Security of supply of ARVs cannot be left in the hands of the free market

South African Child Care worker Nobanzi Somtsewu prepares the daily routine of Antiretroviral (ARV) medicines for children at the HOKISA childrens home in Masiphumelele. File image.

South African Child Care worker Nobanzi Somtsewu prepares the daily routine of Antiretroviral (ARV) medicines for children at the HOKISA childrens home in Masiphumelele. File image.

Published Apr 27, 2024


By Michael Mynhardt

Refusing help for the wrong reasons is self-destructive and counter-productive.

Insisting on being self-reliant takes this idea even further, relegating societal support structures to the status of unimportant or irrelevant footnotes in one’s own life.

It is unsurprising, therefore, that this attitude is viewed by many as a toxic trait embraced by those too vain to accept the fact that they cannot do everything themselves.

On an individual level, this sentiment also speaks to issues of equality – as those who refuse help from others seem to think of themselves as somewhat superior.

Taking this attitude from the realm of the individual to the level of a nation or industry, however, complicates this reaction to the desire to be self-sufficient.

The complication stems from a common place of illogical thinking: for some reason, humans love to anthropomorphise, and whether it is an animal, object, or abstract idea, we all tend to project human values and expectations onto non-human matters.

At the national level, the idea of self-sufficiency in production is largely out of vogue, with the predominant idea of letting a free and fair international market produce and provide goods and services in the most efficient and affordable manner (under the rationale that it is beneficial for everyone). But we also know that, despite the logic, this is only sometimes the case. If it were a foolproof design, then a number of the globe’s most pressing problems would no longer exist, such as food and water scarcity.

Medicine security cannot depend on free market

Aspects of security are best not left to the free market; it makes intrinsic sense that, whether at the level of the individual or society, a degree of selfishness is appropriate when existential matters are on the table. In this sense, being self-reliant moves from being an issue of pride or vanity to that of a moral responsibility.

Critical industries are often shielded from competition – either internationally or domestically – with the logic that the service or product is critical to the security and well-being of the nation.

Different nations and governments consider different industries to be critical to national security; usually, these are to protect a country’s major industries and sources of employment. The most primal of these reasons concerns our existential security – that is, our physical safety, health, and continued well-being.

Avoiding pre-pandemic blunders

The 2020 pandemic showed us all just how vulnerable we are.

Not just from disease, but to chokeholds in the supply of goods and services.

On a domestic scale, fears over dwindling supplies of necessities sent shoppers into a frenzy.

At the international level, Taiwan’s stranglehold on the semiconductor manufacturing space and the Western world’s contractual dominance on the production of pharmaceuticals underlined the reality facing most of the world: distribution and access to critical goods are, ultimately, not as accessible as they previously would have seemed for those less-well-off.

In the case of South Africa and Africa at large, the rollout of the COVID-19 vaccine put a spotlight on the need to ensure access to pharmaceuticals and other critical goods.

Unless aided by international organisations such as the World Health Organisation (WHO) and NGOs, African countries would have had to wait even longer than was already the case, just to receive a vaccine for a disease affecting every single human on the planet (implicitly suggesting that some people’s lives matter more than others).

The handling of the pandemic — the enforced lockdowns and quarantines — also demonstrated just how far governments are willing to go for the protection of their people’s health (going as far as sacrificing potential economic output and political goodwill). But COVID-19, although unparalleled in its reach and ease of infection in the 21st century, is but one pandemic facing the African continent. Why do we not then see similarly strong-handed approaches to other infections?

Tackling the epidemic

South Africa has had the dishonour of being home to the largest cohort of AIDS and HIV infections globally for nearly 35 years.

As a country, we have (with mixed success) continued to combat the disease’s spread and prevalence over the past 40 years through education, abstinence programs, and the provision of drugs to slow down the disease’s progression and curb infection rates.

The latest estimates indicate that nearly 8 million South Africans are afflicted by HIV, for whom the most common treatment remains antiretroviral therapy (ART).

Given the socio-economic makeup of HIV patients in South Africa, most rely on government-provided antiretrovirals (ARVs) for treatment. In 2022, the South African government tendered for the production and supply of ARVs to be distributed to South Africans; 51% of the production capacity was handed to locally based producers, with the remaining 49% entrusted to Indian manufacturers. It is clear that we are capable of producing the drugs needed to combat our HIV epidemic, and as such, there is no reason why local manufacturers should not have access to the lion’s share of this market.

Ultimately, our government needs to place greater trust in domestic producers by creating an enabling environment for the production and manufacture of ARVs in SA.

From a self-sufficiency perspective, greater domestic production also means greater security in terms of access to ARVs; from a long-term perspective, greater domestic production also ensures we can keep up the momentum in the fight against HIV.

From an economic perspective, whether it is produced locally or abroad, producers are remunerated – but if produced locally, jobs are created, ARV production grows, and adjacent, upstream, and downstream industries benefit.

The local creation and provision of active ingredients of ARVs, for example, similarly benefits South Africa’s access to ARVs over the long term.

Additionally, if we produce ARVs locally, we can distribute them to other African countries as well.

This would ultimately contribute to the Africa Centers for Disease Control and Prevention’s (Africa CDC) vision to build a new public health order for the continent, by ensuring equitable access to medicine on the continent.

Being self-reliant and self-sufficient in terms of our medicinal needs ensures that our most immediate health concerns can be addressed in the presence of destabilising global phenomena, while promoting the development of the industry and incentivizing job creation.

In the case of the HIV epidemic, this would ensure that a long-term plan to overcome the disease is realistic, achievable, and less-dependent on external actors affected by their own problems. Self-sufficiency, in this case, is a clear avenue to improve the health security of all South Africans.

Michael Mynhardt, CEO of MMH & Partners Africa.

Michael Mynhardt, CEO of MMH & Partners Africa. Image: Supplied.