Fake and substandard medicines: A persistent threat to global health

Abstract

Background: The proliferation of fake and substandard medicines presents a critical public health threat, especially in low- and middle-income countries (LMICs). These illicit products undermine treatment outcomes, contribute to antimicrobial resistance, and erode public trust in healthcare systems. With rising global connectivity and online medicine sales, the scope of this issue has widened considerably.

Methods: This review synthesizes recent literature on the prevalence, consequences, detection technologies, and regulatory frameworks for combating counterfeit and substandard pharmaceuticals globally, with a focus on LMICs. A comprehensive search was performed in multiple scientific databases and grey literature sources, including WHO and NAFDAC reports.

Results: Substandard medicines are prevalent in both urban and rural regions, particularly affecting anti-infectives, antimalarials, and cardiovascular drugs. Technological tools such as mass spectrometry, handheld Raman spectroscopy, and blockchain-based traceability have emerged as detection aids. Regulatory enforcement remains fragmented, especially where health systems are under-resourced. Consumer education and regional policy harmonization are still lacking in most endemic regions.

Conclusion: Multisectoral collaboration, public awareness, investment in detection technologies, and strengthening regulatory capacity are essential in curbing the menace of fake and substandard medicines. A proactive, technology-driven, and community-centered approach is vital for lasting impact.