In 1967, as the United States sank into war in the jungles of Vietnam and China descended into the cataclysm of the Cultural Revolution, Chinese soldiers secretly fighting alongside the North Vietnamese also battled swarms of malarial mosquitoes. Showing remarkable foresight, Chinese Communist Party Chairman Mao Zedong amassed a secret team of top scientists with one mission: find a cure for malaria.
As China -- then a poor country, barely recovered from a devastating famine -- added insult to injury by dismantling its scientific, medical, and educational institutions under Mao's misguided program of political cleansing, the scientists labored on with clear purpose. Within a decade, some 500 researchers, many of whom were persecuted politically along the way, developed an ingenious drug called artemisinin, pulling off a medical marvel against the odds.
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The scientists and researchers of the People's Liberation Army's Project 523, named for its May 23 creation date, made one of China's greatest contributions to modern medicine at the same time as Mao was destroying the foundations of China's scientific establishment.
Mao's great medical innovation was withheld from the world for four decades because of Chinese military secrecy and intense global pharmaceutical competition. Today, it is the key ingredient in the frontline treatment for malaria in Africa.
Yet before artemisinin even has a chance to get a foothold in the battle against malaria, the drug is in danger of becoming a casualty of China's own overzealous profiteering and global drug counterfeiting.
In East Africa, artemisinin combination therapy, or ACT, became the preferred treatment for malaria a few years ago. Along with the massive influx of lifesaving drugs, first from European manufacturers and now from China, came a deluge of fakes.
In Uganda and Tanzania, whose lands form most of the mosquito-infested Northern and Southern shores of giant Lake Victoria, the malaria death rates are among the highest in the world. Widespread regulatory failure and unscrupulous business practices have created a market flooded with bad drugs. Coupled with China's already bad rap as a producer of inferior goods such as cheap shoes, knock-off phones, and faulty condoms, the reputation of China's malaria cure is perched on a precipice.
A small but growing body of evidence partly faults China for the massive upswing in counterfeit medications in Africa. There is proof of bad medicine originating in China, including the recent haul in France of 1.2 million doses of fake aspirin, some bound for Africa. Until now, the deadly risk of fake medications flooding Africa has been under-studied and under-reported.
"It is an enormous problem," says Nick White, tropical medicine specialist who leads Southeast Asia programs for Oxford University's Wellcome Trust, which spearheads groundbreaking research on counterfeit and fake malaria drugs. "It's not like a boil that's begun to burst, because it's been a problem for a long time. What's happened is we've begun to recognize it more."
The Wellcome Trust and others estimate that one-third of malaria drugs in Uganda, including ACTs and all others, may be fake or substandard. From the streets of Kampala to Lake Victoria's shores, fakes are abundant. Dispensary workers are cagey when asked about fake drugs, but admit they exist and they can do little to tell which are real and which won't work.
Thousands of private pharmacies have opened in recent years, offering quick remedies to maladies that have plagued the region for generations. The pharmacy boom has given counterfeit drug rings a major foothold. Locals routinely blame China for the bad medicine they peddle.
"I took the drugs I bought in a private dispensary when I had malaria two years ago. Nothing happened. Two days later I was still with fever, so I went to a hospital and found the drugs were probably fake," says John Otala, a 32-year-old father of three in Kampala. "We all know everything that comes from China is fake already, so I believe they may have been Chinese."
There is little relief. Fakes come in expertly copied packaging, down to exactly replicated logos, country-of-origin labels, and crisp foil strips, capable of fooling even medical professionals. The best pills bear the same inscriptions as real drugs, but contain little or no real medication. Only lab tests can spot the bad drugs, and testing equipment is scarce and expensive. For those with no time to wait in line for a day to see a doctor, taking malaria pills is a game of chance.
"We all know everything that comes from China is fake already."
Even major Western aid agencies have been duped by fakes of drugs as critical as antiretrovirals for AIDS patients. As aid donations of free malaria drugs to clinics in sub-Saharan Africa rise, filling shelves with pharmaceuticals, the patient demand for pills has boomed: finally there are cures and everyone wants them. But the boom also has opened a new consumer market for bad drugs.
Experts on the global fake drug racket explain: counterfeit medications follow demand. In the United States, customers find fake Viagra. When patients hear of a new cure or treatment, demand skyrockets. In East Africa, patients need malaria medication. Tracking the trade has proven almost impossible. "The counterfeiters try everything and they try everything to hide their identities," explains Sabine Kopp, head of the Anti-Counterfeiting and Medicines Quality Assurance Program at the World Health Organization. "It is very, very difficult to catch. Even in the studies, you only get a picture of the moment when you do the studies."
Just how dire that picture might be for China's homegrown malaria cures is becoming evident to the drug's champions at home. Artemisinin's inventors are concerned the damage will undercut the country's great medical innovation.
Wu Yulin, a 74-year-old veteran of Project 523, helped isolate the chemical structure of artemisinin in the late 1960s from an herb used as a traditional fever remedy. China used the plant for decades, but it only went global when the Swiss pharmaceutical giant Novartis bought the patent and began marketing artemisinin combination therapy (ACT) in the late 1990s. "Authentic ACT is very effective," says Wu, who lives in Shanghai. In Africa and China, "governments need to strengthen management to crack down on fake drugs. The fakes will undermine the health of people and will definitely set back the progress and potential of this medication."
This explosion in fake medications in East Africa did not come without warning, nor has the growing suspicion of China in Tanzania and Uganda.
As elsewhere across the African continent, China's presence has mushroomed in Uganda in the past five years. Though there is intense debate over how to quantify China's investment and aid to Africa, China now is among Uganda's top trade partners and its health aid has grown from nearly nothing five years ago.
China moved into Africa in its own way, with the government, state-owned companies, and private businesses all doing deals on their own terms, avoiding involvement with international organizations that work on health, education, and poverty reduction. The strategy has been both vilified and lauded as an alternative to Western-style aid, which critics say comes with too many strings attached.