Southern African trio flogged old ARVs in Europe

In June 2009, on a cool summer’s day in northern Germany, an HIVpositive man collected his regular antiretroviral (ARV) medicine prescription from his local pharmacy. Opening the drugs at home, he was shocked to find that — although sealed — not every blister contained a pill.

This single discovery in a pack of Viramune, the trade name for nevirapine, unleashed a series of investigations that would expose a multinational pharmaceutical fraud operating in the shadows across a dozen countries in two continents.

The pharmacy reported the incident to the manufacturer, GlaxoSmithKline (GSK), who tested the product and concluded they were original Viramune pills inside fake packaging.

GSK opened a case with the Hamburg police.

The police worked methodically back down the supply chain. From the pharmacy they traced the wholesaler — one Ernst Schwarz, an elderly and seemingly respectable businessman from the far northern German resort island of Sylt.

Specialised medical fraud investigators from the German federal police picked up the case.

Search and seizure operations at Schwarz’s home and business premises uncovered a trove of documents, and a picture of his international network began to emerge.

Police discovered that Schwarz had bought thousands of packs of suspect HIV medicines from Moses Kraus, a wealthy Zurich businessman known to associates simply as “Mosi”.

The investigation snowballed as Swiss medical authority SwissMedic got involved.

And from Switzerland, the scent took investigators to South Africa, where nevirapine was made available to HIV-positive pregnant women and their babies after a fierce and drawn-out court battle between the country’s largest HIV activist group, the Treatment Action Campaign, and then health minister Manto Tshabalala-Msimang.

Research has shown that nevirapine can reduce the risk of HIV transmission from a mother to her baby by half. From 2004, nevirapine has also been used as part of HIV treatment for some adults and, for a short time, was also used as part of paediatric HIV treatment.

In April 2010, another suspicious consignment of HIV medicines turned up in Germany — this time it was 900 packs of Norvir, an ARV manufactured by British pharmaceutical giant Abbott.

The batch number matched a consignment of 1 043 packs of Norvir that Abbot had distributed to the German market more than a year previously.

Laboratory tests on the Norvir capsules indicated they were “a different colour to the original” and that their outer packaging had been “falsified”.

Abbott concluded that these were “original products that had passed their expiry date, or had not been transported in accordance with ‘cold chain’ requirements”.

For the safety of users, ARVs must pass from end to end of the supply chain under controlled temperatures.

Investigations traced this dodgy Norvir back to companies owned by French-Tunisian businessman Antoine Mekni, who had bought the supplies from Rainbow