Treatment Action Campaign News, 26 July 2000. * TAC has sent a letter to the Minister of Health warning that legal action will be taken by August 18 if the minster does not make a committment to mother-to-child transmission prevention by then. The minister has undertaken to consider the issue on August 12 (see body of email). * TAC has sent a submission to the Competition Tribunal with objections to the Glaxo Wellcome/Smithkline Beecham merger (see body of email for an abbreviated version of the submission -- full version available on request). * TAC is raising money for our announced action of importing generic medication, particularly fluconazole, into South Africa. Please see our website for details on how to make a donation. If you wish to contact us directly, please do not hesitate to do so, by emailing info@tac.org.za, or contacting Nathan Geffen at 27 21 462 6322 or 27 21 650 4056. * We have reprinted Harvey Bale's letter that was sent to TAC, refusing to accept the memorandum. Bale is the chairperson of the International Pharmaceutical Manufacturers Association. We highlight the inaccuracies in Bale's comments (see body of email). * Summary of the week's events (see body of text). Included is commentary on the US loan offer made this week. Thank you to the many contributors to this week's newsletter. Treatment Action Campaign Details: Website: www.tac.org.za Email: info@tac.org.za Contact Numbers: Durban Office: 031 304 3673 Cape Town Office: 021 364 5489 JHB Office: 011 403 7021 Also try: 021 650 4056 or 021 462 6322 ---------------------------------- 19th July 2000 The Honourable Minister of Health Dr M E Tshabalala-Msimang Department of Health Cape Town 8001 Fax: (021) 465-1575 (012) 325-5526 Dear Dr Tshabalala-Msimang PROVISION OF NEVIRAPINE TO PREGNANT WOMEN WITH HIV We act on behalf of the Treatment Action Campaign (TAC) a non-profit, voluntary association of individuals and organizations committed to affordable and quality health care for all people in South Africa. Specifically, TAC is campaigning for treatment for all people with HIV/AIDS. We are instructed as follows: 1. Members of the TAC and the AIDS Law Project (ALP) met with the former Minister of Health, Dr Dlamini-Zuma on 30th April 1999 to discuss various issues regarding mother to child transmission. This meeting resulted in a joint press statement where it was said that: “affordable treatment for HIV/AIDS and all medical conditions is a basic human right. “The Minister assured the Treatment Action Campaign that government would name an affordable price for the implementation of AZT to pregnant mothers and report within six weeks on the price and other issues pertaining to the prevention of mother-to-child transmission.” 2. A further meeting was scheduled for mid-June 1999, but was delayed because of the general election and your appointment as successor to Dr Zuma as Minister of Health. However a meeting to discuss the same issues, with yourself, took place on 30th September 1999. 3. At that meeting, you expressed government’s commitment to ensuring that women with HIV who are pregnant receive adequate access to health care, including the provision of drugs to limit the transmission of HIV from mother to child. You advised TAC that the government felt that it was necessary to wait for the results of the South African Intrapartum Nevirapine Trials (SAINT) before implementing any programme of prevention. 4. Although, TAC believes that sufficient scientific evidence exists for the immediate use of a short-course of AZT we agreed that a consensual approach would ensure rapid implementation of Nevirapine, which is cheaper and almost equally effective. Therefore, TAC postponed any litigation against government as a means to try to speed up and concretize policy decisions on this issue. 5. The preliminary results of the SAINT study were announced on 11th July during the XIII International AIDS Conference that took place in Durban. 6. It is now the overwhelming consensus of both the national and international scientific community that these results show that Nevirapine is both a cost effective prevention strategy, particularly in resource poor countries, and also a safe and efficacious one that will significantly reduce the risk of HIV transmission from mother to child. 7. The initial lukewarm response from your Ministry and Department to these results placed TAC in a position where the Courts could be the only arbiter to defend the interests of women with HIV/AIDS against political intransigence. TAC therefore publicly announced its intention to institute litigation against your Ministry. 8. However, subsequent events have shown that your Ministry appears to be adopting a serious approach to the issue. 