Much of the debate surrounding counterfeit medicines to date has focused on how to prevent them seeping into the supply chains of developed-country markets. The majority of counterfeit medicines originate in Less Developed Countries (LDCs), including most of those that end up in the US and EU. The chapter discusses the Malaria, HIV/AIDS, Bird flu. It addresses the counterfeiting of drugs is a global problem which will not be eliminated until the supply-side issues. The majority of counterfeit drugs are manufactured in LDCs, so reform in these countries is absolutely vital if progress is to be made. The most pressing area for reform in the majority of LDCs is the application of the rule of law, the definition and enforceability of property rights and the enforceability of contracts. Without such reforms, counterfeiters will continue to kill hundreds of thousands of people every year.