A few weeks into his stay in rural East Africa, Jack was struck down with a burning fever, which alternated with icy chills. His body felt like someone had taken to him with a sledgehammer. He had prepared for his trip well enough to know that malaria was a possibility, and it could be life-threatening. Jack questioned if he was diligent enough with mosquito avoidance during evening activities.
The diagnosis was easily confirmed at the local hospital. Thankfully, they had malaria treatment medication and, better still, it was super cheap!
But how could Jack be sure of the treatment’s quality?
The global prevalence of counterfeit medical products is a growing concern, with international travellers being especially at risk. Unfamiliarity with the local healthcare system and difficulty identifying reliable pharmacies make travellers prime targets for counterfeiters.
At first glance, counterfeit drugs may be indistinguishable from legitimate medicines, but there are ways in which travellers can protect themselves.
World Health Organization (WHO) defines counterfeit medications in several ways:
Substandard medical products are authorised medical products that fail to meet quality standards or have expired.
Unregistered/unlicensed medical products have not been approved by the National or Regional Regulatory Authority for market nor consumption.
Falsified medical products deliberately misrepresent their identity, chemical composition or source.
Prevalence of counterfeit medications
The WHO estimates that 1 in 10 medical products in low- and middle-income countries is at a substandard quality or entirely counterfeit. In parts of Africa and India, it is thought that up to 35% of the drug supply is fake. More than 70% medication sourced online may be fake.
The most reported substandard and counterfeit medical products are anti-malarial medications and antibiotics.
The insidious nature of the problem was highlighted in a case report by WHO in 2017. In this report 44 children were admitted to hospital in Paraguay in September 2013, including 6 to intensive care. It was thought they were dealing with a new, previously unrecognized disease. The disease started with cold like symptoms and they were treated with locally made cough medicines. Investigators at WHO felt the circumstances of the “outbreak” were very similar to one in Pakistan where 60 adults were affected after using a cough medicine. There were 2 deaths.
In this case, a more expensive cough suppressant, dextromethorphan was substituted by a less expensive, but more powerful one. A link was established between the two cases. The medications had been sourced from the same manufacturer. Further investigation found that the contaminated medication had been exported to several other countries. Recall notices were put in place.
In the World Report in the Lancet, in 2015, it was reported there were 33 million doses of falsified antimalarial medication in one seized container load.
Counterfeit medications are a global issue!
More than a million deaths annually can be attributed, either directly or indirectly to counterfeit medications. It is likely to grow.
Risks to international travellers
Counterfeit drugs can contain incorrect ingredients, contaminants, or incorrect dosages. This can lead to ineffective treatment, harmful side effects, or worse. As a traveller, the consequences can be dire, particularly for those managing a chronic condition abroad, or those requiring urgent medical treatment.
A particularly dangerous situation can arise when a traveller requires treatment for a serious health issue, and unknowingly relies on counterfeit medications.
How to identify counterfeit medications
Check for unusual packaging
Pharmaceutical companies use consistent branding and packaging materials. Any variations in design, package colour, printing or labelling are a red flag. Incorrect spelling/grammar or poorly printed labels can indicate a fake product.
Check for damaged or expired products
Discoloured, cracked or sticky tablets; peeling film coating; pills that disintegrate easily; or liquids that do not mix back into suspension upon shaking are all indicators of drug degradation, which can result in the reduction of the drug’s effectiveness.
Check the manufacture date and expiry date on the package and ensure all details on the outer packaging match the dates stamped on the blister packet.
Check the price
Medications that are significantly cheaper than expected could be counterfeit. When travelling, purchase medication from reputable sources, such as large hospital pharmacies or internationally recognised pharmacy chains.
Preventive measures
Be prepared
To avoid the risk of counterfeit medications, travellers should bring adequate supply of their prescribed medications from home. In the instance where refills are required, carry a copy of the prescription, along with the generic name of the medication.
Avoid purchasing medications in open markets, street vendors, or small businesses
Some countries have a higher prevalence of counterfeit drugs. For example, in known counterfeit hotspots, such as Southeast Asia, parts of Africa and South America, it is recommended that travellers only obtain medications from hospital pharmacies.
In developing countries, pharmacists may not be required to be present in a pharmacy. As a traveller, try to insist on speaking directly with a pharmacist in the event you are seeking an equivalent medication.
Mobile Apps
Some countries have launched mobile apps and authentication tools to allow consumers to verify the legitimacy of medications by scanning the packaging.
Medical kit
A well-stocked medical kit is essential for travelling and ensures access to trusted, high-quality medications, reducing the need to rely on potentially fake or substandard medications in unfamiliar locations. In regions where counterfeit medications are prevalent, relying on local pharmacies is risky, especially for treating serious infections including malaria.
By carrying essential supplies, including existing prescription medications and OTC medications, travellers can have peace of mind knowing they are prepared for a spectrum of medical needs without relying on local sources.
Kits should be tailored to the destination, type of travel and length of stay. Individual differences may also impact on risk. These need to be considered when organising an appropriate kit. It might be more important for an older person to carry a course of medication for influenza when cruising than someone under 40 years. It is particularly important for an immune suppressed traveller.
Medication brand names can cause confusion. Being familiar with the generic name is important when travelling overseas.
Examples of common generic name drugs and their brands
| Brand Name | Generic Name |
|---|---|
| Nexium | Esomeprazole |
| Claratyne | Loratadine |
| Advil | Ibuprofen |
| Panadol | Paracetamol |
| Keflex | Cephalexin |
Recommended Resources
A Pocketbook on Healthy Travel provides useful information on the management of many common health issues experienced during travel. Generic names of medications are provided.
For more information of fake medication, see the WHO's guide on substandard and falsified medical products.
Australia’s TGA (Therapeutic Goods Administration) provides details on how to spot the difference between the real product and the counterfeit.
