Fake medicines now affect all segments of the population. Patients with chronic diseases, consumers seeking weight-loss drugs, users of stimulants, anxiolytics or performance-enhancing products, online buyers or people facing difficulties accessing healthcare: no one is entirely safe anymore.
Tragedies are multiplying. So are the cases.
Faced with these situations, attention is legitimately drawn to several questions: who commits these crimes? How do the networks operate? Who finances them? Who protects them?
These questions are essential.
But another deserves just as much attention: what vulnerabilities make these activities possible, profitable and reproducible?
The Gaya case in India offers a particularly interesting perspective.
In February 2026, Delhi police and the relevant authorities dismantled a clandestine drug manufacturing unit in the state of Bihar. Nine people were arrested as part of an investigation that began following inquiries linked to controlled substance trafficking.
The seized products cover several market segments: zinc (a mainstream health supplement), azithromycin (a high-demand antibiotic), paracetamol (an everyday consumer medication), tramadol (an opioid associated with both legitimate medical use and international trafficking) and alprazolam (an anxiolytic also subject to diversion for non-medical purposes).
This diversity illustrates the network’s ability to simultaneously exploit multiple types of demand, multiple consumer profiles and multiple levels of profitability: a true criminal portfolio.
The Gaya case reads as a mapping of the vulnerabilities that a criminal network managed to exploit simultaneously. It includes mass production of everyday fake medicines benefiting from consumer trust, such as zinc or paracetamol, as well as a high-demand antibiotic like azithromycin. Tramadol is an opioid involved in international trafficking, particularly towards West Africa and the Sahel. Finally, alprazolam illustrates the porosity between the pharmaceutical market, diverted uses and illicit markets. The industrial manufacturing and packaging capabilities further demonstrate the network’s agility and its ability to adapt production according to opportunities.
This case leads us to question a concept still too rarely present in debates about fake medicines: health security.
Developed progressively since the 1990s before gaining prominence internationally after the 2001 anthrax attacks, SARS, Ebola and then the COVID-19 pandemic, the concept of health security rests on societies’ ability to prevent, detect and respond to threats that may affect population health. Traditionally, this concept is associated with pandemics, emerging infectious diseases, biological risks, bioterrorism or major health crises.
Yet fake medicines present many characteristics that place them squarely within this field: they constitute a transnational threat; they directly affect population health; they require prevention, detection and response capabilities; they demand cooperation between health authorities, regulators, laboratories, law enforcement, customs and private sector actors.
They also undermine trust in health systems. They cause deaths, promote antimicrobial resistance, can compromise treatments and fuel criminal markets.
As such, the threat posed by fake medicines fully falls within the scope of health security.
The criminal approach legitimately seeks to identify the perpetrators. The health security approach asks a complementary question: why was this business model able to emerge, function and thrive?
Behind the products seized in Gaya, several vulnerabilities appear: the trivialisation of certain medicines, self-medication, the growing reliance on purchases outside secure channels, tensions in access to certain treatments, the complexity of supply chains, international flows, price differentials, diverted industrial capacities and the fragmentation of responsibilities across institutions.
The seized products describe, beyond a criminal network, the flaws of a system that this network identified, combined and exploited: health, regulatory, logistical, economic and behavioural vulnerabilities.
The Gaya case is a particularly telling example among other networks already involved in manufacturing multiple fake medicines.
It can be read as a revealing indicator of the vulnerabilities of our health systems.
It is essential to identify and prosecute the perpetrators, while also acting on vulnerabilities before they become opportunities for criminal actors.
Analysing fake medicines through the lens of health security profoundly changes our level of responsibility. It goes beyond combating a criminal activity or merely strengthening law enforcement, regulatory and judicial capacities. It also means strengthening the resilience of health systems, protecting populations, preserving continuity of care, reducing strategic vulnerabilities and, in some cases, contributing to national security. This shift in perspective is now necessary.
Fake medicines go far beyond a criminal problem. They are a health security issue.
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