Ensuring the safety of patients should be at the core of healthcare, reflected by one of the earliest maxims learned by professionals, ‘first, do no harm’. However, the stark reality is that the scale of avoidable harm caused by unsafe care worldwide is enormous. The World Health Organization (WHO) estimates that it is one of the 10 leading causes of death and disability worldwide.

In high income countries as many as 1 in 10 patients are harmed while receiving hospital care. The human cost of unsafe care is even more critical in low- and middle-income counties, with poor quality care accounting for 10-15% of total deaths, some 2.6 million deaths annually.

Over 80% of these deaths are avoidable.

Every avoidable death is an unnecessary tragedy for patients, families and for healthcare professionals. Beyond the cost in human lives, there are other consequences of preventable errors: loss of trust in the health care system by patients; diminished satisfaction by both patients and health professionals; the physical and psychological discomfort of patients who experience a long hospital stay or disability as a result of errors; loss of morale and frustration of health professionals at not being able to provide the best care possible. Society bears the wider cost of errors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status.

Coupled with this immense loss of life and harm, there is a staggering financial cost of unsafe care. The Organisation for Economic Co-operation and Development (OECD) estimate that unsafe care accounts for 15% of total hospital activity and expenditure in OECD countries. The global cost is trillions of dollars each year.

The financial penalty that societies endure makes the economic imperative for improving patient safety indisputable.

The global healthcare community has faced the stark reality of the scale of unsafe care since the US Institute of Medicine publication of ‘To Err is Human’ in 1999. Since then, there have been many international and national initiatives to better understand the complexity of causes of unsafe care and the action needed to reduce harm. It is now universally agreed that healthcare needs to transform itself to a safe system with action by everyone including regulators, funders, health providers, professional bodies, industry, educators and policy makers. The cost of making improvements to patient safety is a drop in the ocean compared to the ongoing huge economic burden that unsafe care imposes.

The WHO works with Member States and partners to create patient safety strategies and policies to develop and implement safer and more sustainable health-care systems. Because of the implications on the sustainability of healthcare systems and the global economy, patient safety is being introduced as a priority on the agenda of this year’s G20 summit.

There are clear imperatives for society to take immediate action. We must eradicate harm from unsafe care. We must ensure that resources are spent on delivering safe care and not wasted on responding to this harm.

For more than 30 years RLDatix has been the leading international provider of intelligent patient safety solutions and at the forefront of patient safety technology. We welcome the transformational focus on patient safety that the G20 summit will bring and commit to contributing our thought leadership and innovation as we scale up the ambition and pace of harm reduction.

This month, African leaders will pledge to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support.

Niger’s government is sounding the alarm about bogus meningitis vaccines – and it is not the first time. Five years ago, hundreds of Nigerien people died after receiving fake vaccines. The problem, of course, is not vaccines. It is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion, or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organization, which relies largely on voluntary reporting by health-care professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems. Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality. Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in Sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor. Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.

David Richmond is Chief Executive of the Brazzaville Foundation, an independent London-based charity that focuses on African issues. This op-ed originally appeared on Project-Syndicate.org on 15 January 2020.

A note on the G20 Health and Development Partnership: the threat posed by substandard and falsified medicines is expanding beyond Africa and is also a concern for G20 nations. Under this year’s G20 Presidency, led by the Kingdom of Saudi Arabia, it is of utmost importance that G20 leaders focus on combatting the scale of this challenge, as it not only promotes the financing of terrorism, but is also a huge burden on national economies. Moreover, there is an opportunity under this year’s G20 health agenda and its focus on patient safety, to address the dangers posed by substandard and falsified medicines on patients.

Ensuring the safety of patients should be at the core of healthcare, reflected by one of the earliest maxims learned by professionals, ‘first, do no harm’. However, the stark reality is that the scale of avoidable harm caused by unsafe care worldwide is enormous. The World Health Organization (WHO) estimates that it is one of the 10 leading causes of death and disability worldwide.

