Fighting Medicines that kill
Trafficking in falsified and substandard medicines (FSMs) deprives African patients of affordable quality medicines. In January 2020, six African governments joined together to combat this criminal activity that threatens public health, national security, and the rule of law. It also undermines the health economy.
A public health issue
Trafficking in falsified and substandard medicines (FSMs) poses a serious threat to individuals and families by depriving them of access to good quality medicines at an affordable price.
Due to its geopolitical, demographic, and economic location,
the African continent represents a lucrative market for traffickers of FSMs:
- 70-90% of medicines consumed in sub-Saharan Africa are imported (McKinsey, 2019).
- 42% of trafficking cases reported to the World Health Organization's global surveillance system
are from sub-Saharan Africa (WHO, 2017).
The socio-economic conditions of African populations favor the sale and consumption of FSMs and are one of the driving forces behind the expansion of this traffic. In addition, African countries suffer from a fragile health system marked by a lack of access to health care and essential medicines for many populations. An estimated 122,350 deaths of children under the age of five each year in the 39 countries of sub-Saharan Africa are thought to be related to the use of poor quality antimalarials (The American Journal of tropical medicine and hygiene, 2015).
Caption: Two women standing in front of a
a street pharmacy in Uganda - iStock
An issue related to security, rule of law and health economics
This illegal market is estimated to be worth US$200 billion worldwide. It greatly weakens African economies, particularly through money laundering. Studies conducted by various international organisations indicate that this trafficking is linked to organised crime. Increasingly important indications, reported in particular by the customs services of several countries, point to a link with terrorist networks, which ongoing studies must confirm.
Faced with this scourge, several African governments have joined forces to find ways to fight this multidimensional threat together.
The effects of corruption on the pharmaceutical supply chain
Observing the effects of corrupting agents on the pharmaceutical supply chain raises awareness of the need for (1) inter-ministerial action at the government level and (2) coordinated plans between the public and private sectors and civil society actors to effectively combat trafficking.
The genesis of the project
The Lomé Initiative, a political vision
At an international summit held in Lomé on January 18, 2020, Heads of State and representatives from Congo (B), Ghana, Niger, Senegal, Togo and Uganda met to develop a common response to the trafficking of FSMs and signed a political declaration launching the Lomé Initiative in which they committed to take action against the trafficking of FSMs by resolving to :
- Strengthen and harmonize legislation to combat the trafficking of FSMs.
- Sign and ratify international agreements, notably the MEDICRIME Convention of the Council of Europe, the Palermo Convention against Transnational Organized Crime of the UNODC, and the treaty establishing the African Medicines Agency (AMA).
The Ministry of Health of Togo, political coordinator
As the host of the Lomé Summit in January 2020, the Togolese Republic has since been responsible for the political coordination of the Lomé Initiative by maintaining working relationships with signatory and candidate states.
The coordination of the Lomé Initiative calls for the following actions:
- Meeting and networking of the Ministers of Health of the signatory states
- Meeting and networking of the Directors of Pharmacy
- Accompaniment for the signature of treaties and conventions
- Accompaniment for the elaboration of national plans
- Participation in the monitoring of the pilot in Togo
- Advocacy and representation at the sub-regional, continental and international levels
To carry out these actions, the Ministry of Health of Togo is supported by Brazzaville Foundation, technical coordinator.
We are leading a fight for health, the well-being of all, access to quality care at affordable prices. A fight that shows our faith in the future, the future of our children, the future of Africa.
Because falsified and substandard medical products are a common problem, we must work together on common solutions. With strong regulation and political commitment, we can ensure that all our brothers and sisters in Africa have access to the medicines they deserve.
The methodology of the national plans to combat FSMs
The consultations conducted by the Brazzaville Foundation in 2021 with the Lomé Initiative signatory countries and existing and potential technical and financial partners have resulted in a method agreement on the development and implementation of national plans to combat FSMs. This method agreement calls for:
1. A determined and interministerial action at the level
of the public authorities in order to create a transversal policy;
2. A concerted and coordinated action of the public authorities with
the private sector and the actors of the health system carried,
in particular, by the actors of the civil society (NGOs
The areas of action of the national plans
1. Strengthening the rule of law
2. Strengthening state security
3. Establishing a health economics policy
4. Improving public health
Priority targets of the plans
1. Women who are both buyers and sellers of FSMs
2. Young people who have the capacity to change purchasing behavior
3. Public opinion
Role of the Foundation
The Foundation organised the Lomé Summit in January 2020. The member states, as project owners, have mandated the Foundation to ensure the technical coordination of the Lomé Initiative. As such, it is also the project manager.
The Foundation operates on three axes:
1. Platforming the Lomé Initiative, by promoting the cooperation of all
stakeholders in the fight against FSMs on the African continent.
2. Advocacy, by contributing to the awareness at the international level.
3. Technical support, by working with the Ministers of Health
of the member and candidate countries of the Lomé Initiative.
After commissioning a legislative audit and a study of the pharmaceutical supply chain in 2020 and 2021, it developed a methodological proposal in 2022 to address the issue of combating the trafficking of FSMs in a systemic manner.
On 23 August 2022, during the 72nd session of the World Health Organization (WHO) Regional Committee for Africa, the Brazzaville Foundation co-organised a side event with the Ministry of Health of the Republic of Togo and the WHO Regional Office for Africa. In the photo, Dr. Mamessilé Aklah Agba-Assih, Minister of Health, Public Hygiene and Universal Access to Health Care of Togo; Dr. Joseph Kaboré, WHO Director of Program Management for Africa; Dr. Tedros Adhanom Ghebreyesus, WHO Director-General; Ms. Minata Samaté Cessouma, Commissioner for Health, Humanitarian Affairs and Social Development at the African Union; Dr. Daniel Ngamije, Minister of Health of Rwanda; Mr. Richard Amalvy, WHO Director-General for Africa; and Mr. Jean-Louis Ménard, WHO Director of Health. Richard Amalvy, Chief Executive of the Brazzaville Foundation.
The signatory states are the project owners of programme. The Republic of Togo, as host of the launching summit, is responsible for political coordination.
of the Congo
of The Gambia
of Guinea Bissau
of the Congo
The Brazzaville Foundation is the project manager of the programme and as such is responsible for technical coordination.
The Foundation has had observer status on the Committee of Parties of the Council of Europe's MEDICRIME Convention since May 2021. It is a member of the executive committee of the Fight the Fakes Alliance since March 2022.
Cooperation and collaboration
The Lomé Initiative partners have working relationships with
- Setting up of technical seminars in relation with the signatory countries and the organisations intergovernmental partners.
- Establishment of national plans to combat FSMs around four areas of action: rule of law, security, public health, health economics
- Monitoring the signing and ratification of international agreements
- Improving the legislative framework of signatory states
- Building capacity on the pharmaceutical supply chain and improving the sovereignty of African countries in terms of pharmaceuticals
- Establishment of an international consultation of young experts
Fake medicines: in Lomé, Togo and its partners call for a new approach
Combating the spread of substandard medicines in Africa
Le Point Afrique
Faced with trafficking, an African Medicines Agency
Opening remarks by Chief Executive at the Regional Committee on Combating Substandard and Falsified Medicines in Africa side event
72nd session of the WHO Regional Committee in Lomé: Faure Gnassingbé opens the proceedings
Gnassingbe A, Awesso A, Geissbuhler A, Flahault A, Sprumont D. Expansion of the informal drug market in Togo: an attempt to analyze the phenomenon.
InternationalJournalof Criminology and Technical and Scientific Police 2017; LXX N°3: 259-275.