In February 2025, while on a research visit to Sierra Leone, one of the authors (PK) found hundreds of blister packs of antibiotics and zinc tablets trodden into dirt footpaths and river banks in Freetown. Locals explained that the drugs were donated during the 2014–2016 Ebola outbreak. Yet some of the medicines were stamped with expiry dates from 2012, that is, 2 years before the epidemic started.
It seems morally programmatic that superfluous essential drugs should be transferred to contexts of greater need. Indeed, there are spectacular success stories: the mass donation of ivermectin by pharmaceutical company Merck (with the help of substantial tax breaks) has brought the elimination of onchocerciasis (river blindness) within reach.
Inappropriate drug…