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Kaiser Daily HIV/AIDS Report Fri, 20 Apr 2001

South Africa's Health Minister Manto Tshabalala-Msimang "dropped a bombshell" yesterday when she announced that the government had "no immediate plans to use the landmark legal victory" to obtain antiretroviral drugs.

South Africa's Health Minister Manto Tshabalala-Msimang "dropped a
bombshell" yesterday when she announced that the government had "no
immediate plans to use the landmark legal victory" to obtain antiret-
roviral drugs, the Wall Street Journal reports. The Pharmaceutical
Manufacturers Association of South Africa and 39 pharmaceutical com-
panies yesterday agreed to drop their lawsuit against the South Afri-
can government over a law that would allow the country to import and
manufacture cheaper generic AIDS drugs. But speaking before a
"packed" conference room, the health minister said, "We never said we
want to use antiretrovirals. But we have to place our options on the
table to see what we will use." Tshabalala-Msimang added that the
drugs are "still too expensive, too dangerous and too difficult to
manage for the government to incorporate them into its AIDS-fighting
plans." She said that the government would instead focus on "nutri-
tion programs and better treatment of infections." Following the
health minister's statement, Zackie Achmat, chair of the South Afri-
can Treatment Action Campaign, said that activists would "work to
persuade the government to change its position on antiretroviral
drugs." The Journal notes that the case over the South African law
was "technically about patent rights, not AIDS medication per se."
However, the issue of AIDS drugs was brought to the forefront as AIDS
activists used the high cost of antiretrovirals as a "symbol of bar-
riers preventing poor Africans from getting treatment" (Block, Wall
Street Journal, 4/20). The Guardian added that "large numbers of peo-
ple ... regarded the court battle as primarily a struggle for drugs
to combat the pandemic" (McGreal, Guardian, 4/20).

Government, Pricing Not the Only Problems

The government's attitude toward AIDS drugs is not the only obstacle
to obtaining treatment for South Africa's 4.7 million HIV-positive
patients. The Los Angeles Times reports that many state hospitals
"lack equipment and medicine to treat even basic illnesses," that
there is a shortage of doctors and nurses and that "poor roads and
communications hamper access to medical facilities in rural areas."
In order to make effective use of antiretrovirals, officials estimate
that South Africa needs to invest "at least" $1.25 billion over the
next 10 years to bolster its health care infrastructure (Simmons, Los
Angeles Times, 4/20). The New York Times reports that "the most
sweeping aspects of the South African law will not take effect for
several months and it seems unlikely that they will dramatically im-
prove access to AIDS drugs in [the] country." Even cheaper generic
AIDS drugs sold outside of South Africa are "still too expensive" for
most of the country's residents (Swarns, New York Times, 4/20). Ach-
mat said, "We have won the first round, but there is a lot ahead that
we have to do. We need a much firmer commitment and political commit-
ment from our government." And John Kearney, general manager of the
South African division of GlaxoSmithKline, said, "I feel genuine sad-
ness for those who perhaps believed that the pricing of antiretrovi-
rals was the only barrier (to treatment) and that that barrier would
come down as a result of this court case. If people's hopes have been
raised prematurely by that then that's a great shame" (Nessman, Asso-
ciated Press, 4/19). In a statement issued by a spokesperson, U.N.
Secretary-General Kofi Annan said that "[h]e hopes that [the outcome]
... presages a new era of cooperation between governments and the
private sector in the struggle for better health care throughout the
developing world," adding that the "credit for this positive outcome
goes to the wisdom and perseverance of the parties concerned, and to
the constructive intervention of Presient Thabo Mbeki" (U.N. release,
4/20). However, South Africa's Business Day reported that "Government
may have won a glorious battle ... but Pretoria risks losing the war
unless Health Minister Manto Tshabalala-Msimang takes a more enlight-
ened and sophisticated approach" to dealing with HIV/AIDS (Agence
France-Presse, 4/20).

