Fake and Substandard Drugs Threaten Malaria Treatment in Cambodia

TASANH, Cambodia A stream of poor-quality and counterfeit malaria drugs coming into Cambodia is contributing to a growing resistance to treatment for the disease near the Thai-Cambodian border.

Many of the drugs are cheaply made and don't contain the right chemistry, or are stored at incorrect temperatures, while others are deliberate fakes that have authentic-looking pills and packaging but contain only a small percentage of the active ingredient in each pill.

People in Cambodia are unknowingly using "improper drugs and fake drugs which create resistance," Duong Socheat, director of the nation's malaria control program said. The problem is fueled by the country's many informal pharmacies and merchants that don't have the proper training to provide the correct drug regimen, he said.

Of the drugs the country has confiscated, most were traced to China and Thailand, according to Socheat. India is also known to be a large manufacturer of counterfeit and substandard drugs.

There have been some attempts to crack down on the lucrative industry, such as putting in place greater penalties for counterfeiting, but without much effect, said Roger Bate, an economist at the American Enterprise Institute who researches counterfeit drugs.

"They do not regulate -- and cannot regulate -- things as well as the U.S. or Europe. It's not that they don't want to but they have a massive counterfeit problem and they don't have the money," Bate said.

Fake and substandard drugs of all kinds are a problem around the world, but the scale is difficult to gauge. The World Health Organization estimates that as much as 25 percent of the drugs sold in the developing world are counterfeit. A 2009 report from the International Policy Network found that fake tuberculosis and malaria drugs alone may kill about 700,000 people a year.

In Cambodia, the risks extend even beyond loss of life because the area of western Cambodia near the Thai border has historically been at the heart of development of resistance to antimalarials. Resistance to chloroquine surfaced there in the 1970s, followed by resistance to sulfadoxinepyrimethamine and mefloquine.

Recently, two independent studies carried out in western Cambodia found that early stages of resistance is developing for artemisinin, now considered the first-line treatment for malaria.

Being exposed to low levels, or incorrect dosing of a medication can help grow resistance. A 2006 study published in the American Journal of Tropical Medicine and Hygiene found that 68 percent of anti-malaria drugs found in Laos, Myanmar, Vietnam and Cambodia did not contain the correct amount of active ingredient.

Use of monotherapies can also breed resistance, leading to a World Health Organization ultimatum for artemisinin to only be produced and sold as part of combination therapy, called ACT. However artemisinin monotherapy, a fraction of the price of the combination therapy, has continued to be produced and sold as a cheaper alternative.

In Thasanh, Cambodia, the site of U.S.-funded resistance trials, researchers say patients have brought in a wide range of medications. Some are monotherapies, some are clearly just "fever packs," plastic baggies filled with a variety of pills not really intended for malaria, while others appear to be ACT but may not be the real thing.

In an effort to provide access to good quality malaria medications, and also decrease manufacture of fakes, monotherapies and cheaply made medications, the Global Fund and international partners are launching a $225 million program called the Affordable Medicines Facility - malaria, known as AMFm.

The program aims to flood pilot countries with cheap, high-quality malaria medications to reduce the use of improper or fake medications by patients, and to make the market less desirable for producers of the products.

"If there is an economic incentive for illegal production of a product in all likelihood it will happen," said Dr. Olusoji Adeyi, director of AMFm at the Global Fund.

"So by introducing into the market high quality drugs at rock bottom prices it will reduce the economic incentive for the producers and marketers of fake drugs."

Cambodia is the only non-African country among the 11 invited to participate, and was included because of its history with development of drug resistance, said Adeyi.

Once approved, each country will decide how to implement the program through the public and private sectors. If the drugs are not offered for free to the public by the country, they will be available for a small amount of money said Adeyi.

By negotiating with the manufacturers of ACT and subsidizing the cost of the medicine, AMFm would reduce the cost of ACT treatment for the buyer from about $6 to $10 down to 20 to 50 cents.

The group is moving quickly to start the pilot programs and is aiming to begin distribution in early 2010. But not everyone is convinced the scheme will work.

"I like the idea in principle but I have gone on the record as against it in practice as it currently stands," Bate said. There is not yet a complete understanding of how this intervention will affect the market in each country, he argues.

The United States has also not backed the plan yet, citing a lack of data showing the subsidies will work once implemented.

Adeyi counters that time is short and the pilot program is a smart way to move forward before any attempt at a larger roll out.

"As of today, collectively the global health community has tried many things to achieve universal access to malaria medication and collectively we have not succeeded," he said.