In high income countries as many as 1 in 10 patients are harmed while receiving hospital care. The human cost of unsafe care is even more critical in low- and middle-income counties, with poor quality care accounting for 10-15% of total deaths, some 2.6 million deaths annually.

Over 80% of these deaths are avoidable.

Every avoidable death is an unnecessary tragedy for patients, families and for healthcare professionals. Beyond the cost in human lives, there are other consequences of preventable errors: loss of trust in the health care system by patients; diminished satisfaction by both patients and health professionals; the physical and psychological discomfort of patients who experience a long hospital stay or disability as a result of errors; loss of morale and frustration of health professionals at not being able to provide the best care possible. Society bears the wider cost of errors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status.

Coupled with this immense loss of life and harm, there is a staggering financial cost of unsafe care. The Organisation for Economic Co-operation and Development (OECD) estimate that unsafe care accounts for 15% of total hospital activity and expenditure in OECD countries. The global cost is trillions of dollars each year.

The financial penalty that societies endure makes the economic imperative for improving patient safety indisputable.

The global healthcare community has faced the stark reality of the scale of unsafe care since the US Institute of Medicine publication of ‘To Err is Human’ in 1999. Since then, there have been many international and national initiatives to better understand the complexity of causes of unsafe care and the action needed to reduce harm. It is now universally agreed that healthcare needs to transform itself to a safe system with action by everyone including regulators, funders, health providers, professional bodies, industry, educators and policy makers. The cost of making improvements to patient safety is a drop in the ocean compared to the ongoing huge economic burden that unsafe care imposes.

The WHO works with Member States and partners to create patient safety strategies and policies to develop and implement safer and more sustainable health-care systems. Because of the implications on the sustainability of healthcare systems and the global economy, patient safety is being introduced as a priority on the agenda of this year’s G20 summit.

There are clear imperatives for society to take immediate action. We must eradicate harm from unsafe care. We must ensure that resources are spent on delivering safe care and not wasted on responding to this harm.

For more than 30 years RLDatix has been the leading international provider of intelligent patient safety solutions and at the forefront of patient safety technology. We welcome the transformational focus on patient safety that the G20 summit will bring and commit to contributing our thought leadership and innovation as we scale up the ambition and pace of harm reduction.

This month, African leaders will pledge to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support.

Niger’s government is sounding the alarm about bogus meningitis vaccines – and it is not the first time. Five years ago, hundreds of Nigerien people died after receiving fake vaccines. The problem, of course, is not vaccines. It is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion, or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organization, which relies largely on voluntary reporting by health-care professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems. Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality. Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in Sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor. Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.

David Richmond is Chief Executive of the Brazzaville Foundation, an independent London-based charity that focuses on African issues. This op-ed originally appeared on Project-Syndicate.org on 15 January 2020.

A note on the G20 Health and Development Partnership: the threat posed by substandard and falsified medicines is expanding beyond Africa and is also a concern for G20 nations. Under this year’s G20 Presidency, led by the Kingdom of Saudi Arabia, it is of utmost importance that G20 leaders focus on combatting the scale of this challenge, as it not only promotes the financing of terrorism, but is also a huge burden on national economies. Moreover, there is an opportunity under this year’s G20 health agenda and its focus on patient safety, to address the dangers posed by substandard and falsified medicines on patients.

Ensuring the safety of patients should be at the core of healthcare, reflected by one of the earliest maxims learned by professionals, ‘first, do no harm’. However, the stark reality is that the scale of avoidable harm caused by unsafe care worldwide is enormous. The World Health Organization (WHO) estimates that it is one of the 10 leading causes of death and disability worldwide.

In high income countries as many as 1 in 10 patients are harmed while receiving hospital care. The human cost of unsafe care is even more critical in low- and middle-income counties, with poor quality care accounting for 10-15% of total deaths, some 2.6 million deaths annually.

Over 80% of these deaths are avoidable.

