More About HIV/AIDS
MSF Press Release: "Six Months After Durban: Have HIV/AIDS Drug Prices for the Poor Really Been 'Slashed'?"
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Find out more about MSF's involvement in the push for affordable HIV medication at MSF's Access to Essential Medicines Campaign Website
World AIDS Day
Teleconference Transcript
November
28, 2000
Asia Russell (Health
GAP Coalition):
Ok, I’m going to get
things started. As you’ve
learned we’re all on this call together, unlike the UNAIDS reporters call
that just ended, this is a low tech operation. So I’ll run through after I’ve
introduced folks on what the schedule of the conference call is for the
next hour.
My name is Asia
Russell, I’m a member of Health GAP Coalition—the Global Access Project—a
US based AIDS activist coalition.
I’m also a member of the group ACT UP Philadelphia. I’ll be the moderator today and
also be presenting. This
call, in anticipation of World AIDS Day 2000, is meant to update
journalists on struggles for access to affordable HIV medication happening
around the world.
On this call we’ll
bring you an update on the struggle for affordable HIV medications and
discuss major issues and campaigns in the US and around the world to
demand affordable drug access.
Specifically we will talk about the attention grabbing “Big 5” drug
company and UNAIDS announcement 6 months ago and its true impact on
getting drugs into poor countries and into people’s bodies. People will be discussing current
drug donation programs such as the one Pfizer has been negotiating with
South Africa.
And for any
journalists rolling over from the UNAIDS call, we’ll offer our analysis on
UNAIDS’ ongoing partnership with industry and what that sort of
partnership entails for creating or impeding true access to life extending
medications.
The presenters for
this call are Dr. Anne-Valerie Kaninda, she’s a medical adviser with
Médecins Sans Frontières/Doctors Without Borders. Also Mark Heywood, Treatment
Action Campaign, a grassroots AIDS activist organization from South
Africa. And again myself,
Asia Russell, and that’s the order in which we’ll be presenting.
Just to get the
housekeeping stuff out of the way.
The schedule for the call is as follows: we’ll each take about 7
minutes to provide opening statements and following that time there will
be a question and answer period, and then we’ll just conclude with closing
remarks. The question and
answer period will probably last until 5 of 2:00. In addition, when the question
period opens, if people could just state their name, where they are, where
they are reporting for, and since there is no formal queue, I will try my
best to moderate people as they ask questions and allow themselves one or
two follow up questions. So
let’s go ahead and begin with opening statements from panelists and start
with Dr. Anne-Valerie Kaninda.
Dr. Anne-Valerie
Kaninda (Médecins Sans Frontières/Doctors Without Borders):
Good morning, or good
afternoon everybody. I would like to start with just reminding everybody
of the following statistics that have been released by UNAIDS today. While there are more than 36
million people infected worldwide, 25 million of these people live in
sub-Saharan Africa. And I can credit to the issues that are
very important, first
we recognize that prevention activities are crucial in fighting this
epidemic. We want to
emphasize our experience, our field experience, our medical field
experience, which has shown that prevention-only strategies often
fail. For instance, when you
are talking about Uganda, where there are a lot of prevention-only
activities that have been going on which have often been mentioned as a
success story. Well it’s a
success story, but it’s a country that still has a prevalence if
infection, which is over 10% of the population. So it’s a success story, but only
up to a certain point.
The other thing is
that when you offer treatment, it is really a formidable enhancer for
prevention activities. People
will come and get tested for HIV.
They will want to know if there is some way they can get some
treatment and have some hope.
Otherwise, if you are in a country where you have no treatment
access, the only reason to get tested is to have a death sentence. Then why would you go get
tested? So treatment really
enhances prevention activities.
The availability of
treatment also provides tremendous incentive for countries to mobilize
resources and change their infrastructure. We have seen that in our field
experience. When we’re
talking about treatment, we’re not only talking about basic care
treatment. What we know, also
from experience so far, is that the only treatment that will make a
difference in terms of morbidity and mortality, is antiretroviral
therapy. It is what has
happened in the West. It is
only when antiretroviral therapy, and especially triple therapy, became
available in 1996, that we saw dramatic reductions in terms of morbidity
and mortality for people living with HIV/AIDS. We have seen the survival of
people increase and the quality of life of people increase
dramatically. If we’re
talking about treatment, let’s talk about the things that really make the
difference.
