Sub-Project A-71 · ICSETEP
Everyone who handled it believed it was genuine. The patient was the last person in the chain and the only one with no way to check. What follows is one argument in seven steps: it starts with that single box, widens until the cost is denominated in foreign currency, and ends on the one thing a pack can carry that nobody else can reproduce.
The project
Development and Effective Application of AI-Based, Post-Quantum Cryptography-Enabled Counterfeit Medicine Identification Tools for Better Treatment Outcomes in Bangladesh.
Department of Computer Science and Engineering, Daffodil International University. Funded by the Government of Bangladesh and the Asian Development Bank under the UGC RDG-ICSETEP project.
Funded and administered by
Implemented with
01 / A substitution
Counterfeit medicine is not a manufacturing problem that happens to involve drugs. It is a supply-chain problem: something was put in the place of a genuine product, and every party between that moment and the counter handled it believing it was the real thing.
That is what makes it hard to see. A forger does not need to replicate the medicine; they need to replicate the pack. The tablet, the vial, the carton, the batch number and the expiry date are all things that can be looked at and copied, and a copy that survives a glance at the counter has already done its job[16].
The reporting below is Bangladeshi, published, and spans two decades. Every headline is the outlet’s own.
The Daily Star · · Feature
Rajib was only two-and-a-half years old when he was murdered. More than two decades later, his grief stricken mother tightly clutches on to his picture, almost whispering, amid her tears, “This is all I have left of my son.”
The Daily Star · · Report
They target medicines that are widely sold in the market, like Naproxen-Plus, Pantonex, Seclo, Monas and Finix. And they make the fake versions using flour and semolina.
The Financial Express · · Letter
Yes, medicine can be made from flour, semolina, sugar! This is what some would like us to believe.
Dhaka Tribune · · Feature
Fake medicines harm public health, sold nationwide · Expert demands arrests, separate tribunal for justice
New Age · · Report
Spurious, unregistered and banned medicines have long been flooding pharmacies across the country through a nexus between unscrupulous traders in the Mitford medicine market in the capital and fake manufacturers plus rogue firms of the packaging industry.
Daily Sun · · Report
Just as medicine prices have soared beyond people’s reach, the trading of counterfeit medicines has also expanded rapidly.
The Business Standard · · Report
There is no information about any imprisonment for manufacturing adulterated drugs in 2023
The Daily Star · · Feature
A simple break in the supply chain is compromising life-saving drugs and diagnostic tests.
So: one box, and it is an ordinary one. The obvious next question is how many — and the honest answer is that the ones which worked were never counted.
02 / How many
Every figure below is a floor rather than a total. Counterfeit medicine is measured by what testing and enforcement happen to reach, and anything that worked well enough not to be questioned is never counted at all.
600
crore taka / year
Counterfeit medicine traded annually, on the drug makers’ own estimate — out of a Tk 18,000 crore market.[1]
~10
% of antibiotics
Share of antibiotics sampled in Dhaka found counterfeit, adulterated or substandard. Outside Dhaka, researchers put it near twice that.[2]
Three per cent sounds survivable until it is read the other way round: it is the share by value, not by dose, and the cheapest products are the easiest to copy. A patient has no way of knowing which side of the bar the pack in their hand came from — which is the entire problem, stated arithmetically.
There is no published year-by-year total of counterfeit medicine seized in Bangladesh — the DGDA reports enforcement activity for some years and not others, and the reporting covers individual raids rather than national figures. So this is the record as it exists: documented cases, each with the figure its own source states.
DeathsEnforcement
1991 — deaths
76 deaths
The first mass-casualty event on record. A child kidney specialist raised the alarm over adulterated drugs the same year.[7]
2009 — deaths
28 deaths
Eighteen years after the first. The product was traced to Reed Pharma.[7]
2013
≈ US$ 640,000
Taken from the country’s central wholesale medicine hub — the point product passes through on its way to pharmacies nationwide.[8]
2020
Tk 10 crore destroyed
Fake medicine, cosmetics and sanitiser destroyed by a mobile court in Barishal. Two men were jailed for a year and fined Tk 5 lakh each.[10]
2017–2021
Tk 27 crore fined
34 cases filed against firms over manufacturing fake medicine, and 202 mobile courts run, in the four years to 2021.[6]
2023
Tk 1.73 crore fined
1,696 mobile courts, 8 drug courts and 447 magistrate courts. The same reporting notes no record of anyone imprisoned for manufacturing adulterated drugs.[5]
2023 — deaths
Tk 15.6 crore awarded
Tk 15 lakh to each family of the 76 children who died in 1991 and the 28 who died in 2009 — a reckoning arriving thirty-two years after the first of them.[7]
All of that is volume, and volume is the one thing a patient never sees. What reaches them is a single strip, on one counter, on one day.
03 / One patient
Hold everything constant — the condition, the molecule, the dose, the fact that the course was completed exactly as directed — and change one thing: whether the pack contained what the label promised.
