Counterfeit Drugs in the International Landscape

Author: Regina Paulose

In 2012, customs authorities in Angola inspected speakers which were being shipped from China to local markets in Angola and uncovered 1.4 million packets of counterfeit anti-malarial drugs.[1] In 2013, the US Federal Drug Administration shut down an illegal counterfeit drug ring of 1,677 illegal pharmacy websites. The investigation revealed links to large organized drug networks possibly from Russia, the Middle East, and India.[2] During that same year, China arrested close to 1,300 people in the same kind of operation shutting down 140 fake pharmacy websites and confiscating material worth $362.4 million dollars.[3] Successful cases of counterfeit medicine busts seem to be few and far between around the world.

Counterfeit drugs have become an “exploding industry” which is “fueled by easy internet sales, global supply routes, and minimal punishments.”  The estimated market of counterfeit drugs is worth $75 billion a year worldwide.[4] The reason may be because counterfeit drugs are a “high reward, low risk crime.”[5] It should come as no surprise that criminal networks form a large part of the fake drug enterprise. Counterfeit medicine much like other sources of cash flow – human, drug, and organ trafficking have become an extremely profitable business for organized crime networks. The most common criminal enterprises associated with counterfeit medicines are the Camorra, the Russian Mafia, the Triads, and Yakuza.[6] In many under developed countries, up to 70 percent of the supply chain is made up of counterfeit drugs.[7] Criminal networks can produce an enormous profit even with one single center. For example, prior to the civil war in Syria, it was reported that Damascus was home to a large counterfeit drug operation worth “tens of millions of dollars.”[8]

Credit: The Economist

Credit: The Economist

Counterfeit drugs are killers.[9] Some of the fake drugs which are sold have no medicinal value or contain poison. One of the biggest reasons why counterfeit drugs are now impacting human lives is because networks are making “lifesaving” drugs which treat a whole host of diseases, like malaria, cancer, and tuberculosis.[10]

Unfortunately, actual statistics on how deadly counterfeit medicines are around the world are hard to come by because “there is little published medical research assessing their prevalence, public health impact, or possible countermeasures. The accumulated evidence, such as it is, suggests that mortality and morbidity arising from this murderous trade are considerable, especially in developing countries.”[11]   Interpol estimates that approximately 1 million people die a year from fake drugs. The cases that are known are horrific. In 1995, during a meningitis epidemic in Niger, “the authorities received a donation of 88,000 Pasteur Merieux and SmithKline Beecham vaccines from neighboring Nigeria. The drugs were found to be counterfeit, with no traces of active product. Some 60,000 people were inoculated with the fake vaccines.”[12] In 2008, 84 children are reported to have died (killed) as a result of taking counterfeit teething mixture.[13] The locations in which counterfeits are made are usually “street laboratories” and as photographs from police raids have shown the laboratories are in “deplorable” conditions.[14]

There are several areas that the international community, which evidently lacks the political will to solve the problem,[15] needs to address. As with many other crimes there is a problem with how to define “counterfeit drugs or ill made medicines.”[16] The supply chain needs to be scrutinized as ingredients for various drugs come from one part of the world to the other in order to complete the product.[17] In addition the lack of cross border information sharing and coordination is lacking (as we continue to see with other crimes related to transnational organized crime).[18] Corruption is a large contributing factor in the enforcement of preventing such illegal drugs from entering the market. Further, the prosecution of such crimes is not clear. In some countries, the sale or distribution of counterfeit drugs is considered a copyright violation as opposed to a crime.[19] Finally, the problem is under reported which continues to contribute to the loss of lives.[20]

There are reasons to remain hopeful. Various countries are attempting to make a larger effort in recognizing and combating the problem. Rwanda has proven to be a successful example of where tight regulatory schemes have prevented counterfeit medicines, on a continent where there is a large presence of generic drugs, from entering the local market.[21] In addition, NGO’s are now becoming an alternative supplier of good medicines, as a result impacting the bottom line for counterfeit medicine suppliers.[22] In reality, the problem of counterfeit medicines is not because of a lack of laws. The problem lies in the same place it does for most other crimes: organized crime and corruption. Given the UNTOC and UNCAC more genuine dialogue is needed. With more ingenuity, cooperation, and political will, the market for counterfeit medicine can be eliminated.

[1] Eleanor Whitehead, “Africa: The Killer Curse of Counterfeit Drugs” Africa in Fact, November 11, 2013,

[2] Dina Maron, “Pill of Goods: International Counterfeit Drug Ring Hit in Massive Sting” Scientific American, July 3, 2013,

[3] Reuters, “China detains 1,300 people suspected of making, selling fake drugs: media” December 15, 2013,

[4] Barbara Moran, “Cracking Down on Counterfeit Drugs” NOVANEXT, August 20, 2013,

[5] Scott Davis, former special agent for U.S. Customs, Kathy Chu, “Fake-Drug raids are Uphill Battle” Wall Street Journal, July 26, 2012,

[6] Paul Toscano, “The dangerous world of counterfeit prescription drugs” October 7, 2011, USA Today,

[7] Toscano, note 6

[8] Roger Bate, “The deadly world of fake medicine” CNN,  July 17, 2012,

[9] Moran, note 4

[10] Background Document on Counterfeit Medicines in Asia, WHPA Regional Workshop on Counterfeit Medical Products, June 30 – July 1, 2011,

[11] Michael D. Green, “Murder by Fake Drugs : Time for International Action.” BMJ : British Medical Journal 324.7341 (2002): 800–801.

[12] R. Cockburn, PN Newton, EK Agyarko, D Akunyili, NJ White. “The Global Threat of Counterfeit Drugs: Why Industry and Governments Must Communicate the Dangers.” PLoS Med 2(4): e100. March 14, 2005

[13] Tina Rosenberg, “The Fight Against Fake Drugs” The New York Times, June 4, 2014,

[14] Toscano, note 6

[15] Green, note 10

[16] Whitehead, note 1

[17] The Economist, “Bad Medicine” October 13, 2012,

[18] Background document, note 10

[19] Chu, note 5

[20] R. Cockburn, note 11

[21] Whitehead, note 1

[22] Rosenberg, note 12