About 500,000 people die every year as a result of fake and substandard medications in sub-Saharan Africa, the UN Office on Drugs and Crime has said.
A lack of access to appropriate health care has emboldened traffickers, who mainly import drugs to the Sahel region after they are diverted from the legal supply chain from China, Belgium, France and India.
The products are then moved through the region in cars and lorries, the Trafficking in Medical Products in the Sahel report found.
Most of the deaths were linked to fake or substandard antimalarial medication, which killed 267,000 people in Burkina Faso, Chad, Mali, Mauritania and the Niger.
Malaria itself killed 593,000 in Africa as a whole in 2021, the WHO reported.
A further 169,271 deaths have been linked to falsified and substandard antibiotics used to treat severe pneumonia in children.
Around 40 per cent of the drugs discovered to be fake were picked up within the regulated supply chain, meaning illegally manufactured drugs were making it into the medical systems of Sahel countries.
Beyond the risk of counterfeits and poorly made drugs – which at best do not work and at worst lead to toxic contaminations — the report also warned of legitimate medications being used in unauthorised ways that can lead to increased resistance to front line drugs such as antibiotics and antimalarials.
“Once a (legitimate) product is diverted from the supply chain, there is very little (oversight) about how it is being used,” said Francois Patuel, the head of the UNODC's Research and Awareness Unit.
“If you … ask for an antibiotic in the market, you will be able to purchase it. Whether it is the right antibiotic that should be used, or should be used at all, is not something that is controlled,” he added.
“It is contributing to bacterial resistance and to antimalarial resistance.”
The financial benefits from the illicit trade are reaped by many, including pharmaceutical company employees, law enforcement officers and street vendors.
Agencies said they are fighting back against the scourge of drug trafficking.
International operations saw more than 605 tons of medical products seized in West Africa, between January 2017 and December 2021
In 2020, the Organisation for Economic Cooperation and Development (OECD) blamed the pandemic and the proliferation of online pharmacies for the explosion in fake drugs.
“The sale of counterfeit and defective pharmaceuticals is a despicable crime, and the discovery of fake medical supplies related to Covid-19 just as the world pulls together to fight this pandemic makes this global challenge all the more acute and urgent,” said Angel Gurria, OECD Secretary General.