Treated at home
Still ill.
Nothing in the encounter told anyone the medicine was the problem. The likeliest conclusion drawn is that the treatment does not work here.
Treated abroad
Recovered.
The same prescription, filled from a supply the patient had reason to trust. The difference was never the medicine — it was whether the pack held it.
An under-strength or inert product is not a neutral event. A course of antibiotics that does not clear an infection leaves a resistant one behind; a cardiac or oncology product that under-delivers spends a window that does not reopen.
Dhaka Tribune · · Report
Death after drinking fake paracetamol syrup in 1991, 2009 · Tk15.60 compensation
Dhaka Tribune · · Report
Fake anesthesia drugs recovered during drives · Anesthesia drug halothane banned recently
The Daily Star · · Report
Send text to verify if the medicine is counterfeit or not
That patient is the end of the chain. Walk back up it and the same substitution is being paid for twice more — by two parties who never hold the strip at all.
04 / Who else pays
The patient pays in health. The other two losses are quieter, and one of them is the reason this problem compounds instead of simply recurring.
A falsified product carries a real company's brand. The revenue goes to whoever made the copy, and the failure — when the medicine does not work — is attributed to the company whose name is on it. It loses the sale and the reputation in the same transaction.
Dhaka Tribune · · Report
Market analysts note that unscrupulous traders become exceptionally active during festive seasons, exploiting the rapid growth of online commerce and persistent gaps in market supervision
The Business Standard · · Report
The specific anti-itch drug had been sold for a long time
bdnews24.com · · Report
A mobile court of the Rapid Action Battalion or RAB has fined the Apollo Hospitals in Dhaka Tk 300,000 for selling in their pharmacy 30 types of counterfeit drugs.
The deepest cost is epistemic. When a course fails, nobody can separate a wrong diagnosis from a right one served by a fake — so the conclusion drawn is that the treatment does not work, and the next prescription is written against evidence that was never real.
The Daily Star · · Feature
Pharmaceutical drug adulteration is rampant in Bangladesh. Some estimates suggest that the flow of fake medicine in the open market at any time could be around 2,500 crore taka.
The Daily Star · · Editorial
Lack of registration and oversight raises concerns
A company loses a sale; a prescriber loses the ability to read their own results. Widen the frame once more and the same loss turns up in the national accounts.
05 / What it costs the country
The chain from a failed course of treatment to a drain on foreign reserves is short, and each link follows reasonably from the one before it.
01
Treatment fails
A course of medicine does not work. Neither the patient nor the prescriber can tell whether the diagnosis, the drug or the product was at fault.
02
Trust goes
Once a failure is suspected to be the medicine itself, confidence in what is sold locally does not recover on its own.
03
Patients travel
Those who can afford it seek treatment abroad — and buy their medicine there too, because that is the part they stopped trusting.
04
Reserves leave
The money goes out twice: once for the treatment, and again for the medicine carried home.
The last two links of that chain are measurable, and they have been measured — loosely, by sources that say so themselves.
~800,000
patients / year
Bangladeshis believed to travel abroad for medical treatment each year. The source states plainly that exact figures are unavailable.[12]
$5bn
per year
Spent on treatment abroad annually. A separate estimate, from the Dhaka Chamber of Commerce and Industry, puts it at $4 billion.[13]
482,000
to India in 2024
Bangladeshis travelling to India for medical purposes — about 52% of all its inbound medical tourists, down from 500,000 in 2023.[13]
In most categories a falsified product costs money and time. In these, it costs the outcome the treatment existed to secure.
Every one of those costs follows from a single fact: the pack cannot be checked by the person holding it. Which makes it worth asking what is on the pack today, and what it actually withstands.
06 / Today’s defence
The defences in use today are physical: a distinctive design, a hologram, security printing. Each raises the cost of forgery. None of them changes the fundamental position, which is that the feature is a thing to be looked at — and anything that can be looked at can be reproduced closely enough to pass being looked at.
Sample A
Sample B
One of these is genuine and one is forged. Nothing you can see distinguishes them — and nothing a pharmacist, a wholesaler or a patient can see distinguishes the real pair either.
Raids, fines, destroyed stock and, since the Drugs and Cosmetics Act, a maximum penalty of life imprisonment. Every one of these is a response to product that has already been made, already been distributed and, in most of the cases below, already been sold. Deterrence is worth having. It is not the same thing as a pack that can be checked before it is swallowed.
The Daily Star · · Report
Sellers of antibiotics without prescriptions to face fine; cabinet okays draft law
Dhaka Tribune · · Report
The guidelines of WHO should be followed in all matters in the production of medicines
The Financial Express · · Report
Cabinet approves draft law that slaps Tk 20,000 as fine for selling antibiotic without prescription
The Daily Star · · Report
They set up factory in the capital to produce, distribute those
The Daily Star · · Report
Two sentenced to jail, fined Tk 10 lakh in Barishal
The Financial Express · · Report
Rapid Action Battalion (RAB) has arrested six people for manufacturing and selling counterfeit Ayurvedic medicines in Dhaka.
