Congress of South African Trade Unions

There is no doubt that mine workers with occupationally acquired lung diseases get a raw deal in South Africa. Their counterparts in other industries receive monthly pensions for life.

A National antiretroviral treatment plan is affordable and achievable and cabinet should give it the green light as soon as possible. This is the message of a health department and treasury task team asked to investigate whether it is feasible to provide anti-AIDS drugs in the public sector. The confidential report, which has been through four drafts since work began on it last September, shatters the myth that SA cannot afford to provide free antiretrovirals through the public health sector. The report presents several scenarios, assuming various coverage and adherence rates and drug prices. The most likely scenario, says a task team member, is that by 2008, SA will be comfortably treating 500 000 people (about 50% of those in late-stage AIDS) for about R4bn/year. If it succeeds, it will be the largest and cheapest antiretroviral treatment programme in the world. In the absence of absolute drug prices, the team has estimated that treatment will cost R7 000- R12 000/person/year, including drugs, laboratory tests and consultations. It assumes the mean life span of a person on antiretrovirals will be five to six years. Detailed procurement work can begin once cabinet approves. (Source: Claire Bisseker and Carol Paton: The Financial Mail, 9 May 2003)

One of the founding principles of the constitution is that all citizens should enjoy equal rights, benefits and privileges. The rights to healthcare, food, water and social security are contained in clause 27 of the Bill of Rights. This clause obliges the state to take reasonable legislative and other measures within its available resources to achieve the progressive realisation of these rights. If nothing else, this is a prohibition against the establishment of a two-tier health system where the deciding factor in terms of treatment becomes a diagnosis of each individual patient's bank balance. Growing unemployment and medical aid costs, which have risen well above the rate of inflation, have meant that fewer South Africans can now afford private medical cover. But such cover is now the only guarantee of prompt and efficient healthcare - and it is becoming increasingly expensive. Workers contributing to a medical aid have the right to choose whether they wish to be treated at a government or private facility, says Fedusa spokesperson Kim Mapley. However, the medical aid schemes and the industry's registration body, the Council for Medical Schemes, argue that the move to use state hospitals is one way to reduce the cost to medical aid patients. The greater use of state facilities is seen as a ploy to maintain and increase the burgeoning profits of the major players in the medical aid industry. Fedusa pointed out this week that most state hospital facilities were in a situation of neglect. To cream off resources to satisfy the needs of medical aid companies could compromise the already generally poor healthcare available for the majority of the population. In the view of many within the labour movement, this would qualify as a serious crime. (Source: Terry Bell: Business Report, 31 January 2003)

The Treatment Action Campaign' (TAC) and the Congress of SA Trade Unions (Cosatu) launched a new broadside in their campaign to widen access to affordable AIDS drugs, lodging a complaint of excessive pricing with the Competition Commission against multinational drug companies GlaxoSmithKline and Boehringer Ingelheim. If the Competition Commission refers the case to the Competition Tribunal, it will open up the possibility of the companies being ordered - under provisions in the Competition Act - to reduce the prices of AIDS drugs in the private sector.They could also be forced to pay a penalty of up to 10% of their annual turnover in SA and face damages claims from individuals. The complaint alleges that the local and international operations of the companies have engaged in excessive pricing of antiretroviral medicines, used to delay the onset of AIDS. It also alleges that the pricing practice is detrimental to the consumer because it is directly responsible for premature, predictable and avoidable deaths of people living with HIV/AIDS. Geffen said the commission would consider a price to be excessive if it was higher than one reasonably related to the economic value of the product. Three of the drugs in question are manufactured by Glaxo AZT (Retrovir), Lamivudine (3TC) and the two in combination (Combivir). Boehringer is being challenged over the price of Nevirapine, which it manufactures under the brand name Viramune. Antiretroviral medicines are currently available only in the private sector because government policy limits provision of the drugs in state facilities to victims of sexual assault and medical personnel injured at work. Boehringer SA MD Kevin McKenna said yesterday he rejected completely allegations that the company had abused its dominant market position to charge excessive prices. The SA price of Viramune was about 20% of that in developed countries. Glaxo's director for corporate affairs, Vicki Ehrich, said a preliminary assessment of the complaint led the company to believe that it was unjustified We reject the allegations of excessive pricing. Glaxo's pricing in the private sector in SA was among the lowest in the world. The price of Combivir, for example, was 80% lower than the world average, she said. She also pointed out that Glaxo had offered its AIDS drugs at preferential prices to governments in the developing world, including SA, and they had not taken up the offer. Nine complainants have joined TAC and Cosatu in the case. (Source: Business Day, 20 September 2002)

