system] have been in the African Region,” says Ottiglio.
A study published in the International Journal of Tuberculosis and Lung Disease found one in every six pills in Africa to be fake. Furthermore, a survey conducted by the National Institute of Health, which examined over 2,600 malaria drug samples across 21 sub-Saharan African countries, found 20% of these drugs were fake and a third were of poor quality.
Ottiglio says the first line of defence is to always buy medicine from licensed and certified sellers. People can check the packaging of the product for spelling mistakes or grammatical errors. Check for expiry dates and that the details on the outer package match up with the inner packaging. Those who are familiar with the medicine can check that the pill looks correct, is not discolored, degraded or doesn’t have an unusual smell.
Even with checks, there is still a problem. Some fake products are almost visually identical to the genuine ones. Often it’s difficult to tell the fake from the real thing.
Patrick Lukulay, Vice President of Global Health Impact Programs at United States Pharmacopeia, says during the outbreak of Ebola in Liberia, there were fake drugs on the market purporting to cure Ebola and people were attracted to them.
“The drugs most counterfeited though are lifestyle drugs such as Viagra and Cialis&#8230; Antibiotics and antimalarials are heavily counterfeited also because of demand for these drugs and the tendency for people to self-medicate. ARVs (antiretrovirals) are also counterfeited because of demand and the fact that people might seek to buy them in private settings for confidentiality purposes instead of getting them free from public facilities,” says Lukulay.
These drugs, according to Lukulay, are made in countries that have developed capacity for pharmaceutical manufacturing and packaging, such as India, China, Vietnam and Malaysia.
He says the ingredients used for fake drugs are usually cheaper versions of legitimate ingredients. An example is diethylene glycol, which is toxic but 10 times cheaper than the legitimate pharmaceutical grade ingredient, glycerine.
“They may also include impure cheap raw materials, such as over-sulphated chondroitin sulphate, the one found in blood thinner, heparin, a few years ago that killed people in the US,” says Lukulay.
<img decoding="async" loading="lazy" class="alignleft size-medium wp-image-5208" src="/wp-content/uploads/2017/05/20160801_091625-300x169.jpg" alt="" width="300" height="169" />
Unfortunately, the problem grows at an alarming rate. Lukulay estimates the counterfeit drug market is worth over $75 billion per year.
Like many problems in Africa, it is seen as an opportunity by private money.
In Ghana, entrepreneur, Bright Simons, says he has developed a program that is helping to curb the counterfeit drugs.
In 2007, he launched mPedigree, a company that has created software manufacturers can use to label their product packaging with a random code hidden beneath a scratch-off covering. If a consumer wants to know if their product is fake or not, they can just scratch off the covering and SMS the code to a toll-free number. They will then be notified whether the product is authentic.
Simons claims his services are used by around 100 million people per year in 12 countries, from India to Uganda.
“Our biggest frontier now is predictive analytics, in particular the use of our EarlySensor technology to predict hotspots and flashpoints of emerging counterfeit activity by looking at large data sets across time and space. If we can predict retail points that are likely to be targeted by counterfeiters by disrupting upstream distribution networks, we can actually stop counterfeiting from even getting to the level of the consumer,” he says.
This will help prevent the suffering that Amponsah experienced. She at least lived to tell her story; many more were not so lucky.

Tag: Medication

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Cure For Counterfeit Drugs?

A Deadly $75-Billion Business