Cost price drugs for developing countries are found in Belgian pharmaciesBMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7368.794 (Published 12 October 2002) Cite this as: BMJ 2002;325:794
The pharmaceutical industry's programme of sending HIV/AIDS drugs to Africa at preferential prices has been undermined by unscrupulous traders reimporting the cheap drugs to Europe for sale at full price, it emerged last week.
An investigation by Belgian customs authorities found that at least three million doses of GlaxoSmithKline's Combivir (zidovudine)—earmarked for sale in Africa at about £0.50 (€ 0.80; $0.78) per dose—have found their way onto European pharmacists' shelves, where they sell for about £3.80 (£6.00; $5.94) per dose. Quantities of GlaxoSmithKline's antiretroviral drugs Epivir (lamivudine) and Trizivir (abacavir) have also been illegally diverted back to Europe.
The drugs were supposed to go to HIV/AIDS clinics in Senegal, the Ivory Coast, the Republic of Congo, Togo, and Guinea-Bissau. An estimated 28 shipments, with a retail value of £18m (£29m; $28m), came back to Antwerp through Paris and Brussels.
Most of the diverted drugs were bought by unsuspecting pharmacists in Germany and the Netherlands, though a small proportion may have been sold in Britain. The drugs exported to Africa are identical to those used in Europe. Only the batch number, checked against manufacturers' records, can identify the diverted drugs.
Alan Chandler of GlaxoSmithKline estimated that about a quarter of the drugs it had exported to Africa had come back to Europe. “Upon arrival in Africa, these drugs are generally delivered to warehouses specified by the customers, who are typically local clinics. It's at that point that we lose sight of them, so we can't speculate on who is responsible.”
As the BMJ went to press no arrests had been made in the Netherlands or Belgium, but the investigation is continuing. The prime suspects are the shipping companies responsible for customs clearance at African airports. The pharmaceutical industry had already warned that the discrepancy in price between Europe and Africa drugs would prove a strong temptation to profiteers.
The Dutch government has issued a recall of all batches of Combivir originally intended for use in Africa. Mr Chandler said that, at the least, European laws against the re-importation of exported European goods had been infringed.
He added that the news would not prevent GlaxoSmithKline from continuing to provide drugs to developing countries at cost prices. “We're asking customs authorities to tighten up surveillance all along the line. We're also looking at changing the packaging, so that batches meant for Africa will be clearly labelled as such.”
Jonathan Quick, director of the World Health Organization's department of essential medicines, said there was a precedent for distinct labelling. Novartis's antimalarial drug Riamet (artemether plus lumefantrine) is shipped to Africa under the name Coartem.
GlaxoSmithKline provides essential medicines at cost price to poor countries under the accelerating access initiative, a UN deal signed two years ago. Bristol-Myers Squibb, Merck, Boehringer Ingelheim, and Roche are also signatories. Nineteen countries have concluded supply agreements under the deal, of which 12 are in Africa. The WHO estimates that 27 000 people in those 19 countries are now taking antiretroviral drugs, a 10-fold increase from two years ago but still only a tiny fraction of the patients in need.
Critics of the programme accuse the manufacturers of signing up to fend off competition from generic products.
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