The busy Mbare-Musika market in Harare is stocked with knock off merchandise, from imported car parts, tyres, building materials, vegetables, food, chemicals to handbags, handiworks and an assortment of goods that many buyers from across the country come to purchase for resale at a profit.
But the most dangerous counterfeits are the imitation medicines sold to unwitting consumers in the dusty and open barns in Mbare.
In the sprawling Epworth residential area, some 20km east of the capital and in most flea markets across the country, there is a booming business in the trade of fake drugs ranging from skin lightening creams to contraceptives and painkillers.
Fake drug 3BA tablets, used as skin lightening agents, are one of the most popular fake drugs smuggled from the Democratic Republic of Congo through Zambia into Zimbabwe. Some people are said to have reacted to the chemical damaging their skin and hair.
Fake drugs are being sold through the informal economy in large open-air markets alongside fruit and vegetables.
Experts in pharmaceutical fraud and the World Health Organisation (WHO) say drugs commonly counterfeited include antibiotics, anti-malarial, hormones and steroids and more increasingly, anti-cancer and antiviral drugs.
The experts say counterfeiters take inert ingredients such as chalk, and even dangerous chemicals, package them convincingly and sell them to consumers. Such drugs may have no therapeutic effect and can be toxic.
“Various types of drugs including ARVs which are both expired and unregistered are being smuggled through the country’s porous borders,” says Itai Rusike, director of Community Working Group on Health (CWGH).
CWGH is a non-governmental organisation that deals with community public health issues.
Rusike feels strongly that counterfeit drugs pose a threat to public health as the fake drugs are often sold in unhygienic conditions, in loose quantities not as prescribed and without proper labelling.
He urged the public to buy from registered pharmacies and healthcare institutions.
“These drugs (fake) are sold in hair salons and in the backyards. It is important for people to go to established healthcare institutions to save their lives from harmful counterfeit drugs,” he says.
Trade in counterfeit drugs is booming with consumers buying unwittingly drugs with misleading packaging and mimicking the shape, colour, size and imprints of genuine drugs.
Poverty is the biggest driver of the trade. The dollarisation of the Zimbabwe economy, the collapse of the country’s healthcare system in the past 10 years and the cost of genuine drugs in hospitals and pharmacies is forcing the majority of the poor to buy counterfeit drugs.
Rosemary Chikarakara of the Consumer Council of Zimbabwe says most of the poor have been forced to buy cheap counterfeits in the past 10 years after the collapse of the Zimbabwe economy.
At the peak of the economic crisis, shortages of drugs, cash and food were widespread leaving the poor with no option but to purchase sub-standard drugs smuggled into the country.
“These drugs are dangerous because there are being sold illegally on the market by unlicensed dealers. One never knows if they’re even counterfeits because they have not gone through the routine test,” she says.
According to WHO, an estimated one in four packets of medicine sold in street markets in developing countries could be fake.
Fake drugs do not cure patients’ ailments and health experts say they usually contain little if any active ingredient and often contain chemicals that not only fail to treat the underlying ailment but also cause direct harm to the patient.
The WHO estimates that counterfeit drugs constitute 10% of the global drug market, rising to 25% in developing countries and estimated to be worth approximately US$75 billion worldwide.
However, due to the very nature of counterfeiting where much of the trade goes undetected, the problem is likely to be more severe. Putting the lives of the poor at risk.
Tinashe Mundawarara of the Zimbabwe Lawyers for Human Rights says his organisation has received reports of fake drugs.
His organisation, he says, is concerned about the rising reports and is planning to hold meetings with Medicines Control Authority of Zimbabwe, NatPharm and the Ministry of Health to find ways to curb the influx of fake drugs.
The Medicines Control Authority of Zimbabwe is responsible for registering all new medicines and ensuring the efficacy of the drugs on the market.
“Whilst I do not know of the specific names of the expired drugs being sold illegally on the open market, cotrimoxazole (antibiotic), Lamuvidine (ARV), Kaletra, and Duflica are in short supply in the country. Counterfeit drugs are likely to come in as dealers capitalise on the shortages,” Mundawarara says.
WHO says developing countries are particularly vulnerable, in part because regulatory officials lack the capacity or political will to curb the distribution of fake drugs.
The UN health agency also suggest that, because legitimate drugs can be expensive, poor consumers also fuel demand by knowingly or unwittingly turning to cheaper counterfeit versions.