IN THE HIGH COURT OF SOUTH AFRICA

(TRANSVAAL PROVINCIAL DIVISION)

Case No 21182/2001

In the matter between

TREATMENT ACTION CAMPAIGN AND OTHERS	Applicants

and

MINISTER OF HEALTH AND OTHERS	Respondents

AFFIDAVIT: PROF P A COOPER

I the undersigned

PETER ALLAN COOPER

hereby make oath and say:

1	I have previously made an affidavit in this matter.

2	I wish to reply as follows to those parts of the affidavit of Dr Ayanda Ntsaluba which deal with the affidavit which I previously made.

Ad para 212

3	It is indeed within my personal knowledge and expertise, gained as a Professor of Paediatrics and Secretary of the South African Paediatric Association, that obstetricians and paediatricians in the private sector now regularly prescribe Nevirapine for pregnant women with HIV and their infants, when in their view this is clinically indicated.

4	It would be very surprising if they did not do so, given that intrapartum transmission of HIV carries a high risk of leading to death, and Nevirapine is an inexpensive means of preventing or reducing intrapartum transmission.

5	This is a matter which is regularly discussed at professional meetings of paediatricians.

Ad para 213

6	As I have said, this is a matter within the experience of the Executive Committee of SAPA, which represents about half of the paediatricians in South Africa, including many paediatricians in the public sector.

7	It is also within my personal knowledge, from discussions and meetings with colleagues at the Johannesburg hospital and at other hospitals, that many of them wish to prescribe Nevirapine for their patients.

Ad para 216

8	My account of what medical practitioners in the public health sector are doing is derived from my own experience as a specialist paediatrician in that sector, my knowledge and expertise as Professor of Paediatrics, my knowledge and expertise acquired through my work as secretary of the SA Paediatrics Association, and meetings and discussions with professional colleagues.

9	The obstetricians and paediatricians at the Johannesburg Hospital wished to prescribe Nevirapine for their patients, to prevent intrapartum transmission of HIV, where in their professional judgment this was medically indicated. We wished to do this because of the potentially life-saving quality of this medicine.

10	However, the Gauteng Health Department refused to make Nevirapine available to the Johannesburg Hospital.

11	The packaging system for Nevirapine (and in particular the suspension which is required for the babies) is such that it is generally not possible to obtain single doses through pharmacies. Most of our patients are poor, and could not afford to buy the medicine for themselves in the volumes in which it is available from pharmacies.

12	We were fortunate that the Anglican Church came to our rescue, and to the rescue of our patients. The Anglican Church made a donation to enable us to provide Nevirapine to our patients. We prescribed it and administered it when in our professional judgment, after voluntary testing and counselling had been carried out, this was medically indicated under all of the circumstances.

13	We did this on the basis that our professional ethics required us to do so. It was in the best interests of our patients.

14	Since 1 October 2001, the Gauteng Health Department has made Nevirapine to the Johannesburg Hospital. It is therefore no longer necessary for us or our patients to rely on donations.

15	The paediatricians at the Johannesburg Hospital are continuing, as before, to prescribe and administer Nevirapine when in our professional judgment this is medically indicated under all of the circumstances. As before, we do this where in our professional judgment it is in the best interests of our patients.

16	The paediatricians in the Department are fully able to exercise a proper professional judgment as to when Nevirapine should be prescribed and administered.

17	We were able to make the same professional judgment when we were reliant on donations from the Anglican Church.

18	The Johannesburg Hospital has not been given any additional staff resources since the Gauteng Health Department decided to make Nevirapine available at the Johannesburg Hospital. I am aware that at some of the pilot sites, arrangements have been made for volunteers to assist with counselling. This was not necessary in the case of the Johannesburg Hospital, because we were already doing this with our existing staff.

19	I do not believe that when we have prescribed or administered Nevirapine for our patients, we have acted irresponsibly. We have acted in a manner which our patients and our professional ethics require of us. This applies both to the period when the Gauteng Health Department refused to make Nevirapine available to the Johannesburg Hospital, and after it decided to do so.

Ad para 218

20	On the basis of the knowledge and experience which I have described above, I can say with complete confidence that very many medical practitioners in the public health sector would welcome being given the opportunity to prescribe and administer Nevirapine where in their opinion this is medically indicated. They would not regard this as a burden. On the contrary, they would welcome this as an opportunity to give their patients the treatment which they need.

PETER COOPER

SIGNED AND SWORN TO BEFORE ME AT JOHANNESBURG ON NOVEMBER 2001, THE DEPONENT HAVING TAKEN THE OATH IN THE PRESCRIBED MANNER

COMMISSIONER OF OATHS