“It’s their own problem.” This was an immediate and emphatic response of a pharmaceutical executive, responding to my question to him about the recent report that nearly half of all substandard and counterfeit drugs in Afghan markets are made in Pakistan.
A casual conversation with another colleague in the manufacturing sector, who I called up, suggested a similar attitude, this time peppered with some additional comments about the poor state of governance in Afghanistan and their perpetual failure mode. The report in question, first published by the Associated Press and then circulated widely by newspapers and outlets outside Pakistan, and mentioned sparingly by our own media, is based on a comprehensive analysis by Independent Joint Anti-Corruption Monitoring and Evaluation Committee, a joint body set up by the Afghan government and the international community. The report highlights that up to 300 Pakistani companies are manufacturing drugs exclusively for the Afghan market and most of these would not be good enough for consumption in Pakistan and would not be allowed on the market. The fact that this has not raised any eyebrows from the fraternity of pharmaceutical manufacturers in the country or the regulators or the export control groups highlights that we consider this to be a problem solely of the poor regulatory structure in Afghanistan, and not of the manufacturers who knowingly make counterfeit and substandard products. The fact that we did not even bother to acknowledge the report, or reject its findings, or suggest that we will do our own investigations, is both unfortunate and scary.
Here, it is important to note that we are not talking about a different dose, or a new chemical formulation. We are talking about fraud. We are talking about drugs with intentionally mislabelled packaging, harmful components, or in many cases, no active ingredient whatsoever. Our action, or rather inaction in this case, speaks loud and clear. Our belief is that if we intentionally make a poison, and sell it as a healing product, it is the responsibility of the customer, not ours. As long as we have buyers, we are absolved of any responsibility. We are a straight-forward group of people and only follow the laws of supply and demand.
Using a moral argument with those who take impact on human lives and human suffering out of their business decisions will not lead us anywhere. The fact that their poor quality products can devastate the poor, vulnerable and largely uneducated public, which may consume their medicines as a last hope, probably never enters their mind. So let us, for their ease, use an economic argument.
First, the business of medicines, like many other businesses, is a business based on trust. The moment your name gets associated with a poison pill, you lose customers. Collective punishment is also not out of the question. Once we get branded, as producers of bad products, even the good manufacturers with high standards find it hard to enter new markets. This is no different from our reputation in other global problems of security and terrorism. We Pakistanis know quite well, that regardless of our beliefs or actions, we are often eyed and treated with suspicion. Many suffer because of the action of a few. The pharmaceutical sector, as a whole, needs to protect its own long-term interests and should put pressure on those identified in this report, as well as export regulators within the country to get their act together. There is plenty of clout and influence in the pharmaceutical sector in Pakistan that can be used for some positive action.
Second, our long and porous border with Afghanistan and the ease at which things go back and forth between the two countries means that many of those medicines will inevitably re-enter Pakistan. These medicines will bring with them horrifying consequences, from death and morbidity to long-term drug resistance in our own population. The last thing a polio-ravaged nation needs is a new front in public health.
Burning our own house down is not anyone else’s problem. It is squarely our own.
Published in The Express Tribune, November 25th, 2014.