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EF: Could you please provide an introduction for yourself and Bliss Holdings?
KT: I am the chairman of the Black Pharmaceutical Industry Association, BPIA, where we represent the indigenous businesses and people of South Africa who are the main black professionals and manufacturers of pharmaceutical and medical devices locally. As a founding member of the Association, together with Dr Sello Rathete and Dr Eugene Lottering in 2018, the association has grown to over 21 members who are all passionate about the transformation of the healthcare sector in particular the pharmaceutical sector which has remained “lily white” since the advent of our hard-earned constitutional democracy. Bliss Pharmaceutical is a family-owned company that was started by Connie who is a regulatory pharmacist, in 2007, initially as a regulatory consultant outfit, where she consulted for multinational companies that did not have a presence in South and Southern Africa. Connie comes from 25 years in the regulatory space, having worked for the likes of MSD, Adcock Ingram, and 3M, where she spent most of her commercial life at 3M before it was sold.
In terms of Bliss as a company, one of our core competencies is strong regulatory capacity through Bliss Healthcare, which is our regulatory outfit. The business model changed around 2013 when we needed to establish a fully-fledged pharmaceutical company, where we do not just register products on behalf of people but have our own dossiers. We also get to supply medicines, especially essential medicines, because South Africa has a high burden of communicable diseases. Solutions cannot always come from outside the country, South Africans, local businesses, and local professionals need to participate in developing our own solutions rather than relying on outsiders. Across the world, the top 20 companies will be owned by locals, and this ought to be the case in SA but unfortunately, it is not. Multinationals still dominate ownership of our economy and these are the remnants of apartheid and colonialism that have impacted Africa as a whole, especially in South Africa.
EF: Could you elaborate on the importance of self-sufficiency within South Africa?
KT: We have a situation in our country where in the last 20 years, more than 37 manufacturers closed to establish manufacturing facilities outside of South Africa. That is a huge brain drain. It is a huge disposition of security of supply in terms of essential medicines for sustainable supply of chronic medicines, for example, South Africa has the largest HIV/AIDS programme in the world yet the bulk of more than 85% of antiretroviral drugs are imported. The government should be using that as a lever to drive economic growth and re-industrialization of our economy. We, unfortunately, have these anomalies where there is a lack of commitment to develop and support local manufacturers. The recent ARV tender awarded to mainly 100% Indian-owned companies who do not manufacture locally is currently a huge outcry, wherein local manufacturers have been sacrificed in favour of imported ARVs from India. This is done against the backdrop of youth unemployment being over 40%.
EF: How can the industry leverage the experiences of the past two years and carry them into the future?
KT: When the pandemic hit us in early 2020 there were several initiatives put in place, such as the establishment of the Solidarity Fund. This is something that South Africa and other developing economies can learn from. Bliss is a member company of the Black Pharmaceutical Industry Association (BPIA) and the association is a member association of the Black Business Council (BBC). Through the BBC, we participated with our colleagues at BUSA to establish a social compact with the government. Within a short period of time, the B4SA Work Streams that we participated in facilitated much-needed PPEs and medicines to the country and we supplied various government departments including the private sector. When the pandemic hit, we all knew that most of the PPEs were manufactured in East Asian countries. We further relied as a country on APIs from China and India while most of these countries had embargoed exports, and they first needed to satisfy their local requirements. As a result of the latter, we had a huge shortage of PPEs and Trade Unions like NEHAWU even threatened a strike because their members were exposed to contracting the virus as a result of the unavailability of masks, gloves etc. I remember Paracetamol was mainly produced in India and we were left with only two months' worth of supplies in the country. India had embargoed all exports of medical consumables and some pharmaceutical products and we had to form a team to get the Trade Minister to intervene with his counterpart and come to our rescue.
Social partnerships and leveraging the capacity of the private sector and civil society for me is a great learning experience which we as a country build on to resolve the many challenges we face.
By forming partnerships, we could cross barriers, and essential medicines were able to come through from China and India. South Africa and the situation we found ourselves in we needed to learn from that, the learnings are that we cannot rely on imported products for essential drugs and chronic medicines, developing local capacity for products like masks and other essential products. Unless we address this decisively and create jobs locally, this will not change.
EF: How do you see the role of healthcare in developing the economy of South Africa?
KT: Healthcare is one of the largest and fastest growing industries globally, in South Africa 9.5% of our GDP is spent on healthcare. if you look at most developed nations, they spend around half of that. It is important to dispel this myth and misconception that the healthcare sector is a non-productive sector with little ability to contribute to growth and economic development, especially in developing economies. Some of the funds that were spent should have been invested in developing local capacity, such as during the pandemic, but they were not, instead, we focused on imports. The pharmaceutical industry contributes less than 1% to the total GDP of South Africa, yet we are the second largest contributor to the trade deficit. Throughout the pandemic, we were a huge importer of vaccines which further increased the trade deficit and put us in a worse position.
EF: There are several upcoming opportunities within the logistics, healthcare, and pharmaceutical sectors. Could you share with us the things you are most excited about?
KT: In a UNECA report, it was estimated that Africa's health sector represents an investment opportunity of about $66 billion annually while imported medicines cost Africa an estimated $50 billion annually. Local pharmaceutical production would not only reverse but create more than 16 million jobs. If you look at healthcare as a sector from a global perspective, healthcare spending in the continent of Africa is very low in terms of global standards. It accounts for about 2% in terms of global healthcare expenditure, yet the continent has 14% of the global population and 25% of the global disease burden. This puts the responsibility on local companies such as ourselves to not only seek partnerships and come up with solutions for our continent, but these solutions need to be grounded in resolving and creating long-term economic sustainability for the continent, limiting reliance on imports, and developing local capacities across African countries, and this can be done. Rwanda and recently Zambia are a case in hand. These two countries are turning the tide because of decisive leadership.
We as Bliss are looking at addressing some of these challenges. South Africa Regulatory Authority (SAHPRA), is rated as one of the top five regulatory bodies globally. As South Africans, we need to be proud of our colleagues who have turned SAHPRA into an organization that is rated so highly. Unilab, our strategic partner, are looking to export products to Asia and through this exportation, we are likely to see small black-owned companies being able to supply much-needed products to East Asia that contain local APIs that some of the products in East Asia do not have. This would contribute toward levelling out the trade deficit and inject much-needed foreign currency into the economy of our country. We are looking to create an export-driven pharmaceutical sector where we can compete with other global markets.
EF: Could you elaborate on the use of technology and the future potential of telemedicine in the sector?
KT: Rwanda set an example in this area. They have consistently been growing their economy and they have much more advanced technological capabilities that as a country, we can learn from. They utilize drones to deliver chronic medicines which increases efficiency and hugely reduces distribution costs. The use of telemedicine to expand access to rural areas has great future potential. South Africa has a large rural population that needs access to medication and healthcare. The use of government facilities like the Post Office’s infrastructure which has already been invested in should be utilized to provide primary health services, especially in rural areas where there are no clinics or hospitals.
EF: Do you have a final message that you would like to share?
KT: Healthcare remains one of the largest government spending commitments, significant public funds are involved but public procurement is not fully utilized in our country to drive economic growth. Therefore, as the BPIA, I say that it is incumbent upon the government to ensure that public procurement is used to achieve broader policy objectives such as re-industrialization of our economy, job creation, sector transformation, and development of self-sufficiency for pharmaceutical companies in support of the NHI. The NHI will not succeed if it is reliant on imports, we need strong local pharmaceutical production, vaccines, and chronic and essential drugs.