A reader recently contacted Africa Check to verify if a claim that as many as 40% of medicines sold in Africa were fake.

This was after a user on Twitter in January 2020 said that he had come across this statistic on Radio France Internationale (RFI).

"Heard on RFi, 40% of the medicines sold in Africa are fake. My question: are pharmacies concerned?"

Where could the figure have come from?

Africa Check contacted RFI for more details about the statistic, including what evidence there was for it.

The French radio station, which broadcasts to five continents, said that it would be "complicated to answer without knowing what content this Twitter account is referring to".

We asked the tweet's author what programme or time he might have heard this on, but he has not yet responded. We will update this article should we hear from him.

We did find on RFI's website an interview with Jean-Yves Ollivier, the president of the Brazzaville Foundation. He was the organiser of a summit that took place in Lomé, the capital of Togo on 17 January 2020 and which focused on the trafficking of fake medicines.

In the interview, he said: "(... ) Togo, where I am currently, acknowledges that there are roughly 40% of fake medicines available".

We were however unable to establish if this was what the tweet in question had been referring to.

It is a statistic that is quoted often

It is a well travelled claim. An article on the Togolese website republicoftogo.com says that "according to the World Health Organization (WHO), more than 40% of the medicines sold in Africa are fake".

The article is dated October 2019, three months before the Lomé summit.

What is a fake medicine?

In a study published in 2017, the WHO notes that "for many years, the response to this important threat to public health was embroiled in the discussion of complex definitions that meant different things to different people".

The WHO study was published in 2017.

The study says that the term fake medication includes the following definitions:

Substandard medical products: also called "out of specification": these are authorized medical products that fail to meet either their quality standards or their specifications, or both.

Unregistered/unlicensed medical products: Medical products that have not undergone evaluation and/or approval by the national or regional regulatory authority for the market in which they are marketed/distributed or used, subject to permitted conditions under national or regional regulation and legislation.

Falsified medical products: Medical products that deliberately/fraudulently misrepresent their identity, composition or source.

WHO's database includes two types of drugs: fakes and those below the required quality standards, Dr Elizabeth Pisani, an associate professor at the London School of Hygiene & Tropical Medicine and author of the study, said.

This, she said, means that the data does "not distinguish clearly between the two, although they are really quite different, as are the mechanisms that drive them".

WHO doesn't say 40% of drugs sold in Africa are fake

The study stated that "42% of all fake medicines that were reported between 2013 and 2017 came from Africa".

Pisani told Africa Check that it was important to understand the difference between the statement "42% of medicines in Africa are fake" and "42% of the fake medicines reported to our system come from Africa".

"The WHO data is based on a case reporting system. That means that it counts whatever is reported to it, but what is reported is not, repeat not, representative of what is actually out there," she said.

What does this mean?

To better explain the situation, Pisani gave a practical example. "Imagine that Senegal finds 10 cases of fake medicines in a year, and reports all of them to WHO. Bangladesh finds 100 cases in a year, but only reports the five cases that were discovered by journalists and became public knowledge.

"So now the WHO database would have 15 cases in its database, 66% of them from Senegal. In reality, there are 110 cases, only 9% of them from Senegal."

"This is an imaginary example, but it illustrates the limitations of the WHO database. At the time of that report, 42% of all reported cases were from Africa," Pisani said. The report notes that this in part is because the heath agency trained more national "focal points" to identify and report cases, meaning there "is more reporting from Africa".

"This figure (42%) does not represent the real proportion of what is out there."

Figure refers to the reporting levels

Pernette Bourdillon Esteve is the head analyst in the global surveillance and monitoring system for substandard and falsified medical products at WHO.

She told Africa Check that since 2013, WHO has been receiving reports of substandard and falsified medical products from the national focal points. These reports are then pooled in a single global database.

"This database leverages qualitative and quantitative data to assist in incident handling, understanding the driving forces of substandard and falsified medical products and developing appropriate solutions," Esteve said.

As such, "the global system is a case reporting database and cannot be used to extrapolate prevalence nor incidence rates".

'"The 42% figure refers to the reporting levels from the African region to this global system (and not the prevalence)", she said.

Continent-wide data not yet available

Pisani told Africa Check that the WHO "did sponsor studies of the quality of antibiotics in six African markets in 2019, but the results are not yet available".

There are other studies of narower scope, Prof Abdou Niang, head of the nephrology division at Cheikh Anta Diop University in Dakar told Africa Check.

He directed us to a study published in 2017 that focused on 10 mainly West Africa countries. This found that nearly a quarter of the available generic antihypertensive medicines are of poor quality.

Conclusion: No evidence that 40% of medicines sold in Africa are fake

A much travelled claim holds that "40%" or some similar share of the medicines sold in Africa are fake.

Some sources have attributed this statistic to the World Health Organization. The global health agency did in a study published in 2017 find that "42% of all fake medicines reported to them between 2013 and 2017 came from Africa".

But the study's author told Africa Check that this figure does not represent how prevalent fake medicines are on the continent, but rather the cases that were reported to the WHO.

As such, this study cannot be used as evidence for the claim. There still isn't research that can be said to be representative of the continent.

This fact-check was first published on our French-language site and has been translated from French. You can read the original article here.