The Guardian February 9, 2000


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)

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