Global Implications

While the case settlement may not spur an immediate flood of antiret-
rovirals into South Africa, it may serve to "embolden people in de-
veloping countries around the world to stand up for medicines that
are affordable," TAC's Mark Heywood said (AP/Richmond Times-Dispatch,
4/20). Oxfam, Medecins Sans Frontieres and TAC said in a joint state-
ment, "The outcome of the case signals a dramatic shift in the bal-
ance of power between developing states and drug companies." BBC News
reports that the settlement "could become a blueprint for future re-
lations between pharmaceutical companies and governments in the de-
veloping world" (BBC News, 4/19). In particular, the case may bode
well for Brazil, India and Thailand -- three countries currently
manufacturing generic AIDS drugs. In Thailand, for example, AIDS pa-
tients and activists are planning a legal challenge to "the validity
of a Bristol-Myers Squibb patent on an AIDS drug." And Brazil, which
already permits generic production of some HIV drugs, has also
"threatened" to grant licenses to local companies on patents on AIDS
drugs held by Merck & Co. and Hoffman-La Roche (Pollack, New York
Times, 4/20). I.S. Gilada, one of India's "most prominent AIDS ex-
perts," described the settlement as a "'major triumph' for all devel-
oping countries and said it would throw the doors open to a market
worth a fortune for Indian companies," Agence France-Presse reports.
Indian drug firms involved in manufacturing generic drugs include Ci-
pla, Zydus Cadila, Aurobindo, Sun Pharmaceuticals and "two to three
smaller firms," Gilada said. In addition, several new Indian compa-
nies are expected to enter the generics market. Mukhu Hamied, joint
managing director of Cipla, predicted that international AIDS drug
prices "will come down to a tenth of what they are now." He added,
"This is a terrific victory and opportunity for South African citi-
zens. They will be able to get generic drugs from generic drug sup-
pliers at affordable prices." Cipla is currently involved in "direct
talks" with governments of "several" African countries regarding the
sale of its triple drug "cocktail." Hamied said, "We expect to reach
an agreement with the Nigerian government by the end of this month.
We are also talking to the government of Cameroon. Our registration
process is on in countries such as Laos [and] Thailand" (Mukherji,
Agence France-Presse, 4/20).

Generic Drug Quandary

On a broader level, the settlement "threaten[s] moves toward more
globalization," the New York Times reports. Eight years after most
nations approved the Trade-Related Aspects of Intellectual Property
Rights agreement, which "commits [countries] to enforce drug pat-
ents," the agreement is "coming home to roost," Jim Keon, president
of a trade group representing generic drug companies in Canada, said.
The Times suggests that pharmaceutical companies are now offering re-
duced-cost drugs in developing countries to help protect their pat-
ents and stave off manufacture of cheaper generic drugs. But AIDS ac-
tivists maintain that "it is better to rely on competition from ge-
neric manufacturers than on voluntary actions by big drug companies."
However, the Times notes that even if developing countries are given
the leeway to manufacture their own generic versions of patented
drugs, "it is not clear if African countries have the scientific ex-
pertise for a research-oriented drug industry" (Pollack, New York
Times, 4/20).

Media Coverage

NPR's "All Things Considered" yesterday reported on the case settle-
ment and the pharmaceutical companies' public relations "headache."
To listen to the reports, go to

To listen to NPR's "Morning Edition" report that will be available
approximately three hours after the West Coast show ends, go to

and scroll down to "AIDS-drug Settlement." And to view a South Afri-
can Broadcasting Corporation news clip, enter,1573,3747,00.ram

into your Web browser. Note: You must have RealPlayer to listen to
these clips.


