JASPREET KINDRA and DREW FORREST, Johannesburg | Friday
MINISTER of Health Manto Tshabalala-Msimang had the approval of the African National Congress’s top leadership in repudiating Gauteng’s announcement of a comprehensive rollout of drugs for HIV-infected pregnant women in the province.
Well-placed party sources said Tshabalala-Msimang’s statement distancing herself from the announcement, and accusing Gauteng of a breach of protocol, was sanctioned from the top. They also said there was a noticeable hardening of her stance after Monday’s meeting on Aids between the ANC’s 19-member inner leadership core, the national working committee (NWC), and former president Nelson Mandela.
At the root of her apparent shift was President Thabo Mbeki’s cautious and questioning stance on HIV/Aids and anti-retroviral drugs, including nevirapine, an ANC source said. The source added that Tshabalala-Msimang was “extremely sensitive” to Mbeki’s views.
After the minister’s statement “all hell has broken loose”, said a source, revealing that the minister and her department were not prepared for the bad press and hostile response from ANC and alliance members.
It is understood that Gauteng’s health MEC, Gwen Ramakgopa, has not contacted Tshabalala-Msimang since the statement was released, and has left the matter in the hands of Gauteng Premier Mbhazima Shilowa’s. Shilowa is a close confidant and friend of Mbeki’s.
Contrary to some media reports, the Gauteng government did not set out to defy national ANC leaders. Ramakgopa is known to believe that the province’s treatment plans are in line with national policy and a decision of a Minmec meeting between the health minister and MECs three weeks ago. This appeared to resolve that provinces with the capacity could go ahead and extend nevirapine treatment to pregnant women.
This interpretation was confirmed by none other than Mbeki himself in a recent interview on SABC’s Newshour. Asked whether the pace of nevirapine rollout would be set by the weakest provinces, he said provinces with capacity should go ahead.
Tshabalala-Msimang’s current view is that Minmec decided that MECs should study a voluminous report on progress at pilot sites where nevirapine is being dispensed, and return with policy proposals to the next Minmec meeting, scheduled for two weeks’ time. Gauteng had, therefore, jumped the gun.
ANC representative Smuts Ngonyama confirmed the cautious official view, saying policy was that the future course of action would be determined only after the pilot studies had been fully assessed.
The paradox is that the Gauteng government merely publicised a policy it has been quietly pursuing for two years. A strong motive for the decision to go public was the fact that the Inkatha Freedom Party was stealing a march on the ANC by announcing full nevirapine rollout in KwaZulu-Natal, a source said.
Gauteng’s announcement, coupled with Mandela’s high-profile criticism of government dithering on Aids, seem to have pushed the ANC’s leadership into a defensive posture. Media portrayal of the Gauteng announcement as defiance of national policy may have hardened attitudes.
At the meeting of the NWC – dominated by Cabinet ministers and Mbeki loyalists – Mandela’s views are understood to have made little impact.
An ANC source sympathetic to Mandela said he might have made a greater impact if he had approached the party’s national executive committee, which might take a more independent line.
Presidential representative Bheki Khumalo said there was no bad blood between Mandela and Mbeki. However, the presidency believed the former’s assessment of government efforts on Aids was wrong.
A member of Mbeki’s camp took a harder line on Mandela’s intervention, calling him “a politician pandering to populist demands, who does not understand the party line”. The source pointed out that Mandela had a habit of offering public criticisms of the ANC leadership and then backing down.
After the NWC encounter, he said he was “satisfied” with government’s Aids response.
Although Mandela is an ex officio member of the NWC, he holds no office in the party.
Said another party source: “At the end of the day it was all about retaining central political control over the situation – both in the face of Madiba’s intervention as well as Gauteng’s perceived defiance.”
Mandela is understood to have complained to the NWC about the lack of debate in the national Cabinet on drug treatment for HIV/Aids. The call for debate was welcomed by the secretary of the ANC’s health committee, medical doctor Saadiq Kariem, and by at least one health MEC.
Kariem said he was concerned about the impact of provincial moves to expand the provision of nevirapine on the court case brought against the government by the Treatment Action Campaign, which last year won a high court order instructing government to roll out Aids drugs.
ANC health sector activists are to hold a meeting this weekend with Deputy President Jacob Zuma or secretary-general Kgalema Motlanthe to seek clarity on government’s stance.
Last week senior ANC stalwart and Eastern Cape Premier Makhenkesi Stofile announced that his province would also move towards a full nevirapine rollout. He has not yet been denounced by national government.
Tshabalala-Msimang’s “distancing” of national government from Gauteng’s programme has, meanwhile, left the ANC’s detente with its communist and union allies in disarray.
The Congress of South African Trade Unions immediately attacked the minister’s statement for “politicising” the issue of anti-retroviral drugs and as a “stumbling block” in the fight against the Aids pandemic. The South African Communist Party expressed its “dismay”, saying the statement reflected government’s “hesitancy, prevarication and lack of decisive leadership on HIV/Aids in general, and the prevention of mother-to-child-transmission in particular”.
The SACP said the health minister’s attack on Gauteng also clashed with her “report and commitments” at a party central committee meeting at the weekend, briefed by Tshabalala-Msimang. Also present at the meeting was Shilowa.
The SACP had “underlined the fact that the existing resource and capacity constraints must not be seen as obstacles but as challenges to be overcome within a reasonable period”.
At the central committee meeting, SACP leaders also pressed the health minister on why government was persisting with its appeal against the decision in the case brought by the TAC. She was unable to give a convincing reason, a source said.
As it sought to do on privatisation, the party is trying to mediate between government and its left-wing critics on HIV/Aids.
At a press conference on Monday, SACP general secretary Blade Nzimande and his deputy Jeremy Cronin pointed out that the TAC and government had joined forces to fight pharmaceutical giants over the import of cheaper generic drugs.
Many TAC members belonged to the ANC or to the SACP, Cronin said. He urged government and Aids activists to “patch up” their differences.
“Manto is a reasonable person with a good past record as a health activist,” said one.
“The trouble is that things are wobbly at the very top. We have a president who doesn’t believe the virus exists.”
FEATURES:
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Has Mbeki heard of Nuremberg? December 13, 2001
ANC in new Aids denial December 10, 2001
Politics ‘more important than science’ December 10, 2001
ZA*NOW:
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