Fake medicines: South Africa’s silent epidemic:
In the midst of South Africa’s ongoing healthcare problems — 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 healthcare system. Despite the growing threat, our national response remains dangerously inadequate.
The World Health Organisation estimates that up to 10% of medical products in low- and middle-income countries are either substandard or falsified. In Africa, that figure might 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 healthcare 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. Most active pharmaceutical ingredients come 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. But 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 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 like 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 healthcare system. They also contribute to the erosion of public trust. When patients cannot be sure that the medicine they receive is genuine, the entire healthcare system suffers.
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 expanding SAHPRA’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 healthcare. 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 rand, 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 works for the pharmacy and pharmacology department at the University of Witwatersrand and is a PhD applicant.
The hidden economy of rage bait on social media has a human cost:
In the age of social media commerce, where clicks are currency, anger has now become a commodity that is profitable.
It is unlikely that you would scroll on social media for more than 15 minutes without coming across videos depicting confrontations, controversial opinions, political or social outrage and other emotionally charged rants. These posts go viral not because they’re helpful or informative, but because they provoke and, as a result, invite a lot of engagements.
Rage bait is a manipulation tactic where content is specifically designed to provoke anger, outrage or any form of emotional discontent. This type of content may or may not be fake news, but it is carefully designed to draw strong emotional reactions. Social media amplifies this manipulation tactic by rewarding engagements and attention. At its core, rage bait is backed by algorithms which seek to keep users scrolling, responding and consuming the content, which in turn results in the social media platform profiting. In this way outrage is monetised by the social media platforms.
Social media is the new economy, it is no longer just an entertainment, connecting and information sharing space. According to Business Insider, the creator economy was worth $ 250 billion in 2023. Goldman Sachs, one of the largest investment banks in the world, has projected this amount to double by 2027.
Social media platforms such as Facebook, YouTube and TikTok make a lot of money when users spend more time online.
In 2024, Facebook introduced the Content monetisation beta program to make it easier for creators to earn money on the site.
Andréa Jones, a marketing podcaster states: “If we see a cat, we’re like ‘oh, that’s cute’ and scroll on. But if we see someone doing something obscene, we may type in the comments ‘this is terrible’, and that sort of comment is seen as a higher quality engagement by the algorithm.”
It is for this reason that such content will show up on the users’ timeline, feed or fyp and because they have involuntarily consumed the content, they are likely to also react or comment, which feeds into the main purpose of the rage bait.
Celebrity blogger Musa Khawula is one such creator who uses rage bait for commercial purposes. In his posts or blogs, he often makes obscene statements, controversial remarks or blunt lies about celebrities, which does get a lot of attention and emotional reactions from other users.
The rise and success of MacG’s YouTube podcast, Podcast and Chill with MacG, also borders on using rage bait by spewing controversy or making sensational comments to trend and solicit viewership. Winta Zesu, whose content often depicts her as a self-obsessed New York City model, says she made more than $ 150,000 (R2,667,390) in 2023 from social media.
She has since signed brand deals and gained popularity from her rage bait videos.
Publications and news outlets have also resorted to this tactic, infusing it with clickbait, another manipulative tactic to get users to click on controversial and sometimes misleading catchy headlines.
Although this can be harmful and irresponsible when practiced by news outlets that ought to be trusted with information dissemination to the public, rage bait gets the profits for the publications and news outlets. Outrage, therefore, has become a business model.
Rage bait may be commercialised and profitable but it poses harm to social media users. It may cause psychological and emotional harm, misinformation, social fragmentation, damage to public discourse and may even result in desensitisation especially in young people.
According to a 2022 meta-analysis published in the journal cyberpsychology, social media use is linked to higher rates of depression among social media users. While there are many contributing factors to this, the eminence of rage bait certainly catalyses some of the contributing factors to these.
It is difficult to prevent this manipulation tactic and the law is still not yet fully developed to respond to emerging social media trends. South Africa’s legal system is beginning to reckon with the consequences of digital abuse through legislations such as the Cybercrimes Act and the Protection of Personal Information Act.
But no legislation directly addresses rage bait or anything similar. There is no regulation holding platforms accountable for the effect on people’s mental health and the social damage it causes or for unethically profiting from causing division and harmful engagements.
South Africa needs to join global calls for greater algorithmic transparency. Platforms should be held accountable when their systems amplify harmful content. Institutions of learning must teach young people how to recognise emotional manipulation online, and how to critically consume content. Rage bait is often effective because it is subtle, hence users must be equipped to spot it.
It is also important to build a creator economy that rewards educational, informative, entertaining, creative and community-driven content that does not harm other fellow users.
Shatadi Phoshoko is a candidate attorney at the University of South Africa Law Clinic, master’s candidate in corporate law and digital at Unisa and a digital culture observer.
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