This feature, which focuses on the illegal trade in substandard and fake medicines, is part of a UN News series exploring the fight against trafficking in the Sahel.

From ineffective hand sanitizer to fake antimalarial pills, an illicit trade that grew during the COVID-19 pandemic in 2020 is being meticulously dismantled by the UN and partner countries in Africa’s Sahel region.

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC).

The report explains how nations in the Sahel, a 6,000-kilometre-wide swath stretching from the Red Sea to the Atlantic, which is home to 300 million people, are joining forces to stop fake medicines at their borders and hold the perpetrators accountable.

This fight is taking place as Sahelians face unprecedented strife: more than 2.9 million people have been displaced by conflict and violence, with armed groups launching attacks that have already shuttered 11,000 schools and 7,000 health centres.

Deadly supply meets desperate demand

Health care is scarce in the region, which has among the world’s highest incidence of malaria and where infectious diseases are one of the leading causes of death.

“This disparity between the supply of and demand for medical care is at least partly filled by medicines supplied from the illegal market to treat self-diagnosed diseases or symptoms,” the report says, explaining that street markets and unauthorized sellers, especially in rural or conflict-affected areas, are sometimes the only sources of medicines and pharmaceutical products.

Fake treatments with fatal results

The study shows that the cost of the illegal medicine trade is high, in terms of health care and human lives.

Fake or substandard antimalarial medicines kill as many as 267,000 sub-Saharan Africans every year. Nearly 170,000 sub-Saharan African children die every year from unauthorized antibiotics used to treat severe pneumonia.

Caring for people who have used falsified or substandard medical products for malaria treatment in sub-Saharan Africa costs up to $44.7 million every year, according to World Health Organization (WHO) estimates.

Motley trafficking

Corruption is one of the main reasons that the trade is allowed to flourish.

About 40 per cent of substandard and falsified medical products reported in Sahelian countries between 2013 and 2021 land in the regulated supply chain, the report showed. Products diverted from the legal supply chain typically come from such exporting nations as Belgium, China, France, and India. Some end up on pharmacy shelves.

The perpetrators are employees of pharmaceutical companies, public officials, law enforcement officers, health agency workers and street vendors, all motivated by potential financial gain, the report found.

Traffickers are finding ever more sophisticated routes, from working with pharmacists to taking their crimes online, according to a UNODC research brief on the issue.

While terrorist groups and non-State armed groups are commonly associated with trafficking in medical products in the Sahel, this mainly revolves around consuming medicines or levying “taxes” on shipments in areas under their control.

Snip supply, meet demand

Efforts are under way to adopt a regional approach to the problem, involving every nation in the region. For example, all Sahel countries except Mauritania have ratified a treaty to establish an African medicines agency, and the African Medicines Regulatory Harmonization initiative, launched by the African Union in 2009, aims at improving access to safe, affordable medicine.

All the Sahel countries have legal provisions in place relating to trafficking in medical products, but some laws are outdated, UNODC findings showed. The agency recommended, among other things, revised legislation alongside enhanced coordination among stakeholders.

Custom and law enforcement officers prevent huge quantities of contraband from entering the markets of destination countries.

States taking action

Law enforcement and judicial efforts that safeguard the legal supply chain should be a priority, said UNODC, pointing to the seizure of some 605 tonnes of fake medicines between 2017 to 2021 by authorities in the region.

Operation Pangea, for example, coordinated by UN partner INTERPOL in 90 countries, targeted online sales of pharmaceutical products. Results saw seizures of unauthorized antivirals rise by 18 per cent and unauthorized chloroquine, to treat malaria, by 100 per cent.

“Transnational organized crime groups take advantage of gaps in national regulation and oversight to peddle substandard and falsified medical products,” UNODC Executive Director Ghada Waly said. “We need to help countries increase cooperation to close gaps, build law enforcement and criminal justice capacity, and drive public awareness to keep people safe.”

Following the death of 70 children in The Gambia in 2022, the World Health Organization identified four contaminated paediatric medicines in the West African nation.

The US National Hurricane Center acts as WMO’s Regional Specialized Meteorological hub, based in Miami, Florida.

There is a 40 per cent chance of a near-normal season, 30 per cent possibility of an “above-normal season”, and also 30 per cent of a below-normal season, according to forecasters with the Climate Prediction Center.

The hurricane season covering the Atlantic region, including the Caribbean, Gulf of Mexico and US east coast, lasts from 1 June to 30 November.

NOAA forecasts between 12 and 17 total named storms, which means winds of at least 63 kilometres per hour, or 39 miles per hour.

Up to 4 major hurricanes

Among the potential hurricanes, it forecasts one to four “major hurricanes” – categories three to five – with winds of at least 178kmh, or 111mph.

WMO said that NOAA has “a 70 per cent confidence in these ranges.

“It is expected to be less active than recent years, due to competing factors – some that suppress storm development and some that fuel it – driving this year’s overall forecast for a near-normal season, according to NOAA”, WMO reported in a press release.

