West Africa has become a hub for the trafficking of illegal medical products on the continent. Illicit medicines, vaccines, condoms, screening tests and other injection devices now represent between 20% and 60% of the official market in the Sahel region, as detailed in the report entitled “Illicit trafficking of medical products in Africa. the West” published in August under the aegis of the Economic Community of West African States (ECOWAS).
In 2019, their sale there already reached a billion dollars (some 935 million euros), according to the United Nations Office on Drugs and Crime (UNODC), a value higher than that generated by crude oil trafficking and cocaine.
Untangle the skein
Two researchers, the Senegalese Mouhamadou Kane, based in Dakar, and the Swiss Flore Berger, from the Global Initiative against Transnational Organized Crime, worked as part of the Organized Crime West African Response to Trafficking (OCWAR-T) project.
The report focuses on Guinea, which centralizes the majority of incoming flows by sea or air, and Burkina Faso, where trafficking routes converge before goods are redistributed in the sub-region. “Targeting the maritime entry point of Conakry and studying the consumption and transit market of Burkina, which has no coastline, allowed us to better understand the differences in how flows operate,” explains Flore Berger. Specifying, however, that this focus is not enough to encompass all the complexity and “the scale of West African trafficking, which is very underestimated”. From mass production to retail resale, no country is spared.
To untangle the tangle, the researchers conducted dozens of field interviews and organized focus groups with NGOs, national authorities, civil society organizations, public and private sector experts, pharmacists, doctors and their unions as well as consumer groups. They also got the players in this illicit market talking: manufacturers, traffickers and resellers.
Two circuits stand out. The first, illegal from start to finish, sees shipments leave from clandestine factories set up on the continent (Morocco, Senegal, Nigeria, Ghana) or in Asia (India and China) before being sold by street sellers. or in open-air markets. “A network of Guinean traffickers,” the report illustrates, “can ask a producer in India to reproduce paracetamol at a lower dosage to reduce its cost. »
The second, from legal production, can be diverted at several points in the chain. An official manufacturer may be tempted to attach to an order under-dosed batches of the same product or even inactive ones, which are difficult to detect at customs. The distribution networks, legitimized by the authorities, also have their gray areas. Public organizations and approved private wholesalers see part of their stocks diverted by corrupt agents, sometimes with the complicity of pharmacists or even doctors to health establishments or abroad.
Finally, at the sales stage, wholesalers or pharmacists may be tempted to offload goods whose expiry dates are coming to an end or have passed by selling them to individuals who will resell them in the street. But the opposite is also possible, reveal the authors, when pharmacists and depot owners, "to ensure greater income", come to obtain supplies from illegal wholesalers who display stocks of medicines whose packaging appears authentic on the shelves. open-air markets, such as in Sankariaré, one of the largest in Ouagadougou.
No type of medicine escapes this trafficking which generates enormous profits with prices 30% to 50% cheaper: the illicit market is divided equally between generics and patented molecules. Finally, the law of supply and demand adapts to the pathologies circulating in the sub-region: from antimalarials to antiretrovirals which treat HIV, including antibiotics, vaccines, anticancer drugs and anesthetics.
Some 500,000 deaths per year
How did we get here ? “Globalization and the complexity of cross-border chains have complicated the control of product quality and the tracking of counterfeits,” argue the authors of the report. In 2021, the Institute for Pharmaceutical Safety (ISP) recorded a 38% increase in medical product crime compared to the previous year. » The Covid-19 crisis has been there, with its share of stock shortages and supply difficulties, pushing further the consumption of illicit products, which are available. Too many authorized actors encourage trafficking and corruption at all stages of the chain, right up to customs, and complicate repression.
Beyond these conjectures, the weakness or even absence of laws criminalizing this type of crime is a real encouragement for traffickers. In Guinea, they face five to ten years in prison compared to ten to twenty years for drug trafficking. Burkina Faso has no legislative framework for these offenses. Only recourse to the health code or the penal code punishes the “illegal conduct” of a pharmacist or counterfeiting with two years of imprisonment.
Political instability in Mali, Burkina Faso, Guinea and Niger as well as the expansion of insecurity and jihadism further reduce the space of an already undersized formal market and thwart the efforts of States, increasingly sensitive to the urgency to act. “They expect a lot from the creation of the African Medicines Agency,” concludes Flore Berger, “and from the Plan for the Manufacturing of Pharmaceutical Products in Africa,” which does not only aim to make the continent less dependent on Asia. Every year, in West Africa alone, half a million people die from illicit medicines, the UN estimates. A year ago, The Gambia was mourned by the brutal deaths of seventy children who had ingested cough syrup made in India.