Fake medicines in Africa: what the evidence says

How common are poor-quality medicines?

In November 2017, the World Health Organization (WHO) estimated a 10.5% failure rate for medical products used in low- and middle-income countries, which it rounded to 1 in 10.

WHO also counted the reports sent to its global surveillance system. Of 1,500 reports of substandard or falsified products received since 2013, 42% came from the WHO African Region. Antimalarials and antibiotics were the medicines reported most often.

A review published in JAMA Network Open in August 2018 pooled 96 studies covering 67,839 medicine samples from low- and middle-income countries. It found:

• 13.6% of samples were substandard or falsified across all low- and middle-income countries.
• 18.7% of samples from Africa were substandard or falsified.
• 19.1% of antimalarial samples and 12.4% of antibiotic samples were substandard or falsified.

How many people die

These figures come from models, not from counted deaths. Each one is a range or an upper estimate.

• WHO, 2017: a University of Edinburgh model estimated that 72,000 to 169,000 children may die each year from pneumonia after taking substandard or falsified antibiotics.
• WHO, 2017: a London School of Hygiene and Tropical Medicine model estimated 116,000 extra malaria deaths a year in sub-Saharan Africa from substandard and falsified antimalarials, within a range of 64,000 to 158,000.
• UNODC, 2023: the United Nations Office on Drugs and Crime said trafficked medical products kill almost half a million people in sub-Saharan Africa every year. It linked up to 267,000 deaths a year to falsified and substandard antimalarials, and up to 169,271 deaths a year to falsified and substandard antibiotics given to children with severe pneumonia.

The 2017 WHO release estimated that treatment failure from poor-quality antimalarials costs patients and health providers in sub-Saharan Africa about US$38.5 million a year in further care. Launching those estimates, WHO Director-General Tedros Adhanom Ghebreyesus said substandard and falsified medicines particularly affect the most vulnerable communities.

How fake medicines reach markets

UN News, reporting on the 2023 UNODC study, said trafficked medical products usually travel through normal international trade, mainly by sea, and are often diverted from legal supply chains. China, Belgium, France and India were named as major exporters of these products to the Sahel. Smugglers then move them overland by bus, car and truck.

The report named pharmaceutical company employees, public officials, law enforcement officers, health agency workers and street vendors among the people involved. More than 605 tons of medical products were seized in West Africa between January 2017 and December 2021.

Recent cases across Africa

The Gambia, 2022: contaminated syrups

On 5 October 2022, WHO warned that four cough and cold syrups made by Maiden Pharmaceuticals and found in The Gambia contained unacceptable amounts of diethylene glycol and ethylene glycol. Al Jazeera reported the same day that WHO said the syrups may be tied to 66 deaths in the country.

Cameroon, 2023: a syrup with a toxic solvent

In July 2023, WHO warned about a batch of Naturcold syrup found in Cameroon. Samples held as much as 28.6% diethylene glycol, against a limit of 0.10%. WHO said the syrup may also have reached neighbouring countries through informal markets.

Rwanda, 2025: a transplant medicine with no active ingredient

In December 2025, WHO warned about falsified Simulect, a medicine that helps stop the body rejecting a new kidney. The fake was found in Rwanda, Bulgaria and Türkiye. Testing found no active ingredient, only ascorbic acid.

Kenya, 2026: a fake cancer medicine

In May 2026, the Pharmacy and Poisons Board warned of a falsified batch of the breast cancer medicine Phesgo, batch C5290S20. The vials held a white powder, while the real medicine is a ready-to-use liquid. The board told health workers and the public to stop selling and using the batch.

Uganda, 2026: counterfeit surgical antiseptics

In October 2026, the National Drug Authority arrested two people in Kampala accused of making counterfeit antiseptic solutions used in surgery. Officers seized over 200 litres of the solutions, with thousands of empty containers and counterfeit brand labels. The Daily Monitor reported that the suspects allegedly supplied clinics and laboratories in Kampala.

Nigeria: a study and a market operation

A study of malaria medicines in Enugu, published in PLOS ONE in 2015, tested 3,024 samples from 421 outlets. 90.8% were of acceptable quality, 6.8% were substandard, 1.3% had degraded and 1.2% were falsified. Falsified medicines were more likely to come from patent medicine vendors than from pharmacies.

Between 9 February and 27 March 2025, NAFDAC raided three open drug markets: Idumota in Lagos, Aba and Onitsha. In its update of 30 May 2025, NAFDAC said it removed banned, expired, falsified and substandard medicines worth more than a trillion naira. The premises had no proof of registration with the Pharmacy Council of Nigeria.

Be wary of any article that gives a share of fake medicines for a country without a source and a year.

What this means for you

Buy medicines from a licensed pharmacy. In the Enugu study, falsified medicines were more likely to come from patent medicine vendors than from pharmacies. Read how to identify fake drugs and how to read a batch number and expiry date.

Some companies protect their products with anti-counterfeiting methods. You can verify a product protected with Batach with your phone at batach.io/scan.

If you suspect a medicine, do not use it. Keep it, speak to a pharmacist or doctor, and do not stop a prescribed treatment on your own. Report it to your national medicines regulator, such as the Pharmacy and Poisons Board in Kenya, SAHPRA in South Africa or NAFDAC in Nigeria. The contact details for six countries are in how to report a fake product.