Now if we get to the
big announcement on May 11.
The Wall Street Journal
reported that UNAIDS and 5 drug companies were offering to slash the
prices of HIV drugs for people living in poor countries. What we see today, there’s been a
lot of PR around these announcements for pharmaceutical companies. What we see today from UNAIDS and
the big 5, these initiatives from the 5 companies—they haven’t done
enough.
If we look at the
number of countries that have negotiated price reductions to date for
antiretrovirals, there’s only one: it’s Senegal. So what we’re doing is calling on
these big 5 multinational drug companies to basically reduce their price
of their AIDS drugs by at least 95%.
People living with AIDS in poor countries, cannot afford the
medicines that prolong and improve the quality of their life. MSF/Doctors Without Borders is
really challenging these drug companies to deliver on their promises and
respond to this demand by the first week of 2001, at the latest.
Q:
What did you say your
deadline was? I’m sorry.
A-VK:
We’re really
challenging the drug companies to deliver on their promises and respond to
this demand by the first week in 2001.
Q:
Which promises are you
referring to specifically?
A-VK:
Their announcement
that they would “slash their prices” for HIV drugs for people living in
poor countries. And we are
now calling, MSF is calling for at least 95% reductions for their AIDS
drugs in poor countries.
Q:
You said by 95% for
all people living in poor countries and not just any one country?
A-VK:
Oh yes, yes, for
people living in poor countries, we’re not selecting just one
country.
(Clarification: As a
first step, MSF is demanding an immediate, short-term solution—reducing
prices by a minimum of 95% of US wholesale prices. This reduction should be
unconditional and apply to all AIDS drugs for the developing world in
order to reach people with HIV/AIDS as soon as possible. Developing countries should not
have to negotiate such reductions company-by-company, drug-by-drug. This
complex and time-consuming system prolongs the process of getting drugs to
patients who desperately need them and diverts precious human resources
from national AIDS programs.)
And for instance in
practice, that means that Glaxo Wellcome should make its drug AZT/3TC
available for at least $1 a day.
Bristol-Myers Squibb should charge at least 49 cents a day for d4T
instead of $9.80. And Merck
should charge at least 65 cents for efavirenz.
Q:
Could you go through
that once more?
A-VK:
Glaxo should make
AZT/3TC combination available for at least $1 a day instead of
$19.60.
Q:
That’s Combivir.
A-VK:
Combivir, yes.
Q:
Are these statements
anywhere to facilitate reporters getting access to them?
A-VK:
Yes they are. You can
actually call our Communications Director, Kris Torgeson, here at MSF who
has the whole statement.
Q:
Could you go through
those three statements again?
A-VK:
Bristol Myers Squibb
should charge at least 49 cents a day for d4T instead of a present $9.80
and Merck should charge at least 65 cents for efavirenz instead of
$13.20.
Q:
And the $13.20, these
instead of prices are prices based from the United States?
A-VK:
These I believe are
the general worldwide prices.
I can get back to you on that.
(Clarification: These
prices are the best approximate available for US wholesale prices, and
they have been cited in UNAIDS and MSF reports, as well as on several
websites, including www.globalrx.com and www.hopkins-aids.edu.)
Q:
What’s the
Bristol-Myers drug?
A-VK:
d4T
Q:
And Merck?
A-VK:
Efavirenz
Q:
And the proposed price
for efavirenz is what?
A-VK:
We are calling for at
least 65 cents.
Q:
Are you basing the
prices on what you know they can be made for?
A-VK:
We are basing those on
a 95% reduction compared to the current price. But we also know that when we look
at some of the antiretrovirals that are produced generically, for instance
in Thailand, and when you compare those with how much you are charged by
the brand name pharmaceutical companies, these prices can be
achieved. Yes, when you look
at the difference between the generic price and the brand name price of
the drugs, these are definitely reasonable requests.
Q:
At the UNAIDS
conference, I believe Peter Piot said that the Senegal prices that were
negotiated are lower than the generic prices. Would you like to comment on
that? That price is going to
be lower than what you’re talking about.
