Access to Drugs in Developing Countries
Edited by Kenneth C. Shadlen, Samira Guennif, Alenka Guzmán and N. Lalitha
Chapter 2: Pharmaceutical Production and Access to Essential Medicines in South Africa
2. Pharmaceutical production and access to essential medicines in South Africa Heinz Klug Access to affordable essential medicines has become a central public policy issue in post-apartheid South Africa, particularly in the context of the country’s HIV/AIDS pandemic. While it is clearly true that drug prices are not the only issue limiting access to essential medicines, the cost of medicines remains a central concern because unlike the broader structural goal of upgrading the health care system or more immediate concern to monitor treatment adherence among HIV/AIDS patients, there are just no substitutes or alternatives to the provision of these particular drugs. To this extent the cost of the medicines is in fact the “inelastic” part of the essential medicines equation. This is particularly the case in South Africa which is not a significant producer of pharmaceutical products and does not produce over 90 percent of the active ingredients of medicines. Lacking the capacity to credibly threaten to issue compulsory licenses and if necessary reverse-engineer patented drugs, as have Brazil and Thailand, South Africa’s bargaining power is limited to a moral claim that access to essential medicines is a constitutional and humanitarian necessity to address the severe disease burden in the region, including HIV/AIDS, TB, malaria and other diseases. However, in response to both market and public incentives, from the government’s 2003 decision to provide antiretroviral treatment in the public sector to the United States government’s program to fund access to antiretroviral medicines in Africa (PEPFAR), a significant generic medicines industry...
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