E-drug: Doctors Blast South Africa over AZT/MCT
[copied from HIVNET]
...discussion on the South African Minister of Health decision not to
make zidovudine freely available for HIV+ preganant mothers to
prevent Mother to Child Transmission (MTC) ...
The issue is really that AZT is not exactly a cost-effective means of
HIV prevention in many developing countries regardless of what UNAIDS
and associated pharmaceutical industry sources pronounce. It can make
perfect sense (if your resources are limited) to shift funding for
Glaxo-Wellcome's products to more cost-effective means (ie the money
you have to spend in order to prevent a new HIV infection). Say, if
you'd show that in another context the 130 US$ (where is the
Glaxo-Wellcome promise of 50US$ that I recall???) per HIV pregnant
woman that you need to spend could lead to twice the number of HIV
infections prevented in another context, and you'd have to
prioritisie, then the governmental decision makes sense, even if you
concede that AZT reduces the HIV transmission rate in the pregnancy
context. It might not be very politically correct to point this
out, but if your resources are limited, then that is undoubtedly the
way to go. It's fairly easy for UNAIDS to pronounce what they think
folks in developing countries ought to do, but given that they won't
be the ones to foot the bill, talk really is cheap.
The issue is not to say that those women shouldn't get AZT if they'd like it,
only that if one has limited resources, way overpriced drugs such as AZT should
not be offered till they have been shown to be a cost-effective means of HIV
prevention. Until Glaxo-Wellcome changes the pricing of its product to something
that allows it to compete in a given developing country against other
established means of HIV prevention, it is still in the `race'.
It's probably mistaken (though understandable) that doctors and those pregnant
women vent their anger at the government which has made a resource allocation
decision that affects them negatively. Their real targets should, of course, be
the manufacturers of those drugs. If I's in charge of a health care budget, and
it was clear to me that their pricing is seriously crippling my efforts in other
areas, I'd not offer their drugs either.
Think of the current debate over access to Viagra in Western countries. Viagra
is just one of many lifestyle drugs on offer. The Australian government, rightly
in my view, is not offering it under its Medicare benefits scheme. The UK
government (I read in a newspaper yesterday) is offering it in the NHS [National
Health Service - the public health system in the UK]. Given that people in the
UK die these days because the NHS resources are insufficient to treat them (or
treat them in time), it is completely outrageous to sponsor stuff like Viagra. -
Now imagine that Viagra wasn't a lifestyle drug, but a highly expensive drug
capable of preventing a terminal illness from occuring. Thing is that your
health care budget cannot sustain offering this drug to all those who might need
it, without cutting other people off funding who'd be in need of a much cheaper
drug for a similarly deadly illness. Given that offering the cheaper drug is
carrying you further, in terms of overall deaths prevented, you need to cut off
funding for the highly expensive drugs. In turn you'll bear the full brunt of
anger of those whose lives depended on getting the highly expensive drug. So be
it.
I don't think any government can afford itself to be held for ransom by a profit
driven pharmaceutical industry that believes it can demand the sort of prices
Glaxo is currently asking for its drugs in developing countries. In my opinion
it is absolutely vital to make decisions such as the one made in South Africa,
and to make clear who is to blame for the excess deaths - the marketing
department of Glaxo-Wellcome.
Best wishes
Udo Schuklenk, PhD
Monash University
Centre for Human Bioethics
VIC 3168
Australia
Tel: +61 3 9905 5066
Fax: +61 3 9905 3279
Email: udo.schuklenk@arts.monash.edu.au
http://www.arts.monash.edu.au/bioethics/udospage.htm
ICQ#20438685
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