Report: Six out of ten illegal online ads for medicines are not recognized by consumers

Only half (53%) of online advertisements for medicines are correctly categorized by consumers as legitimate or illicit. This result emerged from project CAPSULE, conducted by Transcrime, Joint Research Center of the Università Cattolica del Sacro Cuore in cooperation with the Inspection & Certification Department of the Italian Medicines Agency—AIFA and supported by Michigan State University's Center for Anti-Counterfeiting and Product Protection (A-CAPP).

The project aimed to investigate consumers' awareness of substandard and falsified medicines (SFMs) and the risk of purchasing them online.

The pharmaceutical illicit market has grown during the COVID-19 pandemic, exploiting vulnerable consumers through misleading online advertisements and websites, endangering public health and undermining regulatory measures. Existing efforts to combat the spread of SFMs online focus mainly on targeting online supply.

The CAPSULE project instead focused on the demand side of the market, assessing the exposure and behavior of Italian and Spanish consumers to define targeted information campaigns and interventions. The report is available here.

In January 2024, a survey was conducted among a representative sample of Internet users in Italy and Spain who were aware of the possibility of buying medicines online and had been exposed to online advertising or had bought at least one medicine online. The survey exposed them to a mix of legitimate and illegitimate online advertisements for medicines.

The results showed that consumers correctly categorized legitimate advertisements 63% of the time, but struggled significantly with illicit ads, correctly identifying them only 43% of the time in Italy and 42% in Spain. The most important factors influencing the decisions of the respondents are the absence of a label certifying authorization by the Ministry of Health, followed by the absence of a drug description or the presence of errors.

To foster responsible choices among consumers, the results of the study highlight the need for awareness campaigns tailored to different demographics and types of consumers: while older participants showed less capacity to detect illicit advertisements, younger participants expressed less trust in health care professionals and a higher propensity to rely on the Internet for obtaining health care information.

Analysis of respondents' awareness and behavior also showed that:

• Most respondents were aware that legitimate online medicine sales in Italy and Spain are restricted to non-prescription medicines (73% in Italy and 66% in Spain).
• Only one third distinguished dietary supplements from medicinal products, underscoring the difficulty in distinguishing between products subject to different regulations.
• More than half of respondents (58% in Italy, 52% in Spain) rely on the internet for medical information and around 40% look for specific health solutions or alternative treatments online.
• Italian participants exhibited a higher rate of online purchases (69%) of medicines compared to Spain (52%). A substantial majority of Italians (85%) and Spaniards (75%) reported having seen at least one form of online advertisement for medicines.
• A comparison with a previous survey conducted in 2015–2016 by AIFA and Sapienza University of Rome revealed a significant increase in online medicine purchases in both countries.
• Websites are the primary access points for both advertising and purchases for online medicines, followed by social media and e-commerce platforms. Social media are emerging as relevant platforms for advertising.
• In Italy, flu treatments were the most popular online purchases, followed by chronic pain and cholesterol management medicines. Spanish consumers mainly bought performance-enhancing and weight-loss products.

"Given the overall increase in online purchases of medicines," says Dr. Marco Dugato, researcher at Transcrime, "the results of the CAPSULE project and, specifically, the difficulty in distinguishing illegal advertising underline, on the one side, the role of targeted awareness campaigns to help consumers make informed choices and, on the other side, the need for better crime-proofing of legitimate advertising and selling channels to reduce the diffusion of substandard or fake medicines.

"This also requires a constant support from research in this area to monitor evolving consumer behavior and market dynamics."

"This collaboration with Transcrime gives continuity to the work on online pharmaceuticals that AIFA has been carrying out for almost twenty years," says Dr. Domenico Di Giorgio, Director of the Office for Product Quality and Fight against Pharmaceutical Crime of the Italian Medicines Agency—AIFA.

"The ability of national centers of excellence to work together in important international initiatives, as Transcrime and AIFA recently did for the MEDI-THEFT project on medicines theft, is one of the most effective features of the Italian approach in this field and a key element in defining strategies to combat pharmaceutical crime and other forms of market distortion."

"This survey findings' point to the significant availability of substandard and falsified medicines in online marketplaces, but more importantly, the proliferation of advertising such products to consumers," says Dr. Saleem Alhabash, Associate Director of Research at the A-CAPP Center.

"The combination of SFM supply and promotion/marketing of these products via social media presents a heightened risk to the health and well-being of consumers in Italy and Spain, as well as other countries around the world."