Antimalarial medicine diversion: stock-outs and other public health problems

Abstract

Background: Antimalarial medicine diversion has been seen across numerous African markets and can lead to serious stock-outs in the public sector, which can be dangerous to countries with high burdens of disease. This study discusses the numbers of diverted antimalarial medicines from several samplings in Africa. Methods: A total of 894 samples of antimalarial medicines were covertly purchased from pri-vate pharmacies in 11 African cities from late 2007 to early 2010. All medicine packages were visually inspected for correctness, in line with the protocol established by the Global Pharma Health Fund e.V. Minilab ® , as well as for signs of diversion. Results: Overall, 6.5% (58 out of 894) of collected antimalarial medicines were found to be diverted, comprising 2.4% (5/210) of medicines collected in 2007 from six African cities, all of which were artemisinin-based combination therapies (ACTs); 2.3% (3/129) of medicines collected in 2008 in Lagos, Nigeria, two of which were ACTs; and 9% (50/555) of medicines collected in 2010 in 10 African cities, 35 of which were ACTs. ACT was by far the most diverted treatment in this study: 15.6% (5/32) of ACTs collected in 2007, and 30.7% (35/114) of ACTs collected in 2010. Conclusion: The number of diverted ACTs over the 33 months covered by this study is prob-ably related to the laudable provision of vast amounts of donated or low-priced ACTs across African nations and the actual increase in diversion of these medicines into the private sector. The small sample sizes in this study might exaggerate any problem, but a potentially serious problem may well exist. To the extent that diversion of medicines exacerbates stock-outs, this is a public health problem, and a perversion of donor intent, but there are other possible harms of diversion, such as increased trade in counterfeit, and expired and otherwise substandard medicines.