[procaare] South African Victory - but what are the next steps?

[ProCAARE <procaare@usa.healthnet.org>]

Dear ProCAARE Members

It would have been hard for you to miss, these last few days, the news of the success in
the recent court case in South Africa of South Africa vs. 39 Pharmaceutical countries. The
39 international drug companies have withdrawn a three-year law suit and the SA government
will be able to import less costly generic drugs.

It has been speculated that this success is partly due to the success of the TAC advocacy
campaign, to the partnership between TAC and the South African government on this issue,
to the international pressure on international drug companies and to the fact that the
drug companies acted on business sense.

Although this cannot be denied as a victory to celebrate - yet it is one of many steps in
moving the country forward in access issues. All eyes are on the government for leadership
at this time.

John S. James wrote in AIDS Treatment News #360, Feb 23, "Africa Access":
"The biggest problem now is lack of leadership on this issue by governments and other
major institutions. So the immediate need is to find enough consensus among the different
stakeholders to induce governments to exercise responsible leadership.(...)
The bottom line for any program on treatment access is whether it actually makes treatment
available. It is not enough to generate press releases and heartwarming media stories
alone, as if to satisfy public demand until the world's attention turns to something
else."

The issue remains that most do not have access to essential drugs, let alone access to HIV
care. Stigma remains to be a huge obstacle and the health infrastructure is not equipped
for the increasing numbers of HIV-positive patients. What are the concrete next steps
ahead?

Below, please find:

1. A message and a pledge from SATELLIFE
2. NY Times Article: "Despite Legal Victory, South Africa Hesitates on AIDS Drugs"

For more discussion on the South Africa court case, please visit
http://www.hivnet.ch:8000/topics/treatment-access/

- HDN Moderation Team
procaare@usa.healthnet.org

==================

1. A Landmark Event in the Fight Against AIDS and SATELLIFE's Pledge to Help

A three year law suit was unconditionally withdrawn in South Africa by 39
international drug companies earlier today. In addition to reimbursing the
South African government's legal fees, this reversal will allow the
government to implement a 1997 law that grants the use of generic
drugs. As a result, the South African government is now free to import
less-costly generic drugs for the 4.7 million South Africans infected with HIV.

"For instance, drug company Pfizer was selling Fluconazole, an essential
drug used to treat certain HIV/AIDS-related infections, for about R29 to
[the] government while generics could be bought for R2" (BusinessDay
on-line, 4/19/01, quoting Sapa, I-Net Bridge).

However, some have expressed concern over the widespread accessibility to
these life-prolonging drugs. "South Africa, like many of its neighbours,
still lacks the infrastructure to use these complicated drugs
effectively. Doctors require specialist training; systems for regularly
monitoring patients who are on medication need to be put in place and drug
supplies must be guaranteed" (BBC News on-line, 4/19/01).

Despite these concerns, this is a great victory for South Africa and AIDS
patients throughout the world. "Now nothing should stand in the way of
countries who want to ensure long-term access to affordable medicines,"
said Ellen 't Hoen, Doctors Without Borders/MSF legal advisor (MSF-USA
on-line, 4/19/01).

SATELLIFE, through its publications such as HealthNet News and HealthNet
News-AIDS, pledges to bring health workers in Africa the information that
they need to effectively use these treatment options. Likewise, through
vehicles such as AFRO-NETS, E-Drug, and ProCAARE, we can facilitate the
development of a shared knowledge base responding to the need for
information about effective delivery and monitoring systems.

-The SATELLIFE Staff
http://www.healthnet.org

================
2. Despite Legal Victory, South Africa Hesitates on AIDS Drugs
Mew York Times, 21 April 2001 - By RACHEL L. SWARNS
Source: Health-L Forum

JOHANNESBURG, April 20   With the Champagne consumed and the celebration
over, advocates for AIDS patients today turned their attention from the South African
government's legal victory over the drug industry and looked to the future.

With sinking hearts, many concluded that the next big barrier to expanding access to
AIDS drugs might well be the government itself.

The drug industry conceded South Africa's right to import cheaper brand-name
medicines, but the governing African National Congress was not aggressively charting
the way forward.

