Annex: Examples of problems with drug donations

Armenia, 1988

After the earthquake, 5,000 tons of drugs and medical supplies worth US$ 55 million were sent. This quantity far exceeded needs. It took 50 people six months to gain a clear picture of the drugs that had been received. Eight per cent of the drugs had expired on arrival, and 4% were destroyed by frost. Of the remaining 88%, only 30% were easy to identify and only 42% were relevant for an emergency situation. The majority of the drugs were only labelled with brand names.⁹

Eritrea, 1989

During the war for independence, despite careful wording of appeals, many inappropriate donations were received. Examples were: seven truckloads of expired aspirin tablets that took six months to burn; a whole container of unsolicited cardiovascular drugs with two months to expiry; and 30,000 half-litre bottles of expired amino-acid infusion that could not be disposed of anywhere near a settlement because of the smell.¹⁰

Sudan, 1990

A large consignment of drugs was sent to war-devastated southern Sudan. Each box contained a collection of small packets of drugs, some partly used. All were labelled in French, a language not spoken in Sudan. Most drugs were inappropriate, some could be dangerous. These included: contact lens solution, appetite stimulants, mono-amine oxidase inhibitors (dangerous in Sudan), X-ray solutions, drugs against hypercholesterolaemia, and expired antibiotics. Of 50 boxes, 12 contained drugs of some use.¹¹

France, 1991

Pharmaciens Sans Frontières collected 4 million kilograms of unused drugs from 4,000 pharmacies in France. These were sorted out in 88 centres in the country. Only about 20% could be used for international aid programmes, and 80% were burnt.¹²

Russian Federation, 1992

Russian pharmaceutical production has fallen far below its 1990 level, and donations of drugs have been welcomed. However, initial enthusiasm soured when the nature of some donations was discovered. Examples of donations include: 189,000 bottles of dextromethorfan cough syrup; pentoxifylline and clonidine as the only antihypertensive items; triamterene and spironolactone as diuretics; pancreatic enzyme and bismuth preparations as the only gastrointestinal drugs.¹³

Guinea-Bissau, 1993

In September 1993 eight tons of donated drugs were sent; all were collected from pharmacies in quantities of between 1 and 100 tablets. The donation contained 22,123 packages of 1,714 different drugs which were very difficult to manage and greatly interfered with government efforts to rationalize drug supply and drug use.¹⁴

Lithuania, 1993

Eleven women in Lithuania temporarily lost their eyesight after using a donated drug. The drug, closantel, was a veterinary anthelmintic but was mistakenly given to treat endometritis. The drug had been received without product information or package insert, and doctors had tried to identify the product by matching its name with those on leaflets of other products.¹⁵

Former Yugoslavia, 1994, 1995

Of all drug donations received by the WHO field office in Zagreb in 1994, 15% were completely unusable and 30% were not needed.¹⁶ By the end of 1995, 340 tons of expired drugs were stored in Mostar. Most of these were donated by different European nations.¹⁷

Rwanda, 1994

Large quantities of a sophisticated antibiotic were donated to refugee camps in Rwanda. Drugs were donated in bulk through private voluntary organizations. Refugee workers were not used to using the drug; most of it was recalled; the remainder posed disposal problems.^18,19

Bosnia and Herzegovina, 1992-1996

Between 1992 and mid-1996 an estimated 17,000 metric tons of inappropriate donations were received with an estimated disposal cost of US$34 million.²⁰

Albania, 1999

A WHO audit of humanitarian drug donations received in Albania during May 1999 revealed serious quality problems. It was estimated that 50% of the drugs coming into Albania during the Kosovo refugee crisis were inappropriate or useless and would have to be destroyed. Sixty-five per cent of drugs had an inadequate expiry date (either missing or expiring less than one year from the date of donation); and 32% were identified only by brand names, which were unfamiliar to Albanian health professionals. None of the short shelf-life donations were requested, and according to aid workers they could not be distributed and used before the end of the year.²¹