The highest incidence is in Sub Saharan Africa, followed by the poorer countries in Latin America and Southeast Asia. The Pharmacy Board of Sierra Leone estimates that $150 million worth of counterfeit drugs are brought into their country yearly. An estimated 20% of drug sold in sub Saharan Africa are fake. Fifty percent of antimalarials sold in the marketplace in these countries contain no active ingredients. The consequences of this situation are obvious. People with severe illness spend their meager resources for medicines that are of no value. It is estimated that 700,000 people die each year because of counterfeit drugs. Some efforts are being made to control this trade, including more rigorous customs inspection. A sophisticated scanning system is in development that will identify chemical variations from the real drug. Yet the incidence seems to be increasing, due to a combination of weak economies, rising drug prices, and increasing sophistication and organization of the illicit manufacturers and dealers. The counterfeiters have become increasingly clever at mimicking the genuine drug, exactly matching the appearance and packaging, making it impossible to tell visually the fake from the real. Another recent development is that of widespread internet selling which has become a problem in countries both rich and poor. As health care volunteers we need to be acutely aware of the widespread nature of this problem. We need to purchase our medicines only through indisputably reputable sources, and to advise our patients to use this same caution when they purchase additional meds. There has been a recent trend among health care teams to purchase medicines locally to support the local economy. Any potential source must be investigated thoroughly before making any such purchase.