Tracking the Global Trade in Unsafe Medicines

Patients should never have to wonder whether the medicines they take are safe, effective, or legitimate. Yet unsafe and illicit medicines remain a serious challenge in every economy, threatening patient health, weakening trust in healthcare systems, undermining intellectual property rights, and fueling criminal networks.

The U.S. Chamber of Commerce's Global Innovation Policy Center seeks to bring greater clarity to this problem with the launch of the Trade in Unsafe Medicines Index. The Index takes a broader look at illicit medicines, going beyond traditional, strictly-defined counterfeits to examine risks from substandard, diverted, and grey-market medicines, as well as products that are improperly stored, shipped, or administered.

Today's pharmaceutical supply chains are global and complex, and bad actors exploit weak enforcement, inconsistent standards, corruption, and unregulated online marketplaces to move unsafe products to patients. The problem is transnational by design: India and China, including Hong Kong, remain the source of the largest share of the global supply of unsafe medicines, with products often transshipped through hubs like Singapore, Egypt, and the UAE.

The Index strives to quantify and compare this challenge, economy by economy. This initial Index benchmarks 12 sampled economies, and the findings are stark: the average score came in below 50 percent, with two-thirds of the sample scoring 45 percent or lower. The United States posted the strongest performance at nearly 89 percent, while the five African economies sampled - Egypt, Ghana, Kenya, Nigeria, and South Africa - face some of the greatest impacts from unsafe medicines while having the weakest legal infrastructure to counter them. Strong laws on paper are important, but they must be matched by sufficient resources, consistent enforcement, secure supply chains, and meaningful cooperation with rights holders and the private sector.

The good news is that this is a solvable challenge. Policymakers can adopt comprehensive definitions of unsafe and illicit medicines, improve customs authorities' ability to stop dangerous products, and modernize drug safety systems for today's global marketplace. Online platforms can strengthen vendor screening and remove repeat offenders, while industry can keep sharing expertise, supporting enforcement, and educating patients, providers, and policymakers.

No single government or company can solve this alone. But with better data, stronger laws, smarter enforcement, and public-private partnership, countries can protect patients, strengthen trust, and support the innovation needed to deliver the next generation of medicines.