Medicines: counterfeit medicines

Counterfeit medicines are found everywhere in the world. They range from random mixtures of harmful toxic substances to inactive, ineffective preparations. Some contain a declared, active ingredient and look so similar to the genuine product that they deceive health professionals as well as patients. But in every case, the source of a counterfeit medicine is unknown and its content unreliable. Counterfeit medicines are always illegal. They can result in treatment failure or even death. Eliminating them is a considerable public health challenge. 

Extent of the problem

Defining the extent of counterfeiting is difficult for a number of reasons.

The variety of information sources makes compiling statistics a difficult task. Sources of information include reports from national medicines regulatory authorities, enforcement agencies, pharmaceutical companies and nongovernmental organizations, as well as ad hoc studies on specific geographical areas or therapeutic groups.

The different methods used to produce reports and studies also make compiling and comparing statistics difficult.

Studies can only give snapshots of the immediate situation. Counterfeiters are extremely flexible in the methods they use to mimic products and prevent their detection. They can change these methods from day to day, so when the results of a study are released, they may already be outdated.

Finally, information about a case under legal investigation is sometimes only made public after the investigation has been concluded.

Counterfeiting is greatest in regions where regulatory and enforcement systems for medicines are weakest. In most industrialized countries with effective regulatory systems and market control (i.e. Australia, Canada, Japan, New Zealand, most of the European Union and the United States of America), incidence of counterfeit medicines is extremely low – less than 1% of market value according to the estimates of the countries concerned. But in many African countries, and in parts of Asia, Latin America, and countries in transition, a much higher percentage of the medicines on sale may be counterfeit.

Not only is there a huge variation between geographic regions in terms of incidence of counterfeit medicines, variation can also be significant within countries: for example, between urban and rural areas, and between cities.

All kinds of medicines have been counterfeited – branded and generic – ranging from medicines for the treatment of life-threatening conditions to inexpensive generic versions of painkillers and antihistamines. 

Internet sales

In over 50% of cases, medicines purchased over the Internet from illegal sites that conceal their physical address7 have been found to be counterfeit. 

Public health risks

Counterfeit medicines pose a public health risk because their content can be dangerous or they can lack active ingredients. Their use can result in treatment failure (and contribute to increased resistance in the case of antimalarials that contain insufficient active ingredient) or even death. Unlike substandard medicines where there are problems with the manufacturing process by a known manufacturer, counterfeit medicines are made by people with the intent to mislead.

The extreme difficulty in tracing the manufacturing and distribution channels of counterfeit medicines makes their circulation on markets difficult to stop. Even a single case of a counterfeit medicine is unacceptable since it indicates that the pharmaceutical supply system in which it was detected is vulnerable. Worse, it undermines the credibility of national health and enforcement authorities. 

Contributory factors

Several factors contribute to the counterfeit medicine problem.

Paying for medicines can consume a significant proportion of individual or family income. Some people seek medicines that are sold more cheaply. These are often available from non-regulated outlets, where the incidence of counterfeit medicines is likely to be higher.

People might also purchase medicines from non-regulated outlets if, as is often the case in the rural areas of developing countries, medicines supplies at regular health facilities do not meet demand.

Counterfeiting medicines can be very lucrative. Since many countries have not yet enacted deterrent legislation, counterfeiters often do not fear prosecution.

The growth in international trade of pharmaceutical ingredients and medicines adds a further dimension of complexity to this issue. For example, trade through brokers and free trade zones where regulation is lax or absent (and medicines repackaged and relabelled to conceal country of origin) is increasing. 

WHO response

Stringent regulatory control of medicines and enforcement by national medicines regulatory authorities contributes significantly to prevention and detection of counterfeit medicines. WHO provides direct country and regional support for strengthening medicines regulation.

To fight counterfeit medicines effectively, a range of stakeholders – not just health professionals – is needed. In 2006, WHO helped to create the International Medical Products Anti-Counterfeiting Taskforce, or IMPACT. The aim is to involve a range of stakeholders in collaborative efforts to protect people from buying and taking counterfeit medicines. To prevent the manufacture and distribution of counterfeit medicines, IMPACT's areas of focus are:

  • legislative and regulatory infrastructure
  • regulatory implementation
  • enforcement
  • technology
  • communication.