Illegal medicines are increasingly being sold through websites, social media platforms, messaging services, wellness clinics and other informal channels, creating growing risks for South African patients and placing pressure on regulators, border and customs authorities, healthcare professionals and the pharmaceutical industry.
This was the key warning from participants at the Pharmaceutical Task Group (PTG) Media
Roundtable, Can You Trust Your Medicine? Inside South Africa’s Fight Against Counterfeit Medicines, Healthcare Crime and Patient Harm, which brought together representatives from regulatory authorities, border and customs enforcement bodies, professional councils and the pharmaceutical industry.
Participants included representatives from the South African Health Products Regulatory
Authority (SAHPRA), South African Revenue Service (SARS), Border Management Authority
(BMA), Health Professions Council of South Africa (HPCSA), South African Pharmacy Council
(SAPC), the Department of Home Affairs and industry stakeholders. The South African Police Services (SAPS) could not make the roundtable, but have committed to being a key part of future discussions.
The discussion highlighted the evolving nature of healthcare crime in South Africa and the need for stronger collaboration, public awareness and enforcement to prevent counterfeit, falsified and unauthorised medicines from reaching patients.
Medicines patients cannot trust
Opening the discussion, a representative from SAHPRA unpacked the differences between substandard, falsified and unauthorised medicines, warning that the common denominator across all three categories is uncertainty around quality, safety and efficacy.
Daphney Fafudi, Senior Manager: Market Control at SAHPRA, explained that substandard products are authorised medicines that fail to meet quality standards, falsified products deliberately misrepresent their identity, composition or source, and unauthorised products have not undergone the required regulatory approval processes.
“Patients often focus on whether a medicine works,” said Fafudi. “But the real question is whether anyone knows what is in that product, whether it was manufactured correctly, whether it contains the correct ingredients, and whether it has been appropriately assessed and authorised.”
Participants warned that suspect products are increasingly being sold through informal markets, social media platforms, websites, wellness centres, gyms, beauty clinics and other unregulated channels.
High-demand categories identified by panellists included weight-loss medicines, performance-enhancing substances, codeine-containing medicines and skin-lightening products.
Fafudi warned that the scale of the challenge is growing, “So far this financial year, we have received approximately 600 complaints relating primarily to informal, illegitimate and falsified products being sold through unauthorised channels. The cases we know about are only those that have been reported. The concern is always the cases that are not reported and the products that continue circulating until harm occurs.”
More than 1.7 million pharmaceutical-related products intercepted
The scale of the challenge was highlighted by Dr. Nakampe Michael Masiapato,
Commissioner and Chief Executive Officer of the Border Management Authority (BMA), who reported that the authority had intercepted more than 1.7 million suspicious pharmaceutical-related products through its border-management operations.
Masiapato explained that medicines are frequently concealed in consignments declared as unrelated products or enter the country through courier services, passenger luggage, postal channels and informal importation routes.
“We are seeing everything from slimming products and skin-lightening products to fake HIV test kits, unidentified pharmaceutical substances and other healthcare products entering through multiple channels,” he said. “The volume of products intercepted demonstrates both the scale of the challenge and the importance of coordinated border management, intelligence sharing and inspections across the country’s ports of entry.”
Gene Ravele, Head of the SARS Syndicated Tax and Customs Crimes Division, described how customs risk engines, electronic import declarations and intelligence-driven inspections are used to identify suspicious consignments before they enter the country.
He noted that high-risk shipments are referred for further inspection and verification, helping authorities detect mis-declared, non-compliant and potentially unlawful products before they reach consumers.
A growing online problem
A recurring theme throughout the discussion was the migration of illicit medicine sales into digital spaces.
Sara Norcross, Board Member of the Innovative Pharmaceutical Association South Africa (IPASA), said illegal medicine sales are increasingly taking place in public online spaces where consumers may mistakenly assume products are legitimate simply because they are visible.
“One of my biggest concerns is that these activities are becoming normalised,” said Norcross. “When medicines are openly advertised on websites, social media platforms and messaging services, people can begin to assume they are legitimate simply because they are visible. Visibility should never be confused with legitimacy.”
Norcross revealed that Novo South Africa has identified and reported 39 suspected unlawful medicine-related cases so far in 2026, the majority of which were linked to websites, social media platforms and WhatsApp channels. The cases included suspected illicit online sales, compounding activities, wellness clinics, aesthetic facilities, unauthorised medicine distribution and other potentially unlawful healthcare-related activities.
“The majority of activity we’re seeing is no longer happening in back rooms,” she said. “It’s happening online, in plain sight.”
Professional accountability, compounding and patient safety
The HPCSA and SAPC outlined the mechanisms available to investigate healthcare professionals suspected of prescribing, dispensing or promoting unsafe or unlawful medicines.
Kwena Mabaso, Head of Complaints Handling and Investigation at the HPCSA, explained that complaints can originate from patients, healthcare professionals, SAHPRA and members of the public, and that serious matters may result in suspension, disciplinary action or removal from professional registers.
