The empty space on the left-hand corner of the counter standing in the middle of the shop run by Dadjè (not his real name) instantly catches the eye. It is the space where the medicine jars used to stand. “It’s quite a profitable business. My husband and I used to make a third of our income from it, but we’ve had to put an end to it now. The last series of arrests convinced us to stop,” explains Dadjè’s wife, who runs the general store with him.

For many years, people in Benin had easy access to all kinds of medication, no prescription required, the only problem being that most of it was counterfeit. “A whole range of illicit medicines were being sold, and widely consumed, from anti-malarial drugs to vermifuge, vitamins, antibiotics, painkillers and medication for high blood pressure,” says Ernet Gbaguidi, president of the association protecting consumer health, Bénin Santé et Survie du Consommateur. According to the estimates of various health organisations, between 40 and 70 per cent of the medication circulating in Africa is either fake or wrongly dosed.

They are, of course, badly made and harmful products, causing several million deaths every year. “These illegally sold medicines often have no active ingredient. Some of them cause stomach ulcers, kidney failure, toxic hepatitis and other unforeseeable symptoms,” he explains.

The Beninese government started to take serious measures to combat this lucrative trade in 2016. The launch of awareness-raising activities and encouraging international mobilisation to end the impunity enjoyed by the traffickers, dates back to 2009, with the Cotonou Declaration calling for action against fake medicines. The aim was to urge Africa’s health professionals and authorities to put words into action. Seven years went by before any concrete measures were taken.

Act 1 opened on 24 February 2017 with ‘Operation Pangea 9’ launched by the government of President Patrice Talon. According to official sources: “Over 80 tonnes of medicine were seized within the space of a few months, as compared with four tonnes in 2015.”

Around 100 fake medicines traders were also arrested. The seizures were staged across the country, in the main markets. The largest bust took place in February 2017 at Adjégounlè, known as the ‘open-air pharmacy’ of the huge Dantokpa market in Cotonou. Assan, who runs a domestic appliances business not far from there, told Equal Times: “We got to the market as usual that morning, when groups of uniformed men appeared, piling out of their vehicles. They blocked the exits just about everywhere and then started breaking up the stalls and gathering up the medicines. Little by little, they rounded up everyone identified as fake medicines traders or business owners. Access to this part of the market was closed off for several days.” Stalls selling a range of goods have since replaced the stands that used to sell fake medicines near Assan’s shop.

There is no longer any trace of medicines being sold on the street, at least not officially. Benin’s pharmacies have more customers than they used to. One pharmacist, expressing her wish to remain anonymous, told us: “Since the campaign really got underway, many have turned to us for medicines. What we sell most are paracetamol and products to combat fatigue.”

It is not just the pharmacists who welcome the political will shown, but also civil society representatives. Théophile Dossou, a trade unionist at the CNHU University Hospital, points out: “Fake medicines kill people more quickly than their illnesses. If you go to the dialysis unit at the CNHU, you’ll find many Beninese people suffering the consequences of taking fake medication.”

Tracing the supply chain back to the source

Stage one of Operation Pangea 9 was a success, but the authorities did not stop there. Another challenge had to be met: tackling the suppliers. According to police sources, people in high places were thought to be involved in the trade, known to be more lucrative, as a rule, than the drug trade. As Jean-Baptiste Elias, president of the National Anti-Corruption Organisations Front (FONAC), points out: “Fake medicines trafficking cannot exist without corruption.”

In December 2017, the police staged a strong-arm raid on the home of a member of parliament: Mohammed Atao Hinnouho. Several hundred boxes of pharmaceutical and medical supplies were seized. The inquiry subsequently opened exposed many of the other actors involved, including pharmacists, who had dealings with the incriminated politician’s men, revealed the Beninese justice system.

Wholesalers, as known as distributors, are authorised by the Health Ministry (five companies in total) to import and distribute medicine in Benin – produced in the country or, more often, in Asia – and have to follow good practice guidelines. The judicial inquiry exposed the existence of illegal trafficking rings and numerous breaches of the rules. Despite their efforts to proclaim their innocence, several wholesalers were fined for their involvement and their failure to report the facts to the police. The whole inquiry, combining corruption, crime and politics, was widely covered by the media for several months.

For the government, the work done by the police and the judiciary puts it in a more favourable light. Addressing the conference on fake medicines in Geneva on 23 May 2018, President Talon proudly proclaimed: “The arsenal in place in Benin leaves the fake medication dealers with no more breathing space.”

The government is also showing its commitment to re-establishing good practices. It wants to increase the resources of the National Laboratory in charge of quality control and to set up a committee tasked with reviewing the texts governing the pharmaceutical sector, to strengthen the legislative framework. On 14 March 2018, the Council of Ministers suspended the National Council of the Order of Pharmacists of Benin with a view to reorganising it.

The fight against fake medicines is a growing concern on the African continent. During the African Union’s 32nd Summit of Heads of State and Government in February 2019, in Ethiopia, African political leaders decided to set up an African Medicines Agency, to regulate medical products with a view to providing better “access to good quality, safe and efficacious medical products and health technologies for the African population”.

The treaty drawn up for its implementation still needs to be ratified by the African states. One of the agency’s roles will be to pool the experience of each country in their fight at national level, so that all countries are able to benefit from it. Benin’s experience could serve as an example for other countries seeking to step up their fight.