Minister’s briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
19 September 2000
MINISTER’S BRIEFING

SUMMARY
The Minister gave an overview of the Health Ministry’s activities at the moment, including some background to the SADC health sector, and its achievements. She mentioned specifically HIV/AIDS, STDs, the standardisation of data and surveillance, bulk purchasing, reproductive health, tuberculosis, malaria, human resources mobilisation, SADC medicines and allied medicines regulation, disaster and collaboration with international organisations. Following this, the Minister and her colleagues responded to questions. These focused on the HIV/AIDS crisis in South Africa. She underscore the commitment of SADC Health Ministers to a comprehensive response to HIV/AIDS, rather than a piece-meal one.

In response to the inevitable question, “Does HIV cause AIDS”, the Minister replied that no one had ever said it didn’t. She added that whoever had started that story has a responsibility to set the record straight.  She said the Ministry of Health was also looking at other factors that contribute to AIDS.

MINUTES
Minister Manto Tshabalala-Msimang was joined by Dr Balfour, the Director of the Health Sector Co-ordinate Unit, and Mr Ray Mabope, her Special Advisor. [Soon after the meeting began, a group of women, children and youth wearing t-shirts reading “HIV POSITIVE” came into the room and took seats to observe the meeting].

The Minister outlined the organisation of the SADC Health Co-ordination Centre, its resources, aims, principles, structure and priorities.

Dr Balfour described the Centre in more detail, saying HIV/AIDS was the Centre’s first priority. She noted they are looking for an Africa-specific vaccine since much available to combat HIV/AIDS is made for the purposes of developed countries. In terms of the affordability of drugs, the Centre is developing a policy on bulk purchasing and trying to facilitate access to more affordable drugs. A sub-committee has been set up to examine the possibility of bulk purchasing. It has piloted a tender on 5 tuberculosis drugs. If these are successful, the program can be extended.

The Minister went on to outline the Ministry’s work, focusing on HIV/AIDS, STDs, standardisation of data and surveillance, bulk purchasing, reproductive health, tuberculosis, malaria, human resources mobilisation, SADC medicines and allied medicines regulation, disaster and collaboration with international organisations. She referred to funding SADC has received to combat HIV/AIDS, mentioning specifically US$14 000 from UNAIDS and US$315 000 from the US government for policy review, as well as 7 500 000 British pounds to “reduce risk behaviour”.

The Minister also mentioned 15 kits provided by WHO for home-based care. She said local government demarcation would make it easier to distribute these now. The kits include bicycles to provide transport for home visits. She noted this mode of transportation worked very well in Uganda’s approach to its AIDS patients, but expressed doubt it would be successful in South Africa. An animated discussion followed on the usefulness of bicycles as transportation in South Africa to reach AIDS patients.

Discussion
(Q) Dr Jassat (ANC): Can’t we speed up the offers from pharmaceutical companies, as well as bulk buying? SADC should look ahead and manufacture drugs here so we don’t have to pay for importation. We have always been a nation of beggars and borrowers; it is time for us to be self-sufficient. Also, what’s wrong with the bicycles? They worked in Uganda. It’s a good solution to the problem of rising fuel prices.

(A) Minister: At this point, we don’t have a solid offer from a pharmaceutical company. We are still having “talks about talks”. I will be in meetings in Geneva on the 29^th of this month where I will hear something more specific.
We can’t afford anti-retrovirals. We would have no ability to monitor their use. We are not prepared to provide anti-retrovirals if we cannot monitor their use.
We are looking into the sustainability of offers we receive from pharmaceutical companies as well as of local manufacturing. There are 190 million people in southern Africa who need these drugs. Therefore, we can’t move quickly enough to accept offers of drugs when they come At this point, we don’t know what these offers are.
Only Pfizer has given us a concrete offer of fluconazole which we are negotiating. The patent for fluconazole expires in two years, after which it will become generic. Pfizer wanted to create a parallel structure to monitor fluconazole but we see no need for this and want to use our own monitoring structures.

There is also the problem of our “soft borders”. It would be unethical for us to refuse drugs to visitors from other countries who need them. For this reason, we suggest regional distribution, rather than country-specific distribution. I am now having talks with Pfizer.

As to the local manufacture of drugs, we shall be meeting together with the Ministers of Finance and Trade Industry.

As for the bicycles, I know the standards of South Africans are too high. They like Mercedes and so on. I don’t believe bicycles would be used here.

