Kaiser Daily HIV/AIDS Report - Tue, 15 May 2001
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* Citing Cost and Infrastructure Concerns, South Africa Has 'No In-
tention' of Purchasing 'Cheap' Antiretrovirals
* Nigeria's Promise of AIDS Drugs Raises Hopes, Decreases Disease
Stigma, Boston Globe Reports
* Anglo American Board of Directors Supports Executives' Plan to Pro-
vide Employees with Drugs
* 'NewsHour' Begins Weeklong Series on AIDS in Africa with Malawi Re-
port, Annan Interview
--
Citing Cost and Infrastructure Concerns, South Africa Has 'No Inten-
tion' of Purchasing 'Cheap' Antiretrovirals
Despite the "courtroom victory" last month that opened the door for
the South African government to buy "cheap" antiretroviral drugs,
Health Minister Dr. Manto Tshabalala-Msimang said in an interview
with London's Guardian that the government "has no intention" of pur-
chasing the drugs. Instead, the government will "limit itself" to
purchasing antibiotics for tuberculosis and other infections that
kill HIV-positive individuals, as well as those not infected with the
virus. The South African government, despite "pressure" from local
and foreign AIDS activists to buy the antiretrovirals, says the
treatments are still too expensive and the country lacks the infra-
structure to "distribute the drugs safely." Although the pharmaceuti-
cal company Cipla has offered to sell the drugs to South Africa for
$250 per person a year, Tshabalala-Msimang said that the price is
"still to high." She added, "It is $250 times millions of people
times the infrastructure that we do not have times the health workers
who are not yet trained times prevention measures." However, the ad-
vocacy group Treatment Action Campaign is "threatening" to sue the
government for failure to provide antiretroviral treatment in order
to prevent vertical HIV transmission. In addition, the London-based
Anglo American mining company is interested in purchasing the drugs
for its workforce and may seek a compulsory license so the drugs
could be produced cheaply in South Africa (Boseley, Guardian, 5/14).
Meeting with Industry
In related news, Tshabalala-Msimang met with leaders of five pharma-
ceutical companies on Friday to discuss the regulations of the Medi-
cines and Related Substances Control Amendment Act, which the compa-
nies claimed in court was unconstitutional. While the drug makers
dropped their case last month, the two sides agreed to have the com-
panies provide "early comment" on the regulations prior to a three-
month public comment period. To "speed up the process," the govern-
ment and the drug firms will establish a "working group" of represen-
tatives from industry and government to foster "interaction ... on
areas where there [are] diverging views," Tshabalala-Msimang said.
The companies involved in the discussions include Bayer, Boehringer
Ingelheim, GlaxoSmithKline, Merck and Roche (South African Press As-
sociation/BBC Monitoring, 5/14).
--
Nigeria's Promise of AIDS Drugs Raises Hopes, Decreases Disease
Stigma, Boston Globe Reports
Nigeria and other sub-Saharan African countries are set to distribute
a "meager round" of discounted anti-HIV drugs this month, but only
Nigerians who can afford the therapy will receive the treatments at
this time, the Boston Globe reports. Although more than four million
Nigerians are HIV-positive, there are only drugs available for
10,000, creating an "ethical problem for doctors," Dr. John Idoko
said. Idoko, who has run AIDS drug clinical trials for three years
for GlaxoSmithKline, helped establish a regional laboratory to test
immunity levels in people with HIV/AIDS and began Halt AIDS, a pre-
vention and education program, said that he has been "inundated" with
requests for medication in the past several weeks. According to the
Globe, "just the whiff of a promise of treatment is revolutionizing
the entire strategy of fighting AIDS in Africa. Suddenly, in a land
where almost everyone was unwilling even to discuss the disease, peo-
ple are asking to be tested. Before the promise of anti-AIDS drugs,
people had little reason to learn if they were infected." When Nige-
ria was under the rule of military dictator Sani Abacha, who died in
1998, there was no government spending on AIDS prevention or educa-
tion. But last year the government appropriated $100,000 for AIDS,
and this year Nigerian President Olusegun Obasanjo increased the
amount to $20 million. However, given the country's reputation for
corruption, the question is whether the money will be well spent, and
"whether the country can develop a workable plan to use it," the
Globe reports (Donnelly, Boston Globe, 5/13).
