Kaiser Daily HIV/AIDS Report - Mon, 22 Oct 2001
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* Negligence Suit Filed Against South African Health Authority on Be-
half of HIV-Positive Baby
* Activists Criticize Pfizer's South Africa HIV/AIDS Drug Program
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Negligence Suit Filed Against South African Health Authority on Be-
half of HIV-Positive Baby
Attorneys representing a six-month-old infant who contracted HIV from
her mother are suing South African health authorities for negligence
for failing to inform the mother of means available to reduce the
odds of vertical transmission, the Johannesburg Mail & Guardian re-
ports. The mother says that she was never asked about her HIV status
while regularly attending antenatal classes at the Ka-Nyamazane
clinic at Rob Ferreira Hospital, and although she underwent repeated
blood tests, no one ever discussed with her the results. She became
aware of her HIV status in 1998, but she did not disclose the infor-
mation to anyone because of the stigma attached to the virus (Ma-
gardie, Johannesburg Mail & Guardian, 10/19). However, the woman's
mother reports that she informed doctors of her daughter's HIV
status, and no one informed the pregnant woman that the drug nevirap-
ine could reduce her chances of passing the virus on to her fetus
(Swindells, Reuters, 10/19). Richard Spoor, the attorney representing
the baby with assistance from the AIDS Law Project, has served a let-
ter of demand on Mpumalanga Health Minister Sibongile Manana seeking
$76,000 (U.S.) in damages (Mail & Guardian, 10/19). "This child faces
a very bleak future unless we win this case," Spoor said, explaining
that the mother is unemployed and will most likely die before the
child's fifth birthday if she does not receive help. "The health au-
thorities and doctors have a duty to care for pregnant women. Their
conduct was unlawful, they are liable," Spoor stated (Reuters,
10/19). Spoor also said that the health authority could have done
"much more" to protect the infant. Doctors could have included HIV
information in the antenatal classes, prescribed vitamin supplements
and delivered the infant by Caesarean section, which carries a lower
risk of transmission than vaginal delivery. The mother says that at
"the very least" health authorities could have informed her that
nevirapine was available in the private sector.
National Implications
If the case goes to court, it could have "dramatic consequences" for
the South African government's policy of not providing antiretroviral
drugs to HIV-positive pregnant women (Mail& Guardian, 10/19). The
South African Medicines Control Council approved nevirapine last De-
cember for use in the prevention of HIV transmission from pregnant
women to their unborn infants, as well as for rape cases, and the
government announced plans to launch an 18-site pilot project to dis-
tribute the drug to HIV-positive pregnant women last January (Kaiser
Daily HIV/AIDS Report, 1/29). In August, the Treatment Action Cam-
paign, an AIDS advocacy group, filed a lawsuit against the government
seeking to force officials to expand the program "throughout the pub-
lic health system" and to require the government to develop a "clear
national policy" on the prevention of vertical transmission, "includ-
ing all components, such as counseling" (Kaiser Daily HIV/AIDS Re-
port, 8/22). Together, the two cases will likely "throw a spotlight
on the government's controversial approach to AIDS," Reuters reports.
A report released last week by South Africa's Medical Research Coun-
cil listed AIDS as South Africa's leading killer and warned that up
to seven million people could die of the disease by 2010 if preven-
tion steps were not taken and treatment was not offered. But the gov-
ernment has declined to provide antiretroviral therapy, saying the
drugs are too expensive and that their safety is unproven (Reuters,
10/19).
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Activists Criticize Pfizer's South Africa HIV/AIDS Drug Program
While Pfizer officials defend their "seemingly generous" plan to give
away the antifungal medication Diflucan to government clinics in
South Africa, many AIDS advocates are criticizing the program, call-
ing it a "very conditional gift," Forbes reports. Diflucan, with an-
nual worldwide sales totaling $1 billion, is an antifungal medication
used to treat infections in HIV/AIDS patients. Under the program,
which Pfizer eventually plans to expand to 50 countries, Diflucan is
donated "only through public-sector clinics." According to Forbes,
this policy excludes a "large segment" of HIV-positive South Africans
who are served by 2,500 private pharmacies. Pharmacy patients must
pay the annual retail price of $3,600 for Diflucan to treat crypto-
coccal meningitis. Those who cannot afford to pay this sum "could
turn to the public clinics," but those clinics are "already hugely
overburdened and not equipped to handle private-sector patients,"
Forbes reports. Since the program was announced in the spring of
2000, only 4,000 South Africans have received Diflucan in 120 of the
nation's "several thousand public clinics and hospitals," well below
the company's projection of 50,000 recipients over two years. Pro-
gress has been slowed by the "red tape" that frequently accompanies
government programs in South Africa -- the company had to meet with
officials from each of the country's nine provinces, establish eligi-
bility criteria for patients and "ensure that the drug wouldn't be
diverted out of the country."
Should Pfizer Follow the Pack?
Activist groups such as Doctors Without Borders and Oxfam Interna-
tional "argue" that Pfizer should follow the lead of its competitors.
In March, Merck lowered the price of its two HIV/AIDS drugs in 40 de-
veloping countries, making "no distinction between public and private
markets," while Bristol-Myers Squibb began selling two of its
HIV/AIDS drugs "below cost" and has allowed generics to be sold in
sub-Saharan Africa. Activists would like Pfizer to charge between 20
cents and 40 cents for Diflucan -- the "approximate cost of a generic
version [that] is barred in South Africa but sold elsewhere" -- and
sell the drug through all the country's "normal outlets."
In Defense
Henry McKinnell, Pfizer's "defiant" chair, takes exception to the
criticism. "For God's sake, why are we being attacked for a program
that's actually produced results?" he asked. Addressing the sugges-
tion that the drug should be distributed more widely, he said the
program is "aimed at getting Diflucan into the hands of indigent pa-
tients who are served by the government -- not the general popula-
tion." He concluded: "We are doing more good for people than any
other pharmaceutical. We should all be working together to get this
horrible problem under control" (Machan, Forbes, 10/29).
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