By Stavros Nicolau, published in Independent Media’s Business Report JOHANNESBURG – Last week’s launch by Minister of Health Zweli Mkhize of a new ARV triple drug regimen in the Ugu district in KwaZulu-Natal and the commemoration of World Aids Day allows us as a country to reflect on how successfully we’ve managed what is arguably one of our country’s most complex post democratic challenges, HIV/Aids. While much room remains to further strengthen a number of areas in our highly acclaimed public ARV programme, one cannot argue against the facts and these remain the following: Life expectancy has increased from a low 53 years in 2004 (when ARVs first started to roll out in our public sector) up to an impressive 66 years today. Few government-led programmes have had this level of success or impact on society and its citizens. This can be directly ascribed to ARVs and other interventions such as male circumcision and the prevention of mother-to-child transmission, with ARVs being the biggest contributor to this impressive statistic. Today, an estimated 5million South Africans are taking ARVs, 4.7million of those receiving ARVs through the public sector, making the South African public programme six to seven times larger than the next largest global programme. This takes some management by the government, making 4.7million patient treatments available month in and month out. Somewhat of a logistical feat, matched by few other government departments. This made it possible for us to dream of meeting targets such as the UNAids 909090 target to help end the epidemic by 2020, ie 90percent know their status, 90percent of these are on ARV treatment, and 90percent of these are virally suppressed. This was, however, not always the case. Dreams were turning into nightmares, helplessness contracting HIV was a de facto visit to death row. Turn the clock back two decades with 350000 mainly young South African lives perishing annually from the pandemic, it would not be an exaggeration to overstate the calamity and gloomy future we faced then. Those were difficult, polarising days, often pitting civil society and parts of labour against parts of our government. Those acerbic times called for practical and evidence-based leadership and solutions. However, there was a small matter of the cost of ART (antiretroviral therapy), which had to be provided as triple therapy in those days at an annual cost of $10000 (R146192) in the US, clearly unaffordable to most South African patients, even many of those in the private sector. So where to, was the burning question? Were we to look on helplessly and watch the next generation disappear before our eyes? Aside from the prohibitive price tag at the time, an even bigger uphill battle lay in getting ARVs recognised as the first treatment point, something we take for granted these days. The battle lines were drawn. Solve the pricing issue and you were in with a fighting chance. Another small matter – these products were all patent protected and intellectual property (IP) is sacrosanct for R&D-based pharma, who held the patents. At the time some argued for compulsory licensing, which would leave investors numb and others called for patent busting, equally unpalatable to investors, particularly foreign investment, who often rely on a balanced IP regimen as a key consideration in their investment decisions. It is when our backs are to the wall that South Africans tend to excel, coming up with innovative solutions at times of crisis. When the history of our remarkable country is written covering this period, much acknowledgement should be given to the TAC (treatment action campaign) and the courageous stance of their leaders Zackie Achmat, Mark Heywood and others, the role of our competition authority, the tireless clinical activism of people like Professor Francois Venter and the HIV clinicians society. They paved the way for a long-last solution. While this was ongoing Aspen, in those days a fledgling and recently JSE-listed minnow, began grappling with how we could positively contribute to solving the vexing HIV problem. The answer was obvious do what you do best, produce quality generic ARVs at accessible pricing without breaking patents. Not for the first time, critics wrote us off, saying that this was neither possible nor realistic. Patents were in place and consequently prices could not come down. Other sceptics stated, as they did when we acquired SA Druggists 18 months earlier, that this management team would be better off taking their medication for delusion rather than trying to sell it to the market. Spurred by the need to find a solution that would prevent the unfolding HIV catastrophe and possibly by some of the scepticism Aspen, encouraged by the changing landscape at the time, entered into discussions with multinational R&D partners with a view to finding a win-win solution for all the parties, particularly patients who were fast running out of time on the proverbial clinical death row. It was not uncommon at that time for Aspen management, when discussing the looming crisis with multinational partners, to recall the hopeless plight of HIV patients that presented at public clinics around our country, no more so than an example we often referenced, the Engcobo clinic in the Eastern Cape that former president Nelson Mandela had asked Aspen founder and group chief executive Stephen Saad to assist revamp – around 80percent of patients at the time presented at the clinic with suspected HIV/Aids or tuberculosis. Engcobo struck a nerve with many, including some of our multinational partners. These discussions paved the way for the first-ever voluntary licences and later manufacturing arrangements for generic ARVs. Our first generic ARV, Aspen Stavudine, was launched by then-Minister of Trade and Industry Alec Erwin, in 2003, with some in the Health Department in those days still unaccepting of ARVs. This proved to be a landmark moment for the company, for management of HIV in our country, a South African-pioneered solution, by a South African company for what was rapidly becoming an epic African problem. It was not long before licences were negotiated for… Continue reading OPINION: Let’s pause for a moment to reflect on SA’s ARV success
