Drug donations from US:
Charity or waste Disposal?
by Amitava Guha Any major disaster, natural or man-made, is invariably followed by reports of massive donations of medicines, usually from the US, made by "charitable" institutions. There have been reports of a large number of US charity organisations rushing medicines to Kosovo, Macedonia, Turkey and now Orissa. But these "donations" are often a cover for a major fraud being perpetrated by some of these organisations. The New York Times (June '99), for example, reported that Project Hope, an American medical charity, slipped US$1.5 million worth of "emergency" supplies to Kosovo refugees. However, relief workers, starved of essential drugs like antibiotics and insulin, found non-essential and cosmetic medications — donated by American companies that got a generous tax break for the donations. The shipment included thousands of tubes of lip balm, haemorrhoid (piles) ointment, anti-smoking inhalers, children's fruit flavoured remedy for sinus pain — all contributed by Johnson & Johnson. A major part of the consignment had expiry dates within the next few months. Problem of donated drugs Major concerns have been raised regarding the usefulness of such donations. Gilles Forte, a World Health Organisation (WHO) advisor in Copenhagen, said that large quantities of donated medicines are not usable and wasted. He commented that as much as 30 to 50 per cent of drugs sent may be eventually worthless. According to the New England Journal of Medicine (1997), 50-60 per cent of the 27,800-34,800 metric tonnes of medical supplies donated to Bosnia-Herzegovina between 1992 and mid-1996, were considered to be inappropriate. By mid-1996 there were an estimated 17,000 metric tonnes of unusable drugs stockpiled in warehouses and clinics throughout the country. Destroying those drugs was estimated to cost over US$3 million, at an estimated $2,000 per tonne. The WHO has cited similar problems in a number of other countries in the past: 1. In the first week after the earthquake in Guatemala in 1976, 700 cartons of assorted drugs were sent. These were sorted by a group of 40 pharmacy students at the rate of 25-50 boxes per day (it took about six months to finish the job!). Only ten per cent of the drugs were sorted and labelled correctly and relevant to the county's needs. 2. In 1978, a 170 kg consignment was airlifted to a rural clinic in Burkina Faso. It contained 90 kg of drugs, of which half had expired before their arrival. Of the rest, 10 kg were useless or dangerous, 15 kg were usable but were not needed and only 20 kg were of clear value. Even of this, half were relevant for use in a hospital setting and not needed for a rural clinic. 3. From the consignment sent to war-and famine-stricken Eritrea in 1993, seven truckloads of expired aspirin tablets took six months to burn and 3,000 half-litre bottles of expired amino acid preparations could not be disposed of anywhere near a settlement because of the pungent smell. Drug donations to India India had first hand experience of this kind of inappropriate drug donation in 1996. In 1995 it was informed that Heart to Heart International (HHI), a US based charity organisation, in collaboration with Rotary International would be donating a very large amount of drugs for West Bengal. For this purpose, a survey was conducted to find a pattern of drug requirements. The hurriedly designed survey was conducted in just three days, and also in a very few selected private organisations. The structured survey format supplied was mostly based on the scope of receiving and distribution of medical supply. At that time concern was expressed regarding the appropriateness of the "donation" given the fact that drugs worth US$10 million would be donated by the HHI, which was several times more than the drug budget of the whole of West Bengal. A local voluntary organisation wrote to the HHI suggesting that it should consider donating a similar amount of money to procure drugs from the Indian market instead, where drugs are much cheaper and the quantity of drugs thus procured would be several times higher. This would also help the Indian companies in producing a considerable amount of drugs. HHI did not bother to reply to this suggestion as they had an entirely different agenda. The same voluntary organisation wrote about its concern to the WHO. The WHO sent a letter to HHI in response. "It is true that some drug donations create more problem than they solve, especially if the donated drugs, the dosage, form, or strength are different from those already used by the health workers concerned; and most definitely if they are different from those on the national list of essential drugs or local formulary. "For your information, please find enclosed a copy of the latest version of the WHO Guidelines for Drug Donations, which will be published in the near future. "If you can ensure that this planned donation of drugs will follow these guidelines, its impact will be more beneficial to the recipients." However, the HHI did not respond to this letter. In response to a letter asking for a list of drugs planned to be donated, the HHI said, "Because we depend on the goodwill of pharmaceutical donors, the value of this airlift ranges from US$2 million to US$5 million. "At this time, we have no idea about the value of this particular airlift. We will not know about the final figure until about a month prior to the airlift." The Government of West Bengal constituted a committee in February 1996 to oversee this operation. However it was not until the end of March the Government of India sent a list of drugs that were being donated to the West Bengal Government. By then it was too late to make a proper analysis of the list. On April 1, 1996, a DC-10 aircraft loaded with the "donations" landed at Calcutta. Among the 44 passengers in the aircraft, there were a large number of executives of American corporate houses. The material contained in this donation was as follows: Total No. of airlifted packs 708 No. of packs containing drugs 304 Packs containing non-drugs and appliances 404 Total number of drug items 57 Number of essential drugs 9 Number of alternative/borderline drugs 7 Non-essential drugs 41 Thus, as the figures above indicate, very little of the content was made up of essential drugs. Many other items like batteries, water purifiers, pillow-covers, dolls, screw-drivers, sand paper, hair shampoo, etc, were sent in the name of drugs. The cost of non-essential drugs in the consignment constituted about 95 per cent of the total cost of drugs in the consignment. The whole lot of anti-allergics, painkillers and cough remedies were not worthy of donation as per the shelf-life criteria in the WHO guidelines. Out of the total value of $10,532,910 worth of drugs received, drugs worth $7,434,125 had either expired before arrival or would expire within one year. Further, three drugs — Terfenadrin, Sucralfate and Glybenclamide — constituted 84 per cent of the total cost of drugs. Further, one of the drugs — Terfenadrin — was banned in the world market and in India within a year from the day the donation arrived. The whole drug consignment, valued at US$10.5 million (Rs370 million) would have cost not more than Rs5 million if they had been produced locally. Ironically, the Government of India had waived duties and taxes worth Rs250 million to receive a donation costing just Rs5 million in the Indian market! The HHI announced to the press that the donations were made to serve Mother Teresa's institutions. Strangely though, none of the donated medicines were meant to treat leprosy or TB — the two main categories of diseases treated at Mother Teresa's institutions. Novel method to earn double benefits In contrast to this the HHI, in a press release stated that "more than 30 of these companies are literally saving hundreds of lives at no benefit to them except for the very great reward of doing good and meeting needs.... "They give us their very best products — top quality pharmaceuticals — never expired, out dated, or experimental medicines." What the release did not say is that drug companies in the US receive very high tax relief if they donate drugs. The New York Times reports that, "American companies are eligible for twice the normal tax deduction when they participate in a humanitarian effort. They also are able to shed old and slow-moving products, and save the cost of disposal. "In some cases, companies may view giveaways as a way to introduce their products to new countries." Recipient countries, in distress situations, are in no position to take a position against such donations. They may feel that a faulty donation is better than no donation. As a consequence US drug companies enjoy benefits from both ends. They get added tax benefits and are able to dispose of expired and banned medicines at no extra cost. It is time the recipient countries demand that all drug donations strictly follow the WHO Guidelines for Donation of Drugs adopted in the World Health Assembly in 1998.
* * *Acknowledgements People's Democracy, paper of the Communist Party of India (Marxist)