Pharmaceutical companies dump useless drugs in Albania

By Debra Watson
3 July 1999

The World Health Organization (WHO) has charged that Western pharmaceutical companies are dumping tons of unusable surplus and expired drugs into Albania for the Kosovo relief effort, simply to reap generous tax breaks from their governments and to avoid paying substantial costs of disposing of hazardous waste.

A WHO audit of humanitarian drug donations received in Albania during May 1999 was conducted in collaboration with Pharmaciens sans Frontières (PSF). Indro Mattei, a member of the Swiss Disaster Relief Unit working with the WHO Humanitarian Assistance Project Office in Tirana was one of the two pharmacists conducting the audit. "We estimate that 50% of the drugs coming into Albania donated by non-medical organizations are inappropriate or useless and will have to be destroyed. We are very concerned that some pharmaceutical companies are using this humanitarian crisis to get rid of unwanted stockpiles."

In April 1999, the Albanian health authorities relaxed import controls to speed up the entry of urgently needed drugs and medical supplies to meet the needs of the 460,000 Kosovar refugees and the continuing needs of the rest of the Albanian population. Even before the refugee crisis, the Albanian health care system depended heavily on drug donations, being able to cover only 20 percent of the drug and medical supply needs of its hospitals.

In December 1997, an article in The New England Journal of Medicine (NEJM) chronicled similar bogus drug-donations in Bosnia and Herzegovina from 1992 to 1996. Using a grant from Medecins sans Frontières-Belgium, Philippe Autier, M.D. from Milan and Patrick Berckmans, M.D. and Gerard Schmets, Ph.D. of Brussels investigated rumors about massive quantities of irrelevant drugs that arrived in Mostar, Tuzla, Gorazde, Sarajevo, and Bihac, cities that were key targets for humanitarian assistance.

The authors estimated that 50 to 60 percent of the 27,800 to 34,800 metric tons of drugs and medical materials that entered Bosnia and Herzegovina between 1992 and mid-1996 were inappropriate. Although miscellaneous donations of small amounts of drugs accounted for 60 percent of all inappropriate donations, they also documented dumping of large quantities, which accounted for 35 percent of such inappropriate donations. They used the example of France to illustrate the large amount of medical waste that needs disposal every year in the industrial countries. In that country, they wrote, the 22,500 metric tons of unused medicines each year equal 40 percent of the annual drugs sold.

"Our investigations nonetheless underscore that inappropriate medical donations to Bosnia and Herzegovina were common, as they were to Armenia and Mexico after their earthquakes, or to Africa during its food crisis, and to the former Soviet Union. Individuals and organizations have many reasons for sending medical supplies to a disaster area. Charitable gifts may lead to tax deductions and represent a convenient way to dispose of waste medical supplies without having to pay for their destruction. Publicity about humanitarian aid usually promotes the image of the people or organizations involved." Added to the cost of destroying the unusable drugs are health and environmental hazards, as well as the costs of storing, handling, sorting, and managing the useless and unusable medicines.

Apparently the June 1999 WHO alert was issued after repeated attempts to discourage inappropriate donations. In a letter replying to the Bosnia study, published in the May 14, 1998 NEJM, a WHO representative in Europe revealed that by 1996 there were about 800 tons of unused drugs in Bosnia and Herzegovina. The representative wrote that WHO planned to open a new sanitary landfill in Mostar to deal with the problem. He reasserted that WHO has repeatedly addressed the problem of inappropriate drug donations and the coordination and control of donations.

The authors of the Bosnia study replied that experiences there and in Armenia showed that the development of guidelines insufficient. They also reiterated the importance of expiration dates in response to a letter writer who defended donations of expired drugs. "That is an open invitation to send drugs nearing their expiration date to any area in the world where humanitarian assistance seems necessary," they said. "Why should a potential criminal act in one country be seen as virtuous when other populations are concerned?"

The authors of the Bosnia study pointed out that a substantial amount of inappropriate drugs did not fit into the usual category of expired, inadequately labeled, or packaged in such a way that they were rendered useless. Some Bosnian medical supplies provided as "humanitarian aid" consisted mainly of prepackaged medical kits designed for refugee situations in developing countries and largely useless in Europe. "Some medicines were provided in excess, whereas there were shortages of others—in particular, medicines for chronic diseases common in industrialized countries (e.g., insulin for diabetes mellitus and drugs for the cardiovascular system)."

Another doctor from Children's Hospital of Philadelphia related the following story to the NEJM: "Unfortunately, the 'altruism' of Western medical-supply donors has a Bosnian counterpart. Expatriate and local entrepreneurs sell medical supplies on the black market for substantial tax-exempt profits. My most troubling memory is of a middle-aged man whose elderly mother we treated for a stroke in Zenica Hospital. This poor man traded 50 kg of flour for five bottles of mannitol, which his physicians, who supplied the mannitol, assured him would cure his mother. Although 50 kg of flour has little street value in America, it was worth some 1,250 German marks, well over two years' salary for a senior physician. More important, 50 kg of flour can feed a family of four for one month. I will never forget the look of despair on the man's face when we told him that the mannitol was useless."

These experiences are now being repeated among the Kosovar Albanians, both those in refugee camps in Albania and Macedonia and those who are returning to their homes in war-ravaged Kosovo. The rapacity of the drug companies shows the real attitude of American and international capitalism towards the Kosovars, despite the humanitarian pretenses of Clinton, Blair and other NATO leaders.

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