Buying drugs on the Internet saves time and money, but it can be deadly. Indonesia is working to regulate online pharmacies and improve public safety.
Shopping online is quick and easy, but sometimes when the order arrives it will be the wrong size or color – or maybe even a fake version of a branded item. It’s frustrating when it comes to a T-shirt or a pair of shoes, but when it comes to medicine, shoddy and counterfeit products can kill.
Online shopping for pharmaceuticals is a big business in Indonesia. It offers many price options and apps like Halodoc and K-24. Some apps are approved by the Indonesian Food and Drug Authority, so consumers believe it is a safe way to get medicine. They are also happy to avoid the queues and administrative hassles of the puskesmas (government-run clinics), where It is said the drugs are of poor quality anyway.
The Indonesian Ministry of Health settlement launched in 2020 to control online pharmacies and protect society from fake medicines. Among the thousands of online pharmacies, only 12 have an online license. The others are illegal and potentially sell fake drugs. None of the pharmacies on popular e-commerce platforms are registered with the ministry, although they appear to have an “official store” logo and have been verified by the platforms. The regulatory and e-commerce effort to control them seems far from successful, sellers are adept at manipulating the system by trying to ban them.
Like online pharmacies growing up, the risk of consumers receiving fake medicines also increases. The fake medicine trade is worth up to 470 trillion rupees ($31 billion) in middle-income countryaccording to the World Health Organization (WHO).
In early January 2022, three men were arrested in Bogor, after making fake ethical drugs in their auto shop. At the end of 2020, two men have been arrested in Mataram, Nusa Tenggara Barat, when they purchased fake drugs online in Jakarta and allegedly planned to resell them. At the height of the COVID-19 pandemic, people have become frantic about getting antimalarials because they were supposed to be a cure. The total number of fake drugs distributed in the online market remains unknown, but the the risk is high.
Fake drugs imitate the genuine item, but they may endanger health, prolong illness and even cause death. For example, poor quality antimicrobial drugs promote bacterial resistance to antibiotics. When patients develop antibiotic resistance, they need stronger antibiotics to fight the infection and risk death if their infection cannot be managed.
In 2017, fake antimalarials in sub-Saharan Africa caused 64,000 to 158,000 deaths. Fake medicines lead to distrust of the effectiveness of vaccines and medicines, and cost consumers more because their low doses are less effective and can prolong treatment. They also weigh on the health system.
The economic cost counterfeit antimalarials in sub-Saharan Africa averaged US$21.4 million to US$52.4 million per year due to the treatment needed to manage the additional cases they created.
Indonesia’s healthcare program has struggled to stick to his budget and faces a deficit of 51 trillion rupees ($3.4 billion). One strategy to ensure the financial sustainability of the program is to reduce the drug budget. Some might wonder if this would lead to poor quality drugs, but the findings of Brawijaya University and George Institute show that universal health care provisions such as Indonesia’s national insurance scheme provide quality medicines.
Given the limited budget and complex supply system, drug manufacturers have struggled to maintain the quality of their production.
Obtaining medicines through unlicensed channels carries a high risk, but official and licensed channels also carry risks. In 2019, the Indonesian Food and Drugs Administration started a business against a pharmaceutical distributor who had repackaged generic and expired drugs in new packaging and sold them to 197 pharmacies at a higher price. An inquest into the death of an infant in 2016 revealed a fake vaccine syndicate which had been in operation for more than 10 years. Union members, including medical staff, had distributed the vaccines to 47 private hospitals and health clinics.
For the perpetrators of these schemes, the motive is clear: huge profits. For patients buying drugs through unofficial channels, the incentive is usually to save money, as fake drugs tend to be cheaper. Although fake drugs can be found anywhere, going to clinics or hospitals is safer than buying drugs online. Obtaining medicines through the Indonesian national insurance program usually also ensures good quality.
These queues at puskesmas are worth for safe and genuine medicines. And the time spent in the queue could be used to order a new pair of shoes online. Hopefully, when they do arrive, they’ll be the real deal.
Yusi Anggriani is a lecturer in public health at the Faculty of Pharmacy, Pancasila University, Jakarta, Indonesia. She directs the systematic monitoring of high-risk drugs (STARmeds). His research interests are pharmacoeconomics and public health.
Stanley Saputra is the Engagement Manager for the STARmeds study.
STARmeds is a joint research project between Pancasila University in Indonesia, Imperial College London in the UK and Erasmus University in the Netherlands. It is supported by the UK’s National Institute of Health Research.
Originally published under Creative Commons by 360info™.
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