The Business Standard · · Report
He said the Directorate General of Drug Administration (DGDA) has been conducting regular field inspections nationwide, operating mobile courts, collecting medicine samples for laboratory testing, carrying out intelligence-based drives and conducting special operations with the assistance of law enforcement agencies.
Not safe enough.
07 / What we propose
A signature is not a feature of the packaging; it is a mathematical statement about it. A forger with a perfect press still cannot produce one, because producing one requires a private key rather than a printer — and the standards below are chosen so that this stays true once quantum computers can break the cryptography protecting the rest of the chain[17][18].
01
Hash
Every pack gets a unique identifier bound to its batch, its strength and its date, condensed to a fixed digest that changes completely if any of it is altered.
02
Sign
The digest is signed with a lattice-based key only the manufacturer holds. A forger can copy the code; they cannot produce a signature that verifies against the manufacturer’s public key.
03
Record
Each custody event — release, distribution, dispensing — is appended to a shared ledger, so a code presented twice in two places is visible as exactly that.
04
Explain
A model reads the pack and returns a calibrated verdict with the evidence for it — which features it weighed and how far each sits from the genuine population — rather than an unexplained yes or no.
The box this page opened with could be looked at, and handed over, and believed. This one can be asked a question it cannot answer unless it is genuine.
References
[1]
Know your medicine
The Daily Star · 21 June 2016
www.thedailystar.net/frontpage/know-your-medicine-1243567[2]
A comprehensive analysis of selected medicines collected from private drug outlets of Dhaka city, Bangladesh in a simple random survey
Scientific Reports (Nature) · 10 January 2022
www.nature.com/articles/s41598-021-04309-1[3]
Countering counterfeit medicine in Bangladesh
The Daily Star · 27 February 2022
www.thedailystar.net/health/news/countering-counterfeit-medicine-bangladesh-2971806[4]
Market flooded with counterfeit medicines
Daily Sun · 20 December 2025
www.daily-sun.com/bangladesh/847000[5]
Health sector in peril as adulterated drugs rampant
The Business Standard · 7 April 2024
www.tbsnews.net/bangladesh/health/health-sector-peril-adulterated-drugs-rampant-824446[6]
Counterfeit medicines flood markets across Bangladesh
New Age · 25 September 2021
www.newagebd.net/article/150157/counterfeit-medicines-flood-markets-across-bangladesh[7]
High Court orders to compensate families of 104 children killed by fake syrup
Dhaka Tribune · 15 November 2023
www.dhakatribune.com/bangladesh/court/331118/high-court-orders-to-compensate-families-of-104[8]
The deadly world of fake medicine
The Daily Star · 21 August 2014
www.thedailystar.net/the-deadly-world-of-fake-medicine-37915[9]
Flour balls for medicines!
The Daily Star · 6 June 2022
www.thedailystar.net/news/bangladesh/news/flour-balls-medicines-3041201[10]
Fake medicine, cosmetics worth Tk 10cr destroyed
The Daily Star · 15 June 2020
www.thedailystar.net/city/news/fake-medicine-cosmetics-worth-tk-10cr-destroyed-1915045[11]
Why your drugs don’t work
The Daily Star · 21 September 2017
www.thedailystar.net/news/bangladesh/special-read/news/why-your-drugs-dont-work-1465561[12]
To reverse medical tourism, we must strengthen local healthcare
The Daily Star · 2024
www.thedailystar.net/opinion/editorial/news/reverse-medical-tourism-we-must-strengthen-local-healthcare-3782891[13]
Medical Tourism: Why people go abroad and how Bangladesh can bring them back
The Business Standard · 29 October 2025
www.tbsnews.net/supplement/medical-tourism-why-people-go-abroad-and-how-bangladesh-can-bring-them-back-1271926[14]
Why Bangladeshis flee for medical treatment, and how to stop it
The Daily Star
www.thedailystar.net/opinion/views/blowin-the-wind/news/why-bangladeshis-flee-medical-treatment-and-how-stop-it-3841826[15]
Bangladeshis spend $4b annually for healthcare abroad
The Daily Star
www.thedailystar.net/business/news/bangladeshis-spend-4b-annually-healthcare-abroad-3759816[16]
Global surveillance and monitoring system for substandard and falsified medical products
World Health Organization · 2017
www.who.int/publications/i/item/9789241513425[17]
FIPS 203: Module-Lattice-Based Key-Encapsulation Mechanism Standard
NIST · 13 August 2024
csrc.nist.gov/pubs/fips/203/final[18]
FIPS 204: Module-Lattice-Based Digital Signature Standard
NIST · 13 August 2024
csrc.nist.gov/pubs/fips/204/final