(Q) Dr Mogoba (PAC): I congratulate the Minister for the work she has done to date, especially in the disastrous floods in the north when there was a potential for us to be overwhelmed by disease. In terms of research for an HIV vaccine, is SADC putting enough money there? This should be a priority.

And what about the question of whether HIV causes AIDS? This is a waste of time. Can’t you just clear the air once and for all? There is a disaster at our doorstep, so let’s get on with it and supply people with drugs. We must fight on all fronts.

(A) Minister: No one ever said HIV does not cause AIDS. Whoever made up that story has a responsibility to set the record straight.
However, if we thought HIV were the only cause of AIDS, we would look only to anti-retroviral drugs and ignore all the other factors. Instead, we are looking at nutrition and condom use, among other things. I will not take back something I never said. Read President Mbeki’s speech at the Durban conference. Interviewers have been uninformed in that the interviewers have not read his strategy plan.

In addition, Nevirapine is not registered in this country. We cannot work with the work of the MCC; we must respect its mandate. We are not blind and deaf. There is the problem of resistance to drugs and the problem of breast-feeding. People receiving Nevirapine can be spreading the virus itself. This is a serious debate. Just as it is hard to change sexual behaviour, so is it hard to change breast-feeding patterns. We are asking if scientists are giving us enough information. Our Department will be thoroughly involved, very hands on, and not rely on scientists only.
The main issue with AZT is we simply can’t afford it.

(Q) Ms Baloyi (ANC): I am interested in the availability of drugs in our region. What about using cheaper drugs? Or manufacturing drugs locally?

(A) Minister: We are looking at floating a tender so that individual states will have contracts with that company. Vaccine research is also a collaborative activity.

(Q) Ms Dudley (ACDP): How much does the IMF’s and the World Bank’s policy of family control impact on HIV policy? I refer to their position that populations must decrease.

(A) Minister: User fees can lead to the major impoverishment of people who already poor.  This is a cautious area. People should not have to accept help on the basis of conditions. No, our policies are independent. There is no link to objectives of population control. In addition, the World Bank’s position has changed in that it now supports more creative population control. There is no link.

(Q) Ms Dudley (ACDP): You say there is no link, but the UN funds planned parenthood in Africa. Remember the theory of eugenics, to “reduce the weeds”. There is a link. Take the example of breastfeeding – why not take the risk that a small percentage of babies could contract HIV when so many others could benefit from the drugs?

(A) Minister: You are out of context. How can I provide Nevirapine when it is not registered?

(Q) Mrs Dudley (ACDP): You can. I know you are a fighter.

(A) Minister: No one has said we won’t provide Nevirapine.

(A) Chairperson Dr Nkomo: Nevirapine is being used in clinical trials by the MCC. It is not registered for large-scale consumption.

(A) Mr Mabope: As far as breastfeeding is concerned, it is unrealistic to dictate to others how to behave. We have to ask what support these women need. In some countries, a woman who does not breastfeed is ostracised.

(Q) Ms Malumise (ANC): Women are the worst hit by AIDS. Why isn’t the female condom freely available here? What about African adolescents? What role is the Department playing?

(A) Minister: Pilot studies have been done on the female condom. Note that male condoms are cheaper: 15 – 18 cents each compared with R4 each for female condoms. Also, few women want to use female condoms. I have heard them described as “noisy, untidy and hard to use”. As for African adolescents, we have the “Love Life” programme and ensure our institutions are user-friendly for youth. We are thinking of not having separate centres for youth but of making the existing places youth-friendly.

(Q) Ms Marshoff (ANC): Is the SADC co-ordinating an overall project or are the plans specific to each country? And what about the lack of human resources?  You mentioned the internship of undergraduates, but what about others?

(A) Minister: SADC is now moving away from country-specific implementation projects, and looking at how all countries can benefit. There are human resources mobilisation issues in that there is a lack of doctors in neighbouring countries. SADC members can respond collectively to this and other issues as they arise.

(Q) Who funds the infrastructure? Is it SADC or the individual country?

(A) Doctor Balfour: There are many sources, both country contributions and SADC. The source of funding depends on the project.

(Q) (ANC member): Thank you Minister for looking for African solutions to African problems. Thank you for clarifying that you have no concrete offers from pharmaceutical companies. And thank you for your political analysis and pointing out that HIV can be seen as a political disease.

(A) Minister: In conclusion, I want to underscore the commitment of SADC Health Ministers to take an international platform and our commitment to a comprehensive response to HIV/AIDS, rather than a piece-meal one.