This thesis examines China’s shifting policy responses to substandard and falsified (SF) medicines, since the economic reform in 1978. To date, most research on national and international policy responses to SF medicines have been concerned with generating scientific data, technological capabilities, regulatory structures and competencies, and coordination amongst bureaucratic agencies. While the importance of these material factors is firmly acknowledged, the social construction of the SF medicines issue also influences policy responses. Drawing on framing theory, this research therefore analyses the dual influence of both material and ideational factors shaping Chinese policy responses to SF medicines over time. Given China’s ascendance in the global pharmaceutical sector during this period and increasing prominence in global health governance, a fuller understanding of the factors influencing how the country has responded to SF medicines has global relevance. This research argues that SF medicines are not only a problem requiring technical solutions, but also an inherently political concern involving complex and contested policy ideas and objectives. It conceptualises China’s policy responses to SF medicines as a contested and evolving landscape, defined by the interrelationships of ideas – embodied in dominant frames – of how the problem is perceived and should be responded to. Based on an extensive review of primary and secondary documentary sources, and seventy in-depth interviews with a wide array of key informants, this research reveals that China’s policy responses to SF medicines have been shaped by three core policy frames over four decades: economism, health and well-being, and security. This analysis highlights that framing of SF medicines can have multiple effects on policy responses, including changing regulatory frameworks, privileging certain interests over others, legitimising certain policy actions, and elevating the issue higher or lower on the policy agenda. Understanding the ascendance and descendance of policy frames advances our knowledge of the changing dynamics in issue perception, priority setting and policy action in Chinese responses to SF medicines. Coexistence of frames can lead to competing policy objectives which undermine effective policy responses. However, cooperation of frames can help align policy objectives and elevate the priority level of the issue. Indeed, this occurred when the security frame acted as a “meta-frame” after 2012, and emerged as a potential bridge for enhancing synergies and coordinated policy response centred on improving medicine quality. These findings provide important insights to strengthen global policy responses to SF medicines, and China’s expanding role in global health governance.