2024 Symposium on Public Health Strategies to Combat Substandard and Falsified Drugs

The 2024 Symposium on Public Health Strategies to Combat Substandard and Falsified Drugs, hosted by the BESAFE team of JHU with support from Pfizer, brought together key stakeholders to confront the escalating global threat of SF drugs.

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Held at the Johns Hopkins Bloomberg Center in Washington, DC, the 2024 symposium welcomed ~ 103 attendees who shared insights and assessed progress. It charted a collective course of action to combat the threat posed by substandard and falsified drugs. Through enlightening keynote addresses and interactive discussions, the event emphasized the importance of a multifaceted public health response through prevention, detection, and response strategies rooted in digital and physical surveillance, capacity building, regulatory enforcement, and education for both healthcare professionals and consumers.

The 2024 Symposium Report Contents:

  • Frontline Capacity Building
  • Strengthening Regulatory Oversight
  • Consumer Engagement
  • Partnerships
  • Technological Innovations
  • Resources for Consumers and Healthcare Providers

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Substandard and Falsified Drugs: The Facts

1 in 10 medicines are substandard or falsified (SF) in LMICs. The burden of SF drugs is high in lower-and middle-income countries (LMICs), but a growing threat in high-income countries like the United States. 137 countries are impacted.

1 million deaths per year are attributed to the consumption of SF drugs. $353.3 billion is lost in economic output annually due to SF drugs.

In the U.S., SF drugs containing fentanyl have fuelled the opioid crisis, having caused more than 100,000 deaths in 2022, contributing to over 80% of opioid overdose deaths. 

95% of online pharmacies are unlicensed and 50-90% of medicines sold online are SF.  In the U.S., over 38% of Americans have been exposed to SF medicines due to online pharmacies.

“Let us unite our efforts, expertise, and commitment to reducing the impact of substandard and falsified drugs, ensuring a future where medication integrity is upheld, and patients remain protected from SF drugs”

Saiffudin Ahmed, MBBS, PhD, Professor, Principal Investigator, BESAFE

Key Takeaways

Only 2% of HCPs are trained to identify SF drugs and counsel patients, with most still perceiving this issue as one confined to LMICs. Meanwhile, only 30% of pharmacists discuss online drug purchases with patients. Addressing this gap requires integrating targeted education into pharmacy school curricula, promoting experiential learning strategies, and leveraging digital tools to improve supply chain tracing and directing patients to safe alternatives.

Regulatory actions should work in tandem with legal mechanisms to ensure criminal networks are held accountable. Challenges such as data collection, resource limitations, and the need for global collaboration persist, requiring bolder partnerships and advocacy. 

Consumers remain vulnerable to the exploitative SF drug industry due to limited knowledge and with the industry’s direct targeting of them through social media platforms. Efforts to educate consumers include using direct engagement with healthcare providers, peer-to-peer networks, and digital and social media campaigns. Education must also be complemented by system-level changes, such as increasing access to safe and legitimate drugs, to empower consumers to make the right decisions. 

Tackling SF drugs demands a shift in perspective, viewing it not only as a public health challenge but also as an issue that intersects with criminal justice, development, and international security. Cross-sector and cross-border partnerships are crucial for creating comprehensive and effective solutions. Progress has been achieved through partnerships that prioritize shared ownership, demonstrating that when partner governments exhibit political commitment and invest local resources into anti-substandard and falsified drug initiatives, the impact of donor support is both amplified and sustained.

While advancements in technology pose one of the greatest threats to public health as criminal operations may exploit these advancements to target vulnerable consumers, there is also an opportunity to leverage artificial intelligence to develop tools that would enhance SF drug monitoring and surveillance. Technology can also be leveraged for digital prevention and health promotion interventions to inform practitioners and patients. 


“We need an all-of-society approach to this crisis. It’s naive to think that we can simply seize our way out of this problem. The scope is too large, the stakes are too high…Law enforcement must be at the table with public health practitioners and the private sector like you, who are already engaged in such critical work on the issue.”
Troy A. Miller
Senior Official Performing the Duties of the Commissioner, U.S. Customs and Border Protection



“Our biggest challenge from a prevention standpoint is raising awareness among consumers that substandard and falsified drugs can cause harm, or even death”


Ivan J. Arvelo
Director, IPR Center




“The presence of counterfeit drugs is more than a health hazard; it underscores inequities within our healthcare systems, erodes trust, and exploits the vulnerabilities of the uninformed and unprotected.”
Cynthia Schaffer Minkovitz
Professor, Chair of the Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health

Impact

With over 100 participants in attendance, the feedback received on this year’s symposium was overwhelmingly positive. Based on an evaluation survey administered to participants, more than 86% respondents reported that the symposium met or exceeded their expectations. Most participants believed that, in addition to building the research evidence base for SF work, the symposium has the potential to increase political and financial commitment to addressing SF.

“As a pharmacist, the information I learned was immensely valuable! I am interested in learning more about opportunities for personal growth and development as well as resources for educating other healthcare professionals and the public at large.”

Participating Organizations

  • Johns Hopkins University Bloomberg School of Public Health
  • Johns Hopkins University School of Medicine
  • Pfizer Inc.
  • Gilead Sciences
  • Boehringer Ingelheim
  • BeiGene
  • International Pharmaceutical Federation (FIP)
  • Uppsala Monitoring Centre
  • United States Pharmacopeia (USP)
  • Pharmaceutical Security Institute
  • University of North Carolina 
  • National Association of Entrepreneurs of Colombia (ANDI) 
  • African Union Development Agency – New Partnership for Africa’s Development (AUDA-NEPAD)
  • Alliance for Safe Online Pharmacies
  • Community Health and Information Network (CHAIN)
  • National Crime Prevention Council (NCPC)
  • National Intellectual Property Rights Coordination Center (IPR Centre)
  • University College London
  • Pan American Health Organization (PAHO)
  • United States Agency for International Development (USAID)
  • Universal Postal Union (UPU)
  • Woods International LLC
  • Bernstein Rx Solutions
  • American Academy of Family Physicians
  • Institute for Safe Medication Practice
  • Butler University College of Pharmacy and Health Sciences
  • University of California San Diego 
  • GS1
  • Fight the Fakes Alliance
  • National Association of Boards of Pharmacy (NABP)
  • Partnership for Safe Medicines
  • U.S. Customs and Border Protection, Office of Trade (CBP)
  • U.S. Food and Drug Administration (FDA)
  • World Customs Organization (WCO)
  • World Health Organization (WHO)