Recent seizures of fake medical products being marketed in the COVID-19 pandemic underscore the need to curb the growing international trade in counterfeit drugs that’s putting hundreds of thousands of lives at risk, the Organisation for Economic Cooperation and Development (OECD) warned this week.

Perhaps most alarming, given the potential for secondary bacterial infections in COVID-19 patients and the rise of superbugs, is that antibiotics are by far the drugs most targeted by counterfeiters, according to a recent report from OECD and the EU’s Intellectual Property Office.

Based on more than $4.3 billion worth of counterfeit drugs seized by customs agents from 2014 to 2016, the report found that more than 35% of the counterfeits were marketed as antibiotics. (Those numbers don’t include domestically produced and marketed counterfeits and biopharmaceutical shipments that are stolen in transit and rerouted for sale in other countries.)

Antimalarials – including hydroxychloroquine and chloroquine phosphate, which are much in demand now as off-label COVID-19 treatments – were the fourth biggest target, accounting for 9% of the seized drugs. Since the antibiotics and antimalarials being used to treat patients with the coronavirus are in short supply, the opportunity for counterfeit versions of those drugs is escalating.

The vast majority of seized drugs contained the incorrect proportion of active pharmaceutical ingredients, which is especially problematic with antibiotics as it could fuel the growing bacterial resistance to the drugs. Many of the counterfeits also contained undeclared substances that can pose serious health risks. “Forensic tests of suspected samples show that in 90% of cases, counterfeit medicines can harm patients,” according to the report.

Between 72,000 and 169,000 children may die from pneumonia every year after being treated with fake drugs, the report concluded, and counterfeit antimalarial drugs could be responsible for an additional 116,000 deaths each year.

Of course, those numbers are for “normal” years. The death toll due to counterfeits could be much higher this year as the demand for antibiotics and antimalarials exceeds the supply.

More than half the counterfeits seized over the three-year period originated in India and nearly a third came from China, the OECD said. Africa, Europe and the U.S. were the primary markets for the fake drugs. While Singapore and Hong Kong are key transit points in the supply chain, other routes run through the United Arab Emirates, Egypt, Cameroon and Turkey.

Nearly 38% of the seized drugs were knockoffs of biopharmaceuticals produced by U.S. companies, but companies in France, Germany and Switzerland also were heavily hit by counterfeits of their products, according to the report.

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