"If we stay on this track we will lose artemisinin [to drug resistance] ...we need to have open minds to a new approach." Read more!

Cambodian PM calls for peaceful border with Thailand

PHNOM PENH, Cambodian Prime Minister Hun Sen said Cambodia and Thailand should try to prevent armed conflicts and to secure a border of peace, security and development, the official news agency AKP (Agency Kampuchea Presse)reported on Friday.

Hun Sen made the remarks when he met with visiting Thai Parliament President and speaker of the House of Representatives Chai Chid Chob on Thursday. The premier stressed that "any dispute could have negative impacts on Cambodia-Thailand trade," according to Ieng Sophalet, assistant to the premier.

Meanwhile, Chai Chid Chob asked Hun Sen to help maintaining good relationship between Cambodia and Thailand and praised him for his right decision to reduce tension between the two neighboring countries.

On the same day, Chai held talks with Cambodian National Assembly President Heng Samrin. During the meeting, Heng Samrin asked once again the Thai Parliament to push the Thai government to accelerate the negotiations by using bilateral existing mechanisms and to withdraw its troops from the Preah Vihear Temple's area.

According to Koam Kosal, cabinet chief and assistant to Heng Samrin, Chai affirmed to bring these recommendations to the Thai government.

During his meeting with Cambodian Senate President Chea Sim, Chai Chid Chob shared the same idea with Chea Sim, especially withCambodia's stance to solve the border dispute peacefully and to avoid confrontations, Pheng Kunthea Borey, head of protocol of Chea Sim, told reporters after the talks.

The delegation of Thai Parliament arrived here on Thursday for a two-day official visit. It was also granted an audience by His Majesty Norodom Sihamoni, King of Cambodia on Friday.
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Cambodia’s child prostitutes need help

When Shari Newman of Lake Oswego made her first trip to Cambodia three years ago to investigate child sex trafficking, she was stunned by what she found.

“It was really emotional. It was so unbelievable,” Newman said. “I actually saw brothels and poverty. At the trauma recovery center there were little girls 3-feet tall and 5 years old holding my hand. They had been prostitutes. It was very taxing, emotional and heart wrenching.

“I’ve done a lot of mission trips, and that was the hardest one I’ve ever done. Other places you came away with a plan of action. There, you ask, ‘How can you do it?’”

What seemed hopeless in 2006, however, has a spark of hope in 2009. While the statistics on child sex trafficking in Cambodia are still overwhelming, young girls are being helped to recover from criminal abuse and awareness is spreading.

You could see how much at the “Children: Not for Sale” conference on July 7 at Lake Grove Presbyterian Church. A capacity audience of 120 people was on hand to hear Haiday Ear-Dupuy, advocacy and communications manager for World Vision Cambodia, talk about a problem that is so shocking when people hear about it for the first time: Cambodian girls being turned into sex slaves.

The statistics faced by Ear-Dupuy and her World Vision colleagues are these: 5 million Cambodians are trafficked in sex and labor.

A native of Cambodia who had barely managed to escape the genocidal reign of the Khmer Rouge in the 1970s, Ear-Dupuy’s decision to return to Cambodia to work for World Vision seemed unbelievable to many people. Especially her parents.

“They said, ‘We took you out of the lions’ den. Now you’re going back in,’” Ear-Dupuy said. “I explained to them why it’s important that I am in Cambodia. Once I started, it became very personal.

“It was like I was looking at my own face in the face of every child I met.”

True, Cambodia is no longer racked by war. But it is plagued by extreme poverty, an ever-widening gap between the rich and poor, a huge HIV/AIDS rate, severe social justice issues and an economy that is sinking.

Selling sex is one way to make dollars in Cambodia. “Sex tourists” from all over the world, especially the U.S. and Asia, come looking for young girls.


Read more!

A Humane Trade Reform

By Michael Gerson


There was a time when international trade was the subject of poetry. In "Locksley Hall," Alfred Tennyson "[s]aw the heavens filled with commerce, argosies of magic sails/Pilots of the purple twilight, dropping down with costly bales."

Recently, however, trade has inspired more resentment than verse. During a recession, the threat of foreign competition can seem more real and present than the opportunities of foreign markets. According to the World Trade Organization, 30 countries have imposed trade-restricting measures since the onset of the economic crisis. China included a "Buy Chinese" provision in its stimulus package. The U.S. Congress has variously threatened to impose tariffs as an instrument of climate policy, limited bailed-out banks in hiring foreign workers and encouraged states receiving stimulus funds to "Buy American."

