While some people are getting sick, others are getting rich, NPR reports—and a new World Health Organization study reveals why. It's all linked to counterfeit drugs, notes the report from the WHO, which estimates one in 10 medical products in low- and middle-income nations is either substandard (licensed and approved, but of iffy quality—say, expired, or containing the wrong amount of an active ingredient) or fake, per a release. Of the 1,500 or so reports of shoddy meds that WHO has culled since 2013 (it also reviewed 100 peer-reviewed surveys related to quality)—mostly centering on antibiotics and antimalarial drugs—42% came out of Africa, while Europe and the Americas each claimed 21%, though WHO notes the numbers overall are likely significantly underreported.
What helps these counterfeit drugs take hold, among other factors: drug shortages and stigma tied to certain drugs, like Viagra. "Patients may be too ashamed to see a physician," Dr. Kristina Acri, a Colorado College economist who's studied fake meds for nearly two decades, tells NPR. The products can injure and kill, as well as worsen bacterial resistance, and the WHO report contains a grim estimate: that 69,000 people may die of malaria annually in sub-Saharan Africa due to these meds. Complicating things: It's not a "few evil masterminds" creating these fake drugs, as NPR puts it. "In the last four years of the surveillance program here, we've seen clandestine factories that have been making substandard and falsified medicines in every WHO region," says a WHO expert.