The cost of pharmaceuticals takes them out of most people's reach and only cheaper, effective versions will make good healthcare attainable.
Africa is where 11% of the world's population lives and 25% of the world's burden of disease is felt. And because access to healthcare is increasing, there is greater demand for medicine on the continent.
But, according to the Council for Health Research and Development, an international non-governmental organisation based in Switzerland, only 37 countries in Africa have some capacity to produce pharmaceuticals. South Africa is the only country with limited primary production of active pharmaceutical ingredients, mostly for non-speciality drugs.
This means African countries, including South Africa, have no choice but to source drugs from outside their borders. There is an exaggerated dependence on imports of pivotal medicines – especially those needed for HIV/Aids and non-communicable diseases – from the United States, Japan, France, Germany and the United Kingdom.
These countries, according to the council's research, produce two-thirds of the global value of pharmaceutical products. The prices of some of these speciality medicines make most of them unaffordable for the majority of the continent. This renders any attempt at national health initiatives unsustainable.
Speaking at a conference organised by the Independent Clinical Oncology Network in Cape Town in March, Professor Richard Sullivan of King's College in London said the price of technology and drugs drives more than 75% of the escalating costs of healthcare globally.
Generic versions of these drugs may offer the only way to ensure that more people gain access to quality treatment, especially in oncology. Business Day recently published a comparison on the drug Glivec, which costs R862 for 400mg in South Africa. The same dosage of the generic costs R86 in India.
The treatment of cancers is particularly vulnerable to the high cost of medicine. Emile Stipp, chief health actuary for Discovery, South Africa's largest medical scheme, said at the conference that oncology treatment in South Africa was 17 times more expensive than any other treatment for non-communicable diseases.
According to his figures, the cost of oncology in South Africa has grown 11% year on year since 2008 and the increase was mainly because of speciality drugs. In 2008, Discovery paid R188-million for these drugs and R265-million in 2010.
There is a recognition that the cost of speciality drugs, in particular new cancer medicine, is just far too high and completely out of reach for the majority of cancer patients.
"This is of great concern to us," said Dr David Eedes, clinical executive of the Independent Clinical Oncology Network, a countrywide organisation of private oncologists set up to ensure a more equitable and sustainable solution to quality cancer care.
The network has developed treatment protocols that strive to include drugs and treatments that have proven efficacy and are appropriate, cost-effective and affordable. The aim is to reserve the more expensive forms of treatment for where and when it will have the most benefit.
"As we try to address the ever- increasing cost of cancer treatment in the country, taking into account the roll-out of National Health Insurance, we believe that generic substitution will play a major role," he said.
Eedes added that, in addition to cheaper drugs, there needs to be an emphasis on the promotion of cancer awareness and screening that will lead to earlier diagnosis of cancer. The hope is that this will result in better outcomes. The downside is that, with more people needing treatment, the overall cost of treating this disease will increase.
The African Union has taken a policy position on increasing local capacity to produce generic medicine and the South African generics market is already growing. Reports suggest that more than 50% of the population now uses generic medicines.
In a release earlier this year, Paul Anley, chief executive of Pharma Dynamics, the biggest generics manufacturer in South Africa, said: "There is now tremendous pressure on medical aids and the need to cut costs is greater than ever. This will inevitably lead to a move towards generic alternatives from expensive originator drugs."
IMS Health, a US-based organisation that analyses healthcare dynamics, forecasts that medicine spending in the developing world will double over the next five years. Of those sales, 83% were predicted to be generic and over-the-counter medicine and diagnostic and non-therapeutic products.
Of course, it is not all plain sailing and drug companies are fighting back. Pharmaceutical giant Novartis is challenging an Indian patent law that prevents originator drug companies from extending their monopolies on patented drugs. It is only when a drug's patent has expired – in most countries a company holds a patent for 20 years – that generics manufacturers may replicate the drug. Because South African patent laws follow the precedent that Indian patent laws set, local oncologists will watch how this drama plays out.
"We have already seen that the appropriate and judicious use of generic medication has had an effect on reducing the oncology drug bill in the network space," said Eedes. "This is one of many initiatives that the network hopes will effect a difference, and not only a financial one. The hope is that, by allowing more people access to the appropriate treatment for the appropriate cancer, there will be less unnecessary suffering," he said.
For some people in this country it may actually be the difference between life and death.
Gareth Coetzee is a writer for the Independent Clincal Oncology Network