A-VK:
Yes, well, if the
pharmaceutical companies can deliver prices which are cheaper than the
generic prices, then that’s good. If they can make the prices
affordable and within the reach of people in poor countries, it’s good,
but so far Senegal is the only country to have negotiated the price
reductions to date. We are
more than 6 months after the May 11 announcement. Meanwhile people are still dying
and suffering from AIDS in poor countries.
Asia Russell:
This is Asia Russell
again. We should move to the
next presentation and we can revisit some of these issues during the
question and answer period.
Q:
Can you just spell the
name of the Dr. who was just speaking.
A-VK:
Dr. Kaninda. Dr. K-a-n-i-n-d-a, Anne is the
first name.
AR:
The bottom line is
that based on experience, the drugs can be made accessible as a result of
competition brought on by generics access and based on deep, deep
discounts. This is the heart
of activists demands—these medications can become affordable and
accessible. Multiple
effective strategies must be used to realize this urgent goal, but the
main point is we need real reduction of price and this needs to be
sustainable, broad, and free from conditions imposed by pharmaceutical
companies.
Q:
Can you spell your
name as well?
AR:
Asia like the
continent, R-u-s-s-e-l-l. We
can move to the next presentation and revisit these matters later in the
question and answer bit. Next is Mark Heywood of the Treatment Action
Campaign in South Africa.
Mark Heywood
(Treatment Action Campaign):
Good evening. As Asia said, my name is Mark
Heywood and I am the deputy chair person of the treatment action campaign
in South Africa. I am phoning
from Johannesburg. I am
speaking as a replacement for Zachie Achmat who is the chairperson of the
Treatment Action Campaign who couldn’t make this call this evening because
one of our volunteers called Queen from Capetown died this afternoon of an
AIDS-related illness. This is
the third person in five days to have died from an AIDS-related illness
who are actively involved in our organization. All of these people have died
within kilometers of first world hospitals, and have died simply because
the medicines that could treat them are unaffordable. Therefore unavailable. The ages of the three people that
have died are 22, 33, and 25 or 26.
This is the situation that we are dealing with in South Africa
now.
I have worked in AIDS
for the last five years and in the last two years I have seen us cross
from HIV epidemic to an epidemic of repeated illness and death among large
numbers of people. Earlier
this evening I was in the final meeting of the AIDS Consortium, which is
an organization based in Johannesburg, where there was a memorial for
people who have died this year.
And amongst the 100 people there forty or so people read out names
of people that they have known who have died. This is the situation we are
facing here: an AIDS epidemic, an epidemic of illness and death. The Treatment Action Campaign is
an organization based in South Africa that now has the support of all the
major trade union federations in this country as well as the major non-governmental organizations and
the general public’s support.
What I am about to report to you about our intensified action on
these issues is a plan that has widespread public support. I want to talk about three
issues. The first is the
Pfizer donation of Fluconazole to the South African government. The second is the Treatment Action
Campaign’s unlawful importation
of a generic version of Fluconazole from Thailand. And the third is the position of
the Treatment Action Campaign in the price reduction negotiations with the
major pharmaceutical companies with the assistance of UNAIDS.
Move to the first
issue. At the end of March
this year as a result of the campaign of the Treatment Action Campaign to
call on Pfizer to either reduce the price of Diflucan/fluconazole to the
equivalent of the generic price or to give the TAC or the South African
government a voluntary license.
Pfizer announced an offer to give the South African government
Fluconazole free for people who cannot afford it in the public health
sector. When we inquired with
Pfizer the details of this offer we discovered that it was only patients
with AIDS who had cryptococcal meningitis and not for other conditions
which required this drug. We
continued our campaign and we now understand that Pfizer is about to sign
a public agreement with the South African government on December
1st, which will make the drug available for the public health
sector for cryptococcal meningitis and for candidiasis, which, for those
of you are not medical doctors, is a severe fungal infection of the
esophagus and so on and so on.
We are prepared to
welcome this offer, this donation, but what we regret is that it has taken
nine months for this donation to become any kind of reality. And even if it is signed on
December the 1st it is not going to be immediately available to
people who suffer from these conditions. The second thing is that Pfizer is
still limiting the offer to the public health sector. And yet in South Africa many poor
people with HIV and AIDS use the private health sector, use general
practitioners, private clinics, NGOs. We therefore are critical of the
offer and do not accept it in the terms with which it is being made
available.