Every avoidable death is an unnecessary tragedy for patients, families and for healthcare professionals. Beyond the cost in human lives, there are other consequences of preventable errors: loss of trust in the health care system by patients; diminished satisfaction by both patients and health professionals; the physical and psychological discomfort of patients who experience a long hospital stay or disability as a result of errors; loss of morale and frustration of health professionals at not being able to provide the best care possible. Society bears the wider cost of errors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status.

Coupled with this immense loss of life and harm, there is a staggering financial cost of unsafe care. The Organisation for Economic Co-operation and Development (OECD) estimate that unsafe care accounts for 15% of total hospital activity and expenditure in OECD countries. The global cost is trillions of dollars each year.

The financial penalty that societies endure makes the economic imperative for improving patient safety indisputable.

The global healthcare community has faced the stark reality of the scale of unsafe care since the US Institute of Medicine publication of ‘To Err is Human’ in 1999. Since then, there have been many international and national initiatives to better understand the complexity of causes of unsafe care and the action needed to reduce harm. It is now universally agreed that healthcare needs to transform itself to a safe system with action by everyone including regulators, funders, health providers, professional bodies, industry, educators and policy makers. The cost of making improvements to patient safety is a drop in the ocean compared to the ongoing huge economic burden that unsafe care imposes.

The WHO works with Member States and partners to create patient safety strategies and policies to develop and implement safer and more sustainable health-care systems. Because of the implications on the sustainability of healthcare systems and the global economy, patient safety is being introduced as a priority on the agenda of this year’s G20 summit.

There are clear imperatives for society to take immediate action. We must eradicate harm from unsafe care. We must ensure that resources are spent on delivering safe care and not wasted on responding to this harm.

For more than 30 years RLDatix has been the leading international provider of intelligent patient safety solutions and at the forefront of patient safety technology. We welcome the transformational focus on patient safety that the G20 summit will bring and commit to contributing our thought leadership and innovation as we scale up the ambition and pace of harm reduction.

This month, African leaders will pledge to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support.

Niger’s government is sounding the alarm about bogus meningitis vaccines – and it is not the first time. Five years ago, hundreds of Nigerien people died after receiving fake vaccines. The problem, of course, is not vaccines. It is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion, or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organization, which relies largely on voluntary reporting by health-care professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems. Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality. Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in Sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor. Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.

David Richmond is Chief Executive of the Brazzaville Foundation, an independent London-based charity that focuses on African issues. This op-ed originally appeared on Project-Syndicate.org on 15 January 2020.

A note on the G20 Health and Development Partnership: the threat posed by substandard and falsified medicines is expanding beyond Africa and is also a concern for G20 nations. Under this year’s G20 Presidency, led by the Kingdom of Saudi Arabia, it is of utmost importance that G20 leaders focus on combatting the scale of this challenge, as it not only promotes the financing of terrorism, but is also a huge burden on national economies. Moreover, there is an opportunity under this year’s G20 health agenda and its focus on patient safety, to address the dangers posed by substandard and falsified medicines on patients.

Ensuring the safety of patients should be at the core of healthcare, reflected by one of the earliest maxims learned by professionals, ‘first, do no harm’. However, the stark reality is that the scale of avoidable harm caused by unsafe care worldwide is enormous. The World Health Organization (WHO) estimates that it is one of the 10 leading causes of death and disability worldwide.

In high income countries as many as 1 in 10 patients are harmed while receiving hospital care. The human cost of unsafe care is even more critical in low- and middle-income counties, with poor quality care accounting for 10-15% of total deaths, some 2.6 million deaths annually.

Over 80% of these deaths are avoidable.

Every avoidable death is an unnecessary tragedy for patients, families and for healthcare professionals. Beyond the cost in human lives, there are other consequences of preventable errors: loss of trust in the health care system by patients; diminished satisfaction by both patients and health professionals; the physical and psychological discomfort of patients who experience a long hospital stay or disability as a result of errors; loss of morale and frustration of health professionals at not being able to provide the best care possible. Society bears the wider cost of errors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status.

