10:00:00 BLACK SCREEN GRAPHIC:
V.O. Baby cries
'IT IS A DISGRACE THAT THE WORLD HAS ALLOWED MALARIA
DEATHS TO DOUBLE IN THE LAST 20 YEARS WHEN SO MUCH
COULD HAVE BEEN DONE TO STOP THE DISEASE.' Bill Gates
Microsoft Corporation
10:00:10 The small hand of a baby pierced with a blood transfusion tube.
10:00:15 COM: This is the untold story of the explosion of child malaria deaths in Africa.
10:00:20 Prof Nick White, Oxford University Laboratory
WHITE: We estimate that there are more than one million deaths each year - which is the equivalent of 7 jumbo jets going down every day.And 90% of those deaths are in children.
10:00:31 Laboratory research at Oxford University's Tropical Medicine Centre.
COM: Thirty years ago malaria, for most children, was no more dangerous than a dose of 'flu. What has happened to turn malaria into Africa's biggest child-killer?
10:00:42 Dr Dora Akunyili, NAFDAC Office, Nigeria
AKUNYILI: It is one of the greatest atrocities of our time. It is mass-murder. Honestly, it is a form of terrorism against public health.
10:00:50 Dr Martin Meremikwu, Calabar University Hospital, Nigeria
MEREMIKWU: I'm right at the point where malaria kills children - so I feel it on a daily basis and I know it is the truth.
10:0058 African child behind cot rails
10:01:01 Windows of a corporate office block.
10:01.15 African mother nurses her sick baby.
10:00:58 COM: This is a very different battle against malaria. One few people want to talk about. It is a battle against greed, corruption and a murderous global racket in fake drugs. But only is now the extraordinary damage caused by the racket coming to light…. And it effects everyone who takes medicine.
10:01:19 Graham Satchwell, Office
SATCHWELL: If we allow politicians to continue saying we didn’t know,we don’t know, when the catastrophe hits they’ll have somewhere to hide. We’ve got to remove that hiding place and ensure that they understand that this is got to be dealt with in a very powerful way now.
10:01:33 TITLES MONTAGE
African night market; magnifying glass; medicine pack; malaria parasites; handcuffed men; microscope; sick baby; mosquito; scientist in lab; drugs on fire; police car; gun.
THE MALARIA PARASITES
a murder mystery
by
Robert Cockburn
10:01:46 A pharmaceutical tablet pops out of a blister pack.
10: 01:49 COM: This tablet contains the world's last effective drug to treat malaria. All the other anti-malarial drugs have failed because of resistance in the malaria parasites.
10:01:54 Prof Nick White studies the drug pack, Artesunate, under a magnifying glass
10:02:01 COM: Called Artemisinin, this drug is all that stands between Africa's 500 million malaria sufferers and disaster.
10:02.10 CAPTION: Prof Nick White, Oxford University
10:02:09 WHITE: Resistance to the Artemisinins would be, as I've explained, an absolute catastrophe for our current attempts to try and control malaria.
10:02:19 Prof Whites opens a second pack and places two similar tablets in his palm.
10:02:20 COM: And there's another problem. Someone is making fakes of these Artemisinin drugs - and all the other drugs - and on a vast industrial scale.
10:02:30 WHITE (comparing tablets): Here we have two identical pills. Imagine your child having had a convulsion, a temperature of 40 degrees and the choice between these two medications is the choice between life and death. They are for all intents and purposes the same.
10:02:54 Researchers at work in Oxford Laboratory
10:02.51 COM: But the tablets beg another question for the scientists who are trying to save Artemisinin. Could there be a link between the fake drugs and all the genuine drugs that failed? To find out means going back 30 years.
10:03:04 Photo Montage of the AKUNYILI in Nigeria in 1960s and '70s.
10:03.07 AKUNYILI (VO): In the 1960s and 70s when we were young, when we had malaria, our parents would just give us money to go and buy chloroquine. You buy chloroquine. Take it. By the next day you are back to school.
10: 03:16 Armed Nigerian Police jump from Land Rover outside NAFDAC HQ.
10:03:17 COM: Then something happened to change everything.
10:03:20 Dr Dora Akunyili enters Nigeria's NAFDAC HQ with her armed body guard.
10:03:20 COM: Today, Dr Dora Akunyili is the director of Nigeria's national Food and Drug regulation body, called NAFDAC. The London-trained pharmaceutical scientist has become a crime fighter. In a corrupt and violent society she has created the world's first effective force to fight the horrors of the fake drug racket. And in doing so she came on a disturbing coincidence.
10:03.43 Dr Akunyili at her desk surrounded by armed guards
10:03.43 CAPTION: Dr Dora Akunyili, NAFDAC
10:03.43 AKUNYILI: Fake drugs were first noticed in Nigeria in 1968. It was when the fake drug racket broke out that people started dying like rats of malaria. People didn't used to die from malaria.
10:03:56 Oxford lab technicians conduct tests. Prof Nick White works in the background.
10:03:56 COM: Prof Nick White is one of the world's top malaria scientists. He and colleagues have been investigating the rise of fake anti-malaria drugs in South East Asia for over ten years.
10:04:07 WHITE: The question is why is malaria getting worse and not better. Fifty years ago it was in retreat. And today the number of cases of malaria and the number of people who are dying, mainly children, is increasing.I think it's a medical mystery, but I think it's one that might be soluble.
10:04:28 Dr Akunyili at work in her office. Prof White working at a microscope.
10:04:28 COM: In a radical new approach Akunyili and White began to study the spread of fake drugs. And also the drug companies and health regulators who were supposed to stop them.
10:04.37 AKUNYILI: The companies kept quiet. The regulators were paid off and everybody was helpless. Drug counterfeiters operated in this country and in most developing countries for almost three decades, unchallenged. And it just got worse progressively until 2001 when NAFDAC started waging a war against them.
10:04:50 Sick baby in Calabar Hospital
10:05:58 AKUNYILI: Can you imagine a child, a sick baby - most of the time they suffer from malaria - taking chloroquine that contains a fifth the strength? Or taking chloroquine that does not contain any chloroquine?
10:05:13 WHITE: I don’t think people quite understand what a serious thing it is to give somebody who has a serious infection no treatment. To me it’s murder or at least manslaughter. It’s a story of criminality. People are, for
a profit of a few cents, killing people.
10:05:36 Awards on Akunyili's office wall. Akunyili's portrait.
10:05:36 COM: Akunyili's campaign has made her a national hero to Nigerians who know her as "Dr Dora". But it has also made her a target of the fake drug racketeers.
10:05:46 WHITE: I think Dora's work is incredibly important, tremendously courageous. But that's what it takes. I think it takes one or two really determined individuals who are willing to put their heads above the parapet and stir things up. Fortunately she's had response from those in power. But she's taken tremendous risks.
10:06:14 NAFDAC raid. A guard holds his gun in a car patrolling the Lagos beachside.
10:06:16 COM: This is where the other battle against malaria begins. On raids like this, in Lagos.
10:06:22 An officer spots a hawker. 'There's one! So get ready!' The car stops. A hawker is arrested on the beach with his goods.
10:06:28 In her office Dr Akunyili unpacks fake drugs hidden in a child's T-shirt.
10:06:28 AKUNYILI: These are drugs hidden in T-shirts. And they stuffed every shirt with as many fakes as possible and we had millions of shirts, of course with many, many billions of the drugs. They had everything down to insulin, anti-snake venom, multi-vitamins, antibiotics. They had almost all ranges of drugs.Of course it is fake! We had it tested. It actually contained nothing.
10:06:59 NAFDAC night raid. Police grab and interrogate a frightened street hawker.
10:07:06 POLICEMAN: Where are you from? Where are you from?
SUSPECT: I'm from Abalindi.
POLICMAN: Abalindi! Abalindi! You no selling fake drugs in this area!?The suspect is mute with fear.
10:07:28 The man is bundled into a police van with several other suspects.
10:07:28 COM: Akunyili's commitment to stop the racket stems from an all too common tragedy.
10:07:38 Akunyili at office. Photo of her sister seen in earlier Family montage.
10:07:38 AKUNYILI: You know how many millions of people died from using fake drugs? My own sister died! That is blood money. My sister was a diabetic. And she was just taking rubbish insulin. Her blood sugar could not be controlled. She eventually died. Even before she died she was given an injection: the antibiotics she was getting they were all fake! And she just slowly, slowly died. That was in 1988. The doctors were confused, we were confused, I'm a pharmacist and my husband, a medical doctor. Yet we were just looking
at her dying. There was no awareness. It didn't even occur to us that this girl was not taking the right insulin. So I have been effected, very badly.
10:08:20 Tied together, suspects are led into a grim police station. interrogation room.
10:08:21 COM: Suspects caught in the raids are interrogated - as a deterrent against selling fake drugs and to try to get information about their source and the big criminals behind them.
10:08:38 OFFICER: Would you like to be harmed yourself?
SUSPECT 1: They are not fakes, sir. I have a NAFDAC licence.
OFFICER: Are you pharmacist?
SUSPECT 2: I'm a chemist.
The row of three suspects sit in frightened silence.
COM: The fake drug racket imposes a silence on everyone it touches.
10:08:55 Men throw boxes from a truck onto the huge dump of fake drugs. Various views of fake drugs and men working on the dump.
10:08:56 COM: NAFDAC brings its fake drug hauls come here. It is a vast tip with millions of fakes of the world's best-selling brand name medicines. They are to be set on fire later this day. It is now estimated that 10% of the world's available medicines are fakes like these - copies of life-saving tablets made of just rice or chalk or with small amounts of active ingredients. In Africa and Asia the fake drug figure is between 50% and up to 90% in some places. The global racket is worth $40 billion a year.
10:09:36 Boxes of fake anti-malaria drugs marked "TRUST MALAREICH"
10:09:36 COM: But it is anti-malarial drugs that are most often faked the demand for treatment grows.
10:09:46 CAPTION: Dioka Ejionueme, NAFDAC Enforcement
10:09:45 Dioka Ejionueme, NAFDAC, displays boxes of fake anti-malaria drugs.
10:09:45 EJIONUEME: We have four different types of anti-malarials we are destroying today. One of them is Halfan, that is halofrantrine.
10:09:54 CU of fake yellow Halfan box and two other fake anti-malaria drugs
10:09:54 EJIONUEME: The other three are different types of sulphadoxine-pyrimethamine combinations. This one is made by Touch Niwahl Exports Ltd, that's India - that's the claim here. Then the two other types are supposed to be made by Malareich company.
10:10:19 CU fake Malareich anti-malaria dug box.
10:10:19 EJIONUEME: One is the 10mil suspension of sulphadoxine-pyrimethamine combination. That's the Halfan, halofantrine. This is a popular drug made by SmithKlineBeecham. These fakers and people who import spurious products quite often they go for fast-moving products - especially anti-malarials. It is made to look like the original, everything about it, except when we send the product to the lab and it faces lab analysis, you know it's a fake one.
10:11:00 Ejionueme tosses the fake drug boxes onto the tip for burning.
10:11:02 EXT NAFDAC Laboratory.
NAFDAC laboratory staff test real and fake Halfan drugs seen on the dump.
10:11:03 COM: Samples of the fake anti-malarial drugs are brought here to the NAFDAC laboratories for analysis.
10:11:10 CU real and fake Halfan drug packs
10:11:11 OLOCU VO: This is the original Halfan tablets… and these are the fake.
10:11:20 CAPTION: Abimola Olocu, NAFDAC
10:11:19 OLOCU These two samples are different. The hologram is different compared to the original.
10:11:30 COM: They are building up a picture of different fake types - and clues to the rise of lethal malaria.
10:11:38 CU box of a fake anti-malarial drug marked, "Fansidar"
10:11:38 OLOCU (holding the fake): It's a fake product. This Fansidar is fake. It's anti-malarial. One of the active ingredients - it has two active ingredients - it has pyrimethamine, it has sulphadoxine. But the pyrimethamine aspect in it is failing. The active is failing.
10:11:58 Drugs pour from a machine into a bin. CU of drug production line.
10:11:58 COM: There are two victims of the fake drug racket. Consumers who lose their health and genuine drug manufacturers who lose sales.
10:12:07 COM: Colin Cummings is the managing director of Swiss Pharma. It is one of Nigeria's biggest drug companies and makes and sells the products of the big multi-nationals Hoffman le Roche and Bayer.Cummings has been with SwissPharma for 14 years.
10:12:23 Cummings and visitors change into white overalls.
10:12:24 COM: As a maker of anti-malarial drugs he is badly effected by the fake drug racket. And he is one of the first people in the industry to talk openly about the fake drug problem.
10:12:26 Swiss Pharma anti-malaria drugs, including Fansidar, laid on board room table.
10:12:34 CAPTION: Colin Cummings, Swiss Pharma
10:12:33 CUMMINGS: Nigeria, as I'm sure you know, has a very bad reputation for faking. The main one we've had faked is Fansidar because that's the highest volume. And what we've had to do, we've do just now changed the outer pack and the inner blister to try and stop the faking. What it'll do, it'll mean the product won't be faked for probably six months
until the fakers perfect our new packaging.
