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7 Counterfeit medicines inLDCs: problems andsolutionsJulian Morris and Philip StevensMuch of the debate surrounding counterfeit medicines to date hasfocused on how to prevent them seeping into the supply chains ofdeveloped-country markets. The majority of counterfeit medicinesoriginate in Less Developed Countries (LDCs), including most ofthose that end up in the US and EU. Steps should be taken to changethe incentives faced by counterfeiters in LDCs participating in theproduction and trade of counterfeit pharmaceuticals.The scale of the problemWhile counterfeit medicines in wealthy markets are a growingconcern for physicians and law-enforcement agencies, their prevalencepales in comparison to their penetration of less developedmarkets. According to the World Health Organisation (WHO), 25 percent of all medicines in LDCs are counterfeit. 1 In some countries, theprevalence is far higher:◆◆◆Counterfeit medicines constitute between 40 and 50 per cent oftotal supply in Nigeria and Pakistan. 2In China, authorities have found that some products have acounterfeit prevalence ranging between 50 and 85 per cent. 336.5 per cent of antibiotics and anti-malarials on WHOessential drugs list in Thailand and Nigeria are substandard(Shakoor et al., 1997).