The COVID-19 pandemic has exposed numerous shortfalls in South Africa’s health system. It has forced us as individuals and as a country to face the reality of inequality evident in the vast differences in public and private healthcare.

It is clear that poor and marginalised South Africans bear the brunt of these shortfalls. Millions of South Africans find that they are directly affected by the international struggles to secure COVID-19 vaccines. Everyday, they are affected by global supply chain backlogs and shortages of essential medicines such as HIV treatment, HIV prevention pills, contraceptives and other chronic medications.

While we can blame COVID-19 for some of these shortfalls, many of these had existed long before the pandemic upended our lives. Last year, President Cyril Ramaphosa said the COVID-19 pandemic showed us that there is a need for the government to invest more in health research and development (R&D).

Supporting health R&D creates an opportunity to improve affordability and access to vaccines and essential medicines for diseases affecting developing countries such as South Africa. Additionally, it is also in line with the United Nations’ third Sustainable Development Goal to “ensure healthy lives and promote well-being for all.”

The world needs new and improved health technologies to prevent and treat existing conditions and health challenges. Therefore, it is crucial to promote health R&D to address such issues. As our researchers and scientists scramble for solutions and vaccines for COVID-19, it is clear that supporting, promoting and advocating for health R&D must become a priority.

Funding obstacle to health R&D

Our government investing in health R&D guarantees that solutions will come from within South Africa instead of waiting for other countries to deliver vaccines and essential medicines to us. We have some of the world’s most renowned scientists and infrastructure and have the potential to create these treatments. With intentional investments, we could be in a much better position to respond effectively against the disease burdens we face as a country. Health R&D is core to saving lives, ensuring a productive workforce, increasing life expectancy, decreasing mortality, and building a strong economy.

Yet, according to National Treasury, funding flows for health R&D is a complex process. Public funding of health research in South Africa cuts across many different institutions such as the South African Medical Research Council, the National Health Laboratory Services and the Human Sciences Research Council. Universities and non-governmental organisations also benefit from this funding.

There are no specific health R&D budgets, and detailed budget decisions are generally centralised to relevant institutions. In the year 2017/18, medical and health sciences was the second-largest research area funded and in the last two years and the higher education sector has been the largest contributor to health research. Additionally, TB, HIV and AIDS and malaria expenditure in South Africa by 2013/14 to 2017/2018 shows a 11.9% increase. While this is encouraging, South Africa still needs to more to improve and invest in health R&D.

Difficult to advocate for health R&D

While R&D is essential, it can be hard to advocate for as this complexity can be difficult to translate to communities and stakeholders who don’t  have the adequate health literacy. This makes it hard to get communities and activists to adequately support and pressurise the government to invest more in R&D.

Often when we talk about health R&D, we see some research institutions going to communities to conduct clinical trials without adequately consulting community members and helping them understand the purpose and importance of their involvement. It’s clear that government and researchers aren’t in sync about bringing more health R&D into the country, as there are no clear agreements for the population to have access when products that are found to be effective.

Successful universal healthcare, which South Africa has tabled as the National Health Insurance, must be coupled with plans to expand health R&D. This will ultimately create an enabling environment for the availability of affordable access to innovative and life-saving treatments, and bridge the current inequalities. But for this to happen, communities must be able to advocate for these benefits. The future of health research and development lies in effectively including communities and civil society from the beginning until the end. For the people, with the people.

Ntando Yola is the Community Mobilisation and Engagement Lead at Advocacy for Prevention of HIV and AIDS (APHA).

APHA was founded in December 2015 by human rights, health and HIV activists, Yvette Raphael, Brian Kanyemba and Ntando Yola. APHA is a not-for-profit organization dedicated to ending the global HIV epidemic, with the particular focus  on key and vulnerable communities in South Africa. APHA works in partnership with communities, NGOs and the medical profession to find and promote rights-based solutions to preventing new infections.