10:13:10 Staff operate tablet-making machines and pack a mound of drugs into boxes.
10:13:11 CUMMING: Faking is obviously very difficult to control. We, as a successful company, our products tend to be faked more so than some of the others. Obviously the fakers don't want to fake a product that is not successful. The more successful you are the more problems you have with faking. It obviously has an impact on sales if there is a large amount of fakes coming in.
10:13:41 CUMMINGS: There is a great deal of money to be made in faking products. Again, it's a special kind of person who would risk people's lives. But some people have no scruples.
10:13:52 A sick Nigerian baby attached to an IV drip in Calabar University Hospital.The baby is attended by a nurse and Dr Martin Meremikwu.
10:13:54 COM: The other victims of fake anti-malarial drugs are patients. Dr Martin Meremikwu and his staff are trying to save the life of newly arrived baby.
10:14:05 Dr Meremikwu calls, 'Sister, come here.'
10:14:10 EXT Calabar University Hospital main gate.
10:14:05 COM: Dr Meremikwu is associate professor of paediatrics at Calabar University Teaching Hospital in Southern Nigeria.
10:14:14 CU the sick baby breathing in distress
10:14:14 COM: He has seen the number child malaria deaths soar.
10:14:24 CAPTION: Dr Martin Meremikwu, Calabar University Hospital
10:14:18 MEREMIKWU: Right across from my room in the emergency room we have children who have been transfused yesterday, some convulsing. And we have not had any death in the last 24 hours - which is strange really because usually there's a couple each day. And most of them, and this is not exaggerating, it would be from malaria.
10:14:42 Dr Meremikwu enters malaria ward to examine children and explain things. Various shots of staff and sick children
10:14:42 MEREMIKWU: This is the Children's Emergency Unit. It's not very big but it's a pretty busy one. On a standard day half the unit will be made up of one type of malaria infections.
10:14:59 COM: By talking to parents that he pieced together the problem.
10:15:04 MEREMIKWU: The source of the problem is fake drugs. And this is not hypothesis, this is a real life situation - it happens every hour. In all the emergency rooms the children who die are likely to die in the first 24 hours of arriving. Those that arrive very late.
10.15.28 A mother nurses her sick child
10:15:29 COM: It is tragedy of timing. In the hours lost giving a child a useless fake, malaria turns into a killer.
10:15:37 MEREMIKWU: Because malaria should not kill people. It's a curable disease. But if they use the wrong drug - either because they are fake or they are ineffective because of resistance - then they are lying here with complications.And in children, young children, the time between a mild disease and a severe disease can be as little as 8 hours, or 24 hours or 12 hours. So time is of the huge essence here. You really cannot afford to try some other drug before trying a good one. You can't. Because you don't have that time.'
10:16:06 A mosquito, swollen with blood, feeds on a hand.
10:16:10 A specimen slide box is taken from a box. Prof White puts the slide under a microscope and examines it.
10:16:11 WHITE: Well, malaria is a remarkable parasite. It’s inoculated through the feeding, the bite of a female anopholine mosquito…
10:16:25 Malaria parasites dance under the microscope
10:16:23 WHITE: She injects roughly 10 microscopic little parasites which find their way to your liver. There they invade the red blood cells. And they invade the red blood cells by boring inside them and eating their contents. So gradually the number of red blood cells infected gets larger and larger. Initially, you begin to feel vaguely unwell, perhaps a bit like flu, shivers and shakes, headache, tummy ache. Now at that stage it’s readily treatable by anti malarial drugs we have, but if you don’t treat it for one reason or another and you leave it the form of
pernicious form of the disease parciforum malaria will continue to expand, occupy more and more red cells and these red cells then start to block up the capillaries and veins, the little tributaries where the blood flows, and eventually your vital organs such as the brain, the kidneys, the lungs start to fail. And you die.
10:17:30 A mother feeds her sick baby in Calabar Hospital.
10:17:31 COM: But it is now suggested that many and perhaps even most malaria deaths are due to fakes.
10:17:38 MEREMIKWU: I would agree that a substantial proportion of the malaria deaths probably are caused as a result of fake or sub-standard drugs.
10:17:49 WHITE: How many deaths I think is very difficult to say. But it just stands to reason that if you have a disease like malaria and you don’t treat it, you will die.
10:18:00 AKUNYILI: We had over 70 per cent of anti-malarials are fake. We don't have reliable statistics but we know that millions of people died.
10:18:06 A mother sits in tears in the Calabar malaria ward.
10:18:09 COM: And it is mostly parents who innocently give their own children fake drugs.
10:18:14 WHITE: I don’t think you can really describe how somebody would feel if they lost their precious child, or husband or wife to an eminently easily treatable disease when in all good faith they had thought that they had done the right thing.
10:18:33 A warehouse stacked high with boxes. An inspector cuts open a box with a knife revealing drugs inside.
10:18:35 COM: Is it possible that millions of children could have been murdered this way over the past 30 years? And if so, who should have stopped it?
10:18:47 AKUNYILI: All these deaths from fake drugs could have been prevented if governments came together to fight it - the way the Nigerian government is fighting it now. And if companies also came out to collaborate with governments it would've been stopped a long time ago. It wouldn't have lasted almost 30 years. That's ridiculous!
10:19:07 The interrogation of the suspects goes on at the police station.
10:19:07 COM: The criminals are only part of the story.
10:19:10 Car sirens. A police convoy crosses Lagos. In her car, Akunyili talks on a cell phone, concerned.
10:19:09 COM: When Akunyili started the fight back she had no idea of who or what she up was against.
10:19:17 CAPTION: Graham Satchwell, Fake Drug Expert
10:19:17 SATCHWELL: There is no standard model for who the counterfeiter is or how he behaves. But it is obviously true that he is a parasite on the back of the genuine manufacturers.
10:19:26 Satchwell at work in his UK office
10:19:26 COM: Graham Satchwell knows how hard it is fight the fake drug racket - from undercover jobs in Africa and Asia right up to the boardroom.
10:19:32 Asian street market
10:19:34 SATCHWELL: Action’s being taken now by the pharmaceutical industry to some extent, by government to some extent, and by other stakeholders like distributors, to some extent, but they’re not moving quickly and they all have their own motives.
10:19:48 COM: A former senior British policeman, he worked for Microsoft and then became head of security for the UK pharmaceutical giant, GlaxoSmithKline.
10:19:56 EXTs GSK Corporate HQ, London
10:19:56 COM: There he led the fight on fake drugs. He is the first person from a major drug company to talk openly about the fake drug racket.
10:20:03 SATCHWELL: It’s one thing to get out of bed in the morning to save Bill Gates an extra 1 m dollars - it’s quite another thing to get out of bed in the morning to thinking that you might actually help to save lives.
10:20:12 GSK logo on Corporate HQ, London
10:20:12 COM: And Satchwell learnt another crucial lesson about the fake drug racket.
10:20:16 SATCHWELL: There’s only one criteria for faking a drug and that is the ability to sell it. Nothing else matters – it’s a business.
10:20:24 Akunyili leaves a Lagos office with armed bodyguards.
10:20:24 COM: Akunyili's seemingly impossible goal was to stop people takingfakes.
10:20:29 Car sirens. A police convoy crosses Lagos.
10:20:29 COM: She took on the racketeers in a series of controversial innovations. It began well… tackling Nigeria's notorious corruption.
10:20:37 AKUNYILI (in car): Women are less prone to corruption than men, even in AFDAC. We no longer post men to some positions.
10:20:45 Akunyili meets with women at NAFDAC office
10:20:45 AKUNYILI: I don't know about developed countries, but in developing countries it's very difficult for men to resist a bribe, very difficult.
10:20:54 Akunyili exits her car at an office complex, flanked her guards. She meets NAFDAC enforcement director, Dioka Ejionueme. They joke a lot
10:20:54 AKUNYILI: This is my Director of Enforcement. Ray. He is a man, but he is not corrupt. But he is a man. (She laughs) I said that men are more susceptible to corruption.
10:21:08 EJIONUEME (laughing): That's a general rule all over the world, really. It's not peculiar to us in Nigeria.
10:21:14 AKUNYILI: Why are you more susceptible to corruption?
10:20:16 EJIONUEME, laughing: We are more exposed than women. We have to struggle generally for the survival of the world, including men… women and the children.
Everyone laughs
10:21:27 We now see the building around them is a blackened shell, gutted by fire.
10:21:30 COM: It soon got serious. The fake drug racketeers hit-back at NAFDAC with coordinated bomb attacks across the country.
10:21:39 Akunyili points to the destruction of the old NAFDAC complex.
10:21:39 AKUNYILI: Fire started on all sides of our laboratory in Kaduna and the place got raised down. That same week it happened to our office in Benin got burned down... and even two years before that our laboratory in Ocean was vandalised, in Lagos here, and all our sensitive equipment were destroyed.
10:21:59 Akunyili and her guards tour the remains of the building's charred interior.
10:21:59 AKUNYILI: From 2001 to 2004 we were working to upgrade this - computerisation, all sorts of softwares and office equipment and documents they were all gone. And we didn't even think of back-up. I think we were wrong. We should have had back-ups. It's not done by all Nigerians. It's done by very few murderers that have been living off the blood of people for many, many years and felt that nobody should stop them.It didn't really occur to me that these people would fight to this level! It didn't occur to me.
10:22:32 Eyes in a car mirror. Akunyili's convoy is halted on a busy Lagos street. Armed guards jump out to push a way through the traffic jam.
10:22:33 COM: When bombs didn't stop her Akunyili's car was ambushed and she was caught in a hail of automatic gunfire. She had a miraculous escape, a bullet burning her scalp. But a bus driver was hit.
10:22:50 AKUNYILI (in car): So the bus driver squeezed himself in between my and my the siren and took the bullets. So for him he was trying to escape the traffic but met his death.
10:23:03 SATCHWELL: In pursuit of crime, those who are prepared to inflict death in selling their products are invariably prepared to inflict death in protecting their profits too.
10:23:16 AKUNYILI: We have another problem of lack of or inadequate legislation. Because the laws against drug counterfeiting are weak and it is at the same time as lucrative as other criminal activities, criminals are now shifting from gun-running and carrying of cocaine and heroin and other hard drugs, to counterfeiting of medicines.
10:23:48 Armed Nigerian police arrest several suspects with boxes of fake drugs.
10:23:48 COM: Little is done to stop the world's hardest organised crime gangs moving into the racket. Akunyili had to find another way to save Nigerians from fake drugs.
10:23:58 NAFDAC TV Advert. A loud Nigerian song warns people against fake drugs.
"Nigerian people shine your eyes, shine your eyes…!"Adverts views of fake drugs, customers, police raids… "NAFDAC! Safeguarding the health of the nation!"
10:24:08 COM: NAFDAC launched a series of radio and television and radio adverts to stop Nigerians from taking fake drugs.
10:24:18 A public meeting packed with media. Akunyili gets a rapturous welcome. MoC shouts, 'Put your hands together for the award-winning Director-General of NAFDAC, Professor, Dr Dora Akunyili!'
10:24:23 COM: She launched an all-out information war.
10:24:28 NAFDAC Fake Drug Bulletin.
Pages of fake drug warnings. CU of fake Swiss Pharma Fansidar data
10:24:28 COM: The biggest breakthrough in saving lives is this NAFDAC bulletin. Alerts are issued for all fake drug finds - like these fake anti-malarials. And they are published in all Nigerian newspapers. They give consumers details about drug companies and brand names and key information to identify the fakes.
10:24:50 NAFDAC TV Advert. Customers in a pharmacy inspect drug products.
10:24:50 COM: Nigerians are becoming private detective to expose fakes and to save themselves.
10:24:57 COM: But the information campaign exposed unexpected obstacle…
…And with it another clue to the return of lethal malaria.
10:25:08 SATCHWELL: There has been secrecy. There still is secrecy around this issue - and misrepresentation around this issue.
10:25:18 Stack of Hollywood DVDs featuring THE THIRD MAN with Orson Welles. DVD opened to reveal a customer warning to report pirate copies of movies.
10:25:18 COM: While other industries are very public in their battle to stop product piracy… Fakes drugs are the pharmaceutical industry's most closely guarded secret.
10:25:27AKUNYILI: These drug companies, when we started they were not comfortable with our coming out openly. They wanted it kept hidden so that it doesn’t effect their legitimate business. Because they believe that when these fake drugs are advertised in the media and so on they believed that their real genuine drugs would not sell well.
10:25:45 CU Boxes of "Fansidar" anti-malaria drugs
10:25:45 COM: Malaria means money. It has created a boom in sales boom for both drug companies and the fakers.
10:25:53 Calabar Hospital corridor. Dr Meremikwu points to a door covered in anti- malaria drug adverts. One poster is for "Fansidar".
10:25:54 MEREMIKWU (pointing to posters): So, this is a classical hospital door, you know, with the drug companies advertising malaria. Look at this door. Everything on it is malaria adverts. This is the picture you see. I'm sure it's driven by the demand for anti-malarials.
