The vast majority of health MECs are in favour of a rapid roll-out of nevirapine, but the minister will play a pivotal role in the final decision
Belinda Beresford and Jaspreet Kindra
The government looks set to buckle under remorseless internal and external pressures and allow pregnant women country-wide access to the drug that could save their children from HIV/Aids.
A decision on whether to accelerate a programme using the anti-retroviral nevirapine to cut mother-to-child transmission of HIV is expected to be taken during a ministerial meeting ending today.
The long-simmering issue exploded in the government’s face this week with more and more provinces and medical personnel going their own way and increasingly public divisions within the African National Congress, as well as with its alliance partners, Congress of South African Trade Unions and the Inkatha Freedom Party.
On Wednesday the departments of health were confronted with another humiliating appearance in court over their nevirapine mother-to-child transmission programme. The Treatment Action Campaign (TAC) filed a compulsion order to force the government to obey a December court decision that it speed up the use of nevirapine or provide better reasons than the ones used in legal argument why it cannot do so. The government has to announce its intention to defend itself against the order by next Friday. If it does so, it may be in court as soon as February 12, having to defend itself again under the eyes of the international media and in the teeth of growing public disapproval.
At the time of going to press, sources within the government and the ANC said that the decision was poised on a knife-edge. Monday’s meeting of the party’s influential discussion group, the national working committee, failed to make a clear recommendation, and left it to the national and provincial health ministers to bite the bullet.
The Mail & Guardian has been told that the vast majority of health MECs are in favour of a rapid roll out, but Minister of Health Manto Tshabalala-Msimang will play a pivotal role in the final decision.
The meeting will look at results from the 18 pilot sites that form part of the national Aids plan. Defending itself against the TAC court action at the end of last year, the government said it could not implement a nationwide programme without analysing the results from these pilot sites. Government lawyers argued that it would take up to two years to collect enough data to make a decision.
The Pretoria High Court found that the government’s reasons for its cautious pace did not justify the number of children at risk of catching HIV and said a justified timetable must be presented to the court by the end of March. TAC has estimated that at least 10 children a day face an early death because their mothers have no access to nevirapine.
According to high-ranking ANC sources, the pressure to save children is now so overwhelming that the national government will be forced to shift its position, but a key concern is how to present such a move.
Public admission that the programme could and should be speeded up would undermine the government’s legal appeal against the TAC decision.
The sources say that the health ministers’ meeting is likely to steadily extend and speed up the nevirapine programme, while avoiding a rapid full-scale implementation. A six-month roll-out period is being mentioned.
After the special meeting late on Wednesday night, the ANC’s national health secretariat admitted “that all spheres of government [are] under severe public pressure to roll out the MTCT [mother-to-child transmission] programme.”
A further sign of a shift in government thinking is that the somewhat amorphous statement by the health secretariat did not question the efficacy of nevirapine in cutting transmission of HIV from pregnant women to their babies, rather citing operational difficulties as a reason for delay.
The health secretariat says that “rational scientific opinion” should prevail over “emotional and uninformed opinons”. Leading ANC members, including Tshabalala-Msimang, have repeatedly questioned the efficacy and safety of the nevirapine regime, despite several internationally recognised scientific trials that have shown it can save the lives of up to 50% of the children who would otherwise face an early death from Aids.
Rather the statement concentrated on the operational capacity of the public health service to implement a programme, saying: “The perception created in the public debate on this issue is that it is simply a matter of taking a single dose of a tablet. This single dose is not the panacea of all ills.”
The concern of the ruling party to maintain an impression of unity was highlighted by the health secretariat’s statement after Wednesday’s meeting with provincial health ANC MECs that emphasised that the party was not divided on the issue. This is questionable since this week Zweli Mkhize from KwaZulu-Natal became the first ANC MEC to publicly break ranks with the national department when it was announced that the province would fully roll out its nevirapine mother-to-chid transmission programme within three months.
The machinations around this statement indicate the political sensivity concerning HIV, Aids and antiretroviral drugs. KwaZulu-Natal has stood behind the government in its fight with the TAC. In court papers filed in October last year, the KwaZulu-Natal secretary of health Ronald Green Thompson said: “The department is not in a position from a resources point of view to immediately or in a short space of time implement a comprehensive programme.”
Last week KwaZulu-Natal Premier Lionel Mtshali said that the province would begin distributing nevirapine at all state hospitals. This week the province’s health MEC, who is also the ANC’s provincial deputy chair, said the process would take longer. At least 20 of the major hospitals could be distributing nevirapine within six months, with the remaining 40 smaller institutions being phased in afterwards.
However, the capacity of the KwaZulu-Natal health system improved dramatically over the next two days. On Wednesday the provincial cabinet announced that it would roll out its nevirapine programme within just three months. Primrose Nxumalo, spokesperson for Mtshali, said “six months was not acceptable to the premier and the parties agreed that three months was a reasonable time frame”.
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