9. In the press release of the Department of Health, dated 12th July 2000, TAC was heartened to note the Department’s commitment to providing adequate care to pregnant women with HIV and their intention to meet with the researchers who conducted the SAINT study. TAC also noted that this commitment was reiterated with urgency by the Director-General of the Department, Dr Ayanda Ntsaluba, on 16th July 2000, during a news broadcast on SABC 3. 10. In the light of these statements by the Department and the special MINMEC meeting due to take place on 12th August 2000 announced by Dr. Nono Simelela on SABC Radio on 19th July 2000, TAC is prepared to give the Ministry and the government a final opportunity to address this issue in accordance with the scientific evidence and consensus. 11. TAC is also aware that the South African National AIDS Council will be meeting during the same period to address its plan. 12. In the circumstances, our client requests that you announce the immediate implementation of the findings of the SAINT study on a phased basis, having regard to the availability of testing, counseling and appropriate referral facilities, by no later than 18th August 2000, failing which our client will have no option but to bring an immediate application for the universal provision of Nevirapine to all pregnant women with HIV. As indicated above, this matter has been unnecessarily delayed for the unacceptable length of more than two years. Any further delay or postponement in the provision of Nevirapine or short-course AZT for pregnant women with HIV is unacceptable, immoral, unethical and unlawful. Yours sincerely Ms. Jennifer Joni Attorney: AIDS Law Project cc Deputy President Jacob Zuma (Chairperson SA National AIDS Council) Dr. Ayanda Ntsaluba (Director-General Department of Health) Dr. Nono Simelela (Head National HIV/AIDS and STD Programme) ---------------------------------- V Msebenzi Legal Services Division Competition Commission, South Africa By fax: 012 482 9003 24th July 2000 SUBMISSION ON TREATMENT ACTION CAMPAIGN (TAC) OBJECTIONS TO MERGER BETWEEN GLAXO WELLCOME AND SMITH KLINE BEECHAM11 This submission was prepared by the AIDS Law Project on behalf of the Treatment Action Campaign. SUMMARY OF TAC RECOMMENDATIONS TO THE COMPETITION TRIBUNAL AND COMPETITION COMMISION TAC requests the Competition Tribunal and Competition Commission to stipulate the following condition for the merger between Glaxo Wellcome and Smith Kline Beecham: the merged firm should allow generic competition for all medicines needed for the treatment of opportunistic infections in HIV/AIDS and anti-retrovirals for HIV. This must be applicable to both the private and public health care sectors. Alternatively,the companies can agree to reduce their prices to generic price levels of anti-retrovirals and medicines needed to treat AIDS-related opportunistic infections and that are owned, produced and distributed by Glaxo Wellcome and Smith Kline Beecham as a condition of merger. This will allow the public and private sector to fulfill their constitutional obligations on health care access while still allowing Glaxo Wellcome and Smith Kline Beecham the opportunity to make a reduced profit. If these conditions are unacceptable to the firms concerned TAC requests that the merger be postponed until the Competitions Tribunal has independently investigated the impact of the merger on health care costs in South Africa and specifically, the exorbitant and prohibitive monopoly pricing practices related to HIV/AIDS treatments. In this case, every drug produced by these companies should be compared to generic equivalents and a finding made on this basis. ---------------------------------- Mr Mark Heywood Deputy Chairperson Treatment Action Campaign P.O. Box 31104 Johannesburg South Africa 6 July 2000 Dear Mr Heywood I received your letter of 4 July yesterday, revisiting the issue of industry participation at the end of your Global March for Access to HIV/AIDS Treatment - inviting a person from our industry who can be there to receive your petition. I have seen our companies renewing their efforts to try to meet the demands of patients in Africa and elsewhere for improved access to HIV/AIDS treatments. It is they that took recent initiatives with the UN agencies. It is still governments that are slow or even not moving to take advantage of these efforts. A few governments still hold out because they allege the drugs are 'toxic'. Yet, you still make the industry - despite this reality - the number one enemy of AIDS patients. As I read your message of 3 July posted on the Treatment Access Network and more recently the press clippings from South Africa today, you still call the industry 'malicious' and even suggest suing one major company in response to its offer of donations to South Africa. Now, I ask: How can any reasonable person to go out and accept such a petition in light of the above facts? Industry, along with the UN