Substandard
Authorized products that fail to meet their quality standards or specifications — often through poor manufacturing practice or inadequate quality control.1
May come from a legitimate maker, in legitimate packaging.
Research brief
Substandard and falsified medicines
What they are, what the evidence says about their scale and harm, why Afghanistan is exposed — and what a photograph of a medicine pack can, and cannot, establish.
1 · The scale
A problem measured in the tens of billions.
In 2017 the World Health Organization published the first systematic estimate, drawing on a review of studies and on reports to its global surveillance system.
- 1 in 10
- medical products in low- and middle-income countries is substandard or falsified, at least.1
- $30.5 bn
- US dollars spent each year by countries on substandard and falsified medical products.1
- 1,500
- reports to the WHO surveillance system, 2013–2017; antimalarials and antibiotics most often.2
- 100
- literature reviews underpin WHO's 2017 study of the problem's public-health and socioeconomic impact.2
Reports reflect where surveillance is strong as much as where the problem is. The absence of reports from a country is not evidence of the absence of the problem.4
2 · Definitions
Two ways a medicine fails.
WHO distinguishes products by how they fail. The distinction decides what kind of evidence can reveal each one.
Falsified
Products that deliberately misrepresent their identity, composition or source, made to deceive buyers for profit.1
An imitation, by definition — of a brand, a maker, a pack.
3 · The harm
A medicine that does not work is not harmless.
It fails the patient, delays effective treatment, wastes scarce money and — for antimicrobials — feeds drug resistance. Two models commissioned for WHO's 2017 study give the order of magnitude.
72,000–169,000
children may die each year from pneumonia because of substandard and falsified antibiotics.2
Model: University of Edinburgh
116,000
additional malaria deaths a year in sub-Saharan Africa (range 64,000–158,000) from substandard and falsified antimalarials.2
Model: London School of Hygiene and Tropical Medicine
Modelled estimates for particular diseases and regions, cited for their order of magnitude — not as figures for Afghanistan.
4 · Afghanistan
The conditions in which falsified medicines circulate.
Reliable national estimates are scarce, and we do not cite figures we cannot source. What is well established are the conditions — and Afghanistan presents many of them.
Import dependence across many borders
Packs reach the shelf from many manufacturing countries, labelled in English, Urdu, Persian, Turkish and more. A pharmacist must judge packaging from many markets.
Limited oversight
Inspection and laboratory testing capacity is limited relative to the size and fragmentation of the market.
Informal, fragmented supply
Medicines move through wholesalers, small pharmacies and informal sellers, with few points at which a product is checked.
Barriers to reading the pack
Many patients cannot read the languages on the packs they buy, so cannot check a name, a strength or a date.
5 · The evidence of a photograph
What a photograph can and cannot establish.
A photograph records what a pack looks like. It cannot measure what a tablet contains.
It can examine
Print and packaging
Typography, colour, layout, print quality, security features.
Batch and expiry
Format and plausibility against the manufacturer's pattern.
Registration details
Whether they take the form they should.
The stated ingredient and strength
Read back to the patient in their language.
It cannot establish
Substandard product, genuine pack
A failed batch can look exactly like a good one.
A perfect imitation
A faithful copy with plausible details can pass.
The contents
Identity, strength, purity and dissolution need a laboratory.
6 · Implications
What follows for practice.
Screen where medicines change hands
At the pharmacy counter, the clinic store and the household — where a falsified product can still be stopped.
State the limits of every result
“No sign of falsification found” is a different statement from “genuine”, and must never be presented as one.
Give doubt a route onward
To the supplier, a laboratory or the authorities — not only a warning to the person holding the pack.
Treat language as safety
A patient who cannot read the pack cannot check it. Information in Dari or Pashto is a safeguard in itself.
These principles shape the counterfeit-medicine scan.
References
- World Health Organization. Substandard and falsified medical products (fact sheet). 3 December 2024. who.int
- World Health Organization. 1 in 10 medical products in developing countries is substandard or falsified (news release). Geneva, 28 November 2017. who.int
- World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: WHO; 2017. who.int
- World Health Organization. WHO Global Surveillance and Monitoring System for substandard and falsified medical products. Geneva: WHO; 2017. ISBN 978-92-4-151342-5. who.int
Cite this page
Mohr-e-Aseel (2026). Substandard and falsified medicines. 21 October 2026. https://mohreaseel.com/research/substandard-and-falsified-medicines