 So, substantial and falsified medical product research problems of medicine quality have had a very long history. There are reports from ancient Egypt of issues with the quality of herbal medicines. The picture at the top right is of doctors beating a pharmacist in the 12th century for selling them poor quality medicines. There's been a lot of tension over the years between intellectual property and public health issues that to some extent have been resolved, but there's still a very poor evidence base to inform policy. And it's very, very transdisciplinary as illustrated with the whole range of skill sets that people working in this field have contributed. Many of us involved with all the issues on the left in medical research and implementation of health policy to try and produce optimum therapy and to inform national policy, but there's not much point in all of that billions of of hours of work and investment if this poor prescribing poor adherence and poor medical product quality. How do we define poor quality medicines. So, in our group we regard them as poor quality medicines is obvious, substandard result from errors within factory not intentional. And the result from deliberate fraudulent production and degraded those that leave the factory in good, good condition but degrade in supply chains. Please note that in this Venn diagram the size of the circles are unknown. The CHO issued a key report in 2017. The reference to it is at the bottom right. And they concluded from the all the evidence that they had then that approximately 10.5% of some of low and middle income country medicine supply was substandard or falsified. And at the top right they illustrated some of the drivers that are thought to play a part in this issue. In our group in the more tropical network and the infectious disease data observatory. We've produced these mapping systems. This is the scientific literature. Which the website is the bottom right that allows one to interrogate the scientific literature on this issue for diverse different classes of medicine. And we also do this a similar system for lay reports on the globe, which, as Karen will explain later we need to take with a larger pinch of salt. Multiple examples. This was the thing very admirable report from Pakistan over the severe problem in Lahore with the substandard production of medicine that led to many deaths. This was a gross error within factory. This was an example of a falsified anti-malarial seized in Angola, which contain no active ingredient. It contain two types of paint. What are the impact. So multiple impacts as one would expect from products that we really rely on globally for health and well being. From deaf and disability to economic losses, loss of faith, loss of trust and friend to microbial drug resistance. There are multiple gaps in the evidence base and its use. I think one key thing that would like to emphasize that if you in your work and live for you, you're suspicious of a medicine then please report to the National Medicine Regulator and also to can also report to the rapid alert system at WHO in Geneva. I'll show this slide briefly now. This is an example of falsified and genuine anti-malarial from one country. One of those is genuine. One of those is falsified. There is a clue that you can just about see on this slide to let you know which one is genuine and which is falsified. I'll show this again at the end and would be grateful if you could fill complete the poll for which whether you would, if you had $1 to choose this and the shop only had two packets, would you choose the left or the right. I'll explain further later.