A vial of the AstraZeneca Covid-19 vaccine. Picture: REUTERS/Clodagh Kilcoyne
A vial of the AstraZeneca Covid-19 vaccine. Picture: REUTERS/Clodagh Kilcoyne

Black-green tears of moss streak the façades of once-white buildings. The city is a maze of narrow streets, some cobbled with sea-stones, calcified by the centuries that have passed since they were laid.

The air, always humid, is aromatic with sweet spices and fish, salt-washed from the nearby sea; the cacophony of the many markets and the muezzins’ call to prayer add to an atmosphere already heavy on the senses.

There is rhythm here, in the cauldron of the Old Town, but it is offbeat — chaotic even.

This is Mombasa — Africa’s fifth-busiest harbour, according to a report by financial advisory firm Okan and the Africa CEO Forum. It is Kenya’s chief port, and handles cargo for the whole of East Africa and parts of Central Africa.

Because of its strategic position, Mombasa has been a place of conflict since at least the 1300s: Arabs, Persians, Portuguese and Turks have all fought wars over it.

It’s also long been a haven for assorted miscreants.

In the 1960s it was a favourite haunt of infamous soldier of fortune "Mad" Mike Hoare and his "Wild Geese" mercenaries.

More recently, Mombasa sheltered one of the world’s most wanted terrorism suspects, Samantha Lewthwaite, an alleged al-Shabaab member known as the "White Widow". She is wanted on charges related to several terror attacks in East Africa and has been implicated in the deaths of hundreds of people.

The city today retains its reputation as an integral part of Africa’s criminal underbelly, being a major entry point for narcotics from the Middle East and illicit pharmaceuticals from Asia. Over the past 12 months, there’s been increasing talk in East African intelligence and law enforcement circles about the role it could play in facilitating shipments of falsified and substandard Covid-19 vaccines.

Mombasa’s organised crime groups have been quick to grab new opportunities — and there are a lot of them. A September report by EU-funded anti-crime initiative Enact says Kenyan law enforcement puts the number of organised crime groups operating there at 132. Most are involved in trafficking cocaine and heroin from Latin America and Asia.

Now, the port is set to become the primary conduit for vaccine supplies from India and China to landlocked East African countries including Uganda, Rwanda and Burundi, plus South Sudan, Somalia and the Democratic Republic of Congo.

Import overload

Interpol East Africa crime intelligence analyst John-Patrick Broome identifies Mombasa as a "key facility" for trade in falsified and substandard medicines.

Already, he says, there’s been a noticeable reduction in inspections at Mombasa port and other ports in the region. It’s an unavoidable by-product of the pandemic: the port needs to receive medication and support from around the world if the region is to cope with Covid-19.

"Inspection regimes have been reduced in order to facilitate the swift and hassle-free movement of items through the border, to be distributed across the region," says Broome. This, however, also allows organised crime groups "to facilitate the movement of illicit medications" — most of them from Asia.

An inspector at the port who spoke to Bhekisisa on condition of anonymity says as much. "At the moment we are only inspecting a small fraction of goods that come in. This is because our systems are overloaded with products. There’s so much cargo coming in that we have introduced trains that can transport double-stacked containers."

In the next few months, large consignments of vaccines will begin flowing into Africa, including jabs bought through international procurement mechanism Covax. With cargo planes not likely to handle the volumes, they’ll be shipped to some of the continent’s many free-trade zones (FTZs), including Mombasa.

It is at these FTZs that the vaccine supply chain will be most at risk of criminals inserting fake and substandard jabs, according to crime analysts, international anti-crime agencies and law enforcement officers.

US think-tank Global Financial Integrity (GFI), which analyses financial crime around the world, has called FTZs "a Pandora’s box for illicit money" and a "haven for free crime".

It defines FTZs, also known as free ports, as "special economic areas that benefit from tax and duties exemptions. While located geographically within a country, they essentially exist outside its borders for tax purposes."

By 2019, Africa was home to 189 of these FTZs, in 47 of 54 countries, according to the Africa Free Zones Association. Ten of them are in SA. And while FTZs are often found at ports, they can also be strategic inland hubs, as is the Musina-Makhado special economic zone in Limpopo, near SA’s border with Zimbabwe.

