Politics of South Africa

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.

In May 1994, a month after being sworn in as the ruling party, the African National Congress (ANC) drew up a National Health Plan, with technical assistance from the World Health Organisation and the United Nations Children's Fund. The ANC called for the development and implementation of an effective HIV/AIDS strategy by the end of 1995. Only now, a decade later, is a comprehensive treatment plan being rolled out.

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)

The South African Medical Association (Sama), a powerful independent lobbying body, has called for the government to declare a state of medical emergency to halt the mounting HIV/AIDS death spiral crippling the country. In accordance with World Trade Organisation rules, the declaration of a medical emergency would, as in the case of Brazil, allow for the immediate setting up of generic manufacturing capabilities and would ensure that the growing number of people receiving funded antiretrovirals are not left to die should short-term funding for treatment run out. At present, about 10 000 South Africans are receiving free anti-AIDS drugs through overseas funding initiatives. However, while medication is for life, most funding is not. Dr Kgosi Letlape, the chairperson of Sama, said it was the responsibility of all those affected and infected by HIV/AIDS as well as healthcare workers and nongovernmental organisations to call on the government to declare a state of medical emergency and come up with a treatment programme that includes affordable and sustainable life-saving drugs. Robert Pawinski, the co-initiator of the KwaZulu-Natal Global Fund bid said that overseas funds would not flow indefinitely and there was no excuse for sitting back and doing nothing. Clem Sunter, the founder of the South African Business Coalition Against HIV/AIDS, said that the time was now appropriate for the government to engage all South Africans in the fight against AIDS. There is a commonality of purpose and willingness whether it be pharmaceutical companies, NGOs, the government or just ordinary citizens. We just need to get together and work it through. Responding to mounting pressure by organisations such as the TAC, Dr Manto Tshabalala-Msimang, the minister of health, said that no official response would be made before the end of April.(Source: Liz Clarke: The Sunday Independent, 23 February 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)

NGO questions if government can turn words into deeds Despite a promising start, negotiations over a national AIDS policy could drag on into the new year. A meeting between negotiators at the National Economic Development and Labour Council (Nedlac) is expected to take place before the end of the week, and AIDS activists have requested that an agreement be reached by tomorrow. But yesterday, business sector negotiator Vic van Vuuren said it was unlikely that all parties who needed to be consulted about the far-reaching agreement could be canvassed this year. The delay is a dramatic change from the position a week ago, when negotiators at Nedlac appeared ready to announce a major breakthrough on Sunday as part of World AIDS Day commemorations.But, last Thursday night, the process came to a halt as government and business negotiators said they still needed to get a mandate. More meetings were held and, by Saturday, a joint statement announcing that an agreement had been reached was prepared. But, due to disagreement about the wording, it was never released. On Sunday, the Department of Labour said the announcement of an agreement had been premature. Now, AIDS activists from the Treatment Action Campaign say, the negotiations have turned into a demoralising controversy. Each day wasted is a day in which lives are lost, the TAC said yesterday. The framework agreement under discussion covers a broad spectrum of AIDS issues and includes provisions for treatment with antiretroviral triple therapy and extending access to the anti-AIDS drug Nevirapine to pregnant women across the country. It seems that the government is unable to turn policy into practice, the TAC said.(Source: Lynne Altenroxel,The Star, 5 December 2002)

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 Treatment Action Campaign says it is to pressure the government to take over a pharmaceutical factory in Midrand, north of Johannesburg, to produce affordable anti-AIDS drugs. TAC chairman Zackie Achmat said on Tuesday this would form part of the group's major campaign for 2001, a drive for the local manufacture of generic antiretroviral drugs. Owners of the plant, international pharmaceutical giant GlaxoSmithKline, plan to shut down the production line and convert it into a packaging facility by the end of 2003. TAC vice chairman Mark Heywood said Glaxo executives told him last year that the plant had the capacity to produce essential HIV/AIDS drugs for not only South Africa but the rest of southern Africa as well. He said he had raised the proposal informally with health Minister Manto Tshabalala-Msimang, who had in turn expressed concern at the shutdown of the manufacturing plant. The government is aware of it, said Heywood. Whether they have entered into negotiations with Glaxo about it is a different matter. But they are well aware of it. Tshabalala-Msimang's spokesman Sibani Mngadi said however he could not comment at this stage. TAC has not approached us on this issue. We don't know anything about it, he said.