This then relates to
the second point I would like to make, which is Fluconazole is currently
sold to the African public untendered for 28 Rand per 200 mg tablet. If you buy it in the private
sector in the pharmacy it cost over 100 Rand for a 200 mg tablet. In October, the chairperson,
Zackie, went to Thailand and bought 5,000 pills at 1.77 Rand per tablet,
unlawfully or illegally returned to South Africa to supply doctors to
distribute to poor people who could not otherwise afford the drug. I would like to draw your
attention to 1.77 opposed to the cheapest 28 Rand available in the public
sector. I would also like to
point out Fluconazole is not an antiretroviral drug. We, because of the request by our
government that we act within the law, surrendered those medicines to our
Department of Health and also applied for permission under our Medicine
Control Act to have an exemption of the use of those medicines by medical
practice in Capetown.
Tomorrow afternoon we
are meeting the chairperson of our Medicine Control Council to receive the
formal response to our application.
If that response is a refusal to grant permission of use of this
medicine we will do two things: We will prepare for legal action to
challenge the refusal. The
second is that we have an intention to continue with the unlawful
importation of medicines which are affordable in order to save the lives
of people who have HIV and AIDS, or to alleviate the illnesses of people
who have HIV or AIDS. We will
make that announcement depending on what the Medicine Control Council says
to us tomorrow afternoon.
The third issue I want
to deal briefly with is the question of price reductions. The Treatment Action Campaign
believes the price reductions by pharmaceutical companies should be
unconditional and should be announced immediately. We do not support that these
reduction should be dealt with on a country by country basis. We feel faced with the emergency
occurring in Africa or Asia and other developing countries that the
pharmaceutical companies have it within their power to announce
unconditional worldwide price reductions, with a view to making essential
medicines available to the largest number of people possible in accordance
with available health infrastructure. We do not believe that the price
reduction should be conditional to governments giving up their power to
use things like compulsory licenses to bring competition into pricing on
these essential medicines.
And we support the position that has been adopted by the ministers
of health in the fourteen countries of the Southern African Development
Community which states that “whilst they will accept price reductions and
donations they will not do so on the basis of conditions that give away
national autonomy.”
The final thing I will
say on this is that the thing we find so sad about this is in a country
like South Africa is that Glaxo Wellcome, which has 37% of the world’s
market in antiviral drugs, is closing down possibly the most modern
pharmaceutical manufacturing plant in Africa by 2003. This is the plant just outside of
Johannesburg. This is a plant
that has the technology to produce many essential medicines for a large
part of the Southern African region.
We’re concerned that actions like that contradict PR actions that
are currently being engaged in around the yet to be felt price
reduction. That is all I
think I have time for.
AR:
Thanks Mark. I will say a few words, after
which time we will open for questions. Again I am from the Health GAP
Coalition a US based organization made up of organizations that are
fighting domestic policy that impedes access to AIDS medication in poor
countries, and fighting for improvements to make access to life extending
medications to treat HIV a reality and not just an exercise of smoke and
mirrors from drug companies and UN agencies such as UNAIDS.
I will mention a few
points briefly, and in addition can direct you to a Health GAP report card
reacting to the state of drug company price reduction schemes can be
downloaded from www.globaltreatmentaccess.org . The announcement from the
pharmaceutical companies of a statement of intent with UNAIDS is not been
received kindly by the Health GAP Coalition for some of the reasons
already discussed by Dr. Kaninda and Mark Heywood. There is no proof as yet that the
cumbersome nature of the country-by-country promised price reductions will
result in significant access to antiviral medication. We are concerned that developing
nations have little leverage in negotiating with incredibly powerful drug
companies according to the initiative’s structure—that is, UNAIDS has the
cards stacked against them. There is no proof that these price reductions
alone will be sufficient to address the overwhelming crisis in lack of
access to medication. We are
in a situation where 95% of people with HIV have little to no access to
medication that would extend their lives and treat HIV and its
complications. There are
other tactics that must be employed by people with AIDS in poor
countries—increasing affordable drug access through importing and
manufacturing generics HIV medications, as has been done to powerful
effect in Brazil. The US
government must play a primary role in promoting global access by
endorsing this strategy.