Developing countries especially encourage the existence of FTZs, as they attract export businesses and foreign investment, and create employment.

But the GFI report warns: "Criminals see them as perfect places to manufacture and transport illicit goods, as controls and checks by authorities are often irregular or absent. Customs authorities have little or no oversight of what actually goes on in an FTZ, goods are rarely inspected and companies operating in FTZs tend to benefit from low disclosure and transparency requirements."

Fake medicine is usually regarded as a violation of intellectual property rights and not a crime in many parts of the world, including Africa
Marius Schneider

The AU launched the African Continental Free Trade Area (AfCFTA) on January 1. With 54 signatories, it’s the largest free-trade area by number of members.

According to the African Centre for Economic Transformation, the AfCFTA could create an economic bloc with a combined GDP of $3.4-trillion and grow intra-African trade by 33%.

It’s not just a free-trade agreement. "It’s a vehicle for Africa’s economic transformation," the centre notes. "Through its various protocols, it would facilitate the movement of persons and labour, competition, investment and intellectual property."

But a former trafficker in illicit medicines, who now co-operates with law enforcement investigating the crime in West Africa, warns: "I’m sure the AU means well by making Africa one big party of a free trade area, but that could not be more perfect for the gangs who are already bringing fake medicine into Africa … It’s like a ‘welcome to Africa’ sign is being held up for them."

Not that there weren’t risks prior to the launch of the AfCFTA. As intellectual property lawyers Marius Schneider and Nora Ho Tu Nam argue, Africa’s plethora of FTZs already unite organised crime groups specialising in the trade in illicit medicines.

Schneider and Ho Tu Nam, advisers to some of the world’s largest pharmaceutical companies, authored a report in May that warned of the probability of falsified Covid-19 vaccines being distributed in Africa.

"At ports like Mombasa, and other FTZs, pharmaceutical products are packaged and repacked in ways that disguise their origins," says Schneider. "There’s no doubt that the use of FTZs is facilitating and boosting trade in counterfeit pharmaceuticals … Could they have a role to play in crime around Covid vaccines? Definitely. Because, in our experience, they aren’t policed properly and they are also very open to corruption."

Broome says organised crime groups have been attempting to "corrupt" officials at East African ports to receive fake personal protection equipment consignments since the pandemic began.

"The unfortunate context of Covid-19 in terms of its socioeconomic impact has led to a situation where individuals fear for their job security. And we’ve seen organised crime groups approach individuals with offers of payment in order to gain access to the reduced inspection capabilities that are present in the ports at the moment."

The ‘end of the Silk Road’

Schneider says Djibouti, which serves as Ethiopia’s port, is also a possible concern.

"It’s at the end of the Chinese Silk Road; a major entry point of Chinese products into Africa," he explains. "Djibouti is therefore in a very strategic position. It’s on one of the world’s busiest maritime commerce routes and links Asia, Africa and the Middle East."

In 2018, the small Horn of Africa state opened what will eventually be Africa’s largest single FTZ. Its various stages of development, funded by China, have cost about $3.5bn.

Several crime intelligence sources in East Africa are anxious about Djibouti, saying it’s ideal for organised crime groups to exploit when it comes to vaccine shipments as it doesn’t have a formal customs recorder (an electronic record of brands or trademarks and products that enter a country).

"The Djibouti authorities don’t record brands; that means they don’t take any action in terms of alerting a company when there’s a suspicious shipment," says a crime intelligence source, who asked not to be named. "The criminals are, of course, well aware of entry points like this, which have weaknesses that they can take advantage of."

Bhekisisa’s attempts to speak with Djibouti customs authorities were not successful, but Schneider confirms that it’s not their policy to notify companies in the event of suspected counterfeit goods.

He says he recently made inquiries of the Djibouti authorities. "There is a possibility of signing a kind of memorandum of understanding with their customs [service] and then they may look after your products," he explains. "But it’s not something that’s provided for and that’s de facto done; in countries such as SA and Mauritius, on the other hand, co-operation with customs to seize illicit goods works quite well."

Last July, a research brief by the UN Office on Drugs & Crime (Unodc) also identified the ports of Lomé (Togo) and Cotonou (Benin) as key entry points for falsified and substandard pharmaceutical products related to the Covid-19 pandemic.