--
Anglo American Board of Directors Supports Executives' Plan to Pro-
vide Employees with Drugs
The board of directors for the London-based mining giant Anglo Ameri-
can PLC has agreed to support company executives' plan to assess if
and how AIDS drugs can be provided to the company's 160,000 African
workers, 20% of whom are HIV-positive, the Wall Street Journal Europe
reports. The board, however, has not yet committed to providing the
drugs. Anglo American will run a clinical trial to address how to
help workers adhere to the complex drug regimens and handle the side
effects, and to analyze treatment costs and benefits. Company execu-
tives have said that offering medicine will help manage the disease
and may save corporate dollars in the long run. The board's decision
to consider the drug provision was welcomed by South African AIDS ac-
tivists (Schoofs, Wall Street Journal Europe, 5/15).
--
'NewsHour' Begins Weeklong Series on AIDS in Africa with Malawi Re-
port, Annan Interview
"NewsHour with Jim Lehrer" last night featured an interview with U.N.
Secretary-General Kofi Annan, in which he discussed his proposal for
a $7 billion to $10 billion international fund to fight AIDS in de-
veloping countries. When asked by correspondent Elizabeth Farnsworth
if the $200 million President Bush has pledged toward a global AIDS
fund was "enough," Annan said, "I think as the president himself
said, this was a fund contribution and there is probably some more to
come. Obviously, our target is to get $7 billion to $10 billion addi-
tional money applied to the epidemic, and I would hope that the
president's action [Friday] would energize other leaders and other
people in society to come on board. ... But I think we launched it
[Friday], and I think it was an important beginning." When asked who
will administer the fund, Annan said, "We will have a board that will
oversee the money and [m]ake the decisions. The board will include
representatives from donor governments, from recipient governments, a
civil society, including those organizations fighting the AIDS epi-
demic, people from the private sector and the international organiza-
tion[s]. There will be a small secretariat attached to this ... that
will do the day-to-day administration. But the funds will be handled
by the World Bank; they will do the banking responsibilities. And of
course there will be a scientific advisory body attached to it to en-
sure that we are aiming for the right result and ... we would ensure
that we are effective and we are getting value for money." Responding
to Farnsworth's question regarding how the funds will be divided be-
tween programs such as prevention and antiretroviral drugs, Annan
said, "I think we are setting up a single global fund with several
windows. It will be a fund for AIDS and infectious diseases such as
tuberculosis, as well as malaria. I have no doubt that some govern-
ments will target their contribution [to be] used only for AIDS. Oth-
ers may want it used for tuberculosis. And I hope others will give us
flexibility to use our funds as we see fit. ... [T]he quality of
those programs will play a role. ... [W]e will give the money to
those programs that we believe ... are likely to be most effective."
Annan said that the next step in setting up the global fund will come
at the June U.N. General Assembly special session on AIDS in New
York. "I hope between now and then governments will have time to de-
termine how much they are going to contribute to the fund. ... [T]he
G8, they're meeting at the end of July, [and] would also be taking up
this issue. ... I trust ... and urge that they all pay into one
fund," Annan said.
Leadership a Must
Annan said that he feels there has been a "great sea change" in rais-
ing awareness and mobilizing world leaders on this issue in the last
year. "We need leadership all across from the North and South, and so
I was very encouraged by the strong support of President Bush for
this effort. And I have reason to believe that all the leaders in
Europe and others will come on board. In fact, President [Jacques]
Chirac of France made a strong statement [Friday] morning supporting
the approach and the fund" after the donation announcement in Wash-
ington, Annan said.
Drugs and Intellectual Property
On the topic of drug manufacturers and intellectual property rights,
Annan said that President Bush's message was that the "intellectual
property regime has to be respected so the pharmaceutical companies
will have the incentive to continue their research to produce medica-
tion, cure and vaccine[s] for diseases like AIDS." Although Annan has
spoken to the pharmaceutical companies and understands the incentive
argument, he said that "we should be able to buy generic medication,
and we should be able to offer treatment to those who have been hard-
est hit by the disease" (Farnsworth, "NewsHour with Jim Lehrer," PBS,
5/14).
Malawi Struggles with Epidemic
"NewsHour" also re-aired its April 25 segment on Malawi's AIDS epi-
demic. Correspondent Elizabeth Farnsworth traveled to the country to
"grasp the scope of the AIDS catastrophe engulfing southern Africa"
(Farnsworth, "NewsHour," PBS, 4/25).
--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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