Coupled with this immense loss of life and harm, there is a staggering financial cost of unsafe care. The Organisation for Economic Co-operation and Development (OECD) estimate that unsafe care accounts for 15% of total hospital activity and expenditure in OECD countries. The global cost is trillions of dollars each year.

The financial penalty that societies endure makes the economic imperative for improving patient safety indisputable.

The global healthcare community has faced the stark reality of the scale of unsafe care since the US Institute of Medicine publication of ‘To Err is Human’ in 1999. Since then, there have been many international and national initiatives to better understand the complexity of causes of unsafe care and the action needed to reduce harm. It is now universally agreed that healthcare needs to transform itself to a safe system with action by everyone including regulators, funders, health providers, professional bodies, industry, educators and policy makers. The cost of making improvements to patient safety is a drop in the ocean compared to the ongoing huge economic burden that unsafe care imposes.

The WHO works with Member States and partners to create patient safety strategies and policies to develop and implement safer and more sustainable health-care systems. Because of the implications on the sustainability of healthcare systems and the global economy, patient safety is being introduced as a priority on the agenda of this year’s G20 summit.

There are clear imperatives for society to take immediate action. We must eradicate harm from unsafe care. We must ensure that resources are spent on delivering safe care and not wasted on responding to this harm.

For more than 30 years RLDatix has been the leading international provider of intelligent patient safety solutions and at the forefront of patient safety technology. We welcome the transformational focus on patient safety that the G20 summit will bring and commit to contributing our thought leadership and innovation as we scale up the ambition and pace of harm reduction.

This month, African leaders will pledge to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support.

Niger’s government is sounding the alarm about bogus meningitis vaccines – and it is not the first time. Five years ago, hundreds of Nigerien people died after receiving fake vaccines. The problem, of course, is not vaccines. It is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion, or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organization, which relies largely on voluntary reporting by health-care professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems. Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality. Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in Sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor. Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.

David Richmond is Chief Executive of the Brazzaville Foundation, an independent London-based charity that focuses on African issues. This op-ed originally appeared on Project-Syndicate.org on 15 January 2020.

A note on the G20 Health and Development Partnership: the threat posed by substandard and falsified medicines is expanding beyond Africa and is also a concern for G20 nations. Under this year’s G20 Presidency, led by the Kingdom of Saudi Arabia, it is of utmost importance that G20 leaders focus on combatting the scale of this challenge, as it not only promotes the financing of terrorism, but is also a huge burden on national economies. Moreover, there is an opportunity under this year’s G20 health agenda and its focus on patient safety, to address the dangers posed by substandard and falsified medicines on patients.

Ensuring the safety of patients should be at the core of healthcare, reflected by one of the earliest maxims learned by professionals, ‘first, do no harm’. However, the stark reality is that the scale of avoidable harm caused by unsafe care worldwide is enormous. The World Health Organization (WHO) estimates that it is one of the 10 leading causes of death and disability worldwide.

In high income countries as many as 1 in 10 patients are harmed while receiving hospital care. The human cost of unsafe care is even more critical in low- and middle-income counties, with poor quality care accounting for 10-15% of total deaths, some 2.6 million deaths annually.

Over 80% of these deaths are avoidable.

Every avoidable death is an unnecessary tragedy for patients, families and for healthcare professionals. Beyond the cost in human lives, there are other consequences of preventable errors: loss of trust in the health care system by patients; diminished satisfaction by both patients and health professionals; the physical and psychological discomfort of patients who experience a long hospital stay or disability as a result of errors; loss of morale and frustration of health professionals at not being able to provide the best care possible. Society bears the wider cost of errors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status.

Coupled with this immense loss of life and harm, there is a staggering financial cost of unsafe care. The Organisation for Economic Co-operation and Development (OECD) estimate that unsafe care accounts for 15% of total hospital activity and expenditure in OECD countries. The global cost is trillions of dollars each year.

The financial penalty that societies endure makes the economic imperative for improving patient safety indisputable.

