Government earmarks funds to halt flood of illegal medicines

Every day Saliou wanders around the suburbs of the Senegalese capital, Dakar, a one-man walking pharmacy. In the small case he clutches lies an array of medicines. He has no chemical expertise or formal training for doling out the drugs. But he has been in the business long enough to make one evaluation -- whether a client will be able to afford a packet of tablets or just one individual pill. A recent study carried out by the French pharmaceutical association Leem found that an estimated one in five people in Senegal turn to the black market for their medicines. The problem is not unique to Senegal. The World Health Organisation reckons trade in counterfeit and sub-standard drugs is worth about US $32 billion worldwide. Now, there are signs that Senegal's government is beginning to tackle the problem. President Abdoulaye Wade's planned budget for 2006 includes 25 million CFA (US $48,000) to "promote generic medicines and strengthen inspections to control the illegal market." Health experts say this is the first time the government has mentioned the existence of the pharmaceutical black market in an official document, but while they applaud this, they are also worried that the amount of funding will be a drop in the ocean. "I think we're seeing the beginning of a change," said Mamadou Badiane, the head of the Office for Pharmacies and Laboratories, told IRIN. He noted that trucks hailing from Nigeria and Gambia were intercepted in July and their cargo of unlicenced medicines was destroyed by the ministry of commerce. And while a television debate on the issue of black market drugs would have been unthinkable a couple of years ago, he recalls, one was held in December 2004 and experts got to say what they wanted to say. "But 25 million that's not enough, it's even faintly ridiculous," Badiane said. "Because included in that figure is the cash to pay the employees here and we number 15." Medicine mountain At the Keur Serigne Bi, a building tucked away behind Dakar's main market, the scale of the illegal trade is clear to see. Health experts refer to the place as a medicine mountain. "This is the place where people who have no money come," said one vendor, who declined to be identified. Here, a packet of antihistamine costs as little as 4,000 CFA (US $8), compared to 5,700 CFA ($11) in a licensed pharmacy. Antibiotics, anti-depressants and anti-retrovirals are also on sale more cheaply. Some have been stolen by petty thieves, others pillaged from central pharmaceutical stocks by pharmacists themselves. And while the lower prices lure in cash-strapped Senegalese, many people are unaware of the gamble they are taking. "The risks are numerous for consumers," said Babacar Thiam, a doctor in the capital. "The medicines don't pass through the proper controls. They are kept in unsuitable places and even if the expiry date is ok then the poor conditions they're kept in can change the chemical properties." Bakary Sambou, a doctor working for the World Health Organisation in Senegal, agrees. "Sometimes you'll see them (the black market vendors) recounting any old rubbish. And people believe it," he said. "One day I saw someone who had simple bronchitis being given something to treat serious tuberculosis."

Senegal is a majority Muslim country and the Islamic brotherhoods are politically and economically important

But if everyone knows about the existence of Keur Serigne Bi, why has it not been closed down? "The authorities are afraid," said Constance Faye Badji, the head of the National Pharmacists Association in Senegal. "The religious (Mouride Islamic) brotherhoods are major players in commerce and they are a powerful component of the electorate that no-one wants to rub up the wrong way." "We're waiting to see what the government is going to do with this 25 million CFA," Faye Badji said. "It's easy to say there's a budget but if it's all for show, then we'll react appropriately." Job market In a country where 26 percent of the population live on less than a dollar a day, it is not only impoverished consumers keeping the black market in business. It also provides income for the mobile unofficial dispensers of drugs. Experts estimate that the black market trade in medicines is valued at between 6 and 8 billion CFA (US $11.4 to $15.2 million). "Any blanket attempt to ban the illegal market will never work," explained Pierre Nabeth, the head of the epidemiological department at the Pasteur Institute in Dakar, who is putting the finishing touches to research on the subject. "People are desperately hungry, and the market is supporting many people. It works for a lot of people," he told IRIN. "Perhaps looking at ways to better regulate it is the path to explore." In his study of 168 black market medicine vendors, Nabeth found that almost half could not read, two thirds did not read the medical warnings, and 70 percent of them were in favour of some form of regulation. "They want some education because they are aware of the gaps (in their knowledge)." There have been some efforts at educating the public too. In 2003 there was a big campaign built around the slogan "Medicines off the street kill". Every May since then, there has been a week-long public awareness drive and there are signs that the message is starting to get across. "There's no question of me swallowing those things," said Mame Thiam, a fisherman taking a breather on one of Dakar's beaches. "These so-called walking pharmacists don't even know how to write their name and you want me to buy medicine from them? And when you die, who are you going to be able to sue?"