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Substandard and falsified medicines are a growing concern both for LMICs and high income countries. Screening technologies help identify poor quality medicines and give an early signal when issues arise. This work also provides data for models to better understand the impact of poor quality medicines on antimicrobial resistance.

My name is Céline Caillet. I am based in LOMWRU in Laos, in Vientiane; it’s a little country in Southeast Asia. My main area of research is the quality of medicine. We work on trying to understand the problems of substandard and falsified medicine.

Substandard medicines are medicines that are manufactured by authorised manufacturers, but there has been an error or mistake during the manufacturing process and so these medicines are of poor quality. Whereas falsified medicines are criminal activities: they come from criminals who manufacture medicines to make profit. They, most of the time, contain no active ingredient or a wrong active ingredient that can be toxic.

The issue of poor quality medicine is not very well understood. What we estimate so far, based on the World Health Organisation, is that 10% of medicines are poor quality medicines in low and middle income countries which are the most affected areas. But we also know that high income countries such as Europe and America are not spared by the problem. There have been cases of fake medicines, from the internet, fake cancer medicine who managed to infiltrate the pharmaceutical supply chain in Europe.

There are different ways to improve medicine quality. There are actually many that we can think of: one of the main ones for low and middle income countries is to enforce regulatory authorities. They are the ones who control and regulate pharmaceutical supply chains. Unfortunately, these poor countries do not have a lot of resources to monitor the quality and prevent them to reach patients; this is one of the key aspects. Engaging with Ministry of Health as well, also international organisations which supply medicines in many countries. I think it is a global issue not only of medicine quality but of the access to medicines as well. I think we should talk more about the access to quality medicines now. And there is another aspect that I believe is very important: raising awareness both in low and middle income countries but also in high income countries to prevent unsafe behaviours that can lead to taking poor quality medicines, unfortunately.

In our group, the most important line of research is to try to understand the issues. It has been quite a neglected field of research. We do not understand what the problems are and where they are. We have been working on trying to understand and visualise what and where the problems are. We have also been working on testing new devices that can enforce medicine regulators and inspectors especially in low and middle income countries. Medicine inspectors go to a pharmacy and take the quality of medicines, but currently they use only their eyes to see if a medicine is a good quality or not. We are working on providing the screening technologies that the medicine inspectors, police officers and custom officers can use to identify poor quality medicines and remove them from the market.

The reason why our research matters is, as for any disease, you need to understand the issues to better inform policies and to engage with stakeholders. That is one of the reasons why our research matters: by understanding the issues, we can engage with the important people to take action against poor quality medicines. The use of screening technology: we hope we will enforce inspectors of the quality of medicines so that we have an early signal of an issue in a country, for example falsified medicine in a rural area in Nigeria, and then we can take a timely action against it and remove the medicine from the market to prevent patients from reaching them. It will save lives by having these devices.

Translational medicine is key in research. Our work on medicine quality will help to understand better the impact of poor quality medicines on antimicrobial resistance which is a big concern at the moment. By trying to understand the issue, we provide data for models, statistical models or mathematical models that can help to better understand antimicrobial resistance. If we understand better antimicrobial resistance issues, then we can do something about it. The second work we are doing about screening technologies to identify poor quality medicines will also lead to recommendations on how to best deploy these devices in specific contexts in low and middle income countries in particular, so they will inform policy makers on how best to deploy these screening technologies in their specific context.

This interview was recorded in September 2019

Céline Caillet

Céline Caillet coordinates IDDO Medicine Quality Scientific Group. Medicines are of vital importance in health systems; poor quality medicines are widespread, jeopardising efforts to improve access to effective health care. Collating and sharing data helps understand the prevalence and distribution of poor quality medicines, encouraging more investments in policies and interventions to improve medicine quality.

Translational Medicine

From bench to bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.