The Global Pandemic of Falsified Medicines: Laboratory and Field Innovations and Policy Perspectives MACKEY AND OTHERS ANALYSIS OF COUNTERFEIT MEDICINES IN LEGITIMATE SUPPLY CHAINS Counterfeit Drug Penetration into Global Legitimate Medicine Supply Chains

Abstract. Counterfeit medicines are a global public health risk. We assess counterfeit reports involving the legitimate supply chain using 2009–2011 data from the Pharmaceutical Security Institute Counterfeit Incident System (PSI CIS) database that uses both open and nonpublic data sources. Of the 1,510 identified CIS reports involving counterfeits, 27.6 % reported China as the source country of the incident/detection. Further, 51.3 % were reported as counterfeit but the specific counterfeit subcategory was not known or verifiable. The most prevalent therapeutic category was anti-infectives (21.1%) with most reports originating from health-related government agencies. Geographically, Asian and Latin American regions and, economically, middle-income markets were most represented. A total of 127 (64.8%) of a total of 196 countries had no legitimate supply chain CIS counterfeit reports. Improvements in surveillance, including detection of security breaches, data collection, analysis, and dissemination are urgently needed to address public health needs to combat the global counterfeit medicines trade