Kenyans have often been casually been described as entrepreneurial. For most, after each experience or occurrence, there is a business angle to be explored.

This mentality has caught up with most Kenyans who travel to India to seek cancer treatment. During the excursion, most patients and caregivers have turned briefcase cancer drugs sellers back in the country.

This has led to a rise in cancer drugs black market, with most sellers using referrals to make a quick buck from patients who cannot afford to travel to the Asian country.

This illicit trade is compounded by the prohibitive cost of the medicine that has seen most patients opt for the “cheaper option”.

Once in India for treatment, the patients and caregivers establish links with cancer drugs outlet for a steady supply and at a cheaper price.

Dr Wairimu Mbogo, a pharmacist and head of commercial and operations at Meraky Healthcare Limited says trend of illicit trade in cancer drug is now widespread.

“Patients have realised that the medicines are cheaper in India, so some of them use those with connections there to procure the drugs for them,” she said.

However, she added, the trade is illegal and the drugs may not be safe, owing to the manner in which the drugs are transported. Most of the drugs, although some are procured using patients’ prescriptions, are sold through the backdoor. The law requires that a person who wishes to import drugs should be licenced.

“There are patients who may have gone to India for treatment but saw an opportunity to start selling drugs which they ferry in their suitcases,” Wairimu said.

Possible contamination

The sellers do not often declare the contents of the suitcases and end up exposing the medicine to possible contamination and unconducive temperature conditions that interfere with their efficiency.

Ordinarily, an importer must declare to the Pharmacy and Poisons Board (PPB) their drugs supplier, location, contacts of each of parallel imported medicinal substance. The full responsibility for quality, efficacy, safety, potency, and security of parallel imported medicinal substance lies on the parallel importer.

Further, such traders are expected to comply with Good Distribution Practice (GDP) standards; ensure that the storage conditions, GDP and Good Manufacturing Practice (GMP) are observed during transport and distribution, for example, cold chain requirements.

However, even as the racketeers fail to declare what they are importing, they further breach regulations and expose the medicines to possible contamination and temperature conditions that interfere with efficacy.

“Instead of putting the medicines in suitcases they should use a logistics provider to bring the medicines here to ensure it is free of contamination or temperature changes;” she said.

The President of the Pharmaceutical Society of Kenya (PSK) Louis Machogu concurred with Wairimu, saying the web of those importing cancer medicines is spreading and includes relatives of patients.

“Relatives who travel with patients find that the medicines are cheaper and bring them here. But sadly, no one checks where the medicines come from,” he says.

“No one knows how the medicines were stored when they were coming in; some medicines are temperature sensitive, so they need special cold chain validation procedures,” he added.

“Cancer develops resistance if patients consistently use medicines that do not meet required safety and efficacy threshold, forcing the user to go for the most effective, and by extension costly. It is a public health issue that needs to be addressed urgently."

Arrest trend

However, Wairimu suggests that hospitals can arrest the trend if patients coming with their own medicines either sign a disclaimer that the oncology centres do not know where these medicines are coming from and that the hospitals are not liable.

In some cases, business people have seen an opportunity because of medical tourism.

“It becomes a connection where a patient is talking to another in the oncology centre,” says Wairimu.

The risk comes when a patient reacts to a drug, for instance in a situation in which medicine is labeled wrongly.

The Pharmacy and Poisons Board admitted presence of cancer drugs originating from invalidated sources, but with lack of adequate personnel at the ports of entry and the cunning nature of some importers, it is difficult to contain the illegal trade.

“We have 11 to 13 gazetted points of entry but the number of officers we have is not enough. We man the main entries. However, as much as it is happening, the quantity of those medicines is insignificant. In the world over, governments have not been able to manage this situation," board CEO Fred Siyoi told journalists in Nairobi during a roundtable meeting.

Siyoi, however, said those importing medicines in suitcases were taking advantage of the Prescription Medicine Importation (PMI) avenue to bring in drugs of commercial significant quantities (commercial packs).

“However, we have clear guidelines that manage this process. If one is seeking a special permit to import on prescription, the part of prescription must be attached when applying to import that drug,” he said.

Dominic Kariuki, an inspector at the board says an importer can only bring in medicine that can run for 18 months.

“Once you are importing you have to ask the officer at the port oi entry to check and confirm the drugs are labeled in the language he understands. He projects that whoever will use them also understands," he said.

Unregistered drugs

The board cautions that sale of unregistered medicines is not allowed, except with written permission under the appropriate provisions in the Pharmacy and Poisons Act.

As a condition, records of sales should be kept, and this may also include special conditions on giving the permission.

Further the medicines should be stored separately from other registered medicines.

“The area should be clearly indicated as to its use to ensure adequate control of sales,” the guidelines say.

More than 70 per cent of cancer cases are diagnosed at late stage when treatment outcomes are poor and palliative care is usually the only management amenable.

To ensure a coordinated response to cancer control in Kenya, the National Cancer Control Strategy 2017-2022 was developed to act as a framework to guide all stakeholders supporting its control. The strategy addresses the whole ecosystem, including prevention, early detection and screening, diagnosis, registration and surveillance, treatment, palliative care and survivorship, coordination, partnership and financing and monitoring, valuation and research.

Low-income countries such as Kenya, Uganda and Tanzania are bearing the biggest burden of the disease due to lack of awareness, misdiagnosis, late presentation to hospitals and the high cost of treatment.

IN NUMBERS

40,000 It is estimated that there are 40,000 new cases annually and approximately 28,000 cancer-related deaths every year.

70%
More than 70 per cent of cancer cases are diagnosed at late stage when treatment outcomes are poor and palliative care is usually the only management amenable.

CANCER DRUGS BLACK MARKET

LOGISTICS

Health experts say instead of putting medicines in suitcases, suppliers should contract a logistics firm to ship for them to ensure it is transported safely free of contamination

RELATIVES

Relatives who travel to India with the patients as caregivers have seen that the medicines are cheaper and bring them here. But sadly, no one who is checking where the medicines are coming from

GAZETTED PORTS

There are 11-13 gazetted ports of entry, but the number of officers we have, is not enough. We man the routes that are main entries. However, as much as it is happening, the quantity of those medicines is insignificant. In the world over, governments have not been able to manage this situation," board Chief Executive Officer, Fred Siyoi told journalists in Nairobi during a roundtable meeting.

BRIEFCASE SELLERS

Dozens of Kenyans, especially those on cancer treatment who travel to India regularly for medication - are now the popular briefcase medicine sellers despite the regulatory framework governing this business being in place.

SHIPPING PRACTICES

When shipping products of medicinal nature, an importer must declare their supplier, location, contacts of each of parallel imported medicinal substance to Pharmacy and Poisons Board (PPB).

Some medicines are temperature sensitive, so they need special cold chain validation procedures

COSTLY AFFAIR

The cost of treating cancer remains way beyond the reach of most households in Kenya.

A survey in three cancer centres in Nairobi revealed deep financial strain for households with patients suffering from the four main strains of the disease—cervical, breast, esophageal and prostate cancer.

It costs between Sh 172,000 and Sh759,000 to treat cervical cancer without surgery in Kenya and Sh672,000 to Sh1.25 million if one undergoes an operation, according to researchers allied to the National Cancer Control Programme and the National Cancer Institute, Kenya.

Patients seeking basic treatment for breast cancer pay between Sh175,200 and Sh1.98 million.

There are patients who may have gone to India for treatment but saw an opportunism start selling drugs - Dr Wairimu