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In a new strategy for preventing heart attacks and strokes, leading cardiologists are urging their fellow physicians to focus on reducing the LDL cholesterol of patients at greatest risk of suffering a cardiovascular crisis, and to use costly new drugs if necessary.

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Their impact is gradual, cumulative and, for that very reason, easier to postpone.That may also make the legal response more difficult.The absence of an immediate emergency creates the illusion that there is still time to act, even as the number of patients requiring long-term treatment continues to grow.What should Africa do next?The conversation should not be reduced to whether compulsory licenses ought to be granted.A more comprehensive strategy is required.From a legal perspective, countries with greater institutional capacity - such as South Africa, Egypt, Morocco and Nigeriacould play a leading role in testing and implementing the TRIPS flexibilities available for essential medicines, creating practical precedents for the rest of the continent.At the regional level, the African Continental Free Trade Area (AfCFTA) provides an opportunity to strengthen regulatory cooperation and coordinate procurement strategies, ultimately increasing Africa's collective bargaining power.At the same time, policymakers should continue to scrutinise the growing use of secondary pharmaceutical patents and consider whether current patent practices strike the appropriate balance between rewarding innovation and facilitating timely generic entry.Yet perhaps the most important lesson lies elsewhere.Without sustained investment in local pharmaceutical manufacturing, research capacity and technology transfer, access debates will continue to focus on legal rights rather than practical solutions.The post-COVID initiatives aimed at expanding vaccine production across Africa demonstrate that industrial capacity can be developed when political will and international cooperation converge

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