Imagine taking medication for days, expecting your symptoms to disappear, only to find that your condition is getting worse. You return to the hospital, undergo more investigations, receive another prescription and spend even more money.

But what if the problem isn't your diagnosis or your body's response? What if the medicine you trusted to make you better was never good enough to work in the first place?

This is one of the worrying realities of fake and substandard medicines, a public health challenge threatening lives and undermining healthcare delivery in Nigeria.

Not Every Bad Medicine Is Fake

Although the terms are often used interchangeably, substandard and falsified medicines are different.

According to the World Health Organization (WHO), substandard medicines are authorised medical products that fail to meet established quality standards. Falsified medicines deliberately misrepresent their identity, composition or source.

Some may contain incorrect ingredients, insufficient amounts of active pharmaceutical ingredients or substances different from what their packaging claims.

Regardless of the category, the consequences can be devastating.

The Human Cost: When Treatment Fails

For patients, the most immediate consequence is treatment failure.

Consider malaria, one of Nigeria's persistent public health challenges. When a patient receives an ineffective antimalarial, the infection may continue progressing despite treatment. This can lead to complications, repeated hospital visits and, in severe cases, death.

A particularly concerning Nigerian study published in 2019, titled The Economic Impact of Substandard and Falsified Antimalarial Medications in Nigeria, by Beargie and colleagues, estimated that poor-quality antimalarial medicines were associated with approximately 12,300 deaths and US$892 million in annual economic losses in Nigeria.

These were estimates generated through mathematical modelling, focusing on children under five, rather than directly counted deaths. Nevertheless, the findings highlight the enormous potential consequences of poor-quality medicines.

For families, the financial burden can be equally troubling. Spending money on ineffective medication only to pay for repeated consultations, investigations and additional treatment creates another layer of hardship.

The Connection With Antimicrobial Resistance

Another major concern is the relationship between poor-quality medicines and antimicrobial resistance (AMR).

When antimicrobial medicines contain insufficient active ingredients or fail to deliver the required therapeutic effect, treatment may become unsuccessful. Inadequate antimicrobial exposure can contribute to the selection and survival of resistant microorganisms.

However, not every treatment failure results from antimicrobial resistance, and not every substandard medicine automatically causes resistance.

Still, poor-quality antimicrobial medicines can complicate an already serious global health challenge, making infections increasingly difficult and expensive to treat.

A Healthcare System Paying Twice

The consequences extend beyond individual patients.

Treatment failure can increase hospital admissions, prolong hospital stays, encourage repeated investigations and place additional pressure on already stretched healthcare resources.

Medical Laboratory Scientists also have an important role in this conversation. Through diagnostic investigations, microbiological testing, pharmaceutical quality control and public health surveillance, they contribute to identifying infections, investigating possible contamination and supporting medicine safety.

However, medicine quality cannot be separated from the collective responsibility of healthcare professionals, manufacturers, distributors and regulatory authorities.

A healthcare system cannot consistently achieve successful treatment outcomes if the quality of the medicines being administered is uncertain.

Who Is Responsible?

It is easy to place the entire responsibility on consumers who purchase medicines from unregulated sources. But the problem goes much deeper.

Manufacturers must maintain appropriate production and quality-control standards. Distributors must ensure proper storage and transportation. Regulatory agencies, particularly Nigeria's National Agency for Food and Drug Administration and Control (NAFDAC), must strengthen surveillance, inspections and enforcement.

Consumers also need to purchase medicines from authorised sources, remain alert to suspicious products and report suspected poor-quality medicines.

Importantly, visual inspection alone cannot establish that a medicine is genuine or safe. Proper laboratory analysis and regulatory investigation remain essential.

We must also acknowledge the role of affordability. When genuine medicines become financially inaccessible, vulnerable patients may turn to cheaper alternatives without knowing the risks. Ensuring access to affordable, quality-assured medicines must therefore be part of the solution.

Beyond Awareness: A Question of Accountability

We often discuss early diagnosis, accurate laboratory results, appropriate prescriptions and improved healthcare infrastructure. Yet, the quality of medicines used to complete that healthcare process deserves equal attention.

The fight against fake and substandard medicines must go beyond occasional raids and public awareness campaigns. It requires stronger quality-control systems, effective regulation, transparent reporting, affordable genuine medicines and accountability across the pharmaceutical supply chain.

Ultimately, patients should not have to gamble with their health every time they purchase medication.

If a medicine is meant to save a life but cannot be trusted to do so, can we honestly say that the patient has received the healthcare they deserve?