[Ip-health] SA Lives or US Kudos? That's the Burning Question

[Mike Palmedo]

http://www.busrep.co.za/index.php?fArticleId=3D404680

SA lives or US kudos? That's the burning question

IOL Business Report
May 11, 2004
By Terry Bell

The ANC government is back in the seat of power with its now customary
overwhelming majority of those who registered and voted. And it will
again have to confront what are widely agreed to be the two major issues
facing this country: unemployment and HIV/Aids.

Given economic growth projections, the issue of unemployment will
continue to hang, like the sword of Damocles, over the head of the
government.

Nobody, least of all the trade unions, expects any sudden improvement.
The hope is for policies that will slowly but surely reduce the numbers
of jobless and improve the standard of living of the poor.

HIV/Aids is a different matter. And it is an issue likely to confront
the government bluntly within the next few weeks.

It is then that the government may face a crucial decision: whether to
support a simple, effective and least costly antiretroviral treatment
method and risk the ire of the US, or agree to more expensive therapy to
access US funds.

One decision could bring it into conflict again with the trade unions
and campaign groups such as the Treatment Action Campaign. The other
could result in a united stand in support of the best and cheapest
treatment available.

Treatment costs have indeed collapsed, especially since the advent of
fixed-dose combinations (FDCs). These combine several drugs in one
tablet, thus greatly simplifying treatment while lowering costs.

First-line treatment for Aids patients can now mean just two tablets a
day - one in the morning and one in the evening.

But FDCs are generic drugs, exact copies of brand name pharmaceuticals
from various sources combined in a single tablet.

What this has meant in cost terms, calculated in US dollars, is that
treatment that cost as much as $12 000 (R78 000) a year five or six
years ago can now be had for as little as $140 a year and certainly for
less than $300.

A South African company, Thembalani, a joint venture between India's
Ranbaxy and pharmaceutical giant Adcock Ingram, is now preparing to
produce FDCs at an apparent annual cost of $285 - if they are approved here=
.

Various Aids treatment practitioners - among them M=E9decins Sans
Fronti=8Fres (MSF), which operates highly successful Aids treatment
projects in Cape Town's Khayelitsha township - are keen to use them.

Clinically and logistically they make sense, says MSF pharmacist Marta
Darder.

MSF already uses the therapies in other parts of the world, and African
countries such as Kenya, Tanzania and Cameroon have approved the use of
FDC regimes
.

The FDC drugs used are given "prequalified" approval by the World Health
Organisation and have proved effective in practice.

But their use has cut into the bottom lines of the major - and often
US-based - pharmaceutical companies, which previously demanded that
their patent rights and prices be respected.

But they backtracked when faced with union-supported Treatment Action
Campaign protests, government intervention, threats of court action and,
most importantly, the arrival of generic drugs.

The FDC drugs most widely favoured and used come from two Indian
manufacturers, Cipla and Ranbaxy.

It is they, along with local companies such as Thembalani, that could
benefit most from US President George W Bush's $10 billion presidential
emergency plan for Aids relief (Pepfar) - if cost is the deciding factor.

"Quality and cost are obviously the most important factors," says
Federation of Unions of SA general secretary Chez Milani. "More
expensive drugs do not mean better drugs."

Cosatu spokesperson Patrick Craven says: "We have consistently argued
for the use of generic drugs, provided they meet quality requirements."

"And we are totally opposed to any attempt by the pharmaceutical
companies to put their profits before the needs of people."

The union federations are prepared to put their weight behind any
campaign that ensures the most effective and least expensive means of
treatment.

The Pepfar funds, on the basis of present FDC costings, could treat as
many as 20 million individuals on simple, two-dose-a-day programmes.
Using separate, brand name drugs, this figure could be reduced to as few
as 5 million sufferers.

"Put bluntly, that means for everyone who survives, three will die,"
says a representative for aid agency Oxfam. But the US administration is
pressing the case for brand name drugs.

In a letter to Bush dated March 26, US senators Edward Kennedy and John
McCain "strongly urged" him to reconsider the policy "to prohibit
recipients of federal funds from purchasing generic medications". That
policy still appears to be in place.

Next week a discussion paper on the regulations and standards to be
applied by the US to FDCs and generics in general is scheduled to be
published.

The battle will be in the open and our third non-racial government may
be faced with the first vital challenge of its new term.