Arkiv: Retssagen i Sydafrika 2001

Durban 6 August 2003 - M&G South Africa

The question is not whether there will be a universal anti-retroviral
treatment programme, but when, Health Director General Ayanda Ntsaluba
told the South African Aids Conference in Durban on Wednesday.

In response, HIV-positive judge Edwin Cameron said in his closing address: "The question is not when, but how soon?"

He
reiterated a warning given on Tuesday by Western Cape deputy director
general in charge of Aids, Dr Fareed Abdullah, that "a no treatment
option does not exist".
Abdullah said that if South Africa did not
implement a large-scale treatment plan soon, five-million people would
die from Aids in the next eight to 10 years.
Cameron said that
neither the Western Cape example of an "implementable programme, nor
Fareed Abdullah's comments, have been repudiated, which by implication
means they have been endorsed [by government]. We need treatment for
all soon. We need time frames and dates".
South Africa's first national Aids conference opened in a mire of controversy late on Sunday.
Protests
were sparked by the Medical Research Council threat last week to
deregister nevirapine for the prevention of mother-to-child care
(PMTCT) if further efficacy figures were not forthcoming from the
manufacturers within 90 days. Boehringer Ingelheim, which manufactures
the drug, says it is impossible to produce such figures in 90 days.
Despite
protests and powerful figures testifying to the efficacy and safety of
nevirapine, from South Africa and beyond, it seemed, at the end, that
bureaucrats within the Department of Health are keen to roll out more
anti-retroviral treatment.
The logjams appear to be coming from the
Medicines Control Council on nevirapine; and Minister of Health Manto
Tshabalala-Msimang.
She presented figures that showed as part of its
Aids preventative programmes, the Department of Health distributes an
average of two condoms for every sexually active man each month
(22-million), and one female condom to be shared among 10 women (100
000) every 30 days. HIV infection is 58% higher in South African women
than men according to UNAids.
Tshabalala-Msimang said: "We will know
we have succeeded when we have been able to prolong the period from HIV
to Aids by supporting those who are infected with nutrition,
nutritional supplements and natural medicines."
However, Abdullah
responded: "No amount of micronutrient replacement or alternative
therapies will significantly reduce the burden of mortality".
Abdullah
provided data that showed that by 2006, if no anti-retroviral therapy
was given to prevent and treat HIV/Aids, there would be an average of
1,4-million Aids cases a year in South Africa.
From 2004 onward, without interventions to treat and prevent HIV infection there would be about 700 000 deaths a year.
Universal
anti-retroviral treatment would see mortality figures drop to 400 000 a
year. Last year in South Africa, according to UNAids, 600 000 people
died of Aids.
Professor James McIntyre of the Chris Hani Baragwanath
PeriNatal HIV Unit in Soweto told the conference that of the 72
countries using nevirapine in the world, South Africa was the only one
considering delisting the drug for PMTCT.
He said that worldwide 150
000 women and their babies had used nevirapine, of which 80 000 to 100
000 were South African women and their babies during the past two years.
McIntyre
pointed out that South Africa had treated more people than elsewhere
because South Africa's HIV infection rates were higher. Only Botswana,
which has a dramatically lower population and therefore lower number of
HIV-positive pregnant women, has a higher infection rate.
He
warned that potentially 2 200 babies born each day to HIV-infected
mothers in South Africa could die if the treatment was removed.
The seriousness of the impact of HIV/Aids came out in other papers too.
A
paper delivered on behalf of the Institute of Molecular Medicine and
Infectious Diseases in Durban found that scientists were detecting
increasing numbers of people infected with more than one strain of the
virus, posing challenges for treatment.
And in their survey, as in
others, infection rates slipped out that showed that in many areas
infection is far higher than the 30% claimed by government. The MMID
survey of sexworkers and their clients, showed 60% of the former were
infected with the clients displaying infection rates of 56%.
Yet
another paper showed that in some parts of South Africa, figures for
HIV infection in pregnant women were higher than that in sexworkers.
Professor
Quarraisha Abdool Karim of the Centre for the Aids Programme of
Research in South Africa discussed a study of sexworkers from 1996 to
1999 in KwaZulu-Natal that showed infection rates averaged 18,2%.
Although
the province-wide statistics for HIV prevalence among pregnant women
was 33,5% in 2001 in KwaZulu-Natal, it was as high as 50,8% in young
pregnant women at Hlabisa clinic in northern KwaZulu-Natal in the same
year, she said.
Rodney Hoff of the US National Institutes of Health
noted that HIV was overwhelmingly a disease of young people -- those
under the age of 24 --and women. Of the 14 000 new HIV infections every
day, 600 were in South Africa, and more than 95% were in developing
nations. More than half of the infected were women. - Sapa

The pall of politics

Durban 08 August 2003
The
glaring absence of President Thabo Mbeki from the first South African
Aids Conference, and the health minister’s ongoing sidelining of
science in favour of politics, took much of the gloss off the
conference’s undoubted achievements.