Broad access must
become a reality in the next several years. Already the world has been waiting
moths and months while only one country, Senegal, has made their
closed-door negotiation with drug companies.
We feel that putting
more effort into ramping up broad and deep access to generic medication is
incredibly important. No one feels there is a panacea, that there is just
one strategy towards rectifying lack of access to medication. But in fact, as we all know from
past experience in the US, there is clear political incentive for
governments and drug companies to deflect attention from building up
access to generics and instead to focus on the terms of insufficient,
inefficient drug company price reduction programs. When drug companies
have very successful PR coming from these programs and appear both to
major stake holders and to their share holders that they are doing
something to address lack of access to life extending AIDS drugs, they
deflects attention from ongoing efforts in developing countries to gain
access to generics. At this
point, we know that the US government has a long and sordid track record
of blocking generic drug access in developing countries. It is our opinion, without forcing
our administration to make public statements that generic medication is
extremely viable and crucial in rectifying lack of access, access won’t be
realized and we will continue to exist this plane of smoke and
mirrors.
Finally, the US
government’s refusal to call for the cancellations of the debt owed by the
world’s poorest countries is directly impeding countries from developing
effective strategies to increasing AIDS drug access. The US government can eliminate
this obstacle by calling for an end to the debt for the poorest countries
in the world. For example
sub-Saharan Africa owes at least $220 billion to international financial
institutions. In the face of
overwhelming debt, countries cannot take the action necessary to create
sustainable treatment action.
It’s not possible.
Ed
Silverman:
This is Ed Silverman
at the Newark Star Ledger and I
must have missed something.
Could one of you straighten me out? On one hand I am hearing a call to
reduce prices across the board by 95% in a few weeks and on another hand I
am hearing someone else say price reductions do not work. Did I hear wrong?
AR:
Actually the linkage
is that generic competition results in decreased medication prices. Dramatic price reductions are just
one part of a strategy to obtain affordable HIV drugs.
ES:
In other words, the
unified message is that they need to reduce prices across the board and
allow for competition because this would reduce prices as well. One or the other right?
AR:
Actually, both will
result in price reduction.
There is community substantial criticism of the cumbersome and
potentially condition-laden process currently driven by the drug companies
and UNAIDS, however.
MH:
Our view is that there
should be drastic price reductions but price reductions should not be at
the cost of the basis of the surrender of developing countries’ rights to
introduce competition of generic drugs. If you take a country like South
Africa where there are 4 million people with HIV, who at some point are
going to need access to drugs including anti-retrovirals, if Glaxo
Wellcome reduces the prices of Combivir to $2 a day the generic producer
can sell it to the South African government for $1.75 a day. And clearly given the numbers that
we face it is in the interest of the South African government to have the
option of purchasing or licensing of generic manufacturers.
ES:
Understood.
Reporter:
Are the donations of
the moment conditional on countries relinquishing their rights?
MH:
It is not 100%
clear. I met Glaxo Wellcome
when I was in London two weeks ago and my impression was that there are
conditions attached. One of
the conditions is a condition that seeks a guarantee that the recipient
government will do everything in its power to prevent the re-exportation
of medicines to industrialized country markets, and that they will not
dispute licenses around compulsory licensing. But I think that you need to
investigate further on that.
AR:
I think this is an
entirely appropriate question for journalists to ask the drug companies.
You have to go one step further and wonder--once a developing country
enters into negotiations with a powerful company like Glaxo Wellcome, how
free they feel to move forward and investigate other possibilities to
increase drug access, such as manufacturing generic versions of Glaxo’s
medications.
Reporter:
I would like to return
to the infrastructure question.
A couple of hours ago we heard Peter Piot say that even if you gave
these drugs away, you couldn’t get them out in the hardest hit countries
in sub-Saharan Africa because the infrastructure simply is not there. Could the three of you address
that issue?
