Cystic Fibrosis Care in South Africa: Facing the Challenge of Diversity and Inequality.

Low-and-middle-income countries (LMIC) like South Africa (SA) were left behind with advancements in cystic fibrosis (CF) care that followed re-imbursement agreements in high-income countries of CF transmembrane regulator protein modulators (CFTRm) for the treatment of CF. A combination of global monopoly, patent protection by international trade agreements and delays in regulatory approvals are factors keeping these transformative drugs out of reach for many LMIC due to their high cost. Unequal and delayed access to CFTRm is amplifying existing disparities in CF care and outcomes worldwide, including SA where currently only 200 (50%) of the 400 eligible people have access to CFTRm. However, the SA experience demonstrated how health professionals, legal experts and global CF community activists can collaborate to mobilize local and international resources to advocate for affordable and equal access to CFTRm In this paper we describe the journey followed in SA to overcome some of these inequalities and challenges and highlight the current and future impact on CF care in SA that may have much in common with other LMIC.