Time for a Fake Drugs Treaty

Roger Bate | 30 Jan 2024
Africa Fighting Malaria How vested interests and NGO politics are stalling much-needed international action against a deadly trade.

The first international narcotics treaty, the Hague International Opium Convention was signed a century ago this week. It focused on controlling international trade in opiates, in the hopes of limiting the damaging effects of opium. A century later there is a much larger illegal trade in opiates, and the war on narcotics is widely regarded as failing - largely because demand for these products persists. Perhaps more mysterious is that there is no international treaty against drugs nobody wants - potentially lethal falsified and substandard medicines. It is time that changed. Since there is no demand for dangerous medicine, international action has a far greater chance of success than the war against narcotics.
In 1912, opiates (opium, morphine and cocaine) were freely traded across borders and were used by small sections of society. Readers of Arthur Conan Doyle or Oscar Wilde might have the impression that opium dens proliferated across East London, but in reality, opiates were mainly used as anesthetics. Nevertheless, they were fairly easy to obtain. The Pharmacy Act in 1868 in Britain was supposed to limit access to opiates, but in practice opium users were able to buy the stuff as easily as we buy vitamins today. And using opium was also tolerated, if not quite socially acceptable. From 1912, international trade largely went underground, beginning the problems of violence and cost associated with the modern narcotics war.

Having directed the East Asian opium trade for well over a century, the British Government was not an enthusiastic backer of an international convention. By contrast, the United States and China, were firm supporters of international action.

Chinese sailors were trading the product widely and were implicated in several British and American deaths from opium overdoses. Although their Government opposed the opium trade, Chinese traders quickly became the scapegoat and were viewed by many in the West as fanning the flames of addiction. Anti-Chinese sentiment in Britain and America was used by western politicians to help rapidly push through an international convention.

Since that time, new international narcotics conventions have come into force, run by the United Nations Office on Drugs Control (UNODC) in Vienna. But demand for narcotics continues, and so does the cost and violence that accompanies its trade.

In a cruel twist of irony, China's Government that a hundred years ago opposed Britain's opium trade today acts as one of the biggest laggards in combating falsified medicine. Part of its reticence is that tens of millions of Chinese nationals have made a great living copying western innovations, and doing so incredibly cheaply. Cheaper medicines is a boon, and many Chinese versions are good quality, but poor copies can be dangerous. Today there is a lethal trade in pills pretending to treat diseases like malaria or conditions like hypertension, but which contain no active ingredient, leaving vulnerable patients to suffer, many thousands die.

In the past two years, attempts to plug the gap in international law against these non-narcotic but lethal medicines have been discussed. Argentina has suggested a treaty through the UNODC, and various academics and health specialists have discussed the possibility of using the UN's World Health Organization (WHO) as the secretariat for a convention against counterfeit or falsified medicines.

Unlike a century ago, however, action is sclerotic and every vested interest's baggage is so significant that little action seems achievable. Health activists, the emerging market generics industry and governments of India and Brazil, and to a lesser extent China, believe that Big Pharma is orchestrating a plot against their interests; sadly, their erroneous suspicions have been reinforced by some stupid actions in Europe. Dutch seizures of legal Indian generic medicines in transit and industry advice on Kenyan anti-counterfeit laws that might limit the generic trade are two obvious errors in judgment by some European nations and pharmaceutical companies. Suspicions also build on 15 years of mistrust over HIV drug patenting and pricing.

But emerging market interests deserve the lion's share of the blame, since they are blocking any concerted action against dangerous medicines. One doesn't have to adopt western industry's often-blinkered attitudes to see that falsified drugs are a major problem worth addressing. Yet India in particular simply will not discuss international law against these products, even though their own generics are probably the most falsified in the world.

Although WHO could be the home for a treaty, member states are still stuck on how to define harmful medicines - again India is largely to blame. Rather than waiting for WHO to act, Europe has moved ahead with its own Medicrime treaty. While the vast majority of the language in this treaty is good, emerging countries will never sign up to a treaty they didn't help negotiate. The result is a global stalemate.

Ottawa University's Amir Attaran, the legal expert pushing most ardently for a treaty on dangerous medicines, believes an agreement will be reached within the next twenty years, but is urging for it to be as soon as possible. By 2032, the Hague International Opium Convention will be 120 years old, and it will still not be working because of significant demand. It would be tragic if by 2032 there is no treaty against falsified medicines, where demand for such products is non-existent, but criminals hoodwink the most vulnerable in society with impunity.

Roger Bate is a co-founder of AFM and the Legatum Fellow at the American Enterprise Institute. He is author of the forthcoming book 'Phake: The Deadly World of Falsified and Substandard Medicines'