10:26:08 SATCHWELL: The sale of drugs is like the sale of any other commercial product. Ultimately, it’s about people making something and selling it for a profit.
10:26:17 Swiss Pharma board room.
10:26:17 CUMMINGS: Er, I think the figure was $500 million supposed to be given in aid to West Africa over the next 3 years for malaria treatment.
10:26:28 Meremikwu points to another hospital door covered in drug company posters.
10:26:28 MEREMIKWU: And you can see what the drug companies do to us, always messing up out doors with adverts, posters. This is all commerce - trying to compel people to buy these drugs.
10:26:42 Cummings displays an advertsing flyer, headlined: "Malaria. An African child dies every 30 seconds!"
10:26:42 COM: But the companies don't show anywhere near the same enthusiasm in advertising the dangers of fake drugs.
10:26:51 CUMMINGS: Normally, what happens is NAFDAC give out the public warnings.
10:26:56 WHITE: But this is a very serious issue and for anti infectious drugs, we're talking about medicines which saves lives. And there is an absolute requirement that if fake drugs are known to be present in the market place or wherever then the public have a right to know about that immediately.
10:27:17 GRAPHIC: Official warning about fake 'Lipitor' heart drugs in US and UK
10:27:17 COM: The number of fake drug warnings issued by health authorities and drug companies is tiny when compared to the size of the problem.
10:27:25 SATCHWELL: They are being reluctant to admit that there is a problem, because once there is an admission that there is a real problem then there’s an expectation that they will act accordingly.
10:27:33 WHITE: Industry considers it in their commercial interest to keep this quiet.
10:27:40 Oxford lab researchers carry out tests.
10:27:40 COM: And White discovered the secrecy around the racket also extended to scientific research.
10:27:46 STILL PHOTO Dr Paul Newton.
10:27:49 EXT views GSK HQ office, London
10:27:45 COM: White's Oxford colleague, Dr Paul Newton, learnt that GlaxoSmithKline was doing research on samples of dangerous fakes of the GSK paediatric anti-malaria drug, Halfan.
10:27:57 Fake Halfan drug packs examined in NAFDAC Lab.
10:27:57 COM: The fake drug was a children's version of adult Halfan.
10:28:02 Oxford lab researchers carry out tests.
10:28:05 EXT views GSK HQ office, London
10:28:02 COM: But when Newton requested details about the fake child Halfan for his research he got this e-mail reply from GSK scientists.
10:28:11 GRAPHIC: E-mail over background of GSK HQ. Read out by actor:
"Analyzing counterfeit products of ours can be a very sensitive issue, and if I was to give you further information I would need to clear it with our corporate security and investigations department.
"The product presented in the paper was found in Central Africa, but for legal reasons, I can't be more specific at the moment." GSK
10:28:29 White reads a letter in Oxford lab.
10:28:29 COM: So, White wrote to Graham Satchwell, who was GSK's security chief, expressing concern about the lack of information and asking who GSK had warned about the fake child Halfan.
10:28:32 White's Oxford letter to Graham Satchwell. 10:28:48 EXT GSK HQ, London
10:28:41 COM: To the scientists' surprise GSK's international public policy director, Jessica Hughes, stepped in.
10:28:52 Jessica Hughes's GSK letter to White
10:28:48 COM: She confirmed that 'counterfeit Halfan is present in Nigeria and
scientists' specific questions
about the fake child Halfan and the public warnings.
10:28:48 COM: She confirmed that 'counterfeit Halfan is present in Nigeria and Sierra Leone' but still answered none of the scientists' specific questions about the fake child Halfan and the public warnings.
10:29:21 Akunyili at fax machine in office. CU fax message.
10:29:21 COM: This inability to get vital to information prompted an investigation by Oxford into the secrecy surrounding the racket.
10:29:29 White in lab
10:29:29 COM: White and Akunyili joined forces.
10:29:30 Public Library of Science Medicine journal front cover (PloS).
10:29:39 PloS article headline: "The global threat of counterfeit drugs -why industry and governments must communicate the dangers"
10:29:31 COM: Their findings were published in this American journal, the Public Library of Science Medicine. Its academic style couldn't hide their shocking conclusion.
10:29:41 CU PloS article headline: "Information Strictly Confidential"
10:29:41 WHITE (referring to article): The global threat of counterfeit drugs -why industry and governments must communicate the dangers.
10:29:46 GRAPHIC: PloS article text read by White.
10:29:46 WHITE: Many pharmaceutical companies and governments are reluctant to publicise the problem to health staff and the public apparently motivated by the belief that publicity will harm the sales of brand name products in a fiercely competitive business. We argue that this secrecy and the subsequent lack of public health warnings is harming patients. And it's also not in the long term interest of the legitimate pharmaceutical industry. It's actually to their benefit to do something about it.
10:30:17 African hospital malaria ward. CUs of nurses with children and a delirious man.
10:30:17 COM: For decades patients have suffered and died from fake drugs while potentially life-saving information has been kept confidential. And the reason for the secrecy, says the team, is not security, but money.
10:30:30 AKUNYILI: If the companies had risen up to their responsibilities early enough the issue of the preponderance of fake drugs would not have gotten to the level it got in Nigeria. It is this silence that is actually, largely encouraging drug counterfeiting.
10:30:40 Lagos beach traders. 10:30:50 A sick child on an IV drip in hospital
10:30:47 COM: During the Oxford investigation a disturbing incident came to light.
10:30:52 Oxford lab. White refers to PloS article.
10:30:53 WHITE: In contrast to the Nigerian experience one of the other authors of this paper, who works in Ghana, found counterfeits of the paediatric formulation of Halofrantrine.'
10:31:08 STILL PHOTO of Emmanuel Agyarko
10:31:08 COM: They were found by Emmanuel Agyarko, head of Ghana's Food and Drug Board. He prepared a public health warning.
10:31:16 WHITE: He also alerted the GSK's local Ghana agent who visited him with staff from GSK's London HQ who took away samples of the fake Halfan.
10:31:25 STILL PHOTO of Emmanuel Agyarko
10:31:25 COM: Agyarko says that GSK then asked to withhold his fake drug warning to avoid damage to the genuine product.
10:31:32 WHITE: So, after his meeting with GSK no warning was issued.
10:31:36 WHITE: GSK, who is the manufacturer, were informed and said they didn't know anything it.
10:31:48 EXT views GSK HQ office, London
10:31:48 COM: GSK issued this denial.
10:31:50 GRAPHIC: GSK statement read by actor:
"The discovery of fake Halfan in Ghana in 2002: we were not provided with any samples of fakes by the authorities in Ghana, nor were any reports of fakes lodged with us." GSK
10:32:01 EXT view GSK HQ office, London
10:32:01 COM: But Agyarko joined the Oxford investigation. And after the team took his case to a BBC radio programme, GSK changed its position.
10:32:10 WHITE: They reversed their position and said that their local agent had "bumped into" Mr Agyarko and had received his alert and samples of fake Halfan syrup.
10:32:23 EXT view GSK HQ office, London
10:32:23 COM: GSK issued this statement GSK:
10:32:26 GRAPHIC: GSK statement read by actor:
"There was some confusion over the interaction with Mr Agyarko. Mr Agyarko did provide us with a sample of the Halfan.
At no point was any pressure put on the Ghanaian authorities not to issue a public warning on fake Halfan. In our view there were minor discrepancies."
GSK
10:32:44 EXT view GSK HQ office, London
10:32:45 COM: One discrepancy concerned GSK's then security director, Graham Satchwell.
10:32:51 CUs Satchwell working at computer.
10:32:51 COM: He expected to get all reports of fake drug finds. He was not aware of the fake child Halfan incident in Ghana - or attempts by the Oxford team to contact him - until much later.
10:33:01 SATCHWELL: I was horrified actually. Because the implication was for me that somehow I was… that I would be the sort of person that in the corporate interest, in the interest of my back pocket, would allow children to suffer to cover the corporate name. That's just, I think that would just be a complete denial of who I hope I am.
10:33:27 EXT view GSK HQ office, London
10:33:27 COM: Asked why Satchwell was not made aware of the Ghana incident, GSK issued this statement:
10:33:32 GRAPHIC: GSK statement read by actor:
"There is a large anti-counterfeit team at GSK so the involvement or non-involvement of one individual is not unusual or significant." GSK
10:33:45 SATCHWELL: I will tell you this, there was one or twice at GSK - a company for which I've got a lot of respect and affection, and it’s full of people who just want to pay the mortgage and do their job - but there were one or two occasions when I said, "Well, if X happens then I’ll go to the press".
COCKBURN VO: Can you tell us what they are?
SATCHWELL: No. They were not about this issue. They were nothing as significant as the issue you've raised. But sufficient for me to say I can’t really think that’s the right way to go.
10:34:18 EXT view GSK HQ office, London
10:34:18 COM: GSK declined an invitation to appear on this programme to discuss fake drugs.
10:34:24 WHITE: I think it's not unique. I don't think GSK are particularly unusual at all in their activities. I think it comes back to this basic problem in that there is no legal requirement for them to do anything about this. So they, at least some of the time the pharmaceutical companies compute that it is in their financial interest to keep things quiet. But it's clearly not in the publics' health interest.
10:34:54 AKUNYILI: Drug companies, I can tell you without any fear of contradiction, most of them are more interested in their money.
10:35:01 Sick African girl sits behind the rails in a cot
10:35:01 AKUNYILI: They are much more interested in their money than in the health of the people. Understandably they are in business. But they forget that this is a business that effects life.
10:35:10 Akunyili at work with staff in office.
10:35:10 COM: Akunyili and White are calling for international legislation to make the reporting of fake drug discoveries mandatory - in line with other industries such as civil aviation.
10:35:20 WHITE: Right now they are not doing anything illegal by withholding that information and I think everybody, including the industry, feels that that's wrong. We absolutely have to have it as a legal requirement that if somebody identifies a fake drug that the government authorities must be notified and must take responsibility for that notification. One of the problems we've identified is that the pharmaceutical industry - who are often the people that do, I mean they’re obviously very concernedabout their drugs, so they're often detect that something is going on - that they are not obliged to inform anybody. Well, they have a clear conflict of interest. We must put the responsibility fairly and squarely on national authorities.
10:36:09 CU Akunyili's office guard
10:36:09 COM: In Nigeria, Akunyili has started to break the silence around the racket.
10:36:13 AKUNYILI: None of the MDs of these multinationals or local companies had the courage to come to me to complain.
10:36:19 Swiss Pharma HQ. Lobby sign reads: "Swiss Pharma welcomes NAFDAC."
10:36:19 COM: And for the first time, the pharmaceutical industry is revealing some its own secrets.
10:36:24 CUMMINGS: You have to be, it's difficult, you have to be very careful how and what you do. You don't want to spoil the company's reputation. You don't want the product to suffer. The reason they are secretive is, you don't want to tell people that there's a product that looks like your product out there and it's not your product. You have to balance the publicity of a product being faked and the damage that it can do to your product.
10:36:59 In hospital a baby girl and her mother are attended by Meremikwu
10:36:59 MEREMIKWU: She's had malaria. She's had chloroquine, by the way. It didn't work. She had another set. It didn't work….
10:37:11 AKUNYILI: We had over 70% of anti-malarials faked. These little children would be having fever, suffering and dying, and they would continue taking anti-malarial that contained nothing. And some of them would contained very little active ingredient - the same problem….
10:37:24 Mother feeds her daughter in hospital ward
10:37:27 CUMMINGS: If there's a fake of our products in the market and people buy them and they don't get well, obviously it has a big impact on our company. Because people don't have the faith in the product.And obviously in the past a lot of the big companies wouldn't say anything about it because they wouldn't want their original product to be damaged by a fake if it was that close .
10:37:56 SATCHWELL: Clearly there are tens of thousands people dying in China. Now in Africa, the situation could be worse because there are millions suffering from malaria there and the death toll’s extremely high.
10:37:57CUMMINGS (surprised): I don’t know how you equate that. I've no idea on figures.
10:38:14 Lagos street scene
10:38:14 COM: Many others have kept quiet, too.
10:38:16 AKUNYILI: Regulators and people that should talk were afraid out of being cowardly. Governments were also gagging the mouths of their regulators. Even up to today some regulators tell us that their governments do not allow them to talk.
10:38:32 GRAPHIC: WHO 1999 Counterfeit Drug Manual
10:38:32 COM: This is the WHO manual drawn up in 1999 to fight the fake drug racket.
10:38:38 SATCHWELL (with WHO Report): The WHO report is fabulous. You could read this report and be really impressed about the wonderful awareness that they have. They set out very clearly all the things clear here all that
has to be done: who has to be educated, what groups that have to work together to solve this problem of counterfeit drugs. Fabulous…. Absolutely useless of course.
10:38:58 WHITE: The WHO has made some good recommendations but these have not really been followed through. There is not, I think, the attention paid to it by international authorities or national agencies that it deserves.
