The Ministry of Health says it needs proof of the effectiveness of AZT before it can accept discount offers for the drug. Aaron Nicodemus reports
The Ministry of Health has so far refused to accept Glaxo Wellcome’s offer of a reduced price for anti-retroviral drugs, and maintains that there is not enough proof that anti-retroviral drugs work.
But that belief is disputed by many Aids experts, and even contradicted by practice in some public hospitals – where the state covers the cost of the supply of anti- retroviral drugs for their health care workers, but refuses to provide it to patients.
Chris Hani Baragwanath hospital in Soweto, for example, provides AZT to its health care staff in the event of a needle-stick injury. Evelyn Keswa, a senior researcher and nurse at the hospital, says in the past two years, three nurses exposed to HIV were given a four-week treatment by the hospital.
Mother-to-child transmission of HIV is another area where anti- retroviral drugs have been proven to reduce transmission of the disease, by anywhere from one-half to two-thirds.
Dr Clive Evian, an Aids clinician at Johannesburg hospital, says that anti- retroviral drugs are a “cost- effective medical intervention to reduce mother-to- child infection. It will save the lives of children, and it will save significant costs in treating children with Aids. I can understand the government’s apprehension, but they are using many other medical interventions on a much more flimsy basis.”
There have been four major studies on the efficacy of AZT, 3TC and other anti- retroviral drugs in reducing mother-to-child infection and needle-stick injuries.
No studies have been conducted on its efficacy on reducing HIV transmission to rape victims, but there are inherent problems with such studies. A traditional study, where some victims would be given anti-retroviral drugs after being raped and others denied the drugs, would be unethical.
“You’d have to do a register, and try and follow which rape victims took AZT and which ones did not,” said Dr Glenda Gray, director of the HIV research unit at Chris Hani Baragwanath hospital. And there are other difficulties, like the fact that most rape victims do not know whether their attackers have HIV, she said.
Glaxo Wellcome’s offer to provide their anti- retroviral drugs to developing countries at reduced cost has other drug companies shivering in fear, according to an industry insider. The prospect of finding a cure for Aids is becoming less and less attractive to drug companies. “The first company to find a really effective Aids drug will go bankrupt,” he says.
“Why? Look where the majority of Aids cases are – South-East Asia and sub-Saharan Africa. Not too many people living in those parts of the world can afford expensive drug treatments.
“In today’s social scenario, how can you say no if you’ve got something to help them?” he asks. “If [the protestors] succeed in getting Glaxo Wellcome to give it away for free or drastically reduced cost, you kill Aids research. When you’re suffering and dying of Aids, things like profit margins don’t go through their minds. That in itself is a costly gesture. To create this kind of issue is seriously disruptive to the cause of finding a cure.”
Dr Peter Moore, Glaxo Wellcome’s medical director for sub-Saharan Africa, agrees that offering drugs to governments at reduced cost is a financial risk, but the company hopes that much higher prices for the drugs in the Western world can offset losses created by offering it at reduced cost to developing countries.
Moore says there are no concessions being requested by Glaxo Wellcome to offset the loss of profits. “It is a totally unconditional offer,” he said. The offer does not restrict the amount of the drug provided and does not ask for any special legislation to be passed that would be favourable to Glaxo Wellcome, he said.
The only safeguard that the drug company will make is to specially mark the drug in a way to make it different from those sold in the West. There is a risk, Moore says, of the drugs being illegally exported from Africa to the Western world, where black marketeers could demand higher prices.
The decision on accepting the offer now rests in the hands of the Department of Health and its minister, Nkosazana Zuma.
The drug will cost the government R400 per month-long treatment under the offer made by Glaxo Wellcome. The current price ranges from between R3 000 and R5 000 for the month-long drug treatment.
Health department representative Vincent Hlongwane says the talks between the government and Glaxo Wellcome are continuing. “There are a number of issues that need to be looked at that do not necessarily impact on health,” he said.
A demonstration was held outside Glaxo Wellcome’s offices in Midrand last week to demand that anti-retroviral drugs like AZT be provided to rape victims free of cost. The rally was held in large part due to a story by Mail & Guardian reporter Charlene Smith, who recounted being raped in her home and then her difficulty in obtaining the drugs that might reduce the chance of her being infected with HIV.
Smith says that by not giving AZT and other anti-retroviral drugs free to rape victims, the government is condemning many of them to death. “If they don’t care about the lives of women, then they should start thinking about the economic consequences of this decision,” she said, noting that hospitalising the thousands of rape victims who contract HIV will prove many times more costly than providing them with AZT.