Generic Drug Companies Try To Balance Social Responsibility, Profits in Providing Antiretrovirals in South Africa
Generic drug companies producing antiretroviral drugs for South Africa's new national HIV/AIDS treatment program are being forced to balance social responsibility and the need to make profits, the New York Times reports (Itano, New York Times, 11/21). The South African Cabinet on Wednesday approved a plan for a national HIV/AIDS treatment program, including the distribution of free antiretroviral drugs through service points in every health district within one year and in every local municipality within five years. The program aims to treat 1.2 million people -- or about 25% of the country's HIV-positive population -- by 2008 (Kaiser Daily HIV/AIDS Report, 11/20). Despite the large demand that the program will create, companies are under "intense public pressure" to keep drug costs down, according to the Times. In addition, profit margins are expected to be low, with most of the financial benefits coming from spreading fixed overhead costs over a wider product base, the Times reports.
Producing the drugs is seen as a "potential public relations minefield" because companies do not want to be seen as making too much money off of the epidemic, according to the Times. Linda Phillip, chief operating officer of Aspen Pharmacare, a South African generic drug company, said that generics are traditionally priced 10% to 20% lower than brand-name drugs, but antiretrovirals' initial pricing has to be "far less," according to the Times. Producing generics in South Africa also presents the hurdle of securing voluntary licenses from brand-name pharmaceutical companies in order to produce the drugs, the Times reports. Most generic antiretrovirals have been produced in countries that do not recognize international patents or that have issued compulsory licenses on the grounds that AIDS is a national emergency. However, generic drug companies in South Africa have said that most of the biggest drug companies have been responsive to their requests for the voluntary licenses, according to the Times (New York Times, 11/21).
Traditional Healers' Role in Treatment Program
The Chicago Tribune on Friday profiled the role that South Africa's 200,000 traditional healers, who provide more than 80% of the country's medical consultations, are expected to play in the new national treatment plan. Since the early 1990s, at least 6,000 traditional healers have attended AIDS training programs and are seen as having "clear advantages" in helping to treat people with HIV/AIDS because "[t]hey know their patients well, live near them, work hours when formal clinics are closed and outnumber doctors by a 10-1 ratio," the Tribune reports. However, program organizers also worry that healers may be reluctant to refer clients to formal health clinics for fear of losing business or may inadvertently prescribe traditional herbal treatments that could interfere with antiretrovirals. Experts say that healers will need more training before taking a large role in the national plan, according to the Tribune. Under a bill expected to come before parliament next year, the government plans to begin registering and licensing healers, which would provide a basis for choosing healers to be involved in the program and would give healers the right to reimbursement from medical insurance programs (Goering, Chicago Tribune, 11/21).
Program Will Extend 'Countless Lives,' Opinion Piece Says
South Africa's national treatment plan means that "countless lives can be extended and families preserved," Dr. Bruce Walker, director of the Division of AIDS at Harvard Medical School, and Dr. William Rodriguez, director of the division's office of international programs, write in a Boston Globe opinion piece. "No program of this magnitude has ever been implemented," Walker and Rodriguez say, adding that the challenges are "large." An estimated 400,000 people are expected to need antiretroviral treatment immediately, and the country must adhere to an equity clause in South Africa's constitution requiring health benefits be made available "equally and simultaneously" to all citizens, according to Walker and Rodriguez. In order for the program to be "success[ful] and sustainab[le]," new clinics and laboratories need to be established, a coordinated effort to train health care workers should be developed and an effective system to manage the program should be implemented, Walker and Rodriguez say, concluding that South Africa's "bold step forward should receive our strongest support" (Walker/Rodriguez, Boston Globe, 11/21).
NPR's "All Things Considered" on Thursday featured a commentary by Joe Wright, a volunteer with the South African AIDS treatment advocacy group Treatment Action Campaign, who discussed the group's efforts in fighting AIDS. Included are comments by Sipho Mthathi of TAC's training program (Wright, "All Things Considered," NPR, 11/20). The segment is available online in Real Player.