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The State of Medicine Quality in the Mekong Sub-Region

Sauwakon Ratanawijitrasin
Souly Phanouvong

6 - The ‘demand’ for poor quality medicines

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1When supplies of a product continue to be available, it is a clear indication that there is a continued ‘demand’ for that product. Why, then, do people in the Mekong Subregion ‘demand’ poor quality medicines which might cause harm to their health? Most of the studies on medicines with poor quality focus on their supply. There have not been adequate concrete studies that help provide relevant insights into the demand side of this issue. Supply and demand meet at a given price. ‘Demand’ can be a result of a consumer’s conscious selecting among a range of available choices; or it can be a result of a consumer’s purchase that is not a matter of choice but rather a need to respond to the necessities of life.

2Why do some people purchase poor quality medicines? Conceptually, a distinction should be made between the ‘demand’ for substandard and counterfeit medicines. Substandard medicines are those produced by legitimate producers. For a product from the same producer, the price of the same product that passed quality standards should be the same as one that failed quality standards. The cause or causes of poor quality might come from the manufacturers (for example, poor formulation, failure to follow good manufacturing practice, and/or poor transportation condition), and/or the sellers (for example, poor storage condition). On the other hand, the prices of products from a producer who does not invest to ensure good quality practices in the manufacturing processes might be lower than those from another producer who invests in these necessities. However, a consumer might not be aware of this difference. In a country where regulations are not sufficiently strong, it is probable that the purchase of a pharmaceutical product sold at substantially lower price might get the consumer a product with poor quality, though this might not always be the case.

3In contrast to substandard products, one defining characteristic of a counterfeit product might be low pricing. Consumers generally purchase a counterfeit product because they are led to believe that these are genuine ones sold at a much lower price. In Cambodia, “suspiciously low prices” were cited as a reason for the initiation of a quality monitoring survey in 1999. The results showed that most of the bottles with mefloquine tablets and about half of the artesunate blister packs sampled appeared to be fakes (Rozendaal 2001). According to WHO, counterfeiting is greatest in regions where regulatory and enforcement systems for medicines are weakest. In most industrialized countries with effective regulatory systems and market control, the incidence of counterfeit medicines is extremely low. But in many African countries, and in parts of Asia, Latin America, and countries in transition, a much higher percentage of the medicines on sale may be counterfeit. Not only is there a huge variation between geographic regions in terms of incidence of counterfeit medicines, variation can also be significant within countries, for example between urban and rural areas, and between cities (WHO 2010). The case of Thailand reviewed in a section above illustrates this fact. While counterfeit antibiotics and anti-malarials were found in the border areas, police raids in Bangkok uncovered expensive lifestyle and cancer counterfeit medicines.

4Setting aside lifestyle medicines, demands for the types of medicines such as those for the treatment of cancer, antibiotics, and anti-malarials appear to come from real needs. Many cancer medicines are extremely expensive, and are unaffordable even for the middle class population in the city, not to mention the poor. And for poor populations, particularly those who live in the border areas, immigrants, and other disadvantaged groups, even the prices for anti-malarials and antibiotics might seem high. Affordability is likely to be a key issue. Furthermore, due to the fact that access to health services and medicines is difficult in the border areas, availability of medicines and services is likely to be another issue.

5There is also another set of questions related to the consumers’ knowledge of medicine quality and the potential harm these medicines might cause. How much do consumers understand about the importance of medicine quality on effectiveness and potential harm? And if consumers did have such knowledge, would they continue to purchase poor quality medicines? The current state of empirical knowledge in this area remains inadequate. To be able to meet the challenge of the issue of medicine quality in a comprehensive manner, there is a need to know more about the demand behaviour at a level that can enable the design of policy interventions.

6Hence, in order to effectively solve the problem of medicine quality, it is necessary to address the demand-side of these issues, in addition to supply-side interventions. Key among the demand-side factors are, first, the availability and affordability of medicines; and second, the consumers’ knowledge of medicine quality.

© Institut de recherche sur l’Asie du Sud-Est contemporaine, 2014

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