The global trade in counterfeit medicines is reaching alarming levels. One in ten medical products sold in low- and middle-income countries is of "substandard or falsified" quality, with nearly 50% of reported counterfeits originating from Africa, according to the World Health Organization.

West Africa in particular has become a hotspot for the sale of fake medical products, a new report by ECOWAS published in August 2023, citing data from the United Nations Office on Drugs and Crime (UNODC).

The “Trafficking illicit medical products in West Africa” report highlights that illicit medical products currently constitute between 20% and 60% of the official market across the entire region. In countries like Guinea and Burkina Faso, this percentage climbs as high as 80%.

Burkina Faso and Guinea: Major Hubs for Illicit Trade

According to the report by Flore Berger and Mouhamadou Kane, several factors contribute to the expansion of this illicit market, including corruption and insecurity. "Ongoing violence and instability in Burkina Faso have contributed to a sharp expansion of the market, and its porous borders have emerged, alongside the seaport in Conakry, Guinea, as major smuggling routes,” the report said. The report also highlights the involvement of criminal organizations in this illicit trade. It notes that weak regulatory frameworks in these countries have made the sector highly vulnerable to corruption, with "state authorities and individual medical workers helping counterfeiters to reach distributors and retailers directly.”

At the production stage, sources revealed that illicit importers in Burkina Faso and Guinea make direct orders from legal (and illegal) laboratories in India, asking them to produce X amount of Y medical product, often with less of the active ingredient to reduce the cost. In other parts of the supply chain, scenarios sometimes reveal the involvement of employees at official distributors, pharmacists, private depot sellers, as well as state officials and corrupt individuals within the healthcare sector.

The most common illicit medical products in the region are antimalarials, a trend explained by supply and demand dynamics. With the highest malaria rate in West Africa, 48% of the antimalarial market is believed to come from illicit sources. Other common products include antibiotics and antiretrovirals (HIV/AIDS). India and China are cited as the primary sources of both legal and illicit medical products found in West Africa.

The report also found that the illicit medical product trade is flexible in adapting to demand, maximizing profits for specific products based on seasonal demand (e.g., antimalarials during the rainy season, and cold and flu remedies during the dry season). This adaptability allowed criminal networks to respond to the peak of the COVID-19 pandemic with a sharp increase in demand for chloroquine, which was then considered an effective treatment.

Significant efforts in combating the issue, yet insufficient

The issue of illicit medical product trafficking is not new, but the ECOWAS report and its data emphasize the urgency of the situation. Efforts are being made, and various national, regional, and continental initiatives are being implemented to combat the problem. These include the establishment of an intervention brigade in Guinea following the ratification of the MEDICRIME Convention. Positive steps are also taken by both Burkina Faso and Guinea to centralize their markets, reducing the number of actors involved in the supply chain. However, these initiatives remain insufficient as the problem continues to grow. The Ecowas report calls for more concerted efforts by national authorities and emphasizes the crucial role that regional organizations and civil society can play.