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HIV in South Africa

With the end of apartheid, South Africa became the epi-center of the AIDS epidemic due to an influx of migrants. Despite the rapid rise of HIV infections and AIDS deaths in Africa in the 1980s, the response to HIV in South Africa was slow. This was a result of the narrative created about the disease in the Global North that connected the spread of the virus to the behaviors of injection drug users and gay men. Another factor was that the spread of the disease in Africa looked incredibly different as more than half of people living with HIV in sub-Saharan Africa are women.

When HIV and AIDS started having a widespread impact on South African society and communities, President Mbeki followed the arguments of Peter Duesberg, who stated that HIV could not be the cause of AIDS and was opposed to Western medical approaches to solving the epidemic. In 2003, the health minister, Tshabalala-Msimang advocated for nutritional solutions to alleviating HIV in South Africa and was notoriously known as “Dr. Beetroot”. Through Mbeki’s reasoning, continuous efforts from other countries to offer help for AIDS were declined and civil society groups raised grave concerns over the need for urgent action. One of the biggest groups to raise concerns and have the greatest impact in the region was the Treatment Action Campaign.

About the Treatment Action Campaign (TAC)

The Treatment Action Campaign (TAC) was founded in 1998 as a tripartite alliance between the AIDS Law Project and COSATU, a key organization that fought apartheid in the 1980s. TAC was formed as a response to HIV in South Africa due to the lack of urgency that the government and the medical industry had in responding to the virus.

The transformative and charismatic Zackie Achmat, a previous gay rights activist who was diagnosed in 1990, initially led the organization.

TAC was a human rights-based organization focused on fighting racial discrimination and economic exploitation. This group was not only technical, but also political in their arguments as they utilized justifications for actions through moral, scientific, and economic reasoning. The TAC also developed partnerships with activist groups such as the Gay Men’s Health Crisis (GMHC) and ACT UP, which have aided training “treatment literacy” and initiated a wider peer education network.

In addition, TAC formed partnerships between elites, academics, professionals, and press, but ultimately served to strengthen the effort for the poor to become advocates for themselves. Through the framework TAC developed and their understanding of the disease, TAC used their model for social mobilization, advocacy, legal action, and education. 

TAC’s First Action

TAC’s first action was to argue for the right to access medical resources – namely antiretrovirals (ARVs). TAC found inherent fault with the World Trade Organization’s 1995 TRIPS agreement, which legally protected intellectual property and patents.

 In 1998, TAC demanded that the South African government introduce the program “Prevent Mother-to-Child HIV Transmission” (PMTCT). The social movement around advocacy for PMTCT was predominantly made up of poor black women living with HIV in South Africa. The issue was framed as a moral issue: that the pharmaceutical company GlaxoSmithKline (GSK), the patent holder of AZT, was profiteering off the sale of the drug. TAC demanded a price reduction and in framing it as a moral issue with reference to the South African constitution, the organization succeeded in its demand for legal action.

Key Tool to Success

A key tool for TAC’s success was its use of legal resources and advocacy. Not only did TAC make legal demands of the South African government, but they collaborated with progressive lawyers, scientists, and researchers to develop plans and alternative policy proposals. The organization went beyond simply advocating for the poor. They also based policy on the entitlement of rights to the individual. TAC has taken successful mitigation measures on five occasions; in 2001-02, for a national program for PMTCT; in 2004, for implementation of ARV roll-out; and in 2006-07, for access to ARVs for prisoners in Westville and KwaZulu Natal province, for ongoing litigation to challenge the profiteering of pharmaceutical companies and for denouncing alternative treatment to defend the Medicines Act. These cases were supported by not only the efforts of lawyers but the actions of TAC which involved marches, media campaigns, legal education, and social mobilization.

These actions were not possible only as a result of the advocacy and partnerships formed by the TAC, but also the structures in which the group functioned. Article 27 of the South African constitution, which took effect in 1997, includes the right to access medical services, reproductive health care, and emergency medical treatment. Through these efforts, TAC has helped advocate for an improved response to HIV in South Africa, a process that must continue to further combat the spread of the virus.

Danielle Barnes
Photo: Flickr


The UN’s 2016 High-Panel report on global access to medicine opens with an inspiring message: “Never in the past has our knowledge of science been so profound and the possibilities to treat all manner of diseases so great.” It is hard to debate that recent advancements in targeted cancer therapy and HIV drug development indicate a bright future for the Rx world. The potential for positive change may go unrealized, however, if access to medicine remains limited. To serve the 3.5 billion people without basic medical services, along with the 100 million who find themselves in extreme poverty because of high medical costs, governments and organizations have to confront the complex economic forces undermining global access to medicine. This article will discuss two such forces and consider how international actors have responded.

Too Big to Heal?

Economic orthodoxy holds that the equilibrium of a product’s supply and demand will determine its price, but medication prices do not adhere to this rule. This is because firms in the pharmaceutical industry possess the key to market distortion. Monopoly power or the ability for firms with outsized market shares to raise prices without experiencing a corresponding drop in sales. Pharmaceutical companies tend to obtain monopoly power for several reasons, such as:

  1. High entry costs, especially those associated with research and development. This excludes smaller, potentially disruptive firms from the market.
  2. The continuation of company consolidation. In the past 20 years, a group of 60 different pharmaceutical companies shrank to a mere 10.
  3. Large profits. Profits are huge, with the 10 highest-earning companies netting a 20 percent profit margin on average. This allows these companies to fortify their already-large market share. Most importantly, once a company patents a drug, it holds exclusive title to the production and distribution of that drug for 20-25 years.

During that period, no lower-priced, generic substitutes can enter the market. Equipped with this uncontested control, these companies can charge high prices for their products, as those who need them will have no other choice but to bear the cost. Yet some, especially individuals in poorer countries dealing with diseases like Hepatitis C and cancer, simply cannot afford these costs.