All this is politically understandable -- and economically insane. With the world experiencing the largest drop in trade volumes since World War II, actions that restrict global trade will delay global recovery. Protectionism is economically self-destructive: Won't American companies eventually want to compete for contracts in India and China? Protectionism is diplomatically self-defeating: Do we really want to pick trade fights with our closest friends, such as Canada and Mexico? Protectionism is outdated: The distinction between foreign and domestic companies is blurred when many use transnational supply chains. And protectionism is unjust: The world's poorest countries are often the most dependent on exports.

Fortunately, after a fling with union-pleasing protectionism during his campaign, President Obama has largely adopted the pro-trade consensus of his predecessors. He has signaled support for bilateral trade agreements with South Korea and Panama, and openness to a pact with Colombia. At the recent Group of Eight meeting in Italy, he joined other leaders in calling for the conclusion of a global trade deal in 2010 to comprehensively reduce tariffs and quotas.

Unfortunately, grand goals are the cynical staple of summits. Completing the global trade negotiations begun in Doha in 2001 will require developing countries such as China and India to open their manufacturing and service sectors, and the United States and Europe to dramatically reduce agricultural subsidies and barriers. And it will require Obama not merely to acknowledge the need for trade but also to press the arguments for trade on Capitol Hill and within his party.

All of this is unlikely (though not impossible). But even in the absence of a global trade agreement, America has a responsibility to fix its tariff system -- a system that often punishes the poor.

Current law is supposed to allow developing nations to export duty-free into U.S. markets. In practice, however, restrictions and limits are placed on imported clothing, textiles, footwear and agricultural products -- which are exactly the kind of labor-intensive products that many poor nations produce best. So American tariffs effectively single out the poorest nations for the highest international taxes. On average, these countries pay more than three times the tariff rates of our richest trading partners.

One example: According to the Center for Global Development, Cambodia and Bangladesh pay about the same total tariffs to America as do France and Britain -- even though those European countries export about 15 times more to the United States. And in 2006, America collected about $850 million in tariffs from Cambodia and Bangladesh, mainly on imported apparel -- which is about seven times more than we provided in foreign assistance to those impoverished countries.

How to change the system? Kimberly Ann Elliott, a senior fellow at the center, recommends that Congress provide 100 percent duty-free, quota-free access to American markets for 70 of the most vulnerable countries on Earth -- ending the discrimination against products produced by the world's poor.

There are good humanitarian reasons for this reform, which would help nations suffering from a global recession they did nothing to cause. There are national security justifications: America has a direct interest in promoting economic growth and stability in parts of the world otherwise prone to terrorism, criminal gangs and epidemic diseases.

And there is a domestic economic argument. The very products produced by the poor abroad -- clothing, shoes, food -- are necessities for the poor at home. Our current tariff system is a regressive tax on these goods.

The cost of this reform to American manufacturers would be minimal -- even under Elliott's proposal, less than 2 percent of American imports would come from the countries granted duty-free, quota-free access. But the effect in those nations could be large. Even if international trade is no longer cause for poetry, it is cause for hope. Read more!

Change of name for SAO Cambodia

SAO Cambodia, born at the Keswick Convention as a result of an impassioned plea by a man later to be martyred under Pol Pot, is focusing more clearly on its task with a new name – Cambodia Action.

This follows the realisation that the name needs to shout out for Cambodia and for the mission’s ongoing active role there.

In 1973 Keswick delegates heard a heartfelt plea from Taing Chhirc for British Christians to rise to the challenge of supporting the young, struggling church in Cambodia. And as a result of this appeal, SAO Cambodia was formed.

Tragically, Chhirc returned to church leadership in Phnom Penh the following year and was among thousands killed when the Khmer Rouge took the country back to ‘year zero’ in 1975.
SAO Cambodia is a mission agency dedicated to help the church and rejuvenate this once rich and plentiful nation back to recovery. In innovative and effective ways, it encourages communities to be self-sustaining.

Since 1990, the mission has had a significant input among local groups, improving their spiritual, social and physical well-being. Working with the local church and other partners, it is committed to see the nation fully restored.

Cambodia Action hosted a reception at the Keswick Convention this year to mark this further significant step. Rev John Wallis, a trustee of Cambodia Action commented: “There are so many opportunities to continue to meet the challenge from Chhirc Taing. We want to partner with others to achieve strong biblical leadership in the Cambodian Church.”

Jonathan Lamb of Langham Preaching said: “We are looking forward to working with Cambodia Action and Cambodian church leaders to establish ongoing training and support for pastors and lay preachers.” Read more!