10:39:13 SATCHWELL: The WHO and its members are so concerned about the world of counterfeit medicines and the hundreds and thousands of deaths every year, that they have one and a half people fully engaged on the problem.
10:39:24 WHITE: The whole issue of fake drugs and in particular fake anti malarial drugs has been, if not ignored, certainly under-appreciated.
10:39:34 The Lancet magazine. Dissolve through pages of fake anti-malaria drug reports.
10:39:35 COM: This is the latest list of fake anti-malaria drugs drawn up by Oxford's Dr Paul Newton for the UK Lancet journal. Only now is the full extent of the damage caused by fake drugs coming to light.
10:39:47 Oxford researchers conduct lab tests
10:39:47 COM: It is now believed that fake and substandard drugs are the main cause of the devastating return of malaria.
10:39:54 WHITE: For example, it’s been estimated that in East Africa in the 1990’s deaths from malaria doubled - and that was entirely attributable to drug resistance.
Resistance effectively means that the drug becomes no longer usable. And that is why malaria came back with such a vengeance in the last two or three decades.
10:40:19 Fake anti-malaria drugs displayed at NAFDAC lab
10:40:21 Malaria parasites under the microscope
10:40:19 COM: All new anti-malarial drugs, except for one, have been lost to this parasite resistance.
10:40:25 WHITE: So, what is the connection between fake drugs and resistance to anti- infectious drugs, such as anti malarials?
10:40:34 SE Asian customers buy tablets from a pharmacist
10:40:34 WHITE: Initially we concentrated on resistance emerging because people maybe took the wrong drugs or the prescribing was incorrect. But with the recent understanding, or at least the recent appreciation of the magnitude of the problem of counterfeit drugs, we realise that substandard drugs could actually be a major contributor to the emergence of resistance.
10:41.02 Calabar Hospital. Meremikwu checks the sick baby on the IV drip.
10:41.02 COM: In a tragic twist, patients assumed that dilute anti-malaria drugs had to be better than taking the cheapest fakes that contained nothing. Nothing could be further from the truth.
10:41.14 WHITE: Fake drugs are a nightmare because, perversely, if they contain nothing that’s better in terms of selection for resistance. But if they contain a little bit that is absolutely the worse scenario.
10:41.29 AKUNYILI: In fact the worst part of it is because of little active ingredient people were developing chloroquine-resistant malaria. Chloroquine- resistant malaria is caused by people not taking the right quantity of chloroquine over a long period of time. And that is the worst - actually using the drug to feed the parasite and getting the parasite used to the drug. In fact, the way I explain it is, the drug becomes food for the parasite. So,that when you eventually give the right quantity and quality of chloroquine to the baby, when the baby has gotten chloroquine-resistant malaria, the baby will no longer respond positively. So children suffer a lot.
10:42:11 Malaria parasites under the microscope
10:42:14 COM: Fake drugs are killing people through a process of resistance that destroys the power of genuine drugs.
10:42:21 MEREMIKWU: So, definitely it's going to kill the genuine ones if the fake ones continue to exist.
10:42:25 AKUNYILI: Yes, the fake drug racket and the silence associated with it have led to the resurgence of malaria.
10:42:33 WHITE: What drives resistance is sub-standard drugs, sub-standards or counterfeits, which contain some of the drug's substance. I think that everybody in the malaria field considers it to be a major threat.
10:42:46 WHO logo
10:42:50 CU tablets in a bag are handed over…
10:42:51 …a man pays for drugs in a shop…
10:42:54 …the man brings the drugs to his sick child and wife
10:42:46 COM: And yet, the WHO, which runs the world's Roll Back Malaria project with funds from the pharmaceutical industry, has missed some critical opportunities to warn about this danger.
10:42:57 Cover of WHO Malaria Drug Resistance Report 1998-2004
10:42:57 COM: This is a new WHO study into the rise of parasite resistance to anti- malarial drugs. Intended to shape health policy, it makes no mention of the link between fake drugs and resistance.
10:43:09 AKUNYILI: And people forget that this resistant strain when it develops in our body it does not need a visa to travel from country to country.
10:43:19 Mosquito biting hands.
10:43:19 AKUNYILI: So, when I get to that country and the mosquito bites me, it is sucking my blood and taking that parasite that has developed resistance and injecting it into another person's body.
10:43:30 MEREMIKWU: For everybody's safety, I mean, if you are visiting Africa and you got infected by a parasite that is resistant to all the drugs, I mean, you're as good as dead.
10:43:40 COMMINGS (startled): That one I don't know… I… I don't think that is really the case. I don't know if the fake drugs has caused that… or whether it's just the malaria parasite mutating or getting used to the products that are there. It also develops a resistance… (looks to a colleague for help) … and this is not my field. I'm looking over to Mr Sambo, here. My understanding is the parasite develops a resistance… anyway. I don't know if… I've no idea,or no way of knowing or being able to comment on whether it's the fakes that are causing the increase. I would like to pass that one to Mr Sambo to answer, really. He's a bit more qualified than I am. Could you take that one, Abbass?
10:44:42 CAPTION: Abbass Sambo, Swiss Pharma
10:44:41 SAMBO VO: Yeah, thank you very much.
10:44:42 SAMBO: Yes, one of the reasons may be that the drug is sub-standard. If you have a sub-standard product it means that the parasite can easily become resistant. The problem we are having with malaria is that malaria parasite can get resistant to basically any drug.
10:44:40 SAMBO: Definitely, yes, there is a challenge to the Artemisinin combination therapy, particularly if they are not used appropriately and because the prices are high, people cannot afford it if these products begin to be faked like the other ones.
10:45:15 Cummings blows out cheeks, surprised
10:45:16 COM: If Artemisinin fails the world will face the extinction of an entire drug type.
10:45:19 Oxford lab researchers, White in background
10:45:21 AKUNYILI: When we get Artesunate-resistant malaria where do we go from there?
10:45:26 Busy SE Asian street market
10:45:30 Child sick with malaria
10:45:36 Rows of blue containers marked "ARTEMISININ"
10:45:30 COM: Has the WHO left it too late to save hundreds of millions of malaria sufferers? And the last effective drug to treat them?
10:45:38 WHITE: We are now down to the last reliable class of drugs.
10:45:42 Air-mail package. White takes out two drug boxes marked "ARTESUNATE" He removes the drug blister packs to inspect
10:45:42 WHITE: The anti-malarial drugs that have been particularly targeted, the Chinese Artesunate which is a very, very important drug now, this drug in the market place costs of the order of US$1 and the fake drug costs about half the price. So for 50 cents somebody dies.
10:46:07 COM: The latest fakes are so sophisticated they require microscopes for identification.
10:46:15 White examines a drug box and its hologram with a magnifying glass.
10:46:18 White picks up a warning sheet with pictures of fake Artesunate holograms
10:46:18 WHITE: By generation six we've now got to have a hand lens. And by more recent generations you just simply can’t with the naked eye tell the difference and you have to have a microscope. And even then it's very difficult.
10:46:32 WHITE: We’ve seen with the people who are making the fakes, they have been adding a little bit, just a little bit, of the active ingredient
10:46:40 A baby's hand, with a blood transfusion tube, grabs at the air.
10:46:40 WHITE: But that little bit doesn’t cure you, what it does do is help resistance to develop.
10:46:46 WHITE: The problem in this particular case is that these drugs, the artemisinin derivatives, are the corner stone of our treatment for malaria. And if we lose those drugs to resistance it's an absolute disaster. All our modern treatment for malaria depends on this particular class of drugs.
10:47:05 BBC News Website Page. Headline: "Malaria drug threatened with resistance."
GRAPHIC: series of similar newspaper headline warnings
10:47:06 COM: Then came the worst news.
10:47:07 Radio grabs of WHO spokesman: "…There are some early warning signs coming from SE Asia and S America showing that there are already strains with reduced sensitivity to Artemisinins and it would be a major disaster.."
10:47:20 COM: Broadcast around the world, the WHO issued a series of dire warning that Artemisinin was now threatened with drug resistance.
10:47:28 Radio grabs of WHO spokesman: "… it would be a major disaster and it would be too late."
10:47:30 COM: And still, not one word was mentioned by the WHO about the role of fake drugs.
10:47:36 AKUNYILI: If we had addressed the problem of counterfeit sub-standard anti-malarials it would have been better for the whole world - especially for us in the developing countries that are suffering from malaria - to look at the problem as they are instead of saying that, "Oh, we have chloroquine-resistant malaria, we go ahead and use a higher drug, from one higher drug to another higher drug" - instead of facing the problem of why chloroquine was not working!
10:48:05 A doctor takes a blood sample from a woman's thumb and put it on a tester
10:48:05 COM: If the artemisinin drugs are lost it will take another 10 years to find a replacement.
10:48:11 SATCHWELL: We’re in a stage with this drug now where unless there is co-ordinated inter governmental action then could well be a massive loss of life - there is already massive - a catastrophic loss of life. What we have to do now is to ensure that the politicians can’t hide their heads under the blankets any longer.
10:48:34 WHITE: With the widespread use of substandard drugs I think we’re just sitting on a time bomb.
10:48:41 MEREMIKWU: It is up to us as a race, as a human race to decide to preserve these drugs until we find better drugs or to be careless with them anyhow and loose it. And then we have to pay for it with millions of lives.
10:48:56 A crowd gathers for setting fire to the fake drug tip. We see Dioka Ejionueme.
10:48:59 NAFDAC officer directing crowd, 'Come this way! Come this way to come and see the fire!'
10:49:04 Armed police arrest men for trying to steal fake drugs.
They are forced to sit on the ground. The media swarms around the men.
10:49:04 COM: Even as the fake drug were to burnt in Lagos the racketeers sent people in to grab back boxes of the best-selling fake brands.
10:49:12 The suspects are led away in handcuffs.
10:49:17 MEREMIKWU: Because big people can do bad things and get they away with it. Small people they do bad things they do get hold of them and put them in gaol.
10:49:24 EJIONUEME: What we are destroying here includes three trucks of mostly spurious pharmaceutical products raided from the Bridgehead markets.
10:49:33 Ejionueme lights the fake drug tip in different places. Flames spread.
10:49:38 AKUNYILI: If Bill Gates wants to save children from malaria - which I believe he wants to because he's very sincere. If he's not sincere he would not be spending all that money, after all nobody forces him to do that - he should spend more money on ensuring that the existing anti-malarials are genuine.
10:49:48 CU Fake Halfan drug box in flames
10:49:51 The fake drug tip roars up in flames
10:49:54 GRAPHIC:
The Bill and Melinda Gates Foundation, which puts money into the development of new anti-malaria drugs, has declined to discuss the issue of fake drugs.
10:50:01SATCHWELL: The problem of counterfeit medicines that once we all imagined was a problem for Africa is now a problem for the western world, for all parts of the developed world. Because these markets - Britain, Germany, USA - these provide a much bigger profit than does selling drugs to Africa.
10:50:10 Smoke and flames rises from the fake drug fire.
10:50:19 FX A baby cries over rising smoke and over following GRAPHIC ...
10:50:23 GRAPHIC: The WHO, Geneva, was preparing to launch of a global Task Force to fight the fake drug racket as this programme was being completed. Task Force leader, Dr Howard Zucker, declined to answer any questions about the fake drug racket.
10:50:36 At the fake drug tip an arrested suspect sits in a car and calls out:
10:50:36 SUSPECT: I don't do it. Somebody else do it.
10:50:39 GRAPHIC: FX fire burning
"We don’t think information is withheld for commercial reasons.
"The industry practice is to systematically report fake drug finds we are aware of to the authorities. It is only the authorities who can do anything about it.
"It is a criminal matter."
International Federation of Pharmaceutical
Manufacturers and Associations, Geneva
10:50:59 WHITE (at microscope): Parasites. Small parasites… and large parasites.
GRAPHIC:
GlaxoSmithKline has now 'formalised' reporting of its fake drug discoveries to government health authorities. It does support calls for laws to make such reporting mandatory.
10:51:06 ROLL CREDITS
Thanks to:
BBC Radio 'File on 4', The Public Library of Science Medicine, The American Prospect, ABC Radio The Science Show, Oxford University Centre for Tropical Medicine Oxford University, Mahodial University Bangkok, the WHO-WPRO, the Welcome Trust, Kamolrat Silamut, Steven Manion, Elena Curzio, Peter Paturi, Barry and Beaulah Bower, SafeMedicines.org.
Tom and Dot Cockburn
Camera Units
Africa
Elizabeth Tadic
Camera Assistant
Yinka Dada
England
Dirk Nel
Editor
Corinne Minore
Giovanni Berghi
Sound
Jon Bidgood
Library
With thanks to WHO Western Pacific Regional Office for use of its fake drug video, 'Dealers in Death'. Its international release was still withheld in November 2006.
Oxford University-Mahodilol University-Wellcome Trust Research Programme.