Kaiser Daily HIV/AIDS Report Rounds Up Editorials, Op-Eds on South
African Lawsuit, Drug Access

The public continues to weigh in on the issue of AIDS drug access for
developing nations, as well as the recently abandoned lawsuit brought
by 39 pharmaceutical companies against South Africa. Excerpts from
some pieces appear below:

* New York Times:
The pharmaceutical industry's decision to drop its lawsuit is the
"latest in a series of deserved setbacks for the drug industry on the
issue of AIDS in the third world" and a "long overdue bow to both
public health needs and common sense," a New York Times editorial
says. But the move now puts the "burden" for distributing AIDS medi-
cations "squarely on [South Africa's] strangely inert government,"
which has been "inexplicably passive -- even hostile -- to treating
the disease." Although officials fear that paying for AIDS drugs will
"balloon the nation's health budget," failing to treat patients early
"carries an even higher future cost in hospitalizations and deaths"
of productive workers. While wealthy nations should help South Africa
pay for AIDS drugs, the editorial concludes, "[T]he country itself
must make a greater commitment to treating its millions of citizens
infected with the AIDS virus" (New York Times, 4/20).

* Bergen Record:
With the withdrawal of the drug makers' lawsuit, South Africa could
now be able to make or import generic AIDS drugs, but the government
has "acknowledged it would be some time before it could come up with
a widespread plan to provide the medications to those who need them,"
a Bergen Record editorial states. The editorial concludes, "The
United Nations should work with the government of South Africa and
other sub-Saharan nations ravaged by AIDS to begin the long process
of finding ways to distribute and monitor treatment" with drugs (Ber-
gen Record, 4/20).

* The Age:
"It is scandalous that it has taken so long for Africans to receive
the benefits of AIDS research," according to an editorial in Austra-
lia's The Age. The blame, however, is not entirely on the drug compa-
nies; the editorial notes that South African President Thabo Mbeki
has questioned the effectiveness of antiretroviral drugs and that the
government has not ordered the production of generic drugs despite
having the "legal power" to do so. Drug makers' profits will not be
hurt seriously by their decision to drop the suit, the editorial
adds, since Africa represents just 1.3% of the world's pharmaceutial
market. Nevertheless, the "withdrawal is symbolically important be-
cause it acknowledges, by default, that human life carries a higher
value than a patent" (The Age, 4/20).

* New York Daily News:
In television ads for prescription drugs, the pharmaceutical industry
touts itself as a "paragon of virtue and compassion," with slogans
such as Pfizer's "Life is our life's work," columnist Arianna Huff-
ington writes. But the fact that "it took world opinion turning on
them -- and three long years of people dying -- to get them to drop
their suit" in South Africa "proves the industry's collective slogan
should be "Profit is our life's work," she adds. Huffington calls the
FDA's decision to permit drug companies to advertise products di-
rectly to consumers a "serious mistake" that should be reversed.
Though the industry's lobbying contributions will make that diffi-
cult, Huffington concludes, "[T]he industry's surrender in South Af-
rica shows that public pressure and grass-roots protests really work.
So let's build on this victory and rid our airwaves of this plague of
prescription drug ads" (Huffington, New York Daily News, 4/20).

* London Independent:
The decision by the 39 pharmaceutical companies to drop their lawsuit
against the South African government is "welcome news -- if belated,"
an Independent editorial states. The editorial predicts that "[a]ny
victory in court by the pharmaceutical companies would have been pyr-
rhic," since the "overwhelming negative publicity would have had
clear commercial knock-on effects." But the recent settlement "puts
the spotlight back on the South African government to show that it
can use the benefit of cheaper drugs to conduct an effective campaign
against the spread of a plague that its prime minister has sometimes
seemed reluctant to acknowledge" (Independent, 4/19).

* London Guardian:
The resumption of the case offered the drug firms "an opportunity to
begin repairing the damage they have wreaked in South Africa," a
Guardian editorial states. The editorial says, "Even the industry now
recognizes what a PR disaster [the case] has been," noting that
GlaxoSmithKline last month "privately confessed" to a Guardian health
correspondent that it "was sorry it had brought the lawsuit" (Guard-
ian, 4/18).