The Treatment Action Campaign (TAC) and trade union federation Cosatu have devised a firm set of recommendations for government to tackle the AIDS crisis head on. Their proposals, which included the provision of antiretroviral medicines to AIDS patients attending public healthcare facilities, would place the state under increased pressure to deliver on its cabinet statement of April 17, said African National Congress (ANC) health secretary Saadiq Kariem. The Cosatu-TAC treatment plan was developed at an AIDS conference in Durban last week. It drew more than 800 delegates from nongovernmental organisations, religious groupings, trade unions and the scientific sector. The plan will shortly be tabled at the National Economic Development and Labour Council for discussion, and will also be submitted to the SA National AIDS Council, which is chaired by Deputy President Jacob Zuma. At present patients can buy antiretroviral medicines privately, and the TAC estimates that 20 000 people access such treatment via medical schemes. A limited number of public hospitals and clinics provide drugs for preventing the transmission of HIV from mother to child, as well as HIV drugs for rape victims, but the state does not provide antiretroviral medicines for people suffering from HIV/AIDS. In the few public healthcare facilities providing antiretrovirals, the provision is made under the auspices of externally funded research projects. TAC spokesman Nathan Geffen said that the treatment plan proposed two pilot sites a province. The TAC estimated that this would cost R10 000 a person for each year, at current drug prices, but if government were able to access cheaper generic medicines, the annual cost per person could be reduced to R7 000, he said. TAC was still finalising its costing models, but believed that it was more cost effective to treat people than to let them get sick and die. He said that the provision of antiretroviral medicines was just one part of the plan, which also recommended the nationwide provision of voluntary counselling and testing, providing Nevirapine to prevent mother-to-child transmission of HIV, and providing post-exposure prophylaxis for rape victims, as well as improving the availability of essential drugs for treating herpes. The plan was intended to complement government's existing five-year plan for tackling HIV/AIDS. (Source: Business Day, 1 July 2002)

Much of the news making headlines nationally and internationally this week, has centered around case number 4183/98 in the Pretoria high court. The court case between pharmaceutical manufacturers and the South African government, which started on Monday, has been looming for three years. The controversial clause under scrutiny, section 15(c) of the Medicines and Related Substances Control Amendment Act No 90 of 97, gives the health minister power to override patent protection when the minister considers it appropriate. The pharmaceutical industry is fighting to prevent the importation or local manufacture of generics or unauthorised drugs that they claim infringe their intellectual property rights. The court case is being perceived as the ultimate battle between big industry's most fundamental weapon and Africa's most fundamental threat - the protection of intellectual property versus access to drugs. Pharmaceutical companies say any infringement of intellectual property rights as enshrined in international trade agreements amounts to a disincentive for investment and research and development. The Pharmaceutical Manufacturers Association (PMA) contends that compulsory licensing and parallel trade have not been effective in increasing access to medicine and healthcare in developing countries. But the Director General in the Department of Health, Dr Ayanda Ntsaluba, said that the real issue is government policy to legally pursue alternative methods of getting lower-cost drugs. The latest figures show that we are about 0,6% of the global market and 1,2% in terms of value. We are not going to make or break major pharmaceutical companies. The issue for them is not South African markets. It's the precedent that it sets. That is the biggest threat to them, he said. In a new twist to the saga, the Health Minister informed the state law advisers that the Medicines Regulatory Authority Act is to be repealed this year. There is specualtion that this move could have an effect on the outcome of the court case.

The Health Department has confirmed that a group of about 40 international pharmaceutical companies would take the government to court over provisions in the Amendment Act, in particular the uncontrolled importation or manufacture of cut- price versions of patented AIDS drugs, bringing to a head a three-year-old intellectual property dispute.  The setting of the court date - 5 March 2001 - holds out the possibility that this protracted matter will now be brought to a resolution, department spokeswoman Jo-Anne Collinge said. The department said government would oppose the application, which will be heard in the Pretoria High Court on March 5. London-based GlaxoSmithKline, the world's largest supplier of HIV/AIDS medicines, said the industry was alarmed by implications of the law. Clause 15c gives the health minister total power to dismiss patents without any process whatsoever. That is what the companies object to, company spokesman Phil Thomson told Reuters. The South African dispute is a thorn in the side of the international drugs industry which is eager to prevent the uncontrolled spread of generic AIDS drugs in the developing world that might leak back on to high-price markets in Europe and North America.