Kaiser Daily HIV/AIDS Report - Tue, 27 Nov 2001
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* Merck Has No Plans to Further Reduce AIDS Drug Costs Despite Threat
of Generic Competition
* Pretoria High Court Judge 'Inclined to Agree' With Treatment Action
Campaign That South African Government Should Distribute Nevirapine
* New York Times Series Examines Traditional Healers Who Are
'Stumped' by AIDS
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Merck Has No Plans to Further Reduce AIDS Drug Costs Despite Threat
of Generic Competition
Merck & Co. Inc. has no plans to further cut the price of its AIDS
drugs, despite the threat of generic competition following a World
Trade Organization agreement adopted this month in Doha, Qatar,
Reuters/South Florida Sun-Sentinel reports (Reuters/South Florida
Sun-Sentinel, 11/26). Earlier this month, WTO ministers approved and
issued a declaration stating that developing nations can override
patent protections to produce medicines during public health emergen-
cies, addressing the Trade-Related Aspects of Intellectual Property
Rights agreement, or TRIPS, which outlines international patent rules
(Kaiser Daily HIV/AIDS Report, 11/15). Merck Vice President of Anti-
Infectives Guy Macdonald, speaking on a conference call about the
company's efforts to increase access to HIV drugs in developing coun-
tries, said that generic drug makers would be unable to match Merck's
already lowered prices in these nations (Reuters/South Florida Sun-
Sentinel, 11/26). Merck announced in March that it would sell to any
government, charitable organization or employer in developing nations
its protease inhibitor Crixivan for $600 per patient per year and its
non-nucleoside reverse transcriptase inhibitor Stocrin (known in the
United States as Sustiva) for $500 per patient per year (Kaiser Daily
HIV/AIDS Report, 3/8). Merck is currently working with the Bill and
Melinda Gates Foundation and Botswana's government to increase educa-
tion and treatment efforts in that country. "We're strengthening
partnerships to find a way to ensure there is a better balance be-
tween the care and management of HIV," Macdonald said, adding that
Merck has "made progress" working with nongovernmental organizations
to distribute AIDS drugs in other developing countries (Reuters/South
Florida Sun-Sentinel, 11/26).
--
Pretoria High Court Judge 'Inclined to Agree' With Treatment Action
Campaign That South African Government Should Distribute Nevirapine
The Pretoria High Court judge who is hearing the court case brought
by the South African AIDS group Treatment Action Campaign to require
the South African government to provide nevirapine to HIV-positive
pregnant women to prevent vertical transmission "seemed inclined to
agree" with TAC that the government should broaden access to nevirap-
ine throughout South Africa, the New York Times reports (Swarns, New
York Times, 11/27). TAC, the Children's Rights Center and Haroon Sa-
loojee, a physician in charge of community pediatrics at the Univer-
sity of the Witwatersrand, filed suit against the South African De-
partment of Health and eight of nine provincial health departments in
an effort to force the government to provide nevirapine to all HIV-
positive pregnant women through public hospitals and health clinics.
In addition, the lawsuit is asking the government to plan and imple-
ment a national program to prevent vertical transmission. The plain-
tiffs are asking that the program be created within three months and
that it include voluntary HIV/AIDS counseling and testing, the provi-
sion of nevirapine "where appropriate" and a supply of formula to
prevent HIV transmission through breastfeeding (Kaiser Daily HIV/AIDS
Report, 11/26). Pharmaceutical maker Boehringer Ingelheim has offered
to provide nevirapine free to developing nations, but South Africa
only offers the drug through 18 pilot programs nationwide (Kraft,
AP/Boston Globe, 11/27).
Arguments Presented
Gilbert Marcus, a lawyer representing TAC, said during arguments yes-
terday that the government's decision to limit nevirapine to the 18
pilot programs "arbitrarily, unnecessarily and irrationally amounts
to a conscious choice ... which results in the predictable and yet
avoidable deaths of ... children" (New York Times, 11/27). He added
that the government's policy on nevirapine is "not only a manifesta-
tion of irrationality, but nothing short of insanity" (McGreal,
Guardian, 11/27). Marcus noted that nearly 23% of pregnant women in
South Africa are HIV-positive, but only 10% of these women can access
nevirapine through the 18 test programs (Kraft, AP/Philadelphia In-
quirer, 11/27). Marumo Moerane, a lawyer representing the govern-
ment, summing up today's arguments said, "There is a right to health
care services; there is no right to nevirapine," adding that the gov-
ernment "cannot solve South Africa's woes overnight" (Kraft, Associ-
ated Press, 11/27). He said that the government must be "cautious"
in introducing a nevirapine program. "In order to give maximum bene-
fits to pregnant women and children, you have to have phased imple-
mentation. We are trying to be responsible," he said. TAC activ-
ists, however, say that the World Health Organization has deemed that
nevirapine is effective and "does not need to be tested in pilot pro-
jects" (AP/Boston Globe, 11/27). Government officials said they need
time to evaluate the test programs and work out any problems before
launching a broader nevirapine program. They added that problems
have already been found in several of the test sites, including a
shortage of space and staff to handle the "surge" of pregnant women
who seek HIV testing and counseling (New York Times, 11/27). Moerane
said that more counselors are needed to help educate HIV-positive
women about how the virus can be spread through breastfeeding
(AP/Philadelphia Inquirer, 11/27). Ayanda Ntsaluba, director-general
of the South African Ministry of Health, said that "it is very diffi-
cult to persuade women" to use formula instead of breastmilk
(AP/Boston Globe, 11/27).
Judge's Remarks
Judge Chris Botha, who is presiding over the case, said that he be-
lieves nevirapine distribution "has to be extended across the country
as soon as is practically possible" (New York Times, 11/27). Botha
"repeatedly voiced frustration at [the government's] reasoning" and
asked why the government had not set targets and timelines for the
drug to be made available across the country (AP/Boston Globe,
11/27). He added that looking at the results of the program in the
Western Cape province -- which already settled with TAC and offers
nevirapine to all HIV-positive pregnant women -- is "like going into
the promised land" (Guardian, 11/27).
--
New York Times Series Examines Traditional Healers Who Are 'Stumped'
by AIDS
Traditional healers are a "crucial" part of the health care system in
South Africa, as polls say that 60% of the country's citizens have
visited a healer, or sangoma, for medical advice. However, Mama
Mtshali, a sangoma in Hlabisa, South Africa, profiled today in the
New York Times' third article in its "Death and Denial" series, ad-
mits she is "stumped" by AIDS. Claiming that she can cure ailments
such as tuberculosis or appetite loss, Mtshali said, "AIDS is too
difficult to see.... And by the time we can see it's AIDS, it's too
late." Mtshali, as well as other sangomas, "say they are not hostile
to Western medicine," and some even work with Western-style physi-
cians to treat AIDS patients. The complete article is available
online at the Times Web site.
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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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