MH:
In South Africa it is
estimated that close to 10,000 people have access to antiretrovirals. Clinicians in this country believe
that if we had significant price reductions in this country it would be
possible to extend access to up to 300,000 within two years. That is not an insignificant
effort to protect life. I
started in my contribution by saying many people in South Africa are dying
within walking distance to high-tech hospitals. Of course the infrastructure
argument is a significant issue and it relates to what Asia said about
debt relief to improve Africa’s infrastructure. And it is not possible to get
access to the most advanced drugs over night to all the people who will
need them. But it is possible
to get drugs to a large population of people quickly. I live and work in the southern
African region: in Botswana there are hospitals that could diagnose and
monitor the treatment of the drugs.
The same is true in Namibia and the same is true in Zimbabwe. So between everything and nothing
there is a significant something and that is what we are after.
A-VK:
This is Dr. Kaninda
from Doctors Without Borders.
Along the lines of what Mark just said, the infrastructure argument
is really a blanket statement because every country is different and
within countries there are striking differences between urban and rural
areas. And it’s used as an
argument for not doing anything and this is totally unethical. Because, as Mark just said, there
are things that we could do.
We wouldn’t be able to cover 100% of the population over night, I
mean 100% of the people who would really benefit from AIDS drugs, this is
for sure, but we could do significant things, really improve the lives of
a significant amount of people.
This is true for South Africa but this is also true in other
countries as well. I think
that the infrastructure issue is very over-emphasized. There are things that we can
do within the constraints. Of
course there are countries that have limitations and Doctors Without
Borders being in the field is very aware of the constraints, but is really
aware that we can do things.
AR:
It seems clear that
this is often a ploy, the infrastructure argument, mounted by the very
drug companies which are actually decreasing many countries’
infrastructure by actions like the shutting down of plants such as Mark
mentioned—it’s ironic. In fact this is an argument the companies tend to
use to justify inaction and to justify keeping drugs out of reach of
people who need them most.
How can we focus solely on developing medical infrastructure while
HIV kills countless lab techs, nurses, and doctors around the world? How can infrastructure be the sole
focus while schools face dramatic shortages in teachers due to death from
untreated HIV infection?
If there are drugs
that are made available there is synergy that accompanies their
availability: James Wohlfensen, head of the World Bank has even said with
drug prices so high, there is no motivation to build infrastructure. The converse of that statement is
that accessible, affordable medication can kickstart the development of
infrastructure. It is not as
if these matters happen separately from each other; there must be
cross-pollination. When drug
companies insist that infrastructure is the biggest problem, not
medication cost, it is as if gaining access to medication won’t promote
the development of infrastructure, when we know from experience, that this
is not the case...(interruption)
Reporter:
I want to know why
Glaxo Wellcome is closing the plant in South Africa.
MH:
Glaxo says it is part
of a global reduction of manufacturing capacity. They apparently took a major
survey and they believe that their plant capacity in South Africa is a
surplus and the manufacturers can be just as successfully produced in
developed countries.
Reporter:
Are there any AIDS
drugs produced there?
MH:
As far as I know, AIDS
drugs are made there but I am not sure which ones. We will be having a meeting in the
very near future. I met with
senior officials in London and asked that question and couldn’t get a
straight answer and was told to speak with the people in South Africa.
Reporter:
What is the price of
Diflucan in South Africa?
MH:
Diflucan in the public
sector is 28 Rand for a 200 mg tablet.
Reporter:
You don’t know the
translation?
ES:
The translation is
$3.60 US dollars for one tablet.
MH:
In the private sector
it is about 80 Rand before pharmacy markups and after it is over 120
Rand.
ES:
$12.85 is equal to 100
Rand.
MH:
It is a significant
variation in price. The
tablets we bought in Thailand cost 1 Rand 77 per 200 mg tablet. They were
produced in a factory called Biolab which is a supplier for MSF among
others in Thailand and has proper certificates of manufacturing and so
on. So there is a significant
variation in price.
AR:
That is, the Thai
prices are about .29 cents US.
ES:
Given the bizarre
attitude of the South African government towards AIDS drugs, if “Big
Pharma” were to negotiate say an $800 per year price for a triple
combination therapy, do you think that the South African government would
accept that?
MH:
That is another
issue. TAC recognizes that we
have a battle on our hands to change the position of the South African
government on the use of antiretrovirals. We are doing our best, and we
believe we will succeed with that in the short to medium term. At the
moment that is a difficulty, made worse by the fact that there is no
communication at present between “Big Pharma” and the South African
government, partly because all the members of “Big Pharma” are still
engaged in a court case against our government to block something called
the Medicines and Related Substances Control Amendment Act, which allows
the government to use parallel importation but also makes generic
substitution a requirement of pharmacists.