There are many individuals and corporations who are attempting to solve this problem, however. For example, GlaxoSmithKline (GSK), a pharmaceutical company based in London, England, is trying to put an end to exorbitant prices for prescription drugs in low-income countries. In March 2016, it announced that it would not seek patent protection for its drugs in 50 of the world’s poorest countries. By doing this, the company opened the path for smaller companies to bring lower-priced, generic versions of their drugs to the market. So far, the approach has been effective, earning GSK the top spot in the 2018 Access to Medicine Index. The positive publicity it receives from the ranking will hopefully motivate other companies to follow suit.

R&D Incentives

While the economics of monopoly power generates the problem of overpricing, the incentives of research and development make it such that many medicines needed in low-income countries go underproduced. As mentioned above, patents spell large rewards, but it costs $800 million on average for a company to obtain one and to bring a drug to the market. This pressures companies to develop the drugs that are most likely to produce a substantial financial return. Additionally, as the UN High-Panel notes in its report, this means that widespread, treatable diseases can oftentimes go unaddressed. For example, antimicrobial-resistant viruses and parasites threaten to kill as many as 10 million people annually by 2050, yet drug companies worldwide have developed virtually no new antibiotics in the past 25 years. In the absence of this innovation, however, public-private R&D partnerships have proven to be a successful substitute. The Global Fund is an example as it has saved 27 million people that malaria, HIV/AIDS and tuberculosis threatened by raising money from both public and private sources and collaborating with domestic task forces and commissions.

A Reconceptualization

Economic barriers to improve global access to medicine remain, but more and more people are starting to conceptualize the problem as an ethical one rather than an economic one. However, ensuring access to health care and maintaining market efficiency are not mutually exclusive. For example, cost-efficient drug production techniques are necessary to disseminate medicines at reduced prices. But other times “policy incoherencies,” as the UN High-Panel report calls them, force decision-makers to choose between the promotion of economic innovation and the provision of public health. Thanks to leading companies like GlaxoSmithKline and compassionate organizations like the Global Fund, the international community is starting to opt for the latter.

James Delegal
Photo: Flickr

malaria vaccine
On Thursday July 24, GlaxoSmithKline asked European Medicine’s Authority to approve RTS,S, its malaria resistant vaccine, for global use. According to scientists, it is the first vaccine to show promising signs of protecting children from malaria.

Malaria plagues 3.4 billion people – in other words – half of the world’s population. It is responsible for 800,000 deaths per year – the majority in children under 5 who live in sub-Saharan Africa.

Until now, no vaccine has been effective enough to quell the endemic. In past trials, the effects of the vaccine are ultimately weakened over time to the point where they are virtually futile. RTS,S, however, is showing promising longevity. It is the first malaria vaccine to reach the regulatory approval.

In the most advanced trial to date, 1,500 infants and children from several African countries were given the RTS,S vaccine. Eighteen months after the last injections, researchers re-examined the young vaccinated children. They found that the vaccine nearly halved the number of cases of malaria. For infants, the drug reduced incidences of malaria by a quarter.

In Kenya, for example, malaria is the leading cause of morbidity and mortality. Out of a population of 34 million, 25 million are at risk for the disease. For every 1000 children who received the RTS,S clinical drug, 2000 clinical cases were prevented.

Researchers predict that the vaccine has the ability to provide up to 46 percent protection against malaria when given to children between 5-17 months old. The vaccine, coupled with other preventative measures, including insecticide-treated bed nets and anti-malarial drugs, could have a considerable impact on malaria-plagued populations.

GSK is now developing RTS,S in conjunction with the nonprofit PATH Malaria Vaccine Initiative with funding support from the Bill and Melinda Gates Foundation. The goal of PATH MVI is to accelerate the development of malaria vaccines and catalyze timely access in afflicted countries.

Scientists and researchers are hopeful that the vaccine will be approved as early as 2015. Although the drug is still not 100-proof, a licensed malaria vaccine would have profound results. It could dramatically halt the prevalence of this persistent and stubborn disease. For years scientists have experienced a vicious cycle of trial and error when it comes to the malaria vaccine; time and time, they have been forced to come back to the drawing board. This time they are optimistic, and eager to see the billions of lives that will be saved.

– Samantha Scheetz

Sources: WHO, BBC, Gavi Alliance, Kemri.org
Photo: BBC

95% Discount on HPV Vaccines for Girls in Poverty

HPV vaccines costing an average of $130 a dose in the United States will now be offered in poor countries for as low as $4.50 a dose, a monumental step made possible by the generous and focused work of the GAVI Alliance. These vaccines help prevent strains of human papillomavirus, or HPV, that cause almost 75% of cervical cancers.

According to GlaxoSmithKline and Merck, the two pharmaceutical companies offering these deeply slashed prices, more than 85% of cervical cancer deaths occur in the developing world. “We hope that this will help reduce the burden of cervical cancer and positively impact future generations,” said GSK President and General Manager Christophe Weber in a press release. GSK already supplies 80% of its total vaccine volume to developing countries.

The GAVI Alliance, formerly the Global Alliance for Vaccines and Immunization, was launched under a generous donation from the Bill & Melinda Gates Foundation in 1999; the Alliance works to partner charitable donations with private pharmaceutical companies by negotiating significantly lower vaccine costs for countries in need. This model has allowed over 370 million children to receive immunizations since GAVI’s founding.

In the next few months, GAVI will provide support to countries worldwide by carrying out demonstration programs that raise awareness among the vaccination target group — pre-adolescents — which will allow countries to incorporate the vaccine into their own immunization programs.

– Naomi Doraisamy

Sources: GAVI Alliance, Merck
Photo: Polifaso