agencies, is trying to get governments to act. Yet, under your scenario,industry is supposed to accept a petition - and under a barrage of accusations from TAC that it has basically been unresponsive. We had a chance to meet in New York in December at the meeting called by Secretary General Kofi Annan, and we would like certainly to work together with serious activist groups like the TAC. But the terms have to be fair and respectful. We cannot work as long as what the industry does positively is ignored or treated negatively. Sincerely Dr Harvey E Bale, Jr Director-General, IFPMA Comments on Bale's email: * This was Bale's 2nd letter refusing to accept the memorandum at the Durban March. * Bale implies that we have been unwilling to negotiate with the pharmaceutical industry. Recently we agreed to a meeting with all the major pharmaceutical companies. The date of the meeting had been set and it was all ready to go. At the last minute, the pharmaceutical companies pulled out for no apparent reason. Bale's email ignores that it is the pharmaceutical industry that time and again has refused to negotiate with TAC. Bale's letter admits that the industry will not negotiate with us because we are critical of them. * TAC always welcomes positive steps made by the pharmaceutical industry, though such steps have been few and far between. We welcomed the Pfizer announcement on free fluconazole. We welcomed the Boehringer Ingleheim offer of free nevirapine. We are indeed considering litigation against Pfizer, because despite their offer of free fluconazole to HIV+ people with cryptococcal meningitis, the offer has not been extended to systemic thrush and the price of fluconazole is absurdly high. * Bale's letter shows the callousness and lack of tact that we have come to expect from a multi-billion dollar industry that is quite prepared to sacrifice lives for massive profits. ---------------------------------- HIV/AIDS issues once again featured prominently in the news this week with the meeting of the Group of 8 in Japan, and their proposal to fight HIV/AIDS with a loan of 1 billion US dollars for sub-Saharan countries. Although there was much lobbying at the G8 conference by the international Jubilee 2000 campaign to scrap debt, apart from an Inter Press Service story there was little in the commercial media that exposed this loan as another ploy by the World Bank/IMF/G8 to further tighten the debt noose around the necks of African countries. An Oxfam press release called the $1b drug deal "a debt for tomorrow's AIDS orphans". Namibia, on the list as a recipient, said it didn't want the loan. Kalumbi Shangula, Namibia's permanent secretary at health and social services, said: "The government policy is that the health sector does not participate in loans. We don't participate in loans as a social sector because a loan means you have to repay back the money. If it is a grant, yes." The major news story of interest to Treatment Action activists was surely the Mail and Guardian's cover story, announcing research by UCT postgraduate economics student Jolene Scordess. Scordess found that the ongoing treatment of infants infected with HIV could be between three and seven times higher than the cost of once-off treatment perinatally with AZT or Nevirapine, and that the state was wasting R800 million per year through failing to provide this treatment. "My study essentially offers a birds eye view of a lot of existing research that was out there," Scordess told SABC radio on Monday. The story is not yet online on the Mail and Guardian website but there is a Reuters report on the research below. HIV/AIDS was also on the agenda of the annual Labour Law Conference held last week in Durban. Judge Edwin Cameron spoke at the conference on discrimination against workers living with HIV/AIDS, and made the clear link to the need for treatment for all. In Nigeria, a medical worker with the HIV virus is claiming 10 million naira ($93 500) from her employers on grounds that she was sacked in bad faith and that it violated her fundamental rights under the African Charter of Human and People's Rights. There was some confusion in the media on Friday 21st July about an apology made by Judge Cameron on the night of July 20th. Judge Cameron apologised only for implying that the government has done nothing to combat HIV. Indeed they have put a legal framework in place, necessary for changing policy. He has not apologised for, or retracted in any way, his comments related to the mismanagement of the disease by government. Finally, the New York Times ran a story on Saturday called "MEDICINE MERCHANTS: Holding Down the Competition - How Companies Stall Generics and Keep Themselves Healthy" which exposes how multinational drug companies work together to keep cheap generics out of production and out of the reach of ordinary people.