Working with Cambodia’s Ministries of Justice and Health, in April EWMI co-hosted the first in a series of groundbreaking workshops bringing together provincial officials focused on the investigation and prosecution of counterfeit and substandard drugs, and illegal pharmacies.  Faced with a growing problem of drug resistance caused by these practices, the USAID/Cambodia Health Office provided funding to EWMI’s Program on Rights and Justice,  to develop a skills training and case tracking program to improve prosecutions.  The April workshop held in Battambang Province assembled 49 judges, prosecutors, and health officials from four provinces to study the role of these crimes in increasing drug resistance, and worsening the impact of diseases like malaria and tuberculosis.

The series of workshops began in western Cambodia where drug resistant malaria is a growing problem not only for the country, but the region and the world.  Artemisinin, the most effective drug used to combat malaria, is threatened by drug resistance traced to Pailin Province in western Cambodia – the last stronghold of the Khmer Rouge, and lagging in the development of the rule of law.  The USAID Health Office program is one of several EWMI global health equity initiatives worldwide, and is the first effort to date to bring together court and health officials to address this problem in Cambodia.  The program builds on a similar EWMI prosecution training and tracking program in Cambodia which, in 2011, doubled the rate of convictions in gender-based violence (GBV) cases in just one year.  The GBV prosecution work followed the same model:  convening officials from the Ministries of Justice and Women’s Affairs to improve joint investigations and prosecutions, and then tracking those efforts using the justice ministry’s prosecution database. 

The problem of drug resistant malaria is part of a growing trend of other failing drug therapies, such as those for tuberculosis, hepatitis, and other common antibiotics.  In India, drug resistant TB has become so prevalent that the TB strains evading drugs are now described in three ways:  multiple drug resistant (MDR), extremely drug resistant (XDR), and totally drug resistant (TDR).  Counterfeit and substandard drugs, and illegal pharmacies, play a significant role in the spread of drug resistance, as they cause patients to take drugs with either a small portion of the active ingredient, or to take an incomplete drug regimen.  These actions result in a weak dosage that leads to drug resistance.  The lucrative global counterfeit drug trade continues to grow, with a recent report by the pharmacy industry measuring illicit revenue at $75 billion a year.  At the same time the WHO estimates more than 600,000 annual malaria deaths, and 1.4 million annual TB deaths.  With drug resistance increasing worldwide, the stakes are high.