In the midst of South Africa’s ongoing health-care challenges — 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 health-care system. Yet, despite the growing threat, our national response remains dangerously inadequate.
The World Health Organization estimates that up to 10% of medical products in low- and middle-income countries are either substandard or falsified. In Africa, that figure may 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 health-care 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. South Africa imports the vast majority of its active pharmaceutical ingredients, primarily 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. However, 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 we continue to treat this as a peripheral issue. 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 such as 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 health-care system. They also contribute to the erosion of public trust. When patients cannot be sure that the medicine they receive is genuine, the entire health-care system suffers.
We cannot afford to wait for a tragedy to spark action. The cost of inaction is measured not just in rands, but in lives lost to preventable harm
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 expandingSahpra’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 health care. 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 rands, 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 is registering for a PhD at Wits University. Her piece is based on findings from her MCom degree
For opinion and analysis consideration, email opinions@timeslive.co.za
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