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ARV programme stumbles?
Khopotso Bodibe. 03 June 2004, Health-E News Service. Republished courtesy of Health-E News Service.
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Tuesday this week was International Children?’s Day. It was also the day on which we heard the news that government had instructed all provinces that had begun implementing an HIV/AIDS Care and Treatment Plan to stop enrolling any more children for treatment. Health-e News Service takes a look at the supply of antiretroviral drugs in the public health sector.
Below follows a transcript of a radio broadcast, conducted by Khopotso Bodibe.
KHOPOTSO: ?“We urge the government not to put us in the position to take it to court again.?” That was the reply of TAC chairperson Zackie Achmat, in response to the announcement attributed earlier to Dr Nono Simelela, the out-going Chief Director of the HIV/AIDS, TB and STI?’s Directorate in the Department of Health. Explaining this turn of events in the public sector?’s two-month old treatment programme, Simelela is reported to have said that children should not be put on treatment ?“until it was clear that the antiretrovirals could be supplied without interruption.?” In an interview in January, as if in a prophesy, Chirfi Guindo, Chief Executive Officer of Merck, Sharpe and Dohme in South Africa, the company that produces Efavirenz in both children and adult doses had this to say about ensuring sustained drug availability.
CHIRFI GUINDO: This is what I keep telling the government Task Force and I come back to that?… Please, please, do a proper planning?… otherwise you?’re not going to meet your own targets in terms of putting patients on treatment.
KHOPOTSO: But then, it?’s a two-way street. They should do proper planning and so should you?
CHIRFI GUINDO: Ja, absolutely. But again, we have to receive the numbers. As we speak today, I cannot tell you how many potential patients there are out there who will be put on Efavirenz as part of the national roll-out Plan. We do not have those numbers. And we must get those numbers as early as the Task Force is ready. Those numbers must be communicated so that we can upscale accordingly.
KHOPOTSO: That was earlier this year in January. Ironically, MSD (SA) itself had run out of its paediatric version of the drug Efavirenz over the Christmas season, forcing six South African children to interrupt their treatment. But the point remains. In order for the pharmaceutical sector to produce sufficient drugs, the government must do its home-work and place its orders in good time. Vice-President of the National Association of Pharmaceutical Manufacturers, Stavros Nicolaru, is quoted as saying that the charge that ?“the industry was failing to cope was true only to the extent that the government failed to provide consistent figures of the supply needed.?”
Up until now the national Department of Health has not ordered a single drug. As an interim measure provinces have been using their allocated budgets to directly purchase antiretrovirals from the pharmaceutical companies. A source in the industry to Health-e that the ?“national government has not completed the tendering process for drug procurement purposes.?”
MSD (SA) is one of the companies waiting in the wings to tender. In that regard, the source said, ?“the government has scheduled a meeting with the pharmaceuticals for the 10th of June.?” It is believed that the government will seek to use the meeting to centralise drug procurement processes, rather than leave it in the hands of the provinces. At a meeting in Pretoria announcing the approval of the Treatment Plan on November 20th, this is what Dr Nono Simelela said.
DR NONO SIMELELA: This Plan is based on an assumption that there will be a 100 % uptake. But we know in reality that not even in the best of programmes ?– uptake never reaches that capacity. So, we based our calculations of patients who will enrol in the programme on a number of factors. First, we did an evaluation of the prevalence, which looked at the population ratios. So, we were able to come up with numbers that indicated how many patients would come to facilities at a given point in time. So, the estimates that we have is that in the year 2003 ?– 2004 up to 53 000 patients could be enrolled?… It could be more because there might be pent-up demand up there?… The drugs will be available for the numbers as indicated. The commitment is to actually reach everybody.
KHOPOTSO: She also added these encouraging words:
DR NONO SIMELELA: Everybody must come to the table. It?’s time for the pharmaceutical industry to prove they meant what they said about these things?… Government has said we want these things, so people must come to the table and tell us: Are they ready? Can they do it, and how soon? On our side as government we will not drag our feet.
KHOPOTSO: The initial expectations have not been met. Instead of 53 000 people on treatment in the public sector ?– the government?’s own estimate of how many people need antiretroviral therapy ?– we have approximately 3 600.
At a parliamentary briefing last week, Health Minister Manto Tshabalala-Msimang, said she was ?“satisfied with the pace and progress made so far in the implementation of the Plan for the Treatment of HIV and AIDS. It remains to be seen whether solving the logistical problems of drug procurement will help with delivery of the Plan. Exactly a week from today, on June 10, the Health Department is due to meet pharmaceutical companies to finalise its antiretroviral medication needs and to confirm what the companies can provide. |
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