Ivor Powell and Belinda Beresford The government has failed to implement the advice of scientists on a panel convened by President Thabo Mbeki himself to advise on HIV/Aids policy and treatment – the latest manifestation of its stubborn reluctance to accept evidence that anti-retrovirals are safe and effective. The Mail & Guardian has learned that after two-day deliberations in Johannesburg in early July, the majority of Mbeki’s scientific advisory panel recommended the urgent and widespread use of anti-retroviral drugs for the prevention of mother-to-child transmission of HIV. The recommendation was made specifically in respect of the drug Nevirapine, whose efficacy the South African government continues to question in the face of overwhelming scientific support. The government has yet to take up offers from international pharmaceutical houses to provide the drug free of charge, arguing the drug requires further testing. Nevirapine has yet to be included on the official register of drugs in South Africa – despite numerous reports by among other agencies the Medical Research Council and the Medicines Control Council endorsing its efficacy.
The majority support among the panellists in the July 3 and 4 meeting, like that of the government agencies, however, flew in the face of views expressed earlier by both Mbeki and Minister of Health Manto Tshabalala- Msimang, both of whom had drawn attention to the supposed toxicity of anti-retroviral medication.
The result of the panel’s deliberations was to be conveyed to the president in a briefing by the panel’s secretariat ahead of Mbeki’s opening of the International Aids 2000 Conference in Durban on July 9. Thereafter the secretariat was to write the panel’s recommendations up in a formal report. However, the report has not yet been made available to members of the scientific panel.
Scientists included in the advisory panel told the M&G that the majority recommendation was to have been drawn up after the 35-member panel decided to divide itself into what was effectively two separate meetings. “It was a farce. There was just no common ground between us and the dissidents that the president had pulled together,” one leading Aids researcher said. “We couldn’t agree on anything, so we broke up into two separate panels, debating policy and drawing up our own recommendations.” In the event, the grouping of mainstream scientists – the majority on the panel – bowed to outside pressure to include prominent local researchers and international experts from the scientific establishment along with the dissident radicals. Endorsing international scientific opinion favouring its use in controlling mother-to-child transmission of HIV, the so-called “scientific panel” threw down the gauntlet to a government still inexplicably reluctant to approve the widespread use of Nevirapine, a drug shown to significantly reduce the incidence of mother-to-child transmission. Panellists contacted by the M&G said the Aids-dissident grouping on the panel had not provided counter-evidence to question the evidence supporting Nevirapine in controlling mother-to-child transmission of the virus. In his opening of the international Aids conference, however, Mbeki paid scant attention to the Nevirapine issue, preferring instead to focus on poverty as an issue in the promotion of infection. And to date there are few indications that the powers that be in government have taken the scientific panel’s advice to heart. It is understood that a subsequent convocation of Aids researchers at a meeting of government ministers and provincial MECs in Pretoria on August 12 and 13 resulted in little more than the scientists being hauled over the coals. At the meeting, government representatives reportedly criticised the quality of research undertaken by eminent local Aids scientists, and delivered themselves of invectives against the scientists for criticisms of government Aids policy during the Durban conference in July. At the conclusion of the meeting, Tshabalala- Msimang reaffirmed the general approach of government’s Aids strategy, saying that prevention remained the key element in dealing with the epidemic. However at the same time the government has announced the extension of pilot projects aimed at using Nevirapine in controlled situations and thereby exposing it to further scrutiny.
n Meanwhile, Timothy Trengove-Jones reports that the Aids Treatment Action Campaign plans to go ahead with legal action against the government.The case will challenge the government’s refusal to implement programmes to prevent the transmission of HIV from HIV- positive mothers to their children.