With the coronavirus spreading, South Africa may be well prepared. But there’s a little thing that nags…

The growing coronavirus pandemic is cause for great concern about South Africa’s ability and capacity, and to provide adequate quality and quantities of medication to treat any likely local outbreaks of the virus. We have to take the Department of Health at its word when it reports that (at the time of writing) “there are not suspected cases [sic] reported in South Africa. Port health professionals routinely conducts [sic] temperature screening for all international travellers… Fortunately, OR Tambo and Cape Town International Airports are the only ports of entry with direct flights from Asia.”

This notwithstanding evidence is slowly building up that illicit pharmaceuticals, including, subtherapeutic medication, are “flooding in” and out of South Africa with the country facing a likely epidemic of counterfeit pharmaceuticals. Following a meeting on fake drugs in Togo in January 2020, it has been stressed that the spread of counterfeit drugs and subtherapeutic medicines can no longer be ignored.

Part of me thinks that this is mild hysteria, that there is no impending crisis, and that South Africa is in a better position than most of the rest of Africa. The evidence certainly supports that. Actually, we should be more concerned about the growing resistance to antibiotics – which is a clearer and much more prevalent danger. Another part of me also remembers that the National Development Plan (NDP) specifically warned (eight years ago) about the dangers of transnational crime, the transnational movement of people (that’s usually how epidemics spread and become pandemics), and the trade in fake or subtherapeutic medication.

The plan was specific and suggested that South Africa needed to be more proactive in addressing the emerging problem. It required collaboration between government departments, especially the departments of International Relations and Co-operation (DIRCO), Home Affairs, Health, Education, the police and customs officials and of the private sector. It also requires widespread public service awareness campaigns. 

Enter Maite Emily Nkoana-Mashabane, a Zuma sleeper in Ramaphosa’s Cabinet

This collaborative approach was identified in chapter seven of the NDP, which was dismissed in 2012 by the incumbent minister, Maite Nkoana-Mashabane, who, at the time, made her job all about herself, and protecting former President Jacob Zuma. We will come back to that issue, below. First, I will answer the question of why the NDP is raised. Notwithstanding the revolutionary refuseniks, there are signs that aspects of the NDP are being implemented. We need, to, therefore, place the plan, and whatever improvements may come, under scrutiny.

Nonetheless, the research that went into the preparation of chapter seven of the NDP showed that substandard and falsified medicines posed a significant health and economic problem for the country. While South Africa is, currently, better placed than most African countries, proactive policies ought to be at the centre of foreign policy, as part of global efforts to secure the global supply chains, increase quality control capacity, improve knowledge-sharing, and surveillance to better assess the problem and identify solutions to the problems of counterfeit medicines.

In general, Africa is “an easier target” for counterfeiters because the continent lacks Europe and the US’s armoury of responses to counterfeit pharmaceuticals, which includes “supply chain regulation, track-and-trace technology and enforcement regimes” – all of which “are almost wholly lacking in African countries”.

The impact of fake pharmaceuticals on society’s health is astounding. According to the World Health Organisation (WHO), fake medicines are the world’s most lucrative counterfeit goods, with a global market estimated at around $200-billion. At least 42% of that exchange is in Africa. The continent is “flooded” with counterfeit medicines, explains Dora Akunyili, director at the National Agency for Food and Drug Administration and control in Nigeria. It’s not just illegal buying and selling of medicines that are a problem, a great problem is when medicines produced on the cheap, or ignoring standards and regulations, are subtherapeutic or in some instances simply deadly.

According to WHO statistics, 42% of detected cases of substandard or falsified pharmaceuticals occurred in Africa. The London School of Hygiene and Tropical Medicine says that fake malaria drugs cause up to 158,000 deaths every year in sub-Saharan Africa.

One clever pharmaceuticals and IT writer asks a very pointed question: “What is behind this scourge, and what can be done to stop it?” Well, setting aside the criminality, there should be a stronger emphasis on policy implementation, monitoring, information-sharing and reporting. These were clearly detailed in chapter seven of the NDP.

