Thoughts on South African and international politics and culture

Wednesday, February 23, 2005

Manto and AIDS

The government's AIDS program really does beggar belief. Recently, Manto Tshabalala-Msimang declared that South Africa has the world's leading AIDS program. Yet it?s been a full 15 months since the government, largely under TAC pressure, announced its plans for antiretroviral rollout, and only yesterday did Manto announce that her department has completed negotiations with drug companies to supply antiretroviral drugs to state hospitals. The health minister had stated that tenders would be delivered by June last year. They have yet to be sent out.

AIDSMAP offers an interesting viewpoint of the delay:
The delay in the national purchasing programme may be traceable to troubles between the Ministry of Health and the Clinton Foundation around the time the treatment plan was approved. The Foundation had originally committed to help in the plan?s implementation ? especially lending its expertise in the procurement of affordable generic antiretroviral medications.

In fact, the Foundation had used their forecasts of South Africa?s demand for ART to help secure an initial agreement from generic drug manufacturers to supply a triple-drug ART combination to treatment programmes in several nations ? including South Africa ? for only $132 dollars each year per person. The price that was more than 50% lower than the previous best price offered by a generic manufacturer for this triple combination (see aidsmap news story).

The Clinton Foundation announcement was the likely cause of a fallout between the South African Ministry of Health and the Clinton Foundation. While South Africa had promised to contribute millions of Rand to pay for its HIV programme, it was also expecting to qualify for vast sums from President Bush?s $15 Billion Presidential Emergency Plan for AIDS Relief (PEPFAR). But PEPFAR?s head Randall Tobias (former CEO of Eli Lilly Pharmaceuticals) had grave concerns about using PEPFAR monies to buy generic antiretrovirals. (See aidsmap news story).

This put the South African government in a delicate situation. Ever the statesman, it was not like President Mbeki to antagonise President Bush or embarrass former President Clinton. So South Africa quietly decided to proceed with implementation on its own, which meant foregoing Clinton Foundation assistance ? and procuring the supply of drugs by itself.

This partly explains the government?s refusal to release the implementation schedule of the treatment plan, Annexure A, to the public. TAC has sued the government for force it to make this document public as it lists the sequence and delegation of tasks that needed to be performed to implement the programme successfully. But releasing the original document would have revealed the Clinton Foundation?s extensive involvement in the plan?s implementation ? as well as the plan?s original reliance on generic drugs.

South Africa?s subsequent procurement process has been halting at best. Many generic companies complained of being shut out of the process ? which mostly seemed tailored to favour the Western pharmaceutical industry and/or possibly, the development of South African sources.

Some activists have alleged that the South African procurement process was waiting for the US Food and Drug Administration (and PEPFAR?s) nod of approval. It is notable that, only three weeks ago, the FDA announced that it had approved a coblistered triple combination of AZT, 3TC and nevirapine manufactured by the South African company Aspen Pharmacare.

This has had the result that the government has managed to treat only between 28,000 and 31,000 AIDS patients with anti-retroviral drugs, far short of its target of treating 53,000 people by March. This only opens the government?s policy to more questions. It is incredibly difficult to substantiate any belief that the government is committed to its AIDS policies, and this in a country with 5 million infected with AIDS.

Mbeki blames the failure of government's rollout program on doctors and the medical system, saying they were not doing enough to bring people in need into the program, but this is an incredibly weak defense, and a sign of a government trying to shift the blame.

Then the Business Day carries a news item this morning that only serves to reinforce the lack of commitment. The government?s National AIDS Trust, which was meant to advise Health Minister Manto Tshabalala-Msimang on HIV/AIDS policy and implementation has not met once since its inception in 2002. The trust has a budget of R30 million, including a donation of R769 000, and to date it has spent R520 000, which has been wasted on the rent of offices that have never been used. This flagrant abuse of funds and complete lack of interest is an incredibly damning factor. The worst thing is that the trust is chaired by the person tasked with co-ordinating the fight against HIV-AIDS within the ANC, deputy president Jacob Zuma. Let?s just say he has other things on his mind, which makes it even more incredulous that he has been given such a pivotal post.

It just seems bizarre when the Stats SA releases a report stating that there has been a 57% increase in deaths in the five years until 2003, and blames most of it on AIDS, that we have a questionable government commitment to AIDS programs.