Mark Micallef, of the Global Initiative against Transnational Organised Crime, says Libya is now the "epicentre" of trafficking in falsified, substandard and stolen pharmaceuticals in North Africa and the Sahel region.

"Drug trafficking in general grew exponentially in Libya after 2011 [when the regime of Muammar Gaddafi was overthrown], with new players, new markets developing and prescription medication and counterfeit pharmaceuticals being a very big growth market, and rapid growth also of an internal market which prior to the revolution was controlled very strictly by the regime."

Micallef says there are "key nodes in ports and strategic border areas that are completely operational for criminal business" and that could easily function as conduits for falsified Covid-19 vaccines.

Exploiting chaos

Like other customs officials Bhekisisa spoke with in several African regions, a Mombasa inspection officer says he’s "under a strict order" to "concentrate on shipments coming in from Asia" when trying to detect possible falsified vaccines.

But the instruction has left him frustrated and disenchanted.

"These days everything comes from China," he says. "We don’t have the capacity to inspect everything that is entering from Asia; no way! We can only look at a few, so lots of illegal stuff is getting past us here, but there is nothing we can do about it."

Ho Tu Nam says if there are "bottlenecks" of vaccines at Africa’s points of entry, organised crime groups will try exploit the chaos.

"About a third of Africa is landlocked, so you have a few ports [such as Mombasa and Durban] serving many countries," she points out.

Six landlocked countries will depend on SA points of entry to process and distribute large consignments of vaccines, especially from China and India: Botswana, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe.

KwaZulu-Natal’s department of transport describes Durban as the largest and busiest shipping terminal in Sub-Saharan Africa and the fourth-largest container terminal in the southern hemisphere — one that links "the Far East, Middle East, Australasia, South America, North America and Europe. It also serves as a trans-shipment hub for East Africa and Indian Ocean islands."

Ho Tu Nam says organised crime groups could take advantage of busy points of entry by mislabelling consignments of falsified and substandard medicines as "in-transit" goods.

"We’ve noticed a lot of counterfeiters are labelling their products, going for example through the port of Mombasa, as destined for South Sudan, destined for Rwanda. The customs officers are so busy, and so focused on products marked for distribution in their own country, that they don’t check those labelled ‘in-transit’.

"Once those mislabelled products hit the road, they’re diverted into local markets."

In East Africa, several police officers tell Bhekisisa they’re concerned that falsified, substandard and stolen Covid vaccines could be distributed by some of the region’s many thousand informal "chemists".

It’s a valid concern, says Interpol.

"The number of unlicensed pharmacies has increased across the region during Covid-19," says Broome. "We see an example of this during this period where 56 arrests were made in Uganda and there was the closure of 1,526 facilities. These enable, for example, the sales of fake antivirals imported from Asia."

Broome says members of organised crime groups are trying to "franchise" illegal pharmacies all over East Africa, "which would give them an even greater air of legitimacy".

But, according to Micallef, it’s the legal as well as the illegal pharmacies that are important channels for the flow of illicit medicines throughout North Africa, and specifically the Maghreb countries of Algeria, Libya, Mauritania, Morocco and Tunisia.

Across the continent, one-person, one-family operations, often doing business from informal settlements or mobile units such as the back of bakkies, are an important source of cheaper genuine medicine for populations that could otherwise not afford treatment. Law enforcement agencies say criminals frequently use such pharmacies as "fronts" and "channels" for illicit pharmaceuticals.

Crime analyst Maurice Ogbonnaya, a former security official in Nigeria’s National Assembly, says: "They’re notoriously difficult to control, because they’re mobile; and if the police start inspecting them they just shut for a while before opening again, or they relocate."

Crime, no punishment

There’s been progress in developing frameworks around substandard and falsified medical products over the past decade, says the Unodc. But "few countries have an adequate legal and regulatory system in place to address substandard and falsified medical product-related crimes associated with Covid-19".

And, says Schneider, if the past is anything to go by, punishment for people in Africa caught distributing falsified vaccines won’t be harsh.

"Fake medicine is usually regarded as a violation of intellectual property rights and not a crime in many parts of the world, including Africa," he says.

Cyntia Genolet, associate director of Africa engagement at the International Federation of Pharmaceutical Manufacturers & Associations, says that’s precisely why organised crime groups could be inspired to invest in falsified and substandard inoculations.

