Over the past few years, a world gripped in the throes of the COVID-19 pandemic came together to some degree and as a result, many countries have relaxed social restrictions in response to stabilizing disease mortality rates and the availability of vaccines. This is good news; however, the proliferation of counterfeit medicines, likened to a pandemic-level public health crisis, has not received the degree of global attention that supported the COVID response.

Counterfeit medicines, also known as ‘fake’ or ‘adulterated’ drugs, are illicit products that carry the label of legitimate brands, but contain ingredients that differ from what is indicated on the label. Such products have not been reviewed or approved by an official regulatory agency and may have either no active ingredient of the brand medicine, an insufficient amount of the active ingredient, or in many cases, contain substances that are irrelevant (or toxic) to the condition they claim to treat. Counterfeit medicines may also contain inactive ingredients - such as fillers or colors, to resemble the original product. Pharmaceutical classes frequently targeted by drug counterfeiters are antimalarial medications, medicines that treat cancers, blood pressure and erectile dysfunction, among others.

Data from the World Health Organization (WHO) suggest that the global health risk resulting from counterfeit medicine is significant, even in comparison to the staggering loss of precious human lives to the COVID-19 pandemic. As of August 17, 2022, the world lost an estimated 6.5 million souls COVID-19. On the other hand, the WHO estimates that 1 million deaths occur annually from counterfeit and substandard drugs, with a global financial impact of over $21 billion. These figures call for urgent and increased global action against counterfeit and adulterated medicines and medical products.

Trade in counterfeit medicine is a thriving business worldwide. Manufacturers and distributors of such products often infiltrate markets in countries with underdeveloped health sectors and under-resourced agencies, tasked with identifying and removing such products. Using the power of the internet, many bad actors have easy access to markets beyond their borders and the trafficking of counterfeit medicines represents an area where these fraudulent individuals have evaded attempts by customs agencies and regulatory bodies to block their proliferation, at the cost of human lives.

Recent studies show that this dangerous trade is not limited to developing nations and further revelations are startling: Consumers of fake medicines, regardless of nationality, are often unaware of the potentially inferior quality of such products or the risk for destructive health impact, even if they are aware the product is a counterfeit. Furthermore, people taking such drugs may lack the resources to purchase the brand (or an approved generic version) due to the high cost of medicines, lower income, or a lack of prescription insurance coverage. This means even though they are fully aware of the dangers of counterfeit medicines, some patients are willing to risk it due to limited options.

The time for global action is now to combat the pandemic of counterfeit medicine. We must address this issue with the following thoughts in mind:

Nations responsible for the largest source of counterfeit and adulterated pharmaceutical products must be held accountable for the activities of their nationals.
The World Sustainable Development Goal 2030 (SDG) should include consolation with respect to the impact of counterfeit medicines on poorer nations at greatest risk for receiving them.
Developing countries must set their visions high to combat systemic corruption, and create an environment conducive to national prosperity to discourage an atmosphere of wealth-seeking through illegal and harmful means. The Civil Service, especially the public security apparatus, must be structured to serve the public good.
Funding for the health sector and pharmaceutical regulatory agencies should be prioritized to enable nations effectively address this challenge.

Ozichi Alimole, PhD

References

1. Barbereau S. La contrefaçon des médicaments: un phénomène en pleine expansion [Counterfeit medicines: a growing threat]. Med Trop (Mars). 2006 Dec;66(6):529-32. French. PMID: 17286014.

2. World Health Organization. Substandard and Falsified Medical Products. January 31, 2018. Accessed August 20, 2022. https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products

3. World Health Organization. Weekly epidemiological update on COVID-19 - 17 August 2022. August 17, 2022. Accessed August 20, 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---17-august-2022