The world's major drug companies have been accused of turning a blind eye to the multibillion-dollar trade in fake medicine that has resulted in an explosion of child malaria deaths in developing countries.
Governments have not tackled the problem and pharmaceutical companies are burying the issue, afraid that any publicity given to their medicines being faked will lead to a fall in the sale of the genuine product, according to a documentary.
The problem has been particularly acute with the treatment of malaria in Africa, with anti-malaria drugs faked on an industrial scale. Professor Nick White, of Oxford University, one of the world's leading experts on malaria, said: "We estimate that there are more than one million deaths each year - which is the equivalent of seven jumbo jets going down every day. And 90 per cent of those deaths are in children."
Professor White said that counterfeit medicine was a major reason why malaria had become, over the past 30 years, Africa's biggest child killer, from an illness that used to be easily treated with medicines.
Some of the fake drugs contain no medicine at all, but others have tiny traces of the real ingredients - which leads to another, potentially bigger problem: it allows the malaria parasite to build up resistance to the drug.
Nigeria's campaigning drugs regulator, Dora Akunyili, described counterfeiting as "mass murder". She told the documentary, which will be aired today on The Business Channel, a satellite station: "The fake drug racket and the silence associated with it have led to the resurgence of malaria... 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."
There is now just one family of drugs left that malaria has not built up resistance to, Artemisinins - which are also being faked. Professor White said: "Resistance to the Artemisinins would be an absolute catastrophe for our current attempts to try to control malaria."
It is estimated that the global fake drug racket is worth $40bn (£20bn) a year, and between 50 and 90 per cent of medicine in some African and Asian countries is counterfeit. Graham Satchwell, the former head of security at GlaxoSmithKline, the British-based global pharmaceutical giant, told The Independent: "Each therapy area is highly competitive, so if one person's drug is undermined, their market share will suffer. It takes a brave company to say they have a problem."
Mr Satchwell said that the "majority of the industry are sitting on their hands", rather than tackling the problem - for instance through radio tracking of their products. He also pointed out that the figures from the industry's own organisation, the Pharmaceutical Security Institute, showed many cases of counterfeiting in the US, but hardly any in China or Africa - despite firm evidence from other sources that tens of thousands die each year in China and Africa as a result of fake medicines each year.
Dr Akunyili said: "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"
Dr Martin Meremikwu, of Calabar University Hospital, in southern Nigeria, said that he had seen child malaria deaths soar. He said that, by the time children who had been treated with fake drugs got to the hospitals, it was often too late to save them.
"Malaria should not kill people. It's a curable disease. But if the patient uses the wrong drug - either because they are fake or they are ineffective because of higher 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 eight 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."
The drugs don't work
* Counterfeit medicines are swamping unregulated markets in developing nations with unknown and sometimes fatal results. Not only are thousands dying needlessly, but patients are also becoming immune to the effects of the real thing. Counterfeit drugs occasionally contain small doses of the active ingredient - enough to induce resistance
* The UN World Health Organisation estimates the incidence of counterfeit medicines is about 10 per cent in developing countries, with prevalence higher where regulatory control is weakest. But in many parts of Africa, according to the WHO, as well as in some countries in Latin America and South Asia, prevalence sits at around 30 per cent. The patients hit are the sickest and the poorest.
* WHO estimates that 200,000 of the one million malaria deaths every year would be prevented if all the drugs taken were genuine. The popularity of combination malaria drugs - which are more expensive than other treatments - has seen counterfeit peddlers cash in on the opportunity to boost sales. In Cambodia, Tanzania and Cameroon, up to 90 per cent of such drugs on sale in local markets are believed to contain nothing but chalk or maize flour.
* As recently as 2001, about 68 per cent of medicines in circulation in Nigeria were unregistered, and as much as 41 per cent were believed to be fake.
The Malaria Parasites, 4pm today, The Business ChannelReuse content