Journeyman Pictures
Original Music
Aaron Cockburn-Woods
Co-Producer
Francesca Arcuri
Producer
Robert Cockburn
Copyright 2006
FADE OUT 10:51:59
V.O. Baby cries
'IT IS A DISGRACE THAT THE WORLD HAS ALLOWED MALARIA
DEATHS TO DOUBLE IN THE LAST 20 YEARS WHEN SO MUCH
COULD HAVE BEEN DONE TO STOP THE DISEASE.' Bill Gates
Microsoft Corporation
10:00:10 The small hand of a baby pierced with a blood transfusion tube.
10:00:15 COM: This is the untold story of the explosion of child malaria deaths in Africa.
10:00:20 Prof Nick White, Oxford University Laboratory
WHITE: We estimate that there are more than one million deaths each year - which is the equivalent of 7 jumbo jets going down every day.And 90% of those deaths are in children.
10:00:31 Laboratory research at Oxford University's Tropical Medicine Centre.
COM: Thirty years ago malaria, for most children, was no more dangerous than a dose of 'flu. What has happened to turn malaria into Africa's biggest child-killer?
10:00:42 Dr Dora Akunyili, NAFDAC Office, Nigeria
AKUNYILI: It is one of the greatest atrocities of our time. It is mass-murder. Honestly, it is a form of terrorism against public health.
10:00:50 Dr Martin Meremikwu, Calabar University Hospital, Nigeria
MEREMIKWU: I'm right at the point where malaria kills children - so I feel it on a daily basis and I know it is the truth.
10:0058 African child behind cot rails
10:01:01 Windows of a corporate office block.
10:01.15 African mother nurses her sick baby.
10:00:58 COM: This is a very different battle against malaria. One few people want to talk about. It is a battle against greed, corruption and a murderous global racket in fake drugs. But only is now the extraordinary damage caused by the racket coming to light…. And it effects everyone who takes medicine.
10:01:19 Graham Satchwell, Office
SATCHWELL: If we allow politicians to continue saying we didn’t know,we don’t know, when the catastrophe hits they’ll have somewhere to hide. We’ve got to remove that hiding place and ensure that they understand that this is got to be dealt with in a very powerful way now.
10:01:33 TITLES MONTAGE
African night market; magnifying glass; medicine pack; malaria parasites; handcuffed men; microscope; sick baby; mosquito; scientist in lab; drugs on fire; police car; gun.
THE MALARIA PARASITES
a murder mystery
by
Robert Cockburn
10:01:46 A pharmaceutical tablet pops out of a blister pack.
10: 01:49 COM: This tablet contains the world's last effective drug to treat malaria. All the other anti-malarial drugs have failed because of resistance in the malaria parasites.
10:01:54 Prof Nick White studies the drug pack, Artesunate, under a magnifying glass
10:02:01 COM: Called Artemisinin, this drug is all that stands between Africa's 500 million malaria sufferers and disaster.
10:02.10 CAPTION: Prof Nick White, Oxford University
10:02:09 WHITE: Resistance to the Artemisinins would be, as I've explained, an absolute catastrophe for our current attempts to try and control malaria.
10:02:19 Prof Whites opens a second pack and places two similar tablets in his palm.
10:02:20 COM: And there's another problem. Someone is making fakes of these Artemisinin drugs - and all the other drugs - and on a vast industrial scale.
10:02:30 WHITE (comparing tablets): Here we have two identical pills. Imagine your child having had a convulsion, a temperature of 40 degrees and the choice between these two medications is the choice between life and death. They are for all intents and purposes the same.
10:02:54 Researchers at work in Oxford Laboratory
10:02.51 COM: But the tablets beg another question for the scientists who are trying to save Artemisinin. Could there be a link between the fake drugs and all the genuine drugs that failed? To find out means going back 30 years.
10:03:04 Photo Montage of the AKUNYILI in Nigeria in 1960s and '70s.
10:03.07 AKUNYILI (VO): In the 1960s and 70s when we were young, when we had malaria, our parents would just give us money to go and buy chloroquine. You buy chloroquine. Take it. By the next day you are back to school.
10: 03:16 Armed Nigerian Police jump from Land Rover outside NAFDAC HQ.
10:03:17 COM: Then something happened to change everything.
10:03:20 Dr Dora Akunyili enters Nigeria's NAFDAC HQ with her armed body guard.
10:03:20 COM: Today, Dr Dora Akunyili is the director of Nigeria's national Food and Drug regulation body, called NAFDAC. The London-trained pharmaceutical scientist has become a crime fighter. In a corrupt and violent society she has created the world's first effective force to fight the horrors of the fake drug racket. And in doing so she came on a disturbing coincidence.
10:03.43 Dr Akunyili at her desk surrounded by armed guards
10:03.43 CAPTION: Dr Dora Akunyili, NAFDAC
10:03.43 AKUNYILI: Fake drugs were first noticed in Nigeria in 1968. It was when the fake drug racket broke out that people started dying like rats of malaria. People didn't used to die from malaria.
10:03:56 Oxford lab technicians conduct tests. Prof Nick White works in the background.
10:03:56 COM: Prof Nick White is one of the world's top malaria scientists. He and colleagues have been investigating the rise of fake anti-malaria drugs in South East Asia for over ten years.
10:04:07 WHITE: The question is why is malaria getting worse and not better. Fifty years ago it was in retreat. And today the number of cases of malaria and the number of people who are dying, mainly children, is increasing.I think it's a medical mystery, but I think it's one that might be soluble.
10:04:28 Dr Akunyili at work in her office. Prof White working at a microscope.
10:04:28 COM: In a radical new approach Akunyili and White began to study the spread of fake drugs. And also the drug companies and health regulators who were supposed to stop them.
10:04.37 AKUNYILI: The companies kept quiet. The regulators were paid off and everybody was helpless. Drug counterfeiters operated in this country and in most developing countries for almost three decades, unchallenged. And it just got worse progressively until 2001 when NAFDAC started waging a war against them.
10:04:50 Sick baby in Calabar Hospital
10:05:58 AKUNYILI: Can you imagine a child, a sick baby - most of the time they suffer from malaria - taking chloroquine that contains a fifth the strength? Or taking chloroquine that does not contain any chloroquine?
10:05:13 WHITE: I don’t think people quite understand what a serious thing it is to give somebody who has a serious infection no treatment. To me it’s murder or at least manslaughter. It’s a story of criminality. People are, for
a profit of a few cents, killing people.
10:05:36 Awards on Akunyili's office wall. Akunyili's portrait.
10:05:36 COM: Akunyili's campaign has made her a national hero to Nigerians who know her as "Dr Dora". But it has also made her a target of the fake drug racketeers.
10:05:46 WHITE: I think Dora's work is incredibly important, tremendously courageous. But that's what it takes. I think it takes one or two really determined individuals who are willing to put their heads above the parapet and stir things up. Fortunately she's had response from those in power. But she's taken tremendous risks.
10:06:14 NAFDAC raid. A guard holds his gun in a car patrolling the Lagos beachside.
10:06:16 COM: This is where the other battle against malaria begins. On raids like this, in Lagos.
10:06:22 An officer spots a hawker. 'There's one! So get ready!' The car stops. A hawker is arrested on the beach with his goods.
10:06:28 In her office Dr Akunyili unpacks fake drugs hidden in a child's T-shirt.
10:06:28 AKUNYILI: These are drugs hidden in T-shirts. And they stuffed every shirt with as many fakes as possible and we had millions of shirts, of course with many, many billions of the drugs. They had everything down to insulin, anti-snake venom, multi-vitamins, antibiotics. They had almost all ranges of drugs.Of course it is fake! We had it tested. It actually contained nothing.
10:06:59 NAFDAC night raid. Police grab and interrogate a frightened street hawker.
10:07:06 POLICEMAN: Where are you from? Where are you from?
SUSPECT: I'm from Abalindi.
POLICMAN: Abalindi! Abalindi! You no selling fake drugs in this area!?The suspect is mute with fear.
10:07:28 The man is bundled into a police van with several other suspects.
10:07:28 COM: Akunyili's commitment to stop the racket stems from an all too common tragedy.
10:07:38 Akunyili at office. Photo of her sister seen in earlier Family montage.
10:07:38 AKUNYILI: You know how many millions of people died from using fake drugs? My own sister died! That is blood money. My sister was a diabetic. And she was just taking rubbish insulin. Her blood sugar could not be controlled. She eventually died. Even before she died she was given an injection: the antibiotics she was getting they were all fake! And she just slowly, slowly died. That was in 1988. The doctors were confused, we were confused, I'm a pharmacist and my husband, a medical doctor. Yet we were just looking
at her dying. There was no awareness. It didn't even occur to us that this girl was not taking the right insulin. So I have been effected, very badly.
10:08:20 Tied together, suspects are led into a grim police station. interrogation room.
10:08:21 COM: Suspects caught in the raids are interrogated - as a deterrent against selling fake drugs and to try to get information about their source and the big criminals behind them.
10:08:38 OFFICER: Would you like to be harmed yourself?
SUSPECT 1: They are not fakes, sir. I have a NAFDAC licence.
OFFICER: Are you pharmacist?
SUSPECT 2: I'm a chemist.
The row of three suspects sit in frightened silence.
COM: The fake drug racket imposes a silence on everyone it touches.
10:08:55 Men throw boxes from a truck onto the huge dump of fake drugs. Various views of fake drugs and men working on the dump.
10:08:56 COM: NAFDAC brings its fake drug hauls come here. It is a vast tip with millions of fakes of the world's best-selling brand name medicines. They are to be set on fire later this day. It is now estimated that 10% of the world's available medicines are fakes like these - copies of life-saving tablets made of just rice or chalk or with small amounts of active ingredients. In Africa and Asia the fake drug figure is between 50% and up to 90% in some places. The global racket is worth $40 billion a year.
10:09:36 Boxes of fake anti-malaria drugs marked "TRUST MALAREICH"
10:09:36 COM: But it is anti-malarial drugs that are most often faked the demand for treatment grows.
10:09:46 CAPTION: Dioka Ejionueme, NAFDAC Enforcement
10:09:45 Dioka Ejionueme, NAFDAC, displays boxes of fake anti-malaria drugs.
10:09:45 EJIONUEME: We have four different types of anti-malarials we are destroying today. One of them is Halfan, that is halofrantrine.
10:09:54 CU of fake yellow Halfan box and two other fake anti-malaria drugs
10:09:54 EJIONUEME: The other three are different types of sulphadoxine-pyrimethamine combinations. This one is made by Touch Niwahl Exports Ltd, that's India - that's the claim here. Then the two other types are supposed to be made by Malareich company.
10:10:19 CU fake Malareich anti-malaria dug box.
10:10:19 EJIONUEME: One is the 10mil suspension of sulphadoxine-pyrimethamine combination. That's the Halfan, halofantrine. This is a popular drug made by SmithKlineBeecham. These fakers and people who import spurious products quite often they go for fast-moving products - especially anti-malarials. It is made to look like the original, everything about it, except when we send the product to the lab and it faces lab analysis, you know it's a fake one.
10:11:00 Ejionueme tosses the fake drug boxes onto the tip for burning.
10:11:02 EXT NAFDAC Laboratory.
NAFDAC laboratory staff test real and fake Halfan drugs seen on the dump.
10:11:03 COM: Samples of the fake anti-malarial drugs are brought here to the NAFDAC laboratories for analysis.
10:11:10 CU real and fake Halfan drug packs
10:11:11 OLOCU VO: This is the original Halfan tablets… and these are the fake.
10:11:20 CAPTION: Abimola Olocu, NAFDAC
10:11:19 OLOCU These two samples are different. The hologram is different compared to the original.
10:11:30 COM: They are building up a picture of different fake types - and clues to the rise of lethal malaria.
10:11:38 CU box of a fake anti-malarial drug marked, "Fansidar"
10:11:38 OLOCU (holding the fake): It's a fake product. This Fansidar is fake. It's anti-malarial. One of the active ingredients - it has two active ingredients - it has pyrimethamine, it has sulphadoxine. But the pyrimethamine aspect in it is failing. The active is failing.
10:11:58 Drugs pour from a machine into a bin. CU of drug production line.
10:11:58 COM: There are two victims of the fake drug racket. Consumers who lose their health and genuine drug manufacturers who lose sales.
10:12:07 COM: Colin Cummings is the managing director of Swiss Pharma. It is one of Nigeria's biggest drug companies and makes and sells the products of the big multi-nationals Hoffman le Roche and Bayer.Cummings has been with SwissPharma for 14 years.
10:12:23 Cummings and visitors change into white overalls.
10:12:24 COM: As a maker of anti-malarial drugs he is badly effected by the fake drug racket. And he is one of the first people in the industry to talk openly about the fake drug problem.
10:12:26 Swiss Pharma anti-malaria drugs, including Fansidar, laid on board room table.
10:12:34 CAPTION: Colin Cummings, Swiss Pharma
10:12:33 CUMMINGS: Nigeria, as I'm sure you know, has a very bad reputation for faking. The main one we've had faked is Fansidar because that's the highest volume. And what we've had to do, we've do just now changed the outer pack and the inner blister to try and stop the faking. What it'll do, it'll mean the product won't be faked for probably six months
until the fakers perfect our new packaging.
