Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries

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Abstract
Increasing access to essential medicines is integral to the effort to reduce global morbidity and mortality.1 While access and health outcomes have generally improved in recent decades, these efforts face a serious obstacle from the threat of substandard and falsified (SF) medicines.2-4 Poor-quality medicines increase risks of morbidity and mortality by prolonging illnesses and heighten the risk of treatment failure, poisoning, and adverse drug interactions.5,6 Circulation of SF medicines with little clinical effectiveness also places entire communities at risk of drug resistance, posing a threat to global treatment effectiveness, as well as undermining people’s overall trust in the health system and its legitimate health care professionals.5-9 Over time, diminished trust in licensed health care professionals may further encourage informal care-seeking and self-medication.10 Poor health outcomes can also erode trust in the manufacturers of genuine pharmaceutical products, which are often challenging to distinguish from SF ones without the use of verification technologies.11

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