* Malaysia New Straits Times:
Patent monopolies provide "a very inferior means of financing re-
search" and are "enormously wasteful," Mark Weisbrot, co-director of
the Center for Economic and Policy Research, an organization that
promotes "democratic debate" on social issues, writes in a New
Straits Times opinion piece. Weisbrot states that pharmaceutical com-
panies are motivated by "pure, unadulterated greed" in their dealings
with developing nations and are poised to use a "formidable arsenal
of weapons to force compliance from poor countries." These tactics
include "economic pressures, lawsuits and the World Trade Organiza-
tion," he writes, noting that the WTO is currently involved in a dis-
pute between the United States and Brazil over Brazil's importation
and production of generic antiretrovirals (Weisbrot, New Straits
Times, 4/16).

* Washington Post:
Responding to Post columnist William Raspberry's March 26 op-ed on
South Africa and the HIV/AIDS crisis, South African Ambassador Sheila
Sisulu writes in a letter to the editor that the piece "may have led
some people to doubt the depth of South Africa's commitment to ad-
dressing the HIV/AIDS epidemic because of its decision not to declare
a 'national state of emergency.'" Declaring an emergency, she writes,
is "not the way to address the HIV/AIDS epidemic." Sisulu notes that
the South African constitution only allows an emergency to be de-
clared "when the life of a nation is threatened by war, invasion,
general insurrection, disorder, natural disaster or other public
emergency," and then only when "the declaration is necessary to re-
store peace and order." In addition, declaring a state of emergency
"curtails the provisions" of the country's bill of rights, and the
declaration can only last for 21 days, unless extended by South Af-
rica's parliament, and carries other "complex consequences" (Sisulu,
Washington Post, 4/16).

* Bulletin of the World Health Organization:
"There is an urgent need for WHO and UNAIDS to provide ... central
leadership in formulating similar clear plans of action for HIV/AIDS
control" in developing nations, Madhur Dev Bhattarai, a postgraduate
teacher at Bir Hospital in Nepal, writes in a letter to the bulletin.
Bhattarai lists several examples of possible strategies to combat the
disease, including outreach programs, short, educational TV and movie
spots, HIV/AIDS education in schools, "vigorous" condom promotion and
"increasing coverage of antiretroviral preventive therapy in preg-
nancy." Initiatives such as these, Bhattarai concludes, "would no
doubt generate proper response from governments in the developing
countries" (Bhattarai, Bulletin of the World Health Organization,
April 2001).

* Boston Globe:
The plan to fight HIV/AIDS in Africa put forward by Jeffrey Sachs and
a number of other Harvard University professors "glosses over major
issues" concerning the infrastructure of African health programs,
Harvard University fellows Clive Gray and Malcolm McPherson write in
a Boston Globe op-ed. The plan's recommendation of using existing in-
frastructures already developed for the treatment of other diseases
raises the question of how long it will take to adapt these struc-
tures to meet the demands of fighting HIV/AIDS, the authors write.
Gray and McPherson note that the World Bank and "other donors have
spent billions expanding health infrastructure in Africa," but that
these efforts proved to be "abject failures." In addition, many drugs
shipped to Africa to treat other diseases are "pilfered before they
leave the port," and those that do arrive at pharmacies are often
sold to patients at full price so that the public health staff can
"avoid starvation," they state. Gray and McPherson write that the
Harvard plan calls for the implementation of "large-scale pilot pro-
jects" as well as the "rapid expansion" of existing pilot programs, a
proposal that is "overly ambitious" and could "cas[t] a shadow on the
whole exercise" (Gray/McPherson, Boston Globe, 4/16).

* San Jose Mercury News:
A number of countries have "piously vowed" to help fight HIV/AIDS in
Africa, but their offers have sounded "pathetically hollow," a Mer-
cury News editorial states. The editorial endorses the Harvard plan,
stating that its cost is "manageable ... when looked at internation-
ally." Calling the plan an "innovative strategy" that offers "a com-
prehensive, stable and long term answer to the AIDS pandemic," the
editorial calls on world leaders to give the proposal "strong consid-
eration" when it is formally released this June (San Jose Mercury
News, 4/15).

Cecilia Snyder
mailto:[email protected]