10:13:10 Staff operate tablet-making machines and pack a mound of drugs into boxes.
10:13:11 CUMMING: Faking is obviously very difficult to control. We, as a successful company, our products tend to be faked more so than some of the others. Obviously the fakers don't want to fake a product that is not successful. The more successful you are the more problems you have with faking. It obviously has an impact on sales if there is a large amount of fakes coming in.
10:13:41 CUMMINGS: There is a great deal of money to be made in faking products. Again, it's a special kind of person who would risk people's lives. But some people have no scruples.
10:13:52 A sick Nigerian baby attached to an IV drip in Calabar University Hospital.The baby is attended by a nurse and Dr Martin Meremikwu.
10:13:54 COM: The other victims of fake anti-malarial drugs are patients. Dr Martin Meremikwu and his staff are trying to save the life of newly arrived baby.
10:14:05 Dr Meremikwu calls, 'Sister, come here.'
10:14:10 EXT Calabar University Hospital main gate.
10:14:05 COM: Dr Meremikwu is associate professor of paediatrics at Calabar University Teaching Hospital in Southern Nigeria.
10:14:14 CU the sick baby breathing in distress
10:14:14 COM: He has seen the number child malaria deaths soar.
10:14:24 CAPTION: Dr Martin Meremikwu, Calabar University Hospital
10:14:18 MEREMIKWU: Right across from my room in the emergency room we have children who have been transfused yesterday, some convulsing. And we have not had any death in the last 24 hours - which is strange really because usually there's a couple each day. And most of them, and this is not exaggerating, it would be from malaria.
10:14:42 Dr Meremikwu enters malaria ward to examine children and explain things. Various shots of staff and sick children
10:14:42 MEREMIKWU: This is the Children's Emergency Unit. It's not very big but it's a pretty busy one. On a standard day half the unit will be made up of one type of malaria infections.
10:14:59 COM: By talking to parents that he pieced together the problem.
10:15:04 MEREMIKWU: The source of the problem is fake drugs. And this is not hypothesis, this is a real life situation - it happens every hour. In all the emergency rooms the children who die are likely to die in the first 24 hours of arriving. Those that arrive very late.
10.15.28 A mother nurses her sick child
10:15:29 COM: It is tragedy of timing. In the hours lost giving a child a useless fake, malaria turns into a killer.
10:15:37 MEREMIKWU: Because malaria should not kill people. It's a curable disease. But if they use the wrong drug - either because they are fake or they are ineffective because of resistance - then they are lying here with complications.And in children, young children, the time between a mild disease and a severe disease can be as little as 8 hours, or 24 hours or 12 hours. So time is of the huge essence here. You really cannot afford to try some other drug before trying a good one. You can't. Because you don't have that time.'
10:16:06 A mosquito, swollen with blood, feeds on a hand.
10:16:10 A specimen slide box is taken from a box. Prof White puts the slide under a microscope and examines it.
10:16:11 WHITE: Well, malaria is a remarkable parasite. It’s inoculated through the feeding, the bite of a female anopholine mosquito…
10:16:25 Malaria parasites dance under the microscope
10:16:23 WHITE: She injects roughly 10 microscopic little parasites which find their way to your liver. There they invade the red blood cells. And they invade the red blood cells by boring inside them and eating their contents. So gradually the number of red blood cells infected gets larger and larger. Initially, you begin to feel vaguely unwell, perhaps a bit like flu, shivers and shakes, headache, tummy ache. Now at that stage it’s readily treatable by anti malarial drugs we have, but if you don’t treat it for one reason or another and you leave it the form of
pernicious form of the disease parciforum malaria will continue to expand, occupy more and more red cells and these red cells then start to block up the capillaries and veins, the little tributaries where the blood flows, and eventually your vital organs such as the brain, the kidneys, the lungs start to fail. And you die.
10:17:30 A mother feeds her sick baby in Calabar Hospital.
10:17:31 COM: But it is now suggested that many and perhaps even most malaria deaths are due to fakes.
10:17:38 MEREMIKWU: I would agree that a substantial proportion of the malaria deaths probably are caused as a result of fake or sub-standard drugs.
10:17:49 WHITE: How many deaths I think is very difficult to say. But it just stands to reason that if you have a disease like malaria and you don’t treat it, you will die.
10:18:00 AKUNYILI: We had over 70 per cent of anti-malarials are fake. We don't have reliable statistics but we know that millions of people died.
10:18:06 A mother sits in tears in the Calabar malaria ward.
10:18:09 COM: And it is mostly parents who innocently give their own children fake drugs.
10:18:14 WHITE: I don’t think you can really describe how somebody would feel if they lost their precious child, or husband or wife to an eminently easily treatable disease when in all good faith they had thought that they had done the right thing.
10:18:33 A warehouse stacked high with boxes. An inspector cuts open a box with a knife revealing drugs inside.
10:18:35 COM: Is it possible that millions of children could have been murdered this way over the past 30 years? And if so, who should have stopped it?
10:18:47 AKUNYILI: All these deaths from fake drugs could have been prevented if governments came together to fight it - the way the Nigerian government is fighting it now. And if companies also came out to collaborate with governments it would've been stopped a long time ago. It wouldn't have lasted almost 30 years. That's ridiculous!
10:19:07 The interrogation of the suspects goes on at the police station.
10:19:07 COM: The criminals are only part of the story.
10:19:10 Car sirens. A police convoy crosses Lagos. In her car, Akunyili talks on a cell phone, concerned.
10:19:09 COM: When Akunyili started the fight back she had no idea of who or what she up was against.
10:19:17 CAPTION: Graham Satchwell, Fake Drug Expert
10:19:17 SATCHWELL: There is no standard model for who the counterfeiter is or how he behaves. But it is obviously true that he is a parasite on the back of the genuine manufacturers.
10:19:26 Satchwell at work in his UK office
10:19:26 COM: Graham Satchwell knows how hard it is fight the fake drug racket - from undercover jobs in Africa and Asia right up to the boardroom.
10:19:32 Asian street market
10:19:34 SATCHWELL: Action’s being taken now by the pharmaceutical industry to some extent, by government to some extent, and by other stakeholders like distributors, to some extent, but they’re not moving quickly and they all have their own motives.
10:19:48 COM: A former senior British policeman, he worked for Microsoft and then became head of security for the UK pharmaceutical giant, GlaxoSmithKline.
10:19:56 EXTs GSK Corporate HQ, London
10:19:56 COM: There he led the fight on fake drugs. He is the first person from a major drug company to talk openly about the fake drug racket.
10:20:03 SATCHWELL: It’s one thing to get out of bed in the morning to save Bill Gates an extra 1 m dollars - it’s quite another thing to get out of bed in the morning to thinking that you might actually help to save lives.
10:20:12 GSK logo on Corporate HQ, London
10:20:12 COM: And Satchwell learnt another crucial lesson about the fake drug racket.
10:20:16 SATCHWELL: There’s only one criteria for faking a drug and that is the ability to sell it. Nothing else matters – it’s a business.
10:20:24 Akunyili leaves a Lagos office with armed bodyguards.
10:20:24 COM: Akunyili's seemingly impossible goal was to stop people takingfakes.
10:20:29 Car sirens. A police convoy crosses Lagos.
10:20:29 COM: She took on the racketeers in a series of controversial innovations. It began well… tackling Nigeria's notorious corruption.
10:20:37 AKUNYILI (in car): Women are less prone to corruption than men, even in AFDAC. We no longer post men to some positions.
10:20:45 Akunyili meets with women at NAFDAC office
10:20:45 AKUNYILI: I don't know about developed countries, but in developing countries it's very difficult for men to resist a bribe, very difficult.
10:20:54 Akunyili exits her car at an office complex, flanked her guards. She meets NAFDAC enforcement director, Dioka Ejionueme. They joke a lot
10:20:54 AKUNYILI: This is my Director of Enforcement. Ray. He is a man, but he is not corrupt. But he is a man. (She laughs) I said that men are more susceptible to corruption.
10:21:08 EJIONUEME (laughing): That's a general rule all over the world, really. It's not peculiar to us in Nigeria.
10:21:14 AKUNYILI: Why are you more susceptible to corruption?
10:20:16 EJIONUEME, laughing: We are more exposed than women. We have to struggle generally for the survival of the world, including men… women and the children.
Everyone laughs
10:21:27 We now see the building around them is a blackened shell, gutted by fire.
10:21:30 COM: It soon got serious. The fake drug racketeers hit-back at NAFDAC with coordinated bomb attacks across the country.
10:21:39 Akunyili points to the destruction of the old NAFDAC complex.
10:21:39 AKUNYILI: Fire started on all sides of our laboratory in Kaduna and the place got raised down. That same week it happened to our office in Benin got burned down... and even two years before that our laboratory in Ocean was vandalised, in Lagos here, and all our sensitive equipment were destroyed.
10:21:59 Akunyili and her guards tour the remains of the building's charred interior.
10:21:59 AKUNYILI: From 2001 to 2004 we were working to upgrade this - computerisation, all sorts of softwares and office equipment and documents they were all gone. And we didn't even think of back-up. I think we were wrong. We should have had back-ups. It's not done by all Nigerians. It's done by very few murderers that have been living off the blood of people for many, many years and felt that nobody should stop them.It didn't really occur to me that these people would fight to this level! It didn't occur to me.
10:22:32 Eyes in a car mirror. Akunyili's convoy is halted on a busy Lagos street. Armed guards jump out to push a way through the traffic jam.
10:22:33 COM: When bombs didn't stop her Akunyili's car was ambushed and she was caught in a hail of automatic gunfire. She had a miraculous escape, a bullet burning her scalp. But a bus driver was hit.
10:22:50 AKUNYILI (in car): So the bus driver squeezed himself in between my and my the siren and took the bullets. So for him he was trying to escape the traffic but met his death.
10:23:03 SATCHWELL: In pursuit of crime, those who are prepared to inflict death in selling their products are invariably prepared to inflict death in protecting their profits too.
10:23:16 AKUNYILI: We have another problem of lack of or inadequate legislation. Because the laws against drug counterfeiting are weak and it is at the same time as lucrative as other criminal activities, criminals are now shifting from gun-running and carrying of cocaine and heroin and other hard drugs, to counterfeiting of medicines.
10:23:48 Armed Nigerian police arrest several suspects with boxes of fake drugs.
10:23:48 COM: Little is done to stop the world's hardest organised crime gangs moving into the racket. Akunyili had to find another way to save Nigerians from fake drugs.
10:23:58 NAFDAC TV Advert. A loud Nigerian song warns people against fake drugs.
"Nigerian people shine your eyes, shine your eyes…!"Adverts views of fake drugs, customers, police raids… "NAFDAC! Safeguarding the health of the nation!"
10:24:08 COM: NAFDAC launched a series of radio and television and radio adverts to stop Nigerians from taking fake drugs.
10:24:18 A public meeting packed with media. Akunyili gets a rapturous welcome. MoC shouts, 'Put your hands together for the award-winning Director-General of NAFDAC, Professor, Dr Dora Akunyili!'
10:24:23 COM: She launched an all-out information war.
10:24:28 NAFDAC Fake Drug Bulletin.
Pages of fake drug warnings. CU of fake Swiss Pharma Fansidar data
10:24:28 COM: The biggest breakthrough in saving lives is this NAFDAC bulletin. Alerts are issued for all fake drug finds - like these fake anti-malarials. And they are published in all Nigerian newspapers. They give consumers details about drug companies and brand names and key information to identify the fakes.
10:24:50 NAFDAC TV Advert. Customers in a pharmacy inspect drug products.
10:24:50 COM: Nigerians are becoming private detective to expose fakes and to save themselves.
10:24:57 COM: But the information campaign exposed unexpected obstacle…
…And with it another clue to the return of lethal malaria.
10:25:08 SATCHWELL: There has been secrecy. There still is secrecy around this issue - and misrepresentation around this issue.
10:25:18 Stack of Hollywood DVDs featuring THE THIRD MAN with Orson Welles. DVD opened to reveal a customer warning to report pirate copies of movies.
10:25:18 COM: While other industries are very public in their battle to stop product piracy… Fakes drugs are the pharmaceutical industry's most closely guarded secret.
10:25:27AKUNYILI: These drug companies, when we started they were not comfortable with our coming out openly. They wanted it kept hidden so that it doesn’t effect their legitimate business. Because they believe that when these fake drugs are advertised in the media and so on they believed that their real genuine drugs would not sell well.
10:25:45 CU Boxes of "Fansidar" anti-malaria drugs
10:25:45 COM: Malaria means money. It has created a boom in sales boom for both drug companies and the fakers.
10:25:53 Calabar Hospital corridor. Dr Meremikwu points to a door covered in anti- malaria drug adverts. One poster is for "Fansidar".
10:25:54 MEREMIKWU (pointing to posters): So, this is a classical hospital door, you know, with the drug companies advertising malaria. Look at this door. Everything on it is malaria adverts. This is the picture you see. I'm sure it's driven by the demand for anti-malarials.
