Fake medicines: South Africa's silent epidemic

Mail & Guardian

a day ago

The sale of fake medicine goes beyond sugar pills; it includes antibiotics and cancer drugs.
In the midst of South Africa's ongoing healthcare problems — rising drug prices, medicine shortages and a strained public health system — there is a quieter, more insidious crisis unfolding: the proliferation of counterfeit and substandard medicines.
These fake drugs are not just a nuisance; they are a public health emergency. They kill, they disable and they erode trust in our healthcare system. Despite the growing threat, our national response remains dangerously inadequate.
The World Health Organisation estimates that up to 10% of medical products in low- and middle-income countries are either substandard or falsified. In Africa, that figure might be even higher. These are not just harmless sugar pills. They are antibiotics with no active ingredients, cancer drugs diluted to ineffectiveness and painkillers laced with toxic substances. In South Africa, where millions rely on both public and private healthcare systems, the consequences of counterfeit medicines are devastating — especially for the most vulnerable.
The problem is compounded by our country's heavy reliance on imported pharmaceuticals. Most active pharmaceutical ingredients come from India and China. While many of these imports are legitimate, the lack of robust border controls and regulatory oversight creates fertile ground for counterfeiters. Once these fake medicines enter the supply chain — whether through informal markets, unregulated online pharmacies or even poorly monitored wholesalers — they are nearly impossible to trace.
The South African Health Products Regulatory Authority (SAHPRA) has made commendable progress in recent years, particularly in clearing the backlog of medicine registrations and improving regulatory transparency. But SAHPRA cannot fight this battle alone. The trafficking of counterfeit medicines is a multibillion-rand criminal enterprise, often linked to organised crime and transnational networks. It requires a coordinated, multi-agency response — one that includes customs, law enforcement, the department of health and international partners.
Yet there is no dedicated anti-counterfeit medicine policy. There is no national task force. And there is no real-time tracking system to monitor the movement of pharmaceuticals from port to patient. In the absence of these safeguards, fake medicines slip through the cracks — into our hospitals, our pharmacies and our homes.
The consequences are not theoretical. In 2022, SAHPRA issued multiple alerts about falsified antibiotics and antiretrovirals circulating in the country. In some cases, these drugs contained no active ingredients at all. In others, they were contaminated with harmful substances. Patients who rely on these medications — often for life-threatening conditions like HIV, tuberculosis or cancer — are left vulnerable to treatment failure, drug resistance and even death.
Moreover, the economic impact is staggering. Counterfeit medicines undermine legitimate pharmaceutical companies, discourage investment in local manufacturing and place additional strain on an already overburdened healthcare system. They also contribute to the erosion of public trust. When patients cannot be sure that the medicine they receive is genuine, the entire healthcare system suffers.
So what can be done?
First, the government must tighten border controls and invest in forensic testing at ports of entry. Customs officials need the tools and training to detect counterfeit medicines before they enter the country. This includes portable testing devices, laboratory support and access to international databases of known counterfeit products.
Second, South Africa must implement a national track-and-trace system for pharmaceuticals. Using barcodes, QR codes or blockchain technology, every medicine sold in the country should be traceable from manufacturer to end user. This would not only deter counterfeiters but also allow for rapid recalls in the event of contamination or fraud.
Third, we need a public awareness campaign to educate consumers about the dangers of buying medicines from unregulated sources. Many South Africans, particularly in rural or underserved areas, turn to informal markets or online sellers out of desperation or convenience. They must be empowered with the knowledge to make safer choices — and given access to affordable, legitimate alternatives.
Fourth, SAHPRA must be empowered with greater enforcement authority and resources. This includes the ability to conduct surprise inspections, seize counterfeit products and prosecute offenders. It also means expanding SAHPRA's capacity to monitor the post-market safety of medicines and collaborate with international regulatory bodies.
Finally, we must address the root causes that make counterfeit medicines so appealing in the first place: high drug prices, medicine shortages and weak supply chains. Policies like the single exit price system have helped standardise medicine pricing, but they have also led to unintended consequences, such as product withdrawals and reduced availability of certain drugs. A more flexible, responsive pricing system is needed — one that balances affordability with sustainability and ensures a stable supply of essential medicines.
We must also invest in local pharmaceutical manufacturing. South Africa has the scientific expertise, industrial capacity and regulatory framework to produce high-quality medicines domestically. What we lack is the political will and financial investment to scale up production and reduce our dependence on imports. By supporting local manufacturers, we can create jobs, strengthen our supply chains and reduce the risk of counterfeit infiltration.
The fight against fake medicines is not just a regulatory issue, it is a moral imperative. Every South African has the right to safe, effective and affordable healthcare. That right is meaningless if the medicines we rely on are compromised by greed, negligence or criminal intent.
We cannot afford to wait for a tragedy to spark action. The cost of inaction is measured not just in rand, but in lives lost to preventable harm. South Africa must take a stand against counterfeit medicines — before the silent epidemic becomes a national catastrophe.
Fentse Maseko works for the pharmacy and pharmacology department at the University of Witwatersrand and is a PhD applicant.