While authorities are actively intervening, the scale of the illicit pharmaceuticals problem remains significant. South Africa is facing a growing public health and economic risk from the illegal trade in prescription medicines, with experts warning that the market for counterfeit, smuggled, and unregulated drugs continues to expand. According to the TRACIT 2025 Strategic Review, South Africa faces a significant illicit trade challenge, ranking 60th globally out of 158 countries and 4th in Africa on measures of resilience to illegal markets, with a score of 52.4 out of 100.
The report notes that theillicit economy includespharmaceuticals alongside alcohol, tobacco, foodstuffs, and other sectors, with unregulated spaza shops and informal markets serving as common distribution points. This systemic weakness not only erodes tax revenues and legitimate business but also facilitates the sale of counterfeit and unregulated prescription medicines. According to the South African Health Products Regulatory Authority (SAHPRA), 507 suspected cases of counterfeit or illicit medicines were reported in 2024/25, with 110 confirmed.
The state spent approximately R3 million to destroy fake products in that year as regulators emphasised that prescription medicines cannot legally be sold online or outside authorised channels. In Johannesburg,investigators have documenteda thriving informal market for prescription-grade medicines, particularly antibiotics, sold on the streets without valid prescriptions, SAHPRA spokesperson Lindiwe Motsoaledi has said. Many of these products are reportedly smuggled from Malawi and Zimbabwe.
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Experts warn that the unregulated sale of such drugs contributes to the rise of antimicrobial resistance, which could undermine public health efforts across the region. While street sales remain prevalent, the illegal trade has increasingly moved online. Research from the University of KwaZulu-Natal highlights the risks in digital spaces. A study reviewing 25 South African online pharmacy websites found that three operated without links to physical pharmacies and supplied prescription medicines without requiring valid prescriptions, exposing consumers to the risk of receiving substandard or harmful products.
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