10:26:08 SATCHWELL: The sale of drugs is like the sale of any other commercial product. Ultimately, it’s about people making something and selling it for a profit.
10:26:17 Swiss Pharma board room.
10:26:17 CUMMINGS: Er, I think the figure was $500 million supposed to be given in aid to West Africa over the next 3 years for malaria treatment.
10:26:28 Meremikwu points to another hospital door covered in drug company posters.
10:26:28 MEREMIKWU: And you can see what the drug companies do to us, always messing up out doors with adverts, posters. This is all commerce - trying to compel people to buy these drugs.
10:26:42 Cummings displays an advertsing flyer, headlined: "Malaria. An African child dies every 30 seconds!"
10:26:42 COM: But the companies don't show anywhere near the same enthusiasm in advertising the dangers of fake drugs.
10:26:51 CUMMINGS: Normally, what happens is NAFDAC give out the public warnings.
10:26:56 WHITE: But this is a very serious issue and for anti infectious drugs, we're talking about medicines which saves lives. And there is an absolute requirement that if fake drugs are known to be present in the market place or wherever then the public have a right to know about that immediately.
10:27:17 GRAPHIC: Official warning about fake 'Lipitor' heart drugs in US and UK
10:27:17 COM: The number of fake drug warnings issued by health authorities and drug companies is tiny when compared to the size of the problem.
10:27:25 SATCHWELL: They are being reluctant to admit that there is a problem, because once there is an admission that there is a real problem then there’s an expectation that they will act accordingly.
10:27:33 WHITE: Industry considers it in their commercial interest to keep this quiet.
10:27:40 Oxford lab researchers carry out tests.
10:27:40 COM: And White discovered the secrecy around the racket also extended to scientific research.
10:27:46 STILL PHOTO Dr Paul Newton.
10:27:49 EXT views GSK HQ office, London
10:27:45 COM: White's Oxford colleague, Dr Paul Newton, learnt that GlaxoSmithKline was doing research on samples of dangerous fakes of the GSK paediatric anti-malaria drug, Halfan.
10:27:57 Fake Halfan drug packs examined in NAFDAC Lab.
10:27:57 COM: The fake drug was a children's version of adult Halfan.
10:28:02 Oxford lab researchers carry out tests.
10:28:05 EXT views GSK HQ office, London
10:28:02 COM: But when Newton requested details about the fake child Halfan for his research he got this e-mail reply from GSK scientists.
10:28:11 GRAPHIC: E-mail over background of GSK HQ. Read out by actor:
"Analyzing counterfeit products of ours can be a very sensitive issue, and if I was to give you further information I would need to clear it with our corporate security and investigations department.
"The product presented in the paper was found in Central Africa, but for legal reasons, I can't be more specific at the moment." GSK
10:28:29 White reads a letter in Oxford lab.
10:28:29 COM: So, White wrote to Graham Satchwell, who was GSK's security chief, expressing concern about the lack of information and asking who GSK had warned about the fake child Halfan.
10:28:32 White's Oxford letter to Graham Satchwell. 10:28:48 EXT GSK HQ, London
10:28:41 COM: To the scientists' surprise GSK's international public policy director, Jessica Hughes, stepped in.
10:28:52 Jessica Hughes's GSK letter to White
10:28:48 COM: She confirmed that 'counterfeit Halfan is present in Nigeria and
scientists' specific questions
about the fake child Halfan and the public warnings.
10:28:48 COM: She confirmed that 'counterfeit Halfan is present in Nigeria and Sierra Leone' but still answered none of the scientists' specific questions about the fake child Halfan and the public warnings.
10:29:21 Akunyili at fax machine in office. CU fax message.
10:29:21 COM: This inability to get vital to information prompted an investigation by Oxford into the secrecy surrounding the racket.
10:29:29 White in lab
10:29:29 COM: White and Akunyili joined forces.
10:29:30 Public Library of Science Medicine journal front cover (PloS).
10:29:39 PloS article headline: "The global threat of counterfeit drugs -why industry and governments must communicate the dangers"
10:29:31 COM: Their findings were published in this American journal, the Public Library of Science Medicine. Its academic style couldn't hide their shocking conclusion.
10:29:41 CU PloS article headline: "Information Strictly Confidential"
10:29:41 WHITE (referring to article): The global threat of counterfeit drugs -why industry and governments must communicate the dangers.
10:29:46 GRAPHIC: PloS article text read by White.
10:29:46 WHITE: Many pharmaceutical companies and governments are reluctant to publicise the problem to health staff and the public apparently motivated by the belief that publicity will harm the sales of brand name products in a fiercely competitive business. We argue that this secrecy and the subsequent lack of public health warnings is harming patients. And it's also not in the long term interest of the legitimate pharmaceutical industry. It's actually to their benefit to do something about it.
10:30:17 African hospital malaria ward. CUs of nurses with children and a delirious man.
10:30:17 COM: For decades patients have suffered and died from fake drugs while potentially life-saving information has been kept confidential. And the reason for the secrecy, says the team, is not security, but money.
10:30:30 AKUNYILI: If the companies had risen up to their responsibilities early enough the issue of the preponderance of fake drugs would not have gotten to the level it got in Nigeria. It is this silence that is actually, largely encouraging drug counterfeiting.
10:30:40 Lagos beach traders. 10:30:50 A sick child on an IV drip in hospital
10:30:47 COM: During the Oxford investigation a disturbing incident came to light.
10:30:52 Oxford lab. White refers to PloS article.
10:30:53 WHITE: In contrast to the Nigerian experience one of the other authors of this paper, who works in Ghana, found counterfeits of the paediatric formulation of Halofrantrine.'
10:31:08 STILL PHOTO of Emmanuel Agyarko
10:31:08 COM: They were found by Emmanuel Agyarko, head of Ghana's Food and Drug Board. He prepared a public health warning.
10:31:16 WHITE: He also alerted the GSK's local Ghana agent who visited him with staff from GSK's London HQ who took away samples of the fake Halfan.
10:31:25 STILL PHOTO of Emmanuel Agyarko
10:31:25 COM: Agyarko says that GSK then asked to withhold his fake drug warning to avoid damage to the genuine product.
10:31:32 WHITE: So, after his meeting with GSK no warning was issued.
10:31:36 WHITE: GSK, who is the manufacturer, were informed and said they didn't know anything it.
10:31:48 EXT views GSK HQ office, London
10:31:48 COM: GSK issued this denial.
10:31:50 GRAPHIC: GSK statement read by actor:
"The discovery of fake Halfan in Ghana in 2002: we were not provided with any samples of fakes by the authorities in Ghana, nor were any reports of fakes lodged with us." GSK
10:32:01 EXT view GSK HQ office, London
10:32:01 COM: But Agyarko joined the Oxford investigation. And after the team took his case to a BBC radio programme, GSK changed its position.
10:32:10 WHITE: They reversed their position and said that their local agent had "bumped into" Mr Agyarko and had received his alert and samples of fake Halfan syrup.
10:32:23 EXT view GSK HQ office, London
10:32:23 COM: GSK issued this statement GSK:
10:32:26 GRAPHIC: GSK statement read by actor:
"There was some confusion over the interaction with Mr Agyarko. Mr Agyarko did provide us with a sample of the Halfan.
At no point was any pressure put on the Ghanaian authorities not to issue a public warning on fake Halfan. In our view there were minor discrepancies."
GSK
10:32:44 EXT view GSK HQ office, London
10:32:45 COM: One discrepancy concerned GSK's then security director, Graham Satchwell.
10:32:51 CUs Satchwell working at computer.
10:32:51 COM: He expected to get all reports of fake drug finds. He was not aware of the fake child Halfan incident in Ghana - or attempts by the Oxford team to contact him - until much later.
10:33:01 SATCHWELL: I was horrified actually. Because the implication was for me that somehow I was… that I would be the sort of person that in the corporate interest, in the interest of my back pocket, would allow children to suffer to cover the corporate name. That's just, I think that would just be a complete denial of who I hope I am.
10:33:27 EXT view GSK HQ office, London
10:33:27 COM: Asked why Satchwell was not made aware of the Ghana incident, GSK issued this statement:
10:33:32 GRAPHIC: GSK statement read by actor:
"There is a large anti-counterfeit team at GSK so the involvement or non-involvement of one individual is not unusual or significant." GSK
10:33:45 SATCHWELL: I will tell you this, there was one or twice at GSK - a company for which I've got a lot of respect and affection, and it’s full of people who just want to pay the mortgage and do their job - but there were one or two occasions when I said, "Well, if X happens then I’ll go to the press".
COCKBURN VO: Can you tell us what they are?
SATCHWELL: No. They were not about this issue. They were nothing as significant as the issue you've raised. But sufficient for me to say I can’t really think that’s the right way to go.
10:34:18 EXT view GSK HQ office, London
10:34:18 COM: GSK declined an invitation to appear on this programme to discuss fake drugs.
10:34:24 WHITE: I think it's not unique. I don't think GSK are particularly unusual at all in their activities. I think it comes back to this basic problem in that there is no legal requirement for them to do anything about this. So they, at least some of the time the pharmaceutical companies compute that it is in their financial interest to keep things quiet. But it's clearly not in the publics' health interest.
10:34:54 AKUNYILI: Drug companies, I can tell you without any fear of contradiction, most of them are more interested in their money.
10:35:01 Sick African girl sits behind the rails in a cot
10:35:01 AKUNYILI: They are much more interested in their money than in the health of the people. Understandably they are in business. But they forget that this is a business that effects life.
10:35:10 Akunyili at work with staff in office.
10:35:10 COM: Akunyili and White are calling for international legislation to make the reporting of fake drug discoveries mandatory - in line with other industries such as civil aviation.
10:35:20 WHITE: Right now they are not doing anything illegal by withholding that information and I think everybody, including the industry, feels that that's wrong. We absolutely have to have it as a legal requirement that if somebody identifies a fake drug that the government authorities must be notified and must take responsibility for that notification. One of the problems we've identified is that the pharmaceutical industry - who are often the people that do, I mean they’re obviously very concernedabout their drugs, so they're often detect that something is going on - that they are not obliged to inform anybody. Well, they have a clear conflict of interest. We must put the responsibility fairly and squarely on national authorities.
10:36:09 CU Akunyili's office guard
10:36:09 COM: In Nigeria, Akunyili has started to break the silence around the racket.
10:36:13 AKUNYILI: None of the MDs of these multinationals or local companies had the courage to come to me to complain.
10:36:19 Swiss Pharma HQ. Lobby sign reads: "Swiss Pharma welcomes NAFDAC."
10:36:19 COM: And for the first time, the pharmaceutical industry is revealing some its own secrets.
10:36:24 CUMMINGS: You have to be, it's difficult, you have to be very careful how and what you do. You don't want to spoil the company's reputation. You don't want the product to suffer. The reason they are secretive is, you don't want to tell people that there's a product that looks like your product out there and it's not your product. You have to balance the publicity of a product being faked and the damage that it can do to your product.
10:36:59 In hospital a baby girl and her mother are attended by Meremikwu
10:36:59 MEREMIKWU: She's had malaria. She's had chloroquine, by the way. It didn't work. She had another set. It didn't work….
10:37:11 AKUNYILI: We had over 70% of anti-malarials faked. These little children would be having fever, suffering and dying, and they would continue taking anti-malarial that contained nothing. And some of them would contained very little active ingredient - the same problem….
10:37:24 Mother feeds her daughter in hospital ward
10:37:27 CUMMINGS: If there's a fake of our products in the market and people buy them and they don't get well, obviously it has a big impact on our company. Because people don't have the faith in the product.And obviously in the past a lot of the big companies wouldn't say anything about it because they wouldn't want their original product to be damaged by a fake if it was that close .
10:37:56 SATCHWELL: Clearly there are tens of thousands people dying in China. Now in Africa, the situation could be worse because there are millions suffering from malaria there and the death toll’s extremely high.
10:37:57CUMMINGS (surprised): I don’t know how you equate that. I've no idea on figures.
10:38:14 Lagos street scene
10:38:14 COM: Many others have kept quiet, too.
10:38:16 AKUNYILI: Regulators and people that should talk were afraid out of being cowardly. Governments were also gagging the mouths of their regulators. Even up to today some regulators tell us that their governments do not allow them to talk.
10:38:32 GRAPHIC: WHO 1999 Counterfeit Drug Manual
10:38:32 COM: This is the WHO manual drawn up in 1999 to fight the fake drug racket.
10:38:38 SATCHWELL (with WHO Report): The WHO report is fabulous. You could read this report and be really impressed about the wonderful awareness that they have. They set out very clearly all the things clear here all that
has to be done: who has to be educated, what groups that have to work together to solve this problem of counterfeit drugs. Fabulous…. Absolutely useless of course.
10:38:58 WHITE: The WHO has made some good recommendations but these have not really been followed through. There is not, I think, the attention paid to it by international authorities or national agencies that it deserves.