The issues of transnational crime and counterfeit goods were specifically identified, as in need of attention in chapter seven of the NDP. Pages 248-253 of the NDP referred specifically to Transnational Crime, Counterfeit Goods (with counterfeit drugs as a “particular problem”), Migration and Increase in Communicable Disease. South Africa faces problems in each of these areas, and the coronavirus pandemic should make us sit up and pay attention.

As it goes, I played a part in the preparation of chapter seven of the NDP. I was a public servant and had to follow instructions. For instance, it was suggested by someone of whom I have the most immense respect, that I drop the section on piracy. It was suggested that piracy was a problem specific to the horn of Africa. I pointed to evidence of piracy further south, along the coast of Tanzania. I won that round and carried on writing.

With chapter seven, and under the instruction of Nkoana-Mashabane, I was (personally) placed in the crosshairs of DIRCO. After the first draft of chapter seven – which was cobbled together in four-and-a-half-days, and sent to DIRCO for comment, after which the final draft was written in about three weeks (and DIRCO’s rejections of the “too economistic” parts arrived on the day of printing) – the Minister called upon “17 esteemed” scholars and thinkers on international relations and political science – to rip into chapter seven. Their main charge was that I (personally) was being “too economistic”. (Eight years later the economy is on the edge of collapse – I wonder where these “esteemed” thinkers are today.)

Led by Aziz Pahad, the group conducted a type of inquisition against me (I was not their ultimate target, but I took the blows – it was nasty). All the while, DIRCO, under our Emily, rejected chapter seven. And so, here we are. The economy is tanking, but Nkoana-Mashabane’s posse said chapter seven was “too economistic”, and we face the possibility, albeit slim, that the coronavirus pandemic will reach South Africa. How do you like them apples now?

Since the NDP was tabled and accepted by about 90% of the parties in Parliament in 2012, South Africa has seen serious failures in Human Security (flagged on page 248 of the NDP) which urged a change of mindset from security as a military issue, to a human issue. We have seen increased xenophobic attacks on migrants – on which South Africa’s economy was built – and the spread of communicable disease (pp 252-253 of the NDP).

But instead of collaboration – I spent several weeks with DIRCO officials – Nkoana-Mashabane’s political agenda, emboldened by revolutionaries who have now crept from the woodwork as advocates of radical economic transformation, was to reject anything and everything that had had the slightest association with the mythological “1996 class project”. I have to insert a caveat, here, I am not making a defence of real or imagined neoliberalism.

With the coronavirus becoming a global pandemic, and Nkoana-Mashabane kept inside the tent, with the ruling alliance apparently confused by its own being and nothingness, and those who virtually destroyed the NDP now indulging in revolutionary imaginaries, it really is difficult to avoid saying: They were warned. 

What’s to be done? Well, chapter seven of the NDP flagged these issues – especially the issue of fake medicines. When the NDP was initially tabled, we considered it an “almost-good plan” that required more work. If the current NPC were to produce a renewed plan – without the zeal of the revolutionaries, and of misguided 18th-century Marxists – they would look at the success of Nigeria in curbing the flow of counterfeit drugs.  

As part of a campaign to promote food and drug regulation in Nigeria, public awareness was raised at home and abroad. The result was a reduction of about 90% of illicit pharmaceuticals entering the country since 2001. The benefits of the campaign, in terms of human safety, are immeasurable, Dora Akunyili explains. 

“The economic benefits are tangible. The ban on drugs manufactured in Nigeria was lifted by other West African countries. The production capacities of domestic pharmaceutical industries have increased, and 24 new drug manufacturing outfits were established… From April 2001 to January 2006, NAFDAC seized and destroyed substandard products valued at around $100-million.” 

Now then, while some South African politicians are performing a drawn-out battle to show off who is more radical than the other, while others are keeping lawyers on retainer (just in case), the government may be missing an opportunity to protect South Africans from any pandemic or from subtherapeutic medication that, if reports are to be believed, are “flooding in” and out of South Africa.

It would be disingenuous to ignore the Department of Health’s statement (above), which makes room for optimism about South Africa’s capacity to deal with the coronavirus. But that nagging feeling of remains. DM