This paper, co-authored by Paul Newton of the Mahosot Hospital in Laos — who has collaborated closely with INTERPOL in its anti-counterfeiting operations — summarises evidence on the prevalence of counterfeit drugs, and details their medical and economic impact on poor countries. It outlines how the international community can tackle the problem, which the authors say needs to be taken more seriously. Although the trade in counterfeit drugs has obvious health impacts, its indirect effects are no less significant and include a loss of confidence in health systems and health workers.

This study documents the chemical composition of drugs randomly sampled from pharmacies in Delhi and Chennai in India, and aims to offer the government guidance on improving drug regulation. India is a major producer and consumer of pharmaceuticals but, with quality control standards varying significantly between states, the country has high levels of counterfeit drugs. The study shows that 12 per cent of Delhi samples and 5 per cent of Chennai samples collected in 2008 and 2009 did not meet international quality standards. Although these numbers roughly match the government's estimates, there were differences between pharmacies in the types of drugs commonly counterfeited. And while some had no fake drugs, others had up to 30 per cent.

This document from the Medicines Transparency Alliance — founded by the World Bank, the WHO and the UK Department for International Development (DFID) — gives an account of a pilot programme that  investigated the medicines supply chain to identify problems that prevent vulnerable people from accessing essential medicines. It presents findings from Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia. The programme relied on different stakeholders from government, civil society and the private sector to collect, share and analyse data. The evidence gathered through the project was used to inform policy in these countries.

This toolkit from the World Health Professions Alliance (WHPA) — an alliance of organisations representing more than 25 million healthcare professionals worldwide — aims to educate staff and patients about counterfeit medicines. It was commissioned by the WHO's International Medical Products Anti-Counterfeiting Task Force (IMPACT). The toolkit includes a form that healthcare workers can use to report on suspected counterfeit medicines and a visual inspection checklist that can be used to judge whether or not a medicine might be fake. It also offers useful advice on how health professionals can answer media questions, how to communicate concerns to patients and how to educate the public on the dangers of counterfeit drugs.

This briefing paper, aimed at policymakers and researchers, discusses the regulatory implications of having varied definitions of the term 'counterfeit' and outlines successful law enforcement initiatives to halt the trade in fake drugs. The paper outlines the problem of counterfeit medicines and the urgent issues to be considered by the international community before taking additional steps to tackle it. It discusses the controversy around intellectual property rights and counterfeits, and investigates the motives behind some anti-counterfeiting initiatives that seem to be more concerned with protecting patents.

This report, published by the WHO, collates data obtained over 8 years by WHO assessment teams working in 26 African countries. The teams analysed different aspects of national regulatory systems such as management, funding and quality control procedures. Poor regulatory systems in impoverished nations are often blamed for allowing the spread of counterfeit drugs in the developing world.  The report says that although mechanisms for drug regulation existed in every country, and there were guidelines for quality-control inspections, these were often not well executed because of a severe lack of resources and staff.

This report makes a case for the importance of antimalarial drug monitoring as an integral part of disease surveillance programmes in developing countries. Antimalarials are some of the most commonly counterfeited drugs — the high prevalence of malaria translates to a large consumer market in the developing world. The problem is serious in South-East Asia but is expected to become significant in African countries too. The report suggests that scientists ensure drugs are genuine and of a good quality before conducting efficacy or resistance studies in areas where counterfeits circulate widely.

This article is a call for radically improved communication about the dangers of substandard and fake drugs, particularly in poor countries. This is currently a "vast and underreported problem" that the pharmaceutical industry fails to address, and it should be monitored independently, say the authors. Using examples of fake drug sales in Africa and Asia, they argue that without action, lives will remain at risk, and public confidence in the pharmaceutical industry will be undermined in the long term.