South African president maintains cost is too high

By Sabin Russell

San Francisco Chronicle 25 May 2000

South African President Thabo Mbeki said yesterday that the potent drugs used to fight AIDS in San Francisco are still unaffordable for his country, even at the steep discounts recently offered by manufacturers.

During a daylong Bay Area visit, Mbeki did little to counter his image as a leading skeptic of the value of anti-retroviral drugs such as AZT and ddI, although he made it clear that his primary concern is the cost of such therapies.

Mbeki told an audience of 500 at the Fairmont Hotel in San Francisco that the 85 percent discounts offered this month on the prices of anti-retroviral drugs made by five pharmaceutical firms would still leave the medicine beyond the reach of South Africans.

He later told reporters that his health minister, Dr. Manto Tshabalala-Msimang, has learned from the World Health Organization in Geneva that the offer would lower AIDS drug prices in South Africa to $2,400 a year from $10,000 today.

"We would then have to spend the entirety of our public health drugs budget on anti-retroviral drugs only. What are we to do?" he asked.

The South African president, accompanied by his foreign minister, Dr. Nkosazana Dlamini-Zuma, showed no inclination to use anti-retroviral drugs even for relatively low-cost treatments of pregnant women or rape victims.

Studies have shown that at a cost of about $40, the use of AZT during childbirth can cut in half the risk that a newborn will pick up HIV from an infected mother.

"Forty dollars is cheap?" Dlamini- Zuma scoffed. She added: "There are still a lot of unanswered questions about the toxicity of AZT."

Zuma, who has taken most of the criticism for South Africa's unwillingness to use AZT for pregnant women, said there may be more important priorities for pregnant women than AIDS drugs, noting that seven of 10 babies born to infected women are not infected at birth.

"You need to have a population that is well-fed. You need a population that has access to a good health care infrastructure . . . Pregnant women need to have affordable medicines, not just anti-retroviral drugs," she said.

Mbeki likewise stressed the importance of building up South Africa's health care infrastructure, without which the effectiveness of the costly drugs would be diminished. He acknowledged that it would cost "billions" of dollars to build such an infrastructure.

Asked the one thing the West could offer South Africa to fight HIV, Mbeki quickly said: "Those billions." But he also acknowledged that "those billions are not there."

The South Africans also indicated that they could not accept AIDS treatments for only a portion of the population. "People say, 'Why don't you give it to some?' You cannot discriminate in that way," Mbeki said.

He dismissed the idea of even a short course of anti-retroviral drugs for rape victims. AZT manufacturer Glaxo-Wellcome has never applied for a license to use the drug for such purposes, the president said.

Shannon Herzfeld, senior vice president for international affairs at PhRMA, the largest U.S. pharmaceutical lobbying group, said she hoped South Africa would reconsider its opposition to the use of anti-retroviral drugs to prevent mother-to- child transmission. "It can be cheaper than the cost to the public health system of one visit to the hospital by an HIV-positive baby," she said.

Herzfeld said the South African leaders have a realistic understanding of the need for a complex and expensive infrastructure to support effective use of anti-retroviral drugs. "There is a competition for the health care dollar for drugs that treat other diseases, such as malaria, tuberculosis and common infant diarrhea," she said.

Current estimates are that 4.2 million South Africans are infected with HIV, the virus that causes AIDS. The sheer scope of the epidemic, in a nation where the majority of citizens are black and poor, means that South Africa must find other means to fight the disease.

Asked about his widely publicized discussions with dissident scientists who contend that the human immunodeficiency virus, or HIV, is not the cause of AIDS, Mbeki said his major concern is why Africa's AIDS epidemic is so different from that in the West.

He noted that when AIDS first appeared in Africa in the mid-1980s, it was not endemic but was similar to the disease that was rampant in San Francisco -- those infected with HIV were primarily homosexual. Just five years later, AIDS was endemic in Africa and was striking the heterosexual population, while in the United States AIDS was still primarily a disease of gay men.

Research that would determine just why the African epidemic appears to be different from that in the West could help the continent target its response, Mbeki said. "There is a very serious AIDS problem in Africa," he said. "Let's respond in a way that produces results."