UC San Diego

Perhaps no greater challenge exists for shared global health security and patient safety than fake, unregulated, and/or poor quality drugs, also known as "counterfeit medicines" now endemic in the global drug supply chain. Counterfeit medicines are prevalent everywhere including in traditional healthcare settings, unregulated sectors, and on the Internet. These dangerous medicines are on the rise in both therapeutic and geographic scope, threatening patient lives, potentially leading to antimicrobial resistance, and profiting illicit criminal actors. Yet, despite these clear threats, surveillance is extremely limited, with available data pointing to an increasing global health crisis worldwide that has yet to be addressed. Efforts by a variety of international organizations have made inroads in combating this illicit trade, but are stymied by ineffectual governance. In this paper, I employ an interdisciplinary research approach to assess the policy environment for this global public health issue for both the physical and digital global drug supply chain. This is accomplished in the first chapter by conducting an analysis of current diplomatic and governance efforts to address the issue. Using analysis from the first chapter, I then formulate governance-based solutions for physical and digital distribution and sale of counterfeit drugs. The results of this research indicate that combating the global counterfeit medicines trade requires engagement, cooperation, and coordination among a wide array of public and private stakeholders. Governance solutions to address this issue must be inclusive and transparent with a focus on crime, public health, and patient safety. To address this global public health crisis, we recommend the establishment of an enhanced governance trilateral mechanism between UNODC-WHO -Interpol for the counterfeit drug trade and incorporating and partnering with existing Internet Governance mechanisms to combat the online trade of counterfeit medicines