The agency reminded however, that it takes just one landfalling major hurricane to set back years of growth and development.

Statistics presented to the ongoing World Meteorological Congress showed how Small Island Developing States suffer disproportionately in terms of both economic impact and the human toll.

Early warning imperative

For instance, Hurricane Maria in 2017, cost the Caribbean island nation of Dominica, a staggering 800 per cent of its Gross Domestic Product.
 
“Between 1970 and 2021 tropical cyclones (the generic term which includes hurricanes) were the leading cause of both reported human and economic losses worldwide, accounting for more than 2,000 disasters”, said WMO.
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However, the death toll from deadly storms has fallen from around 350,000 in the 1970s to less than 20,000 in 2010-2019. Reported economic losses in 2010-2019 were at $573.2 billion.

‘Major killers’

“Tropical cyclones are major killers and a single storm can reverse years of socio-economic development. The death toll has fallen dramatically thanks to improvements in forecasting, warning and disaster risk reduction. But we can do even better,” said WMO Secretary-General Prof. Petteri Taalas.
 
“The UN Early Warnings for All initiative seeks to ensure that everyone has access to warnings of life-threatening winds, storm surge and rainfall in the next five years, especially in Small Island Developing States which are on the frontlines of climate change,” he said.

Name that storm

An average Atlantic hurricane season has 14 named storms, seven hurricanes and three major hurricanes. 
 
In total, the 2022 Atlantic hurricane season produced 14 named storms, of which eight became hurricanes and two were major hurricanes (Ian and Fiona). Both 2020 and 2021 were so active that the regular list of rotating names was exhausted.
 
After three hurricane seasons with a La Niña, there is a high potential for El Nino to develop this summer, which can suppress Atlantic hurricane activity. El Nino’s potential influence on storm development could be offset by favorable conditions local to the tropical Atlantic Basin.

New model boosts prep time

“With a changing climate, the data and expertise NOAA provides to emergency managers and partners to support decision-making before, during and after a hurricane has never been more crucial,” said NOAA Administrator, Rick Spinrad.

“To that end, this year we are operationalizing a new hurricane forecast model and extending the tropical cyclone outlook graphic from five to seven days, which will provide emergency managers and communities with more time to prepare for storms.”

Ahead of World No Tobacco Day on Wednesday 31 May, WHO deplored that 3.2 million hectares of fertile land across 124 countries are being used to grow deadly tobacco – even in places where people are starving.

WHO Director-General Tedros Adhanom Ghebreyesus said that governments across the world “spend millions supporting tobacco farms”, and that choosing to grow food instead of tobacco would allow the world to “prioritize health, preserve ecosystems, and strengthen food security for all”.

Disaster for food, environmental security

The agency’s new report, “Grow food, not tobacco”, recalls that a record 349 million people are facing acute food insecurity, many of them in some 30 countries on the African continent, where tobacco cultivation has increased by 15 per cent in the last decade.

According to WHO, nine of the 10 largest tobacco cultivators are low and middle-income countries. Tobacco farming compounds these countries’ food security challenges by taking up arable land. The environment and the communities which rely on it also suffer, as the crop’s expansion drives deforestation, contamination of water sources and soil degradation.

Vicious cycle of dependence

The report also exposes the tobacco industry for trapping farmers in a vicious cycle of dependence and exaggerating the economic benefits of tobacco as a cash crop.

Speaking to reporters in Geneva on Friday, Dr. Rüdiger Krech, WHO’s Director for Health Promotion, warned that tobacco’s economic importance is a “myth that we urgently need to dispel”.

He said that the crop contributes less than 1 per cent of gross domestic product (GDP) in most tobacco-growing countries, and that the profits go to the world’s major cigarette-makers, while farmers struggle under the burden of debt contracted with the tobacco companies.

‘Smokers, think twice’

Dr. Krech also explained that tobacco farmers find themselves exposed to nicotine poisoning and dangerous pesticides. The broader impact on communities and whole societies is devastating, as some 1.3 million child labourers are estimated to be working on tobacco farms instead of going to school, he said.

“The message to smokers is, think twice”, Dr. Krech said, as consuming tobacco came down to supporting an iniquitous situation in which farmers and their families were suffering.

Breaking the cycle

WHO, along with the UN’s Food and Agriculture Organization (FAO) and the World Food Programme (WFP) have joined forces around the Tobacco Free Farms initiative, to help thousands of farmers in countries like Kenya and Zambia to grow sustainable food crops instead of tobacco.

The programme provides farmers with microcredit lending to pay off their debts with tobacco companies, as well as knowledge and training to grow alternative crops, and a market for their harvest, thanks to WFP’s local procurement initiatives.

Dr. Krech said that the programme was a “proof of concept” of the power of the UN system to enable farmers to break free from harmful tobacco cultivation. He outlined ambitious plans to expand the programme, as countries in Asia and South America were already requesting support.

“We can help every farmer in the world to get out of tobacco farming if they wish,” he said.