Instead, in its online newspaper, the party was ticking off countless reasons why the
country should think twice about providing lifesaving AIDS cocktails.

In this, the ruling party was echoing the health minister, Dr. Manto Tshabalala-
Msimang, who dashed the hopes of her allies on Thursday when she made it clear that
providing AIDS drugs was not a government priority, even though the drug industry had
just dropped its objections to a law that allows South Africa to import brand-name
drugs at the lowest prices available.

When pressed about her plans for treating the nation's 4.7 million people infected with
H.I.V., Dr. Tshabalala-Msimang insisted that the government was already offering
adequate care without costly AIDS drugs.

Mark Heywood, a lawyer who helped organize the street protests that applied pressure
on the drug industry to drop its lawsuit against South Africa, said today that the
minister's remarks felt "like a stab in the back." And her comments and those from the
A.N.C. have revived concerns about the government's commitment to providing the
medicines in a country with more people infected with H.I.V. than any other.

This morning, Mr. Heywood and other advocates for AIDS patients gathered to
consider a new campaign to pressure drug companies to lower prices of AIDS drugs in
the private sector. But they also decided to focus on the government, and to turn up
the heat if necessary, to persuade health officials to work harder to bring the AIDS
drugs readily available in the West to the poor in South Africa.

"Our work on the court case shows our willingness to enter into partnership, but we
will not shirk from very difficult engagements with the government," Mr. Heywood said.
"Yesterday was an important and empowering victory. But we're measuring success
by bringing real medicines to real people."

On Thursday, 39 drug companies agreed to drop a lawsuit intended to block a law that
would expand access to cheaper medicines. Among other things, it would allow the
government to buy brand-name drugs that advocates say are sold more cheaply in
India and Brazil than in South Africa.

But the law, which will take effect in several months, is unlikely to expand access
significantly. The drugs are still expensive for South Africa, and the health care system
here, particularly in rural areas, is still largely unprepared to administer such
complicated medicines and to monitor patients.

Advocates for AIDS patients acknowledge those obstacles. Still, many had hoped to
hear a sense of urgency from the government about addressing them.

Other African countries that are poorer than South Africa and that have even weaker
health systems have already moved ahead with pilot programs that provide anti-
retrovirals at a low cost. The countries include Ivory Coast, Uganda and Senegal.

Botswana, a relatively wealthy African country, hopes to provide the medicines to all of
its citizens who need them by the end of the year.

Many people here hoped South Africa would be next. AIDS activists want the
government to consider financing plans, to start training nurses and doctors and
upgrading local hospitals and to put together a national treatment plan.

Other activists are pressuring the government to apply for special permission to import
cheap generic versions of the patented AIDS drugs, which would finally bring the
"cocktails" within reach.

But the government is clearly reluctant to take the preliminary steps to get those drugs
to the dying.  Some suspect this reluctance may come from President Thabo Mbeki,
who has publicly questioned the safety of the drugs and whether H.I.V. causes the
disease. After being assailed here and abroad for his stance, Mr. Mbeki withdrew from
the AIDS debate last year.

And in recent months, the government has taken positive steps, announcing a pilot
program to distribute anti-retrovirals to pregnant women to prevent transmission to
newborn; accepting a drug company donation to treat opportunistic infections; and
developing guidelines for the proper use of anti-retrovirals in the private sector.

But Dr. Thabalala-Msimang emphasized that programs to provide anti-retrovirals for
adults were not coming anytime soon.  "For the moment, the best advice is to treat
opportunistic infections," she said on Thursday. She added that such treatment, along
with improved diet and counseling, would "allow people with H.I.V. to manage their
lives and participate adequately."

"We are indeed treating people who are H.I.V. positive," Dr. Thabalala-Msimang
continued, in response to repeated questions about when anti-retroviral programs
might be available. "It is not correct to say that just because we do not provide anti-
retrovirals that we are not treating people."

- A posting from health-l@hivnet.ch


--
Send mail for the `ProCAARE' conference to `procaare@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-procaare@usa.healthnet.org'.