10:39:13 SATCHWELL: The WHO and its members are so concerned about the world of counterfeit medicines and the hundreds and thousands of deaths every year, that they have one and a half people fully engaged on the problem.
10:39:24 WHITE: The whole issue of fake drugs and in particular fake anti malarial drugs has been, if not ignored, certainly under-appreciated.
10:39:34 The Lancet magazine. Dissolve through pages of fake anti-malaria drug reports.
10:39:35 COM: This is the latest list of fake anti-malaria drugs drawn up by Oxford's Dr Paul Newton for the UK Lancet journal. Only now is the full extent of the damage caused by fake drugs coming to light.
10:39:47 Oxford researchers conduct lab tests
10:39:47 COM: It is now believed that fake and substandard drugs are the main cause of the devastating return of malaria.
10:39:54 WHITE: For example, it’s been estimated that in East Africa in the 1990’s deaths from malaria doubled - and that was entirely attributable to drug resistance.
Resistance effectively means that the drug becomes no longer usable. And that is why malaria came back with such a vengeance in the last two or three decades.
10:40:19 Fake anti-malaria drugs displayed at NAFDAC lab
10:40:21 Malaria parasites under the microscope
10:40:19 COM: All new anti-malarial drugs, except for one, have been lost to this parasite resistance.
10:40:25 WHITE: So, what is the connection between fake drugs and resistance to anti- infectious drugs, such as anti malarials?
10:40:34 SE Asian customers buy tablets from a pharmacist
10:40:34 WHITE: Initially we concentrated on resistance emerging because people maybe took the wrong drugs or the prescribing was incorrect. But with the recent understanding, or at least the recent appreciation of the magnitude of the problem of counterfeit drugs, we realise that substandard drugs could actually be a major contributor to the emergence of resistance.
10:41.02 Calabar Hospital. Meremikwu checks the sick baby on the IV drip.
10:41.02 COM: In a tragic twist, patients assumed that dilute anti-malaria drugs had to be better than taking the cheapest fakes that contained nothing. Nothing could be further from the truth.
10:41.14 WHITE: Fake drugs are a nightmare because, perversely, if they contain nothing that’s better in terms of selection for resistance. But if they contain a little bit that is absolutely the worse scenario.
10:41.29 AKUNYILI: In fact the worst part of it is because of little active ingredient people were developing chloroquine-resistant malaria. Chloroquine- resistant malaria is caused by people not taking the right quantity of chloroquine over a long period of time. And that is the worst - actually using the drug to feed the parasite and getting the parasite used to the drug. In fact, the way I explain it is, the drug becomes food for the parasite. So,that when you eventually give the right quantity and quality of chloroquine to the baby, when the baby has gotten chloroquine-resistant malaria, the baby will no longer respond positively. So children suffer a lot.
10:42:11 Malaria parasites under the microscope
10:42:14 COM: Fake drugs are killing people through a process of resistance that destroys the power of genuine drugs.
10:42:21 MEREMIKWU: So, definitely it's going to kill the genuine ones if the fake ones continue to exist.
10:42:25 AKUNYILI: Yes, the fake drug racket and the silence associated with it have led to the resurgence of malaria.
10:42:33 WHITE: What drives resistance is sub-standard drugs, sub-standards or counterfeits, which contain some of the drug's substance. I think that everybody in the malaria field considers it to be a major threat.
10:42:46 WHO logo
10:42:50 CU tablets in a bag are handed over…
10:42:51 …a man pays for drugs in a shop…
10:42:54 …the man brings the drugs to his sick child and wife
10:42:46 COM: And yet, the WHO, which runs the world's Roll Back Malaria project with funds from the pharmaceutical industry, has missed some critical opportunities to warn about this danger.
10:42:57 Cover of WHO Malaria Drug Resistance Report 1998-2004
10:42:57 COM: This is a new WHO study into the rise of parasite resistance to anti- malarial drugs. Intended to shape health policy, it makes no mention of the link between fake drugs and resistance.
10:43:09 AKUNYILI: And people forget that this resistant strain when it develops in our body it does not need a visa to travel from country to country.
10:43:19 Mosquito biting hands.
10:43:19 AKUNYILI: So, when I get to that country and the mosquito bites me, it is sucking my blood and taking that parasite that has developed resistance and injecting it into another person's body.
10:43:30 MEREMIKWU: For everybody's safety, I mean, if you are visiting Africa and you got infected by a parasite that is resistant to all the drugs, I mean, you're as good as dead.
10:43:40 COMMINGS (startled): That one I don't know… I… I don't think that is really the case. I don't know if the fake drugs has caused that… or whether it's just the malaria parasite mutating or getting used to the products that are there. It also develops a resistance… (looks to a colleague for help) … and this is not my field. I'm looking over to Mr Sambo, here. My understanding is the parasite develops a resistance… anyway. I don't know if… I've no idea,or no way of knowing or being able to comment on whether it's the fakes that are causing the increase. I would like to pass that one to Mr Sambo to answer, really. He's a bit more qualified than I am. Could you take that one, Abbass?
10:44:42 CAPTION: Abbass Sambo, Swiss Pharma
10:44:41 SAMBO VO: Yeah, thank you very much.
10:44:42 SAMBO: Yes, one of the reasons may be that the drug is sub-standard. If you have a sub-standard product it means that the parasite can easily become resistant. The problem we are having with malaria is that malaria parasite can get resistant to basically any drug.
10:44:40 SAMBO: Definitely, yes, there is a challenge to the Artemisinin combination therapy, particularly if they are not used appropriately and because the prices are high, people cannot afford it if these products begin to be faked like the other ones.
10:45:15 Cummings blows out cheeks, surprised
10:45:16 COM: If Artemisinin fails the world will face the extinction of an entire drug type.
10:45:19 Oxford lab researchers, White in background
10:45:21 AKUNYILI: When we get Artesunate-resistant malaria where do we go from there?
10:45:26 Busy SE Asian street market
10:45:30 Child sick with malaria
10:45:36 Rows of blue containers marked "ARTEMISININ"
10:45:30 COM: Has the WHO left it too late to save hundreds of millions of malaria sufferers? And the last effective drug to treat them?
10:45:38 WHITE: We are now down to the last reliable class of drugs.
10:45:42 Air-mail package. White takes out two drug boxes marked "ARTESUNATE" He removes the drug blister packs to inspect
10:45:42 WHITE: The anti-malarial drugs that have been particularly targeted, the Chinese Artesunate which is a very, very important drug now, this drug in the market place costs of the order of US$1 and the fake drug costs about half the price. So for 50 cents somebody dies.
10:46:07 COM: The latest fakes are so sophisticated they require microscopes for identification.
10:46:15 White examines a drug box and its hologram with a magnifying glass.
10:46:18 White picks up a warning sheet with pictures of fake Artesunate holograms
10:46:18 WHITE: By generation six we've now got to have a hand lens. And by more recent generations you just simply can’t with the naked eye tell the difference and you have to have a microscope. And even then it's very difficult.
10:46:32 WHITE: We’ve seen with the people who are making the fakes, they have been adding a little bit, just a little bit, of the active ingredient
10:46:40 A baby's hand, with a blood transfusion tube, grabs at the air.
10:46:40 WHITE: But that little bit doesn’t cure you, what it does do is help resistance to develop.
10:46:46 WHITE: The problem in this particular case is that these drugs, the artemisinin derivatives, are the corner stone of our treatment for malaria. And if we lose those drugs to resistance it's an absolute disaster. All our modern treatment for malaria depends on this particular class of drugs.
10:47:05 BBC News Website Page. Headline: "Malaria drug threatened with resistance."
GRAPHIC: series of similar newspaper headline warnings
10:47:06 COM: Then came the worst news.
10:47:07 Radio grabs of WHO spokesman: "…There are some early warning signs coming from SE Asia and S America showing that there are already strains with reduced sensitivity to Artemisinins and it would be a major disaster.."
10:47:20 COM: Broadcast around the world, the WHO issued a series of dire warning that Artemisinin was now threatened with drug resistance.
10:47:28 Radio grabs of WHO spokesman: "… it would be a major disaster and it would be too late."
10:47:30 COM: And still, not one word was mentioned by the WHO about the role of fake drugs.
10:47:36 AKUNYILI: If we had addressed the problem of counterfeit sub-standard anti-malarials it would have been better for the whole world - especially for us in the developing countries that are suffering from malaria - to look at the problem as they are instead of saying that, "Oh, we have chloroquine-resistant malaria, we go ahead and use a higher drug, from one higher drug to another higher drug" - instead of facing the problem of why chloroquine was not working!
10:48:05 A doctor takes a blood sample from a woman's thumb and put it on a tester
10:48:05 COM: If the artemisinin drugs are lost it will take another 10 years to find a replacement.
10:48:11 SATCHWELL: We’re in a stage with this drug now where unless there is co-ordinated inter governmental action then could well be a massive loss of life - there is already massive - a catastrophic loss of life. What we have to do now is to ensure that the politicians can’t hide their heads under the blankets any longer.
10:48:34 WHITE: With the widespread use of substandard drugs I think we’re just sitting on a time bomb.
10:48:41 MEREMIKWU: It is up to us as a race, as a human race to decide to preserve these drugs until we find better drugs or to be careless with them anyhow and loose it. And then we have to pay for it with millions of lives.
10:48:56 A crowd gathers for setting fire to the fake drug tip. We see Dioka Ejionueme.
10:48:59 NAFDAC officer directing crowd, 'Come this way! Come this way to come and see the fire!'
10:49:04 Armed police arrest men for trying to steal fake drugs.
They are forced to sit on the ground. The media swarms around the men.
10:49:04 COM: Even as the fake drug were to burnt in Lagos the racketeers sent people in to grab back boxes of the best-selling fake brands.
10:49:12 The suspects are led away in handcuffs.
10:49:17 MEREMIKWU: Because big people can do bad things and get they away with it. Small people they do bad things they do get hold of them and put them in gaol.
10:49:24 EJIONUEME: What we are destroying here includes three trucks of mostly spurious pharmaceutical products raided from the Bridgehead markets.
10:49:33 Ejionueme lights the fake drug tip in different places. Flames spread.
10:49:38 AKUNYILI: If Bill Gates wants to save children from malaria - which I believe he wants to because he's very sincere. If he's not sincere he would not be spending all that money, after all nobody forces him to do that - he should spend more money on ensuring that the existing anti-malarials are genuine.
10:49:48 CU Fake Halfan drug box in flames
10:49:51 The fake drug tip roars up in flames
10:49:54 GRAPHIC:
The Bill and Melinda Gates Foundation, which puts money into the development of new anti-malaria drugs, has declined to discuss the issue of fake drugs.
10:50:01SATCHWELL: The problem of counterfeit medicines that once we all imagined was a problem for Africa is now a problem for the western world, for all parts of the developed world. Because these markets - Britain, Germany, USA - these provide a much bigger profit than does selling drugs to Africa.
10:50:10 Smoke and flames rises from the fake drug fire.
10:50:19 FX A baby cries over rising smoke and over following GRAPHIC ...
10:50:23 GRAPHIC: The WHO, Geneva, was preparing to launch of a global Task Force to fight the fake drug racket as this programme was being completed. Task Force leader, Dr Howard Zucker, declined to answer any questions about the fake drug racket.
10:50:36 At the fake drug tip an arrested suspect sits in a car and calls out:
10:50:36 SUSPECT: I don't do it. Somebody else do it.
10:50:39 GRAPHIC: FX fire burning
"We don’t think information is withheld for commercial reasons.
"The industry practice is to systematically report fake drug finds we are aware of to the authorities. It is only the authorities who can do anything about it.
"It is a criminal matter."
International Federation of Pharmaceutical
Manufacturers and Associations, Geneva
10:50:59 WHITE (at microscope): Parasites. Small parasites… and large parasites.
GRAPHIC:
GlaxoSmithKline has now 'formalised' reporting of its fake drug discoveries to government health authorities. It does support calls for laws to make such reporting mandatory.
10:51:06 ROLL CREDITS
Thanks to:
BBC Radio 'File on 4', The Public Library of Science Medicine, The American Prospect, ABC Radio The Science Show, Oxford University Centre for Tropical Medicine Oxford University, Mahodial University Bangkok, the WHO-WPRO, the Welcome Trust, Kamolrat Silamut, Steven Manion, Elena Curzio, Peter Paturi, Barry and Beaulah Bower, SafeMedicines.org.
Tom and Dot Cockburn
Camera Units
Africa
Elizabeth Tadic
Camera Assistant
Yinka Dada
England
Dirk Nel
Editor
Corinne Minore
Giovanni Berghi
Sound
Jon Bidgood
Library
With thanks to WHO Western Pacific Regional Office for use of its fake drug video, 'Dealers in Death'. Its international release was still withheld in November 2006.
Oxford University-Mahodilol University-Wellcome Trust Research Programme.
Journeyman Pictures
Original Music
Aaron Cockburn-Woods
Co-Producer
Francesca Arcuri
Producer
Robert Cockburn
Copyright 2006
FADE OUT 10:51:59