Facilitating a framework for managing rare diseases in South Africa: Comparative insights from the UK and Italy

Main Article Content

S Pazaropoulos-Koot
S Mahomed
L Pienaar

Abstract





Managing and treating rare diseases is a global concern, largely because of their rarity and the complexities associated with their care. Robust ethico-legal frameworks governing rare diseases are essential as they establish coordinated guidelines that ensure patients receive the care and support which they require. This article examines and compares the existing frameworks for rare diseases in the United Kingdom and Italy, with those in South Africa (SA), highlighting the differences and similarities in how they operate, towards facilitating a national framework that suits our context. The recommendations offer proposed solutions to add to the ongoing dialogue regarding the current lack of governance for rare diseases in SA. The article further calls for a coherent national framework to better address and represent the needs and rights of individuals affected by rare diseases. SA requires a systematic approach, with clear guidelines for diagnosing, treating and funding rare diseases. This approach would establish a basis for efficient resource allocation and equitable access to essential treatments.





Article Details

Section

Research Articles

Author Biography

S Pazaropoulos-Koot, School of Law, University of South Africa, Pretoria, South Africa. Admitted attorney of the High Court of South Africa.

School of Law, University of South Africa, Pretoria, South Africa.

Admitted attorney of the High Court of South Africa.

How to Cite

Facilitating a framework for managing rare diseases in South Africa: Comparative insights from the UK and Italy. (2025). South African Journal of Bioethics and Law, 18(1), e2805. https://doi.org/10.7196/

References

1. Jacobson BF. Not so rare: It’s time to raise awareness of rare diseases in South Africa. S Afr Med J 2022;112:6. https://doi.org/10.7196/samj.2022.v112i1.16010

2. Eurordis Rare Diseases Europe. What is a rare disease? https://www.eurordis.org/

information-support/what-is-a-rare-disease/ (accessed 3 May 2023).

3. Wakap S, Lambert D, Oilry A,. Estimating cumulative point prevalence of rare diseases: analysis of the Orphanet database. Eur J Hum Genet 2020;28:165-173.

https://doi.org/10.1038/s41431-019-0508-0

4. Rare Disease South Africa. Our purpose. https://www.rarediseases.co.za/our-

purpose (accessed 5 May 2023).

5. Malherbe HL. Introducing the South African Rare Diseases Access Initiative. S Afr

Med J 2023;113(8):1301. https://doi.org/10.7196/samj.2023.v113i8.1142

6. Owings L. In-depth: What happens to people in SA who have rare diseases? Spotlight, 2021. https://www.spotlightnsp.co.za/2021/09/06/in-depth-what-

happens-to-people-in-sa-who-have-rare-diseases/ (accessed 5 May 2023).

7. Delobelle P. The health system in South Africa. Historical perspectives and current challenges. In: Wolhuter CC, ed. South Africa in focus: Economic, political

and social issues. New York: Nova Science, 2013:159-206.

8. Ross IL. Exploring rare diseases in South Africa, a personal journey: Time for

electronic record-keeping. Ann Med Health Sci Res 2016;6(1):1-3. https://doi.

org/10.4103/2141-9248.180216

9. Orphanet. What is an orphan drug? https://www.orpha.net/en/other-information/

about-orphan-drugs (accessed 1 October 2024).

10. Health Professions Council of South Africa. National patients’ right charter.

https://www.hpcsa.co.za/Content/upload/professional_practice/ethics/

Booklet_3_Patients_Rights_Charter_vSept_2023.pdf (accessed 1 October 2024).

11. Ngene NC, Khaliq OP, Moodley J. Inequity in health care services in urban and rural settings in South Africa. Afr J Reprod Health 2023;27(5):87-95. https://doi.

org/10.29063/ajrh2023/v27i5s.11

12. Council for Medical Schemes. What are prescribed minimum benefits? CMS, 2020. https://www.medicalschemes.co.za/resources/pmb/ (accessed 22 August 2024).

13. Mahomed S, Labuschaigne M, Slabbert M. Justice in the provision of healthcare services – a stifled right in the private sector. S Afr J Bioethics Law 2022;15(3): 91- 95. https://doi.org/10.7196/SAJBL.2022.v15i3.371

14. Maphumulo WT, Bhengu BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis 2019;42(1): 1-9. https://doi.org/10.4102/curationis.v42i1.1901

15. Sobuwa Y. Health experts insist that NHI benefits should include rare diseases. News 24, 2023 https://www.news24.com/news24/southafrica/news/health- experts-insist-that-nhi-benefits-should-include-rare-diseases-20231204 (accessed 12 January 2024).