The pall of divisive
politics hung over the conference. This was a recurring preoccupation
in corridor talk at the conference. At the same time participants were
united in expressing a sense of triumph that the provision of
anti-retroviral treatment is now part of the government’s HIV/Aids
agenda.

Aids experts, government officials and scientists
gathered at the Durban Convention Centre this week for the three-day
conference to share experiences and research, and to “reinvigorate” the
country’s efforts in dealing with HIV/Aids.

The conference was
an opportunity for researchers and practitioners to build bridges,
Professor Salim Abdool Karim, the conference’s scientific programme
committee chairperson, told the Mail & Guardian.

But the eruption of politics into science began before the conference kicked off.

Mbeki’s
article in his letter on ANC Today on August 1 commented on the
decision by the Medicines Control Council decision to review
nevirapine: “We must free ourselves of the ‘friends’ who populate our
ranks, originating from the world of the rich, who come to us, perhaps
dressed in jeans and T-shirts, as advisers and consultants, while we
end up as the voice that gives popular legitimacy to decisions we
neither made, nor intended to make, which our ‘friends’ made for us,
taking advantage of an admission that perhaps we are not sufficiently
educated.”

His words were echoed at the opening of the
conference when Minister of Health Manto Tshabalala-Msimang addressed a
capacity crowd. She was allocated two minutes to introduce Deputy
President Jacob Zuma, but instead defended the government’s actions in
fighting the spread of HIV/Aids.

While she spoke, members of
the audience wearing bright yellow T-shirts, bearing the slogan “2
pills can save a life”, held up posters with the names of people who
have died from Aids. This was the first visible protest by the
Treatment Action Campaign (TAC) with Médicines sans Frontières since
the suspension of its civil disobedience in April.

At the end of
her speech the minister switched from English to Zulu, saying: “We are
prepared to work together ... but we are not prepared to work with
agents who are bent on misleading the people of South Africa.”

A
delegate said “the most disturbing part of her speech was a reference
to external forces that create ambivalence in the government Aids
agenda.”

When Zuma took the podium the protesters sat down,
suggesting that they do not see the government en bloc as the greatest
barrier to the roll-out of anti-retroviral treatment. Zuma’s speech
promised a strong commitment by the government.

“Some people
sometimes feel that the government is not caring for people that are
infected with HIV and Aids by not providing them with anti-retroviral
therapy,” he said. “We are in the process of finalising several
international agreements that will ensure access to medication to the
many people infected with HIV and Aids.”

Despite his statement
the TAC marched to the conference the next day and handed over a
memorandum calling on the conference to support a national treatment
plan.

The TAC director, Zackie Achmat, said people were tired of
the “foot-dragging” by the government on an anti-retroviral treatment
plan. “We have given them enough time to act by suspending our civil
disobedience campaign.”

But the TAC also hit flak for resuming
its campaign. A statement by the ANC in KwaZulu-Natal urged “all
patriotic South Africans to ignore a recent call by the [TAC] to engage
in a so-called civil disobedience”.

In sharp contrast — and
indicative yet again of divisions within the ruling party — Faried
Abdullah, the deputy director in the Western Cape health department,
spoke of the need for anti-retroviral treatment to prevent the collapse
of the hospital system if people with Aids are not treated.

Wearing
one of the TAC’s bright yellow T-shirts, Abdullah said: “No Aids
programme could be effective without the widespread use of
anti-retroviral treatment.” He also said no nutritional programme will
diminish the deaths from Aids.

Zweli Mkhize, KwaZulu-Natal
health minister, delivered a conciliatory speech at the end of the
conference, calling on partnerships among all sectors. “The matter of
anti-retrovirals does not constitute an area of disagreement. It needs
to be placed on the record that the matter of anti-retroviral drugs is
not an ideological issue ... Government has approached the
comprehensive plan of HIV/Aids in a phased manner.”

Appeal court
Judge Edwin Cameron said the conference expressed a strong sense of
commitment by the government to a treatment programme. “They said the
question is not if, but when … we must not delay and be disempowered by
waiting for the perfect moment [to roll-out].”

Judge Cameron
said the most significant session of the conference was Abdullah’s
presentation. “The point Abdullah made which he did not say but was
implicit in his whole speech [was that the] Western Cape government is
a coalition of the New National Party and the ANC … This is not a party
political issue. The Western Cape programme is being implemented by an
ANC government. We want those same commitments nationwide.”

