Over the past decade, growing concern has been expressed in some public health circles about the problem of the circulation of illicit drugs (“substandard, spurious, falsely labelled, falsified .This problem is defined as a global health problem by the nature of the mechanisms it engages (transnational circulation of health goods and internationalization of markets). It affects most countries in the world and in particular those whose pharmaceutical markets are poorly regulated.
The African continent is then frequently designated as a fragile space and as the target of trafficking and irregularities of all kinds. The often alarming figures relayed by scientific publications or the press make the apparent inability of the public authorities to take charge of the situation all the more intolerable. Many voices are raised in favor of strengthening legislation, World health organization (WHO).
The actors who display this concern come from diverse backgrounds. International organisations (the World Health Organisation, Interpol, the World Customs Organization), professional organizations (the International Nurses Association ), foundations (the Jacques Chirac), private non-profit organisations funded by pharmaceutical laboratories (the Partnership for Safe Medicines ,
the Institute of Research Against Counterfeit Medicines). These actors share the concern to fight against illicit drugs, but the interests they defend do not systematically converge and the solutions they put forward to promote a quality global pharmaceutical market are sometimes contradictory. The diversity of interests represented highlights the intricacy of moral, commercial, legal, industrial, scientific and technical issues in the production of the problem of illicit drugs.
Technology pharmaceutical markets
Economic and technological configurations in which it is embedded. The hypothesis put forward is that the way of dealing with this problem is part of a process of reconfiguration of certain public health mechanisms; the policies implemented have consequences in terms of public health. For example, to deal with the issue of illicit drugs, the Kenyan State has passed a law, redefined the areas of competence of regulatory and customs authorities, and participated in specific police operations. Media “coups” and political actions are difficult to discern,
Technology about medicines.
More specifically, the article sets out to show that the fight against illicit drugs, by promoting the establishment of technopolitical tools, contributes to transforming the challenges of access to drugs in the countries of the South. Until now, access to medicines in the countries of the South was largely determined by the question of prices,
the availability of medicines and by the strategies of competition between brand companies and producers of generic medicines which were expressed in the field. intellectual property. Through the fight against illicit drugs, companies are investing more in the field of security technologies and control standards, which is not without consequences in terms of access.
Technology and society
In this perspective, the approach of the article focuses on technologies for securing pharmaceutical markets. As we will see, these are numerous: technologies for controlling the quality of medicines, brand authentication, traceability of trajectories, market regulation, to name but a few. These technologies deploy conceptions of the relationship between biomedicine, technology and society; they also teach us about the different modes of government and control of the circulation of the flow of goods through a simultaneously technological, legal and social security process.
Two theoretical reflections will more particularly guide the process. The first concerns the entanglement of the social and the technical by following a tradition of research already nurtured on the social construction of technologies since the work of the current – Social Construction of Technology (Bijker et al., 1989).
technology is entanglement between the social and the technical
I will retain in particular from this tradition of research the attention given to the singularity of the forms of entanglement between the social and the technical and the refusal of a simple technical determinism in favour of a conception which has since been affirmed in the terms of a “co-construction” of the social and the technical (Jasanoff, 2004). The second reflection is an extension of Michel Foucault’s work on the notion of security, applied here not to individuals or populations but to consumer and health goods such as drugs.
Technology aims to protect populations.
Admittedly, the policies for combating illicit drugs aim to protect populations; the security operations carried out nevertheless relate to flows of objects and components. Pharmaceutical security is therefore a process that primarily affects the circulation of drugs. I will seek here to understand how this process is constructed (through which discourses, which knowledge, which devices) and to explain its consequences on the production of flows of objects.
This approach seems all the more important to me in that it makes it possible to document an essential characteristic of the globalisation of exchanges, namely the standardisation of markets which is
Access to medicines in Kenya: the case of antiretrovirals
Approaching access to drugs in Kenya through the prism of antiretrovirals and the fight against HIV presents a significant bias due to the specificity of the history of this treatment and the distribution methods that have imposed themselves. This ignores other treatments, other illnesses, and runs the risk of missing critical access issues that are less common with antiretrovirals than with other treatments, such as antimalarials, dewormers, or simple antibiotics; this is also silent the inclusion of anti-HIV treatments in a broader “moral economy of survival”
Nevertheless, without claiming to exhaust the question of access, a brief historical review of the conditions of access to antiretrovirals in Kenya makes it possible to underline how, at the national and international level, the challenges of access to medicines in the countries of the South, in particular around the problem of competition between pharmaceutical companies producing originator drugs and generics and around the relations between States, industries and patient movements
The public problem of illicit drug
Multiple studies (Newton, 2011), multiple estimates make illicit drugs a major public health problem in many developing countries and in particular in Africa (Peterson, 2012). This problem is not recent because the concerns for the authenticity of drugs are old and inseparable from the standardisation of the markets (Chauveau, 2006). More generally, the distinction between products whose marketing is legitimate and others whose circulation should be prevented has affected areas as different as pharmacy or food (Stanziani, 2005).
However, the issue of illicit drugs has been the subject of renewed and increasing attention since the 1980s, if we stick to the reports of the World Health Organisation devoted to the subject. In 1985, the Nairobi conference used the term “counterfeit” in the context of a meeting devoted to the rationalisation of pharmaceutical policy.