The global healthcare community has faced the stark reality of the scale of unsafe care since the US Institute of Medicine publication of ‘To Err is Human’ in 1999. Since then, there have been many international and national initiatives to better understand the complexity of causes of unsafe care and the action needed to reduce harm. It is now universally agreed that healthcare needs to transform itself to a safe system with action by everyone including regulators, funders, health providers, professional bodies, industry, educators and policy makers. The cost of making improvements to patient safety is a drop in the ocean compared to the ongoing huge economic burden that unsafe care imposes.

The WHO works with Member States and partners to create patient safety strategies and policies to develop and implement safer and more sustainable health-care systems. Because of the implications on the sustainability of healthcare systems and the global economy, patient safety is being introduced as a priority on the agenda of this year’s G20 summit.

There are clear imperatives for society to take immediate action. We must eradicate harm from unsafe care. We must ensure that resources are spent on delivering safe care and not wasted on responding to this harm.

For more than 30 years RLDatix has been the leading international provider of intelligent patient safety solutions and at the forefront of patient safety technology. We welcome the transformational focus on patient safety that the G20 summit will bring and commit to contributing our thought leadership and innovation as we scale up the ambition and pace of harm reduction.

This month, African leaders will pledge to introduce tough criminal legislation to combat the proliferation of substandard and fake medical products – a deadly business that disproportionately affects the poorest and most vulnerable. They need and deserve international support.

Niger’s government is sounding the alarm about bogus meningitis vaccines – and it is not the first time. Five years ago, hundreds of Nigerien people died after receiving fake vaccines. The problem, of course, is not vaccines. It is the widespread distribution of substandard and falsified medical products. And it is a problem that disproportionately affects Africa.

The global market for medicines that are substandard (failing to meet quality specifications) or falsified (with the composition, identity, or source deliberately misrepresented) is estimated to be worth up to $200 billion, or 10-15% of the total pharmaceutical market. But it could be much bigger: according to the World Health Organization, which relies largely on voluntary reporting by health-care professionals, we may know about “just a small fraction” of all cases. What we do know is that the problem is particularly acute in Africa. In 2013-2017, 42% of substandard and falsified medicines found were on the continent. This is undermining Africa’s hard-won progress on health, not least by eroding trust in nascent health-care systems. Needless to say, the use of substandard or falsified medicines – which range from ineffective to poisonous – can have devastating consequences, with the poorest and most vulnerable being hit the hardest. After all, it is those with limited funds and poor access to medical professionals and quality health care who are most likely to buy discounted medicines on the streets, where there is no guarantee that they are real, let alone of high quality. Ultimately, this can result in much higher costs for victims, who must pay more to treat the original illness once it has progressed further, as well as for any side effects from the fake medication, if they survive at all. A 2015 study estimated that, in Sub-Saharan Africa, 122,000 children under the age of five had died in just one year as a result of substandard or falsified antimalarial medications. Moreover, since people don’t know what they are taking, let alone the proper dose, falsified and substandard medicines contribute to rising antimicrobial resistance – a trend that doesn’t discriminate between rich and poor. Yet fake-medicine traffickers have little incentive to stop. It is estimated that every $1,000 traffickers “invest” in counterfeit medicines can yield as much as $450,000 in profit. That margin is 10-25 times larger than that enjoyed by sellers of illicit narcotics. And those massive rewards are not counterbalanced by significant risk. Even when caught, fake-medicine traffickers often avoid prison time. They merely pay a fine and get back to business.

David Richmond is Chief Executive of the Brazzaville Foundation, an independent London-based charity that focuses on African issues. This op-ed originally appeared on Project-Syndicate.org on 15 January 2020.

A note on the G20 Health and Development Partnership: the threat posed by substandard and falsified medicines is expanding beyond Africa and is also a concern for G20 nations. Under this year’s G20 Presidency, led by the Kingdom of Saudi Arabia, it is of utmost importance that G20 leaders focus on combatting the scale of this challenge, as it not only promotes the financing of terrorism, but is also a huge burden on national economies. Moreover, there is an opportunity under this year’s G20 health agenda and its focus on patient safety, to address the dangers posed by substandard and falsified medicines on patients.