While Bangladesh's mammoth pharmaceutical industry exports drugs to as many as 52 countries worldwide, new investigations reveal an estimated US $150 million worth of spurious drugs are posing a risk to public health at home.

In its annual testing of 5000 drug samples this year, the Public Health and Drug Testing Laboratory (PHDTL) detected 300 drugs that are either counterfeit or of very poor quality. Significantly, these include many popular antibiotics and lifesaving drugs.

Jolted into action, the health ministry's Drug Administration authorities have launched a drive against illegal and fake drug vendors in the country. Preliminary findings reveal Bangladesh boasts a whopping 80,000 unlicensed drugstores.

Drug Administration chief Abdul Gani expresses his helplessness in combating the menace,"There are so many illegal operators that we cannot cope. Our 25 branches across the country are staffed with just 40 drug superintendents and inspectors. We act when we get specific complaints. But this set up is hopelessly inadequate."

Gani points out that smuggled drugs are the biggest threat, as this is a grey area which is totally unmonitored. Remarks retired medical professor Nurul Islam, "In the absence of quality controls, any dishonest importer can smuggle in fake drugs at a takeaway price and sell them at a higher price."

The rampant growth of contraband drugs is blamed on the poor quality of health services and cutthroat competition between drug manufacturers. The 100,000 strong industry produces drugs worth over US $500 million.

Worse, the acute shortage of doctors and clinics in rural areas forces patients to purchase off-the-counter drugs sans a prescription. This helps fake drug vendors to thrive, stresses pharmaceutical industry executive, Dr Reaz Ahmed.

A large percentage of patients also travel to neighboring India for treatment, returning with prescriptions of Indian drugs. To cater to them, dozens of unauthorized pharmaceutical establishments have mushroomed on the Bangladesh border.

These units either smuggle in Indian drugs or manufacture fake ones that threaten the lives of thousands of patients, observes chief of the Drug Testing Laboratory, Dr AK Zakaria.

Although doctors warn these drugs could be causing deaths, no survey has so far been conducted to assess their negative impact on public health.

Recently, the Drug Testing Laboratory found that a popular drug used for strokes and brain hemorrhages - Cavinton - was being marketed minus its main chemical ingredients. Remarks Zakaria, "It is obvious that patients who used this counterfeit drug have either died or suffered an ordeal."

Ironically as the general secretary of the Bangladesh Pharmaceutical Industries Association, Nazmul Hasan remarks, "The presence of fake and illegal drugs in Bangladesh is itself surprising because we manufacture over 96 per cent of our requirements and even export drugs."

Hasan adds that the value of fake and contraband drugs flooding the market is estimated to be between US $100 million and $150 million.

According to him, these drugs are produced in hundreds of fly-by-night drug factories functioning along the borders of Bangladesh, India, Pakistan, China and Thailand.

Paradoxically though, as the president of the Chemist and Druggist Association Sadequr Rahman points out, the pharmaceutical industry is Bangladesh's second largest foreign exchange earner, boasting exports to 52 countries.

The industry comprises over 800 drug-manufacturing companies, 230 of which manufacture allopathic drugs, 255 producing traditional herbal drugs, 300 engaged in the manufacture of modern herbal drugs and 80 homoeopathic drug producing outlets.

Rahman alleges that apart from some three dozen leading allopathic drug manufacturers, the rest are involved in the production of fake and low quality drugs.

Ahmed terms this cannibalistic marketing of competing companies. As he puts it, "Due to its high returns, businessmen with no commitment to health services have started investing in the pharmaceutical sector. Their companies thrive on faking popular brands and manufacturing drugs sans authentic ingredients. The low prices help their drugs to sell."

Ahmed relates a recent personal experience where a child pneumonia patient urgently needed a lifesaving injection called Ceftiane. He recounts, "The injection was administered thrice but the child failed to respond. We then realized the brand might be false. After changing it, we administered the same drug and it worked."

He points out that many companies manufacture fake post-operative antibiotics like Cephradine and Hydrocortisone. Fungus-coated saline fluids and used syringes are also commonly found.

In addition, most drug manufacturers lack suitable storage facilities and enclose tablets and capsules in such low quality foil that it is impossible for them to retain their potency.

Health Minister Khandaker Mosharraf Hossain says the local pharmaceutical industry meets nearly 96 percent of the country's drug demands.

According to him, the Prime Minister has ordered a crackdown on illegal drug networks in the country.

Informs Hossain, "We are preparing to sue some 15 illegal and fake drug vendors in the capital Dhaka. We are currently inspecting other towns and cities as well."

- Sharier Khan (OneWorld)