The United Nations (UN) has warned that the growing trafficking of counterfeit, substandard and unapproved medicines across Central Africa has become a major public health threat, driven in part by poor access to safe and affordable healthcare.
A new report by the United Nations Office on Drugs and Crime, the World Health Organisation and the Central African Economic and Monetary Community said the gap between healthcare needs and access to quality medicines was helping to expand the illicit market across the six CEMAC countries.
The countries are Cameroon, the Central African Republic, Chad, the Republic of Congo, Equatorial Guinea and Gabon.
At least 251 tonnes of medicines were seized across the six countries between 2020 and 2025, according to the report.
The drugs included antibiotics, anti-malarial medicines, painkillers, anti-inflammatory drugs and psychoactive substances such as tramadol and pregabalin.
The report said traffickers obtain medicines by diverting products from regulated supply chains and national health programmes, while other products are counterfeit, below required quality standards or have not been approved by relevant authorities.
The consequences can be severe.
The UN said illicit medicines can cause treatment failures and poisoning, while poor-quality antimicrobial drugs can contribute to the spread of drug-resistant infections.
WHO has previously estimated that at least one in 10 medicines in low- and middle-income countries is substandard or falsified.
The agency has warned that people are particularly vulnerable where access to quality medicines is limited, healthcare systems are weak and regulatory capacity is inadequate.
WHO modelling has also estimated that substandard and falsified antibiotics could be associated with between 72,000 and 169,000 deaths annually among children under five suffering from pneumonia.
Poor-quality antimalarial medicines have similarly been estimated to contribute to between 31,000 and 116,000 deaths each year in sub-Saharan Africa.
The figures are modelled estimates and do not represent confirmed deaths individually attributed to counterfeit medicines.
The Central African trafficking network operates through multiple routes, according to the UN report.
Medicines are smuggled through sea and river ports and transported by air as freight or in passengers’ luggage before being distributed into the hinterland through major commercial routes.
In the Central African Republic, armed groups have reportedly profited from the trade by looting health centres and imposing charges on medicine shipments moving through territories under their control.
The illicit trade also involves psychoactive substances such as tramadol and pregabalin, increasing concerns about the diversion of medicines for non-medical use.
One of the major challenges is that illegally sourced medicines can sometimes make their way into legitimate healthcare facilities, where patients may assume that drugs supplied through recognised institutions are safe.
The UN warned that the trade therefore goes beyond the sale of fake medicines on informal markets. It can undermine legitimate healthcare systems, weaken public institutions and provide revenue for organised criminal groups.
WHO has previously identified porous borders and uneven regulatory capacity as major vulnerabilities in Central Africa, where medicines moving through one poorly regulated jurisdiction can enter neighbouring countries.
The latest warning places greater emphasis on strengthening medicine regulation, improving access to affordable quality drugs and increasing cooperation among health authorities, customs agencies and law-enforcement bodies.
For Central African countries, the challenge is not only to intercept illicit medicines after they enter the market but also to close the healthcare and regulatory gaps that allow the trade to flourish.
