When the choice is between poor-quality medicine and no medicine at all

Poverty drives the market in inferior medicines just as it drives other examples of inequality. A socially integrated approach is needed to fight the problem.

“A patient wanted to buy antibiotics for a bruise. They want antibiotics even for influenza.” Indonesian pharmacists had alarming stories when researchers interviewed them about their experiences.

But the story gets even more alarming: 2021 research shows that 70 percent of Indonesian pharmacies dispense antibiotics without a prescription. And many Indonesians who cannot afford appropriate health care buy prescription-only drugs, including antibiotics, in the informal sector for self treatment.

In Indonesia, licensed drug stores (which are different from pharmacies) often sell antibiotics, evading inspection by the authorities. The informal and formal sectors – licensed and unlicensed sellers, grocery stores and pharmacies – are entangled. The Indonesian distribution channels for medicines are said to be the most complicated in the world.

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