Selon l’OMS, un produit médical sur 10 vendus dans les pays à revenu faible ou intermédiaire est « de qualité inférieure ou bien falsifié » et près de 50% des contrefaçons signalées viennent d’Afrique. Un nouveau rapport indique que ce phénomène prend de l’ampleur dans la zone CEDEAO.
La vente des médicaments de contrefaçon en Afrique de l’Ouest atteint environ un milliard de dollars américains, soit un montant supérieur à la valeur du trafic du pétrole brut et de la cocaïne réunis. C’est ce que révèle un nouveau rapport de la CEDEAO paru en août 2023 et qui cite des données de l’Office des Nations unies contre la drogue et le crime (ONUDC).
Selon le document intitulé « Le trafic illicite de produits médicaux en Afrique de l’Ouest », les produits médicaux illicites représentent actuellement entre 20 et 60 % du marché officiel pour l’ensemble de la région. Dans des pays comme la Guinée et le Burkina Faso, ce pourcentage grimpe jusqu’à 80%.
Burkina Faso et Guinée, plaques tournantes
Pour les auteurs du rapport, Flore Berger et Mouhamadou Kane, plusieurs facteurs peuvent expliquer l’expansion de ce marché, y compris la corruption et l’insécurité. « La violence et l’instabilité au Burkina Faso ont contribué à une forte expansion du marché, et ses frontières poreuses sont devenues, aux côtés du port maritime de Conakry, en Guinée, les principaux itinéraires de contrebande », ont-ils déclaré. Ils ont aussi souligné l’implication des organisations criminelles dans le trafic. On peut lire dans le document que la faiblesse des cadres réglementaires de ces pays a rendu le secteur très vulnérable à la corruption, « les autorités de l’État et les travailleurs médicaux aidant même, dans certains cas, les produits de contrefaçon à atteindre directement les distributeurs et les détaillants ».
En ce qui concerne le stade de production, les auteurs des circuits d’approvisionnement illicite ont par exemple décrit des situations où « les importateurs illicites au Burkina Faso et en Guinée effectuaient des commandes directes auprès de laboratoires légaux (et illégaux) en Inde, à qui ils demandaient de produire X quantités d’un produit médical Y, souvent avec un dosage moindre du principe actif pour réduire les coûts ». Pour ce qui est des autres points de la chaine, les scénarios décrits révèlent parfois l’implication d’agents travaillant chez les distributeurs officiels, des pharmaciens, des vendeurs de dépôts privés, ou encore des fonctionnaires d’Etat et des personnes corrompues du secteur de la santé.
Les produits médicaux illicites les plus courants dans la région sont les antipaludiques, ce que le rapport explique par la dynamique de l’offre et de la demande. En effet, pour une maladie comme le paludisme, le taux en Afrique de l’Ouest est le plus élevé du continent, ce qui fait que 48% du marché des antipaludiques proviendrait de sources illicites. Les autres produits courants comprennent, apprend-on, les antibiotiques et les antirétroviraux (VIH/sida). L’Inde et la Chine seraient les principaux pays d’origine des produits médicaux licites et illicites que l’on trouve en Afrique de l’Ouest.
Selon le nouveau rapport, le marché du trafic illicite de produits médicaux s’adapte avec souplesse à la demande, avec des bénéfices maximisés pour certains produits selon le niveau de la demande (la saison des pluies pour les antipaludiques, la saison sèche pour le rhume, la toux ou la fièvre). Cette souplesse a par exemple permis aux réseaux criminels de répondre au pic de la pandémie de Covid-19 à une forte augmentation de la demande de chloroquine, qui était alors considérée comme un traitement efficace.
De grands efforts consentis pour lutter contre le phénomène, mais encore insuffisants
La question du trafic des produits médicaux n’est pas nouvelle. Si elle a déjà fait couler par le passé beaucoup d’encre, le nouveau rapport de la CEDEAO, et les données qu’il contient, interpelle sur l’urgence de la situation. Des efforts sont cependant consentis et des initiatives nationales, régionales ou encore continentales sont mises en place pour lutter contre le phénomène.
Au nombre des initiatives évoquées dans le document, on retrouve, en Guinée, la création d’une brigade d’intervention à la suite de la ratification de la Convention MEDICRIME. Cette brigade a intercepté un camion transportant 33 milliards de francs guinéens de produits médicaux illicites. Les auteurs soulignent aussi comme point positif le fait que le Burkina Faso et la Guinée ont tous deux travaillé à la centralisation de leurs marchés afin de réduire le nombre d’acteurs impliqués dans la chaîne d’approvisionnement. Cependant, ces initiatives restent insuffisantes étant donné que l’ampleur de ce problème sanitaire continue d’augmenter. Les auteurs appellent donc à davantage d’efforts concertés de la part des autorités nationales et insistent sur le rôle important que peuvent jouer les organisations régionales ainsi que la société civile.
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