South Africa’s Achmat Discusses Efforts to Obtain Cheaper AIDS DrugsZackie Achmat, leader of the South African AIDS advocacy group Treatment Action Campaign, recounted his group's efforts in lobbying for the introduction of cheaper HIV drugs into South Africa in an interview published in the January/February issue of the Multinational Monitor. Achmat specifically described the actions of the Defiance Campaign, a TAC committee launched in July 2000 to protest drug maker Pfizer's pricing and patent policies of its antifungal drug Diflucan, or fluconazole, which is commonly used by AIDS patients to treat fungal infections. Officially called the Christopher Moraka Defiance Campaign Against Unjust Trade Laws and Patent Abuse, the campaign was named for Christopher Moraka, who died of AIDS-related systemic oral thrush, a condition that is treatable with fluconazole. The Defiance Campaign has three objectives, Achmat said -- saving lives, educating the public on "patent abuse and profiteering by drug companies" and setting a "moral example" for the government to follow. The campaign has a separate committee within TAC that raises funds to "brin[g] good quality, safe generic medicines into the country in defiance of patent laws," Achmat said. Achmat is one of several Defiance Campaign members who have imported generic fluconazole from Thailand to South Africa (Multinational Monitor, Jan./Feb. 2001). In October, TAC reported having imported 5,000 generic fluconazole capsules, a move that was criticized by South African Health Minister Manto Tshabalala-Msimang and the opposition Democratic Alliance Party (Kaiser Daily HIV/AIDS Report, 10/20/00).
Although it was officially launched last July following the 13th International AIDS Conference in Durban, the Defiance Campaign actually developed through several acts of "defiance" conducted by TAC last year, Achmat explained. In March, TAC wrote a letter to Pfizer asking the company to reduce the price of Diflucan to 50 cents per 200 milligram dose. Governments are able to purchase this dose for $7.50 -- nearly $5 less than the drug's normal market price -- but Biozole, a generic version of the drug made in Thailand, only costs about 25 cents per 200 mg dose. At the beginning of April, Pfizer offered to give the South African government a "limited donation" of Diflucan for two years to treat the country's cryptococcal meningitis patients. However, thrush patients would not be able to receive the medicine under this arrangement, and TAC suggested to Pfizer that the deal be extended to also include patients with thrush and infected patients from other "poor" countries. Pfizer "ignored" TAC's suggestions and maintained its original offer. The South African government originally rejected the Pfizer deal, but in July it agreed to move forward with the plan. At this time, TAC announced the launch of its Defiance Campaign against Pfizer's Diflucan patent unless the company reduced the cost of its drug or included thrush patients in its deal. TAC produced a study showing that Biozole was a "good quality" drug, and the South African Medicines Control Council then offered TAC a legal exemption to import the drug, provided that the organization find a medical facility that would apply to import it as well. Brooklyn Medical Center agreed to import Biozole, and in November was given a legal exemption to do so, as long as an "approved South African facility" conducted an assay identification test showing that Biozole contained fluconazole. Achmat stated that two tests, one conducted by Doctors Without Borders and another performed by a South African facility, "proved Biozole's equivalence and quality."
Popular support for the Defiance Campaign has caused the South African government to become "increasingly positive" regarding generic production of HIV drugs, Achmat said. "Even our own health minister ... is showing some spine with the drug companies," Achmat added. TAC is urging the government to adopt a plan for the production of generic AIDS drugs similar to the Brazilian model before the end of August 2001. The organization is planning to continue to import Biozole from Thailand and distribute it through the Brooklyn Medical Center, a "challenge," Achmat stated, to "Pfizer and the entire profiteering industry to sue TAC." The organization also plans to challenge "without advance warning" patents on AIDS drugs held by GlaxoSmithKline, Bristol-Myers Squibb, Boehringer Ingelheim, Merck, Abbott Laboratories and Roche. Achmat listed several goals he would like to see achieved in the near future, including increased health spending by the South African government on treatment and prevention efforts for opportunistic infections such as tuberculosis and Pneumocystis carinii pneumonia. In addition, he said, drug production should "move away from the multinational corporate drug producers to local generic producers," including private generic production in South Africa (Multinational Monitor, Jan./Feb. 2001).