Fake covid vaccines boost the black market for counterfeit medicines

An age old problem

Counterfeiting has existed in the medicine trade for centuries—it was rampant during the Great Plague pandemic of the 17th century, for example.10

Alok Dhawan, director of the Centre of Biomedical Research in Lucknow, India, says, “Fake medicines and vaccines are part of a parallel and illegal industry that flourishes in developing countries where most products are available over the counter and medical shops often lack qualified pharmacists.”

The globalisation of the pharmaceutical industry has spread both fake and substandard products worldwide. Active ingredients may come from China, while the product may be manufactured in India and be packaged in a third country before being shipped through Dubai. It might then be repackaged and shipped to yet another country to take advantage of exchange rates. These many steps provide places for fraud to occur.

A common practice is to procure empty vials and refill them with saline solution or substandard products. Dhawan says knock-offs that contain lower concentrations of the active pharmaceutical ingredients than the official drug are also common. “Small pharma companies, especially those which do outsource work for big companies, often flout good manufacturing practices to cut the cost,” he adds.

Health economist Eric Feigl Ding says counterfeits and substandard products “may contain harmful ingredients, less active ingredients, the wrong drug, the wrong concentration, or drugs past their expiry dates, resulting in poor effectiveness and unexpected side effects which may cause serious health implications.”

“More importantly, such products give patients the illusion of protection or a cure—which could further endanger themselves and endanger others if the disease is an infectious one,” he told The BMJ.

Counterfeits are marketed through spam email and social media. Yashasvi Yadav, special inspector general of police (cybercrime), Maharashtra, says consumers should be “cautious of emails advertising medical products with spelling mistakes and poor grammar, lacking a physical address, or offering prescription-only medicines without a prescription at a low price.”

Yadav says sales also take place over the darknet (hidden networks within the internet), and are almost impossible to track. It is unknown what proportion is genuine or counterfeit. According to Israel cybersecurity firm CheckPoint, darknet advertisements for covid-19 vaccines—including AstraZeneca, Johnson & Johnson, Sinopharm, and Sputnik V at $500-1000 per dose—have increased by more than 300% in the past three months.11

Pyzik says better authentication is needed. “At a macro level, a critical anti-falsification strategy is needed to reduce the number of imported pharmaceutical products by further developing local manufacturing capacity and investing in new technologies to protect the supply chain.”

But technology alone is not enough, says Pyzik. “Without a joined up global strategy and political will to increase medicine access, improve education and training around fake and substandard medicines, enhance regulatory capacity in low and middle income countries, and deter criminal activity via legislative reform, the black market will continue to thrive and poor-quality production sites proliferate.”

The trade indirectly funds other criminal activities, from human trafficking to funding terrorism, she says.

“With high profits, difficult detection, and low penalties or fines, the falsification of medicines may be described as the perfect crime.”