“A patient wanted to buy antibiotics for a bruise. They want antibiotics even for influenza.” Indonesian pharmacists had alarming stories when researchers interviewed them about their experiences. But the story gets even more alarming: 2021 research shows that 70 percent of Indonesian pharmacies dispense antibiotics without a prescription. And many Indonesians who cannot afford appropriate health care buy prescription-only drugs, including antibiotics, in the informal sector for self-treatment. In Indonesia, licensed drug stores (which are different from pharmacies) often sell antibiotics, evading inspection by the authorities. The informal and formal sectors – licensed and unlicensed sellers, grocery stores and pharmacies – are entangled. The Indonesian distribution channels for medicines are said to be the most complicated in the world.
When prescription-only drugs are distributed without a prescription in pharmacies it seems that regulations don’t work. When they are distributed by unlicensed sellers, it shows there is a market beyond the reach of laws and regulations. Both are characteristics of a world in which low-quality drugs are prevalent. The question remains whether the problem can be solved simply by tightening regulations.
Low-quality generic drugs are a major challenge for low- and middle-income countries in two ways. First, the high availability of low-quality antimalarials and antibiotics in these countries seems to relate to demand: many consumers need these drugs. Second, the BRICS (Brazil, Russia, India, China and South Africa), an emerging group of low- and middle-income countries, need to develop their pharmaceutical business as an export industry.