16. Malherbe HL. Introducing the South African Rare Diseases Access Initiative. S Afr Med J 2023;113(8):1301. https://doi.org/10.7196/samj.2023.v113i8.1142

17. Rare Diseases South Africa. Recognising rare diseases – access and action.

https://www.rarediseases.co.za/post/recognising-rare-diseases-access-and action#:~:text=About%20the%20RDAI%3A,for%20those%20with%20rare%20 diseases (accessed 17 August 2023).

18. Zamora B, Maignen F, O’Neill P, Mestre-Ferrandiz J, Garau M. Comparing access to orphan medicinal products in Europe. Orphanet J Rare Dis 2019;14(95):1-12. https://doi.org/10.1186/s13023-019-1078-5

19. Anderson M, Pitchforth E, Edwards N, Alderwick H, McGuire A, Mossialos E. The United Kingdom: Health System Summary, 2022. European Observatory on Health Systems and Policies. Brussels: World Health Organisation, 2022:1-22.

20. National Institute for Health and Care Excellence. Who we are. https://www. nice.org.uk/about/who-we-are (accessed 19 March 2024).

21. United Kingdom. Health and Social Care Act, 2012. https://www.legislation. gov.uk/ukpga/2012/7/contents

22. Hyry H, Roos JC, Manuel J. The legal imperative for treating rare disorders. Orphanet J Rare Dis 2013;(8):1-7. https://doi.org/10.1186/1750-1172-8-135

23. United Nations. International covenant on economic, social and cultural

rights. https://www.ohchr.org/en/instruments-mechanisms/instruments/ international-covenant-economic-social-and-cultural-rights (accessed 4 June 2024).

24. United Kingdom. Human Rights Act, 1998. https://www.legislation.gov.uk/ ukpga/1998/42/contents

25. Department of Health and Social Care. Policy paper – UK rare diseases framework. Gov.UK, 2021. https://www.gov.uk/government/publications/uk- rare-diseases-framework/the-uk-rare-diseases-framework (accessed 19 May 2023).

26. Department of Health and Social Care. Policy paper - England rare diseases action plan 2024. Gov.UK, 2024. https://www.gov.uk/government/publications/ england-rare-diseases-action-plan-2024/england-rare-diseases-action-plan- 2024-main-report#:~:text=The%202021%20UK%20Rare%20Diseases%20 Framework%20set%20out%20a%20national,rare%20diseases%20among%20 healthcare%20professionals (accessed 28 February 2024).

27. Rechel B, Maresso A, Sagan A. Organisation and financing of public health services in Europe: Country reports. European Observatory on Health Systems and Policies. Denmark: World Health Organization, 2018:1-133.

28. Francea G, Francesco Taroni F, Donatinic A. The Italian health-care system. Health Econ 2005;14:187-202. https://doi.org/10.1002/hec.1035

29. Ferrè F, Noto G, Vola F. Italy’s health care system and the crisis: overview of policy actions and their implementation. An Inst Hig Med Trop Lisb 2018;17(1):47-58. https://doi.org/10.25761/anaisihmt.251

30. Cursano R, Ovidi R. Italy: Consolidated Law on rare diseases. Baker McKenzie, 2021. https://insightplus.bakermckenzie.com/bm/healthcare-life-sciences/ italy-consolidated-law-on-rare-diseases (accessed 25 April 2024).

31. Italy. Law 189/2012.

32. RD-Action: Data and policies for rare diseases. Summary of rare disease

activities in Italy. https://www.rd-action.eu/country/italy/#:~:text=The%20 national%20rare%20disease%20decree,benefits%20and%20access%20to%20 care (accessed 24 July 2024).

33. Bernardini A, Sancandi M. Advancing rare disease care: The National Rare Disease Plan 2023-2026. Partners for Action, 2023. https://partners4access. com/blogs/advancing-rare-disease-care-the-national-rare-disease-plan- 2023-2026/#:~:text=Advancing%20Rare%20Disease%20Care%3A%20 The%20National%20Rare%20Disease%20Plan%202023%2D2026,-Home%20 %C2%BB%20Blogs%20%C2%BB%20Advancing&text=I. (accessed 26 April 2024).

34. M.D and Another v MediHelp Medical Scheme and Another [2022] ZAGPPHC 640. 35. Congiu ME. The Italian national plan for rare diseases. Blood Transfus

2014;12(3):614-616. https://doi.org/10.2450/2014.0337-13s

Similar Articles

You may also start an advanced similarity search for this article.