"If you don’t have any [real] punishment, you just take the risk, then maybe you have three days of jail, you pay your small fine, and then you’re good to continue," she says.

In 2018, an OECD report identified Egypt as a continental hub for trade in, and production of, illicit products. However, in that year, the country made just one arrest for the manufacturing of counterfeit medicines.

Disturbingly, that single arrest was enough to put Egypt among the top 10 countries for the number of arrests for such a crime.

"That says it all about how seriously not just Africa, but the world, has taken this issue so far," says Schneider. "If you’re caught in the Comoros, for example, selling counterfeit pharmaceuticals, they will let you get away with a fine and you will be able to walk away with your fake products."

Andy Gray, a senior pharmacist at the University of KwaZulu-Natal, recalls what is arguably SA’s most infamous case of trade in falsified medicines, for which the perpetrators also got off extremely lightly.

In 2000, police raided a factory in Potchefstroom and confiscated pharmaceuticals, many smuggled from India, with a market value later estimated at R95m.

Two years later, a magistrate concluded that three pharmacists from the North West city — Derrick Adlam, Deon de Beer and Johan du Toit — had operated a syndicate that repackaged and distributed falsified, stolen and expired medicines.

The three pleaded guilty — but only to contravening the trademarks act. Each received a suspended five-year jail term and was set free immediately after paying a fine.

Ogbonnaya says some government agencies, especially in West Africa, are trying to confront the trade in illegal pharmaceuticals, but most action is taken by individual governments focusing only on local crimes.

Organised crime groups, he says, operate regionally, continentally and globally, so what’s needed is corresponding cross-border co-operation.

"What you have in some African countries right now is, every few months or even years you’ll have raids and arrests, and shutting down of illegal pharmacies, for example, and then a few months after that, the criminals are up and running again," says Ogbonnaya.

"This is a well-entrenched system and it’s not one that will end with a few arrests here and there. It will be prevented in a big way by co-ordination between law enforcement, governments, pharmaceutical manufacturers and many other actors. And that’s what’s missing at the moment, co-ordination. Africa, and the world, needs a single system focused on the illicit medicine trade, and we don’t have that."

What it means:

To beat Covid vaccine criminals, the world needs a single system focused on the illicit medicine trade

In 2010 the Council of Europe drafted and adopted the Medicrime Convention — the only international legal instrument providing the means to criminalise the falsification of medical products as a public health threat. But only 18 countries have ratified it so far. Of those, three are African: Benin, Burkina Faso and Guinea.

"So, they are the only three [countries] in Africa that actually make falsification of medicines a crime," says Genolet — though it’s hoped that more will ratify the agreement soon.

Ruona Meyer, producer of Sweet, Sweet Codeine, an Emmy-nominated documentary on the illegal trafficking of medicine in Nigeria, says she’d like to see an example being made of the first person or group caught distributing falsified, substandard or stolen Covid-19 vaccines in Africa, no matter where that may happen.

"It would be a big help if the law enforcement authorities stamp out the fires of fake vaccines as soon as the flames start," she says. "Get these dealers into court and into jail as fast as possible to deter organised crime. The fake vaccine cases must be expedited and must be very, very public."

But, Salim Abdool Karim, co-chair of SA’s scientific ministerial advisory committee on Covid-19, warns that falsification in itself could do "tremendous harm" to people’s faith in the safety of the jabs.

Gray similarly believes any wave of falsified vaccines in SA could have a "really chilling effect on people’s confidence and trust, both in government and in the regulatory authority".

"We already have vaccine-hesitant parents and members of the public in this country. If we want to eventually vaccinate 70% of the population, we can’t have a third or half of them refusing that vaccination," he says.

"And anything which breaks down trust — be it mismanagement of adverse effects after genuine vaccination, or experience of a falsified vaccine or suddenly it’s arriving in strange places and people are being [vaccinated] on the pavements — that’ll hit the press very quickly and I think it could be really damaging."

*This article was produced by the  Bhekisisa Centre for Health Journalism, as part of a series on Covid-19 and organised crime. This investigation was made possible with a grant from the Global Initiative Against Transnational Organised Crime (GI-TOC). Sign up for Bhekisisa’s newsletter here.

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