Obstacle 4: Medicine quality
Poor medicine quality is often ignored in discussions of disease control but the problem is massive, and it affects particularly the antimalarial drugs. In many countries the private sector is main source of antimalarials and there is weak regulation of pharmaceuticals (48). A recent systematic review and meta-analysis estimated that 12·4% of antibiotics and 19·1% of antimalarials in low-income and middle-income countries were substandard or falsified, with an estimated economic impact ranging from US$10 billion to $200 billion (49).