The discussion also highlighted growing concern around medicine compounding and the increasing demand for customised medicines, particularly in high-demand therapeutic areas. Compounding is the practice of preparing a medicine specifically for an individual patient’s needs when a suitable registered product is not available in the required formulation, strength or dosage form.
Vincent Tlala, Registrar and CEO of the SAPC, reiterated that lawful compounding should occur only in response to an individual patient’s prescription and should not be used as a mechanism to manufacture medicines in anticipation of demand.
“What we are seeing in the market, and which we are against, is when pharmacies become small-scale manufacturers,” said Tlala.
He confirmed that the SAPC is working with SAHPRA on updated minimum standards and guidance for compounding, with the revised standards expected early next year. Participants stressed the importance of finalising the updated regulations as a matter of urgency, noting industry concerns that the revised standards are unlikely to be in place before the six-month interim interdict in the ongoing iDexis matter expires.
Fafudi warned that the issue extends beyond questions of medicine access and into broader concerns regarding quality, safety and regulatory oversight. “There is a scourge of compounded products, especially in the area of weight-loss,” she said.
She explained that updated SAHPRA guidance is intended to provide greater clarity on what is and is not permissible when compounding medicines, particularly where differing interpretations of existing regulations have led to disputes and regulatory intervention.
Healthcare crime is also economic crime
Stavros Nicolaou, Chairperson of the Pharmaceutical Task Group, urged stakeholders to recognise healthcare crime as more than a patient-safety issue.
“Healthcare crime is both a patient-safety issue and an economic-crime issue,” said Nicolaou. “It harms patients, weakens trust in healthcare systems, undermines legitimate businesses, discourages investment and diverts economic activity away from the formal economy.”
He added that organised criminal networks exploit fragmented systems and that stronger cooperation between regulators, border and customs authorities, healthcare professionals, professional councils, government and industry will be critical to addressing the problem. “Criminal networks collaborate,” he said. “Those protecting patients must collaborate too.”
Education alone is not enough
While participants agreed that public awareness remains a critical tool for protecting consumers, several panellists warned that education must be supported by visible enforcement and accountability.
Discussions highlighted the challenges posed by fragmented mandates across multiple agencies, limited specialist capacity and lengthy investigative processes. Participants welcomed efforts to strengthen coordination through formal agreements and collaborative initiatives involving regulators, border and customs authorities, professional councils and industry stakeholders.
Fafudi acknowledged that successful enforcement depends on effective cooperation between multiple stakeholders, “SAHPRA does not have arresting powers. We can investigate, seize products, issue recalls and open criminal cases, but successful prosecutions require collaboration with enforcement and prosecutorial authorities.”
She said SAHPRA is currently working to strengthen enforcement coordination through formal cooperation agreements with key partners.
“In addition to broader engagement with enforcement agencies, SAHPRA is working on a formal memorandum of understanding with the Health Professions Council of South Africa (HPCSA) and the South African Pharmacy Council (SAPC) to strengthen coordination and support enforcement action in matters involving healthcare professionals, pharmacies and other identified cases,” said Fafudi. “Our objective is to ensure that cases do not stop at the point of identification or referral, but that the entire enforcement chain is strengthened through coordinated action and information sharing.”
Norcross warned that awareness campaigns on their own would not be enough. “We cannot educate our way out of this challenge alone,” she said. “Education must be matched by enforcement, accountability and visible action. Patients need to know that unlawful activity is being addressed and that there are consequences for those who put public health at risk.”
What should patients do?
- The panel’s message to South Africans was clear:
- Obtain medicines only through authorised healthcare professionals and licensed pharmacies
- Avoid medicines sold through social media, unofficial websites, WhatsApp groups and informal channels
- Verify medicines and healthcare products with your healthcare professional where there is any doubt
- Report suspicious products to the relevant authorities, such as SAHPRA
- Seek advice from qualified healthcare professionals before using any medicine
The problem is growing faster than the system is adapting
Concluding the discussion, participants agreed that South Africa has the regulatory, professional and enforcement framework needed to address illicit medicines. The challenge now is ensuring that implementation, coordination and enforcement keep pace with an increasingly sophisticated and fast-moving threat.
While SAHPRA is strengthening cooperation with enforcement partners and the SAPC is progressing revised compounding standards, participants acknowledged that unlawful operators are often able to move faster than regulatory, disciplinary and legal processes.
Participants also stressed the importance of making enforcement action more visible where legally appropriate. Product seizures, investigations, disciplinary outcomes and successful interventions can help deter unlawful activity while giving the public confidence that action is being taken.
“As a country, we cannot afford to treat healthcare crime as someone else’s problem,” said Nicolaou.
“The challenge is moving faster than many people realise. New products, new sellers and new online channels emerge constantly. Regulatory frameworks, professional standards and enforcement mechanisms must be able to keep pace with the threat. Healthcare crime does not stand still while systems deliberate. If enforcement, prosecutions and regulatory responses lag behind the threat, the damage may already have been done. The question is not whether South Africa has the right laws and authorities. The question is whether we can act quickly enough, consistently enough and visibly enough to prevent unlawful activity from becoming entrenched.”