Reporter:
What other generic
drugs are you considering importing into SA? You said if you don’t get
what you want from the Control Council, you may go ahead in importing
other drugs. What are those
other drugs?
MH:
First of all, to
explain, the reason we imported the generic flucanozole was because we
didn’t want to encounter the arguments around infrastructure but we have
doctors who are part of TAC who can prescribe and monitor appropriate use
of antiretroviral drugs and drugs that would be considered for bringing
into the country on humanitarian grounds would include drugs such as AZT,
3TC and Combivir.
David Brown:
This is David Brown
from The Washington Post. Mark, could you spell your
name?
MH:
Mark
H-e-y-w-o-o-d.
Reporter:
How many pills/doses
of flucanozole did Mr. Achmat bring from where?
MH:
Mr. Achmat bought
5,000 200 mg tablets of flucanozole. He returned to South Africa with
3,000 tablets. All of those tablets were surrendered to the Department of
Health in good faith. 2,000 tablets remain in Thailand to be brought into
South Africa depending on the response of the Medicines Control Council.
The argument of the TAC is that we are not breaking the law, we use the
legal defense of necessity, which is a defense that can be used to
override or justify breaking the law in the interest of the preservation
and protection of people’s lives. We also believe that what we’re doing is
in accordance with the South African constitution, which is the supreme
law in South Africa, which guarantees our citizens the rights of access to
dignity and access to health care.
We believe that is more important than the patent rights that are
being contested here.
ES:
Are you objecting to
any specific conditions that you objected to in the summer concerning
Diflucan and what Pfizer wanted to do?
MH:
It seems to us that
Pfizer has changed their position since the summer. First of all, they’ve
extended the offer to cover candidiasis, which is a significant
development. (Candidiasis is a severe esophageal or vaginal infection
associated with HIV.) But we
have not seen the dots and commas. At one point I was on the negotiating
team with the South African government, and I was disinvited from
membership of that committee. We are waiting to see the details, but we do
know is that it is not on offer to the private sector, and it is only for
South Africa. In southern Africa, where borders are very fluid, where
people with HIV cross borders, where you have a regional, not just a
national epidemic, that is not satisfactory for us.
ES:
What about the various
conditions, the 2 years for example, how it can be monitored, where people
can be treated and so forth?
MH:
We understand that the
2 year time limit has been dropped, for that we wait to see on
Friday. Secondly we
understand that the South African government has insisted that the
implementation of the donation should not require the setting up of
parallel systems for monitoring, and that it should be done within the
framework of the existing health service infrastructure, which we should
also support. But again I would have to stress that although we know that
the deal will be signed on Friday, we do not know the final details of
what is being signed.
(A few seconds lost
due to tape change.)
MH:
…for use in mother to
child prevention. We have not yet heard the outcome of their
discussions. We are hoping
that it will lead to the registration or at least the conditional
registration of nevirapine. The South African government has moved its
position on mother to child transmission and is now introducing pilot
projects to test the operational issues around use of nevirapine in all 9
provinces in at least 2 sites per province with a minimum of at least
3,000 deliveries per site. That is a significant movement, but it is not
sufficient as far as we are concerned. Nevirapine should be made available
to every woman in South Africa who knows that she has HIV and is pregnant.
We endorse what has been said by the WHO and UNAIDS in their October
consultation that we have moved beyond the period of pilot projects, and
we believe that even if South Africa needs to test the issues around
implementation, that could be monitored in the context of expanding access
to the drug on a nationwide basis.
Brad
Nelson:
This is Brad Nelson
from Newsday. You were talking
about the expected announcement by Pfizer on Friday. Are you expecting other major
announcements by pharmaceutical companies?
MH:
We don’t know anything
in South Africa.
AR:
We have not heard
anything here. But we expect
that it will happen. In the past year we’ve seen price reduction schemes
amount to very elaborate public relations shows by the big companies. Anything to add,
Anne-Valerie?
A-VK:
No, we’re just
waiting.
(Conclusion of
teleconference)