“We don’t really have that problem here,” said a spokesperson from South Africa’s Treatment Action Campaign in response to our question regarding a recent string of counterfeit medicine seizures across the country. The campaign is well known for its expertise on issues surrounding the import of medicines, so one would expect it to be concerned about the discoveries in 2014 of millions of fake imports at ports, border crossings, and informal distribution points. Its denial is nonetheless characteristic of a broader lack of awareness about the issue in South Africa.
South Africa is increasingly being targeted by traffickers and is more vulnerable than its neighbors to online distribution tactics due to relatively high rates of online purchases. Elsewhere on the continent, where the problem is more advanced, awareness and mitigation efforts are miles ahead. These have responded to the illicit pharmaceutical industry advancing and expanding. The industry is adopting more sophisticated technologies such as packaging that fool inspection agents and consumers, as well as internet-based marketing and distribution channels. Traffickers are also growing their markets in terms of volume and destination countries. South Africa, meanwhile, appears to be allowing inertia and political sensitivities to prevent it from tackling a threat that, according to Interpol, claims more than a million lives a year. If it learns from its neighbors and acts soon, however, it is in an advantageous position to implement new technologies and tap into international momentum to address the problem before traffickers more firmly establish themselves.
For now, South Africans simply aren’t thinking much about the problem. A 2011 Gallup poll showed that only one in four were aware that fake medicines were in the country, compared with much higher percentages in East and West Africa. Media coverage may be part of the problem. A search of South Africa’s top newspapers’ online editions revealed that none have mentioned Operation Biyela 2, a World Customs Organization campaign against contraband that last summer intercepted 122 containers at 15 African ports, finding a total of 113 million counterfeit pharmaceutical products, much of it headed to South Africa. The Pharmaceutical Industry Association of South Africa contrasts the scant attention paid to these fake medicines with the way the national media highlights other counterfeited goods, such as pirated DVDs.
South Africa is targeted by counterfeit medicine traffickers for several reasons. Its long coastline, porous land borders, relative prosperity, overburdened criminal justice system, and well-developed air transit infrastructure all combine to make it an attractive target and warehousing location for international traffickers. Its high purchasing power and frequent use of online pharmacies relative to neighboring countries also enable traffickers to use sales techniques seen in developed markets. Overlapping networks of organized crime and narcotics trafficking are also on the rise and feed into this problem. Meanwhile, only a small fraction of counterfeit medicine trafficking gets detected because of inadequate consumer reporting and customs monitoring. In cases where fake medicines aren’t made out of immediately toxic materials, consumers generally don’t recognize that they’ve been defrauded. Even when they do realize they have purchased counterfeits they might be hesitant to report it for fear of disclosing health conditions they would rather keep quiet. Online purchases of restricted medicines that turn out to be counterfeit may also go unreported because consumers fear legal implications.
South Africa’s history with border security and international organizations adds another layer of vulnerability. During the Cold War and the Apartheid era, flaunting border enforcement measures both internal and external was part and parcel of political activism and the liberation struggle. According to the US State Department’s International Narcotics Control Strategy Report, techniques developed during Apartheid to get around sanctions are still used today to evade law enforcement. In the 1990s South Africa imported generic antiretroviral drugs for HIV/AIDS patients who would not have been able to access them otherwise, and the World Trade Organization took action against Pretoria to enforce patents, sparking defiance and indignation across the country. Given this record, calls for tougher border security and bans on criminalized pharmaceuticals today can be met with skepticism.
The consequences of counterfeit medicines are severe. It could add to South Africa’s already huge overall market for fake goods, which had an estimated value of 360 billion Rand (30.6 billion USD) in 2011, up from 2 billion Rand (170 million USD) in 2000. This is believed to have grown significantly in recent years. The rise in South African counterfeit drugs is again part of a continental trend. The United Nations Office on Drugs and Crime estimates that in parts of Africa 30 percent of the pharmaceutical market is counterfeit, and a 2013 World Customs Organization report shows that African countries constitute 10 of the top 12 nations in terms of quantity of intercepted counterfeit medicine. The same report identifies 76 percent of total contraband interceptions on the continent, some 2.3 billion items, as illicit pharmaceutical products. This is a drastic increase from only 10 percent in 2012. It’s unclear whether the upsurge reflects improved monitoring and interception or greater volumes of illicit trade, but the Institute of Research Against Counterfeit Medicine points to increased African trade with India and China, the two main source countries of illicit medicine seized in Operation Biyela 2.
Of even greater concern is the toll on human health. Many counterfeits contain toxic—sometimes lethal—ingredients. According to a 2009 study, fake tuberculosis and malaria drugs alone kill an estimated 700,000 people globally each year. Other counterfeits contain little or no active ingredient, meaning consumers think they’ve received treatment when they haven’t. Most intercepted counterfeits in Africa are for primary care purposes, such as antibiotics. Counterfeit antibiotics with reduced doses can breed resistant strains of disease, which puts everyone at risk.
Government interventions, public awareness drives, and mobile technology campaigns in other African countries have delivered impressive results. Nigeria’s National Agency for Food and Drug Administration and Control and its Director Dora Akunyili successfully pushed for the removal of corrupt officials, banning guilty manufacturers, and executing informal market raids. This led to the share of counterfeit drugs in Nigerian medicine markets dropping from 40 percent to 17 percent between 2001 and 2005. Kenyans, meanwhile, are all familiar with the line in singer Eric Wainaina’s famous anti-corruption song “Nchi ya Kitu Kidogo” (“Country of a little something extra’”) about medicines being diverted from public hospitals to informal markets, a reference to a larger campaign aimed at increasing awareness of the problem. SMS–based technologies such as mPedigree, which was developed in Ghana, also allow consumers to verify the authenticity of the medicines they purchase and have taken off in a number of countries.
There is still time for South Africa to stem the tide of counterfeit medicines, which would be far preferable to mopping up afterwards. As a tech-savvy country, it may be able to benefit from new digital responses such as those that allow for immediate on-site testing of medicine contents at border checkpoints. Medicines can mean the difference between life and death, so the problem must be faced squarely. Some of the attention paid to intercepting fake DVDs or watches might be better directed toward illicit goods that can have far graver consequences, and consumers are well within their rights to demand the technologies to verify the authenticity of their medicines now.
Devon Knudsen and Benjamin P. Nickels lead the Counterterrorism and Transnational Threats Portfolio of the Africa Center for Strategic Studies. The views expressed in this article are entirely their own.