W

hen Edward Jenner, the father of immunology, laid the foundation for vaccination methodology in the 18th century, he perhaps did not imagine that someone in the future would dare to produce counterfeit vaccines for financial reasons. But the humanity may have already disappeared from certain people as evident in the reports of nationwide distribution of fake vaccines in Indonesia quite recently.

Fake vaccines threaten mostly the young generation. In Indonesia, children are still unprotected from diseases, not only due to the low rate of breastfeeding, but also because of the less than optimum vaccination coverage.

According to the WHO National Health Accounts in 2012, almost 15 percent of Indonesian kids aged one to three years old who are incompletely immunized are highly likely to miss their DPT3 immunizations.

This number could be higher if fake vaccines were taken into account.

Drug, including vaccine, forgery is widespread and affects developing as well as developed countries.

According to BioMed Central Journal, it is believed that up to 10 percent of all medicines sold worldwide are counterfeit, with higher prevalence in regions where drug regulatory and enforcement systems are weak.

The 2012 WHO report estimated that counterfeit drugs could account for over 30 percent of all drugs in parts of Africa, Asia and the Middle East, compared with less than 1 percent in the US and Western Europe.

The dangers of fake vaccines are abundant. A Journal of Antimicrobial and Chemotherapy study stated that counterfeit drugs could result in adverse health outcomes, treatment failure, development of drug resistance and decline in confidence in health systems, all of which contribute to the burden of disease and, subsequently, to excess morbidity and mortality.

Why have fake vaccines spread nationwide? One of the main reasons is because there is a demand for cheap vaccines.

With millions of Indonesian families still impoverished, it is not uncommon for them to use cheap drugs, including vaccines.

Indonesia remains an easy target for the distribution of counterfeit medicines, which are sold not only through the internet, but also in pharmacies.

The distribution of fake drugs persists despite raids by the authorities. Fake drugs sold in pharmacies are hard to detect because they look similar to the genuine ones.

The markers of genuine vaccines such as the red K mark for drugs that can be bought only with a doctor’s prescription and a distribution permit from the National Agency for Drug Monitoring written on vaccine packaging are easily forged by criminals.

Fake vaccines can be identified from the price. Bogus vaccines normally cost US$20 to $40 cheaper than the genuine products and do not need a doctor’s prescription.

The packaging of fake vaccines is usually rough and unclean, and its batch number is not clearly visible while the rubber stop color of its vial package is different from that of the genuine product.

Distribution of fake drugs in the Greater Jakarta area has already reached a worrying level. It seems that everyone in Indonesia knows that people can buy cheap counterfeit drugs easily from drug markets such as the Pramuka Market in East Jakarta.

The National Agency for Drug Monitoring should also monitor vaccine sales at this market.

Most consumers in Indonesia are usually passive so they simply accept the drugs they get from doctors and pharmacists without knowing whether the drugs are fake or genuine.

Therefore, one of the keys to eradication of counterfeit drugs is the active role of health practitioners.

The government, Indonesian Medical Association and Indonesian Association of Pharmacist should provide training to health practitioners so they can differentiate between counterfeit and genuine drugs.

It is predicted that the amount of fake medicine in circulation will rise further because of a lack of law enforcement. And frequent raids to confiscate fake drugs is not enough.

To deter people from committing the crime harsh sentences should be mandatory. Judges have so far handed down very lenient punishment to those producing and trading counterfeit medicines, using only the Trademark Law.

Counterfeit drugs criminal must be charged under the Health Law, which says the crime is punishable for a jail term of up to 15 years.

Hospitals and clinics that use counterfeit vaccines should also be investigated to ascertain whether they know about the quality of the vaccines. It must be assumed they use them because of the cheap price. Hospitals and clinics that deliberately use fake vaccines should be shut down.

Against the backdrop of the most-recent findings of fake vaccine distribution the momentum is there for the government to take the lead in the fight against counterfeit drugs for the sake of people’s safety and health.
___________________________

The writer is a medical doctor and PhD student at Gunma University, Japan.