He said the conference has made progress in the fight, but now the question to ask is when the treatment will be available.

Constitutional Court ruling

The
Congress of South African Trade Unions hails today's Constitutional
court ruling on the provision of antiretroviral medicines to
HIV-positive pregnant women as an historic breakthrough for South
Africa and all its people, especially the poor. Not only will this
judgement lead to many lives being saved but it has set a precedent
which should make it impossible for any government to ignore the needs
of the poor.

It is tragic that the Court ruling comes too late
for many babies who have died unnecessarily but is nevertheless a
victory for logic. It lays down exactly what COSATU has been calling
for - that "Sections 27 (1) and (2) of the Constitution require the
government to devise and implement within its available resources a
comprehensive and co-ordinated programme to realise progressively the
rights of pregnant women and their newborn children to have access to
health services to combat mother-to-child transmission of HIV".

It
is imperative that this ruling is now implemented as quickly as
possible. COSATU urges the government not to see the Court judgement as
an attack on itself but as an opportunity to put aside past differences
and unite with civil society to tackle the HIV/AIDS epidemic. The
federation will do everything in its power to assist the government,
health professionals and the
community to prepare and administer a national treatment plan.

As
well as implementing the Court's ruling to treat HIV-positive pregnant
women, the government must start immediately to roll out antiretroviral
treatment in the state hospitals and clinics to all people living with
HIV/AIDS. We will also support the government in any efforts to reduce
the cost of antiretroviral medicines by pressuring the pharmaceutical
companies to cut their prices or by importing or manufacturing generic
versions.

COSATU is well aware however that while these
treatments can prolong and transform the lives of people living with
HIV/AIDS they cannot cure them. The campaign for treatment therefore
must
go hand-in-hand with an intensified prevention campaign to educate
people in how to avoid contracting the virus and stop its spread.

COSATU
is encouraged not only by the court's ruling on treatment but also by
the arguments the Court uses to justify the ruling, which could have
far- eaching implications for other areas of social policy.

In
particular we note the statement that "the state is obliged to take
reasonable measures progressively to eliminate or reduce the large
areas of severe deprivation that afflict our society." This should
compel the government to act to get rid of poverty and deprivation.

It
could mean that if the government does not implement measures like the
Basic Income Grant or other policies to alleviate poverty they could be
in contravention of the Constitution. Similar obligations are likely to
be enforced by the Court in respect of the provision of housing,
education, basic services and other areas of health care.

Finally
COSATU sends its best wishes to Zackie Achmat, Chairperson of the
Treatment Action Campaign, who has done more than anyone to achieve
today's victory. We wish him a speedy recovery and many more years of
health and struggle for the poor and people living with HIV/AIDS.

Læs dommen over den sydafrikanske regering fra TACs retsag mod denne, for at sikkere mødere gratis AIDS/hiv medicin.

BAGGRUND: Retssagen mod Sydafrika

De
to danske virksomheder Novo Nordisk og Lundbeck havde sammen med 39
andre medicinalvirksomheder lagt sag an mod den sydafrikanske stat for
at forhindre, at landet fremstiller og importerer billig kopimedicin
til behandling af f.eks. HIV-smittede. Hvis medicinal-virksom-hederne
vinder retssagen, kan det forhindre, at verdens fattigste får adgang
til livsvigtig medicin. I Afrika er der over 25 millioner HIV-positive
mennesker og AIDS koster hvert år 2½ millioner mennesker livet.

Læs her om sagens fakta og juraen bag - og hvorfor Sydafrika Kontakt forsætter kampen mod medicinpatenter.

Hvorfor kopimedicin?

I
1997 besluttede den Sydafrikanske regering med Nelson Mandela i
spidsen, at det skulle være lovligt at importere billig kopimedicin.
Det skulle bl.a. give HIV-smittede adgang til den livsforlængende
kombinationsbehandling, som ellers er ubetalelig for landet.
Medicinalindustrien
mener, at den Sydafrikanske lov er et brud på de internationale
patentregler, som landet har underskrevet. Derfor valgte de 41
medicinalkoncerner og deres sydafrikanske brancheforening i 1998 at
bringe lovændringen for Højesteret. I mellemtiden venter de syge på
medicin. Den 5. marts i år startede retssagen med at blive udsat til
den. 18. april.

Den Sydafrikanske lov

Loven
fra 1997 er et opgør med 40 års uretfærdig sundhedspolitik under
Apartheid-styret og med en sygdomsudvikling i Sydafrika, der er ude af
kontrol. Forsigtige skøn fra regeringen anslår, at ca. 4,5 millioner
sydafrikanere er HIV-smittede. FN anslår, at 25% af befolkningen er
ramt. Dertil kommer, at en lang række andre sygdomme kræver flere liv.
Det er bl.a. tyfus, malaria og kolera, som der findes en effektiv
behandling af – hvis man har råd til medicinen.
Sydafrikas
regering har lavet en national AIDS-plan som en del af landets
sundhedsstrategi. Denne plan går kort fortalt ud på, at bekæmpe
almindelige folkesygdomme fremfor f.eks. dyre hjerteoperationer. Der er
bl.a. oprettet mere end 2000 sundhedsklinikker i landet.

Brasiliens lov

Den
sydafrikanske retssag er formentlig bare den første af en række sager
medicinal-virksomhederne vil anlægge. Brasilien bliver det næste land i
rækken. Brasilien var ét af de lande, der blev hårdest ramt, da
AIDS-epidemien brød ud, og i 1994 opfordrede regeringen brasilianske
medicinalvirksomheder til at kopiere HIV-medicin. Landets lovgivning
tillader nemlig, at patentregler omgås i krisesituationer.
I dag
laves 8 af de 12 præparater, der indgår i den såkaldte
kombinationsbehandling, i Brasilien. Priserne på dem er faldet med 70%
og udgifterne til en livsforlængende behandling er derfor tre gange
billigere end i USA.

TRIPS og patenter

TRIPS-aftalerne
er en del af den aftalepakke et land skal acceptere, når det bliver
medlem af verdenshandelsorganisationen (WTO). TRIPS står på dansk for
handelsrelaterede aspekter ved intellektuelle ejendomsrettigheder, det
vil sige patenter, copyrights, varemærker mm.
Patenter er en
metode til at gøre viden og opfindelser til ejendom - på samme niveau
som materiel ejendom. Dette øger den økonomiske motivation for
virksomheder til at forske i at finde nye medikamenter. På den anden
side betyder patenter, at udviklingen forsinkes, da andre virksomheder
ikke kan videreudvikle produkter eller processer sålænge patentet
gælder (typisk 20 år). Derfor er patenter samfundsmæssigt et dilemma
Desuden
er det problematisk, at det er medicinalvirksomhederne, der bestemmer
hvilke produkter, der udvikles. Forskningen indenfor nervemedicin,
hjertekarsygdomme og lignende vestlige sygdomsgrupper er prioriteret
langt højere end de globalt mest udbredte sygdomme, da det er i vesten
købekraften er størst.
WTO’s medlemslande skal indføre aftalerne
under WTO som en del af deres nationale lovgivning på området.
TRIPS-aftalerne er således ét af de områder, hvor nationalstaternes
suverænitet til at lovgive sættes under internationale aftaler. Hvis et
land vil have de fordele, der er i medlemskabet af WTO (som
frihandelsaftaler mm.), skal aftalerne implementeres indenfor de
aftalte tidsrammer, der er i WTO.
Indenfor patentområdet betyder
aftalerne, at landene skal bevilge 20 års patenter på henholdsvis
produkter og processer indenfor alle fremstillingssektorer, på
betingelse af at produktet og fremstillingsprocessen er ny og
ikke-åbenlys, og at det kan bruges industrielt og kommercielt.
Udviklingslandene havde 5 år fra 1995 til at implementere aftalerne
generelt, samt yderligere 5 år indenfor sektorer, der ikke før var
omfattet af patenter i det pågældende land. Hvis dette ikke sker, har
de andre lande mulighed for at indføre handelssanktioner imod landet.

Indien og patenter

Mange
u-lande har ikke haft patenter indenfor områder som fødevarer,
agrokemiske produkter (f.eks. kunstgødning) og medicin, da disse
produktområder bliver anset som vigtige basale behov for landenes
udvikling. Indien har f.eks. ikke haft patenter på medicin siden 1970,
og derfor har landet en relativt stor farmaceutisk produktion, og
medicin i Indien er væsentligt billigere end i mange andre lande.
Indiske
virksomheder har frit kopieret medicin, også den der var underlagt
patenter i andre lande, og dette har gjort at markedet er billigt,
dynamisk og uden monopoler. Der har også været eksport af denne
kopimedicin fra producerende udviklingslande som Indien, Thailand, Kina
og Brasilien til andre udviklingslande, da denne medicin er billigere
end medicin fra de store multinationale virksomheder, der har haft
patenter og dermed monopol på deres produkter.

Medicin som en vare

At
medicin bliver gjort til en vare, som man kan patentere og dermed få
monopol på, er et problem