Julia Hornberger Department of Anthropology University of the Witwatersrand, Johannesburg (E-mail: julia.hornberger@wits.ac.za) From Drug Safety to Drug Security: A Contemporary Shift in the Policing of Health The counterfeiting of medication is increasingly seen as a major threat to health, especially in the light of both the everyday reliance on and a broadening of world- wide access to pharmaceuticals. Exaggerated or real, this threat has inaugurated, this article argues, a shift from a drug safety regime to a drug security regime that governs the flow of pharmaceuticals and brings together markets, police, and health actors in new ways. This entails a shift from soft disciplinary means aimed at incremental and continued inclusion of defaulters, to one of drastically sovereign measures of exclusion and banishment aimed at fake goods and the people associated with them, in the name of health. Through a multi-sited ethnographic study, this article shows how such new drug security efforts play themselves out especially in (South) Africa, highlighting a modus operandi of spectacular performativity and of working through suspicion and association rather than factuality, producing value less so for those in need of health than for a petty security industry itself. [counterfeit medication, South Africa, pharmaceuticals, security] Introduction In May 2008, I visited Mr. Bandile Masuko, 1 a pharmacologist and the head of the law-enforcement unit of the South African Department of Health, in his offices in Pretoria. He and his team are partly responsible for overseeing the regulation of pharmaceutical trade and consumption in South Africa. They are the executive arm of the Department of Health’s Medical Control Council, the statutory regulatory body that decides which drugs can be sold in South Africa and which cannot. During the interview, Masuko explained to me the modus operandi of his unit. The diverse capacity of his team, composed of lawyers, pharmacists, and criminal and forensic investigators, provides multilayered expert knowledge with which they tackle their cases. He proudly mentioned the singular status South Africa occupies within Africa with regard to the regulation of substandard medication, and their degree of participation in global regimes of drug safety. Yet Masuko was worried. He was worried, not so much about the limited re- sources of his unit, as one might suspect, but about the lack of attention they were drawing—nationally and internationally. He told me that without displaying MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 32, Issue 3, pp. 365–383, ISSN 0745- 5194, online ISSN 1548-1387. C  2018 by the American Anthropological Association. All rights reserved. DOI: 10.1111/maq.12432 365