Can a code of professional ethics influence the supply of substandard and falsified medicines? Insights from Ethiopia

Substandard and falsified (SF) medicines are serious global health problems. Their high prevalence is a threat to public health in resource-limited settings. It is assumed that professionals will uphold specific standards of behaviour to protect the public interest and maintain trust. This study assesses whether a professional ethical code can serve as an effective way to prevent and respond to SF medicines by enhancing ethical behaviours in practice. The study adopted a cross-sectional qualitative design employing interviews and observation. Participants were selected through purposive, convenience, and snowball sampling techniques and included pharmacists, physicians, wholesalers, pharmacy owners, regulatory staff, and members of the local community. The data are analysed within a framework from the Actor-Network Theory. The influence of the professional ethical code is entangled in a complex network of practices involving various actors who adapt their behaviours to meet local needs and demands. Its effectiveness depends on supportive institutions, and on economic and educational infrastructure. Embedding ethics as an enforceable component of a systems rather than a symbolic marker for professional identity may reduce the spread of SF medicines and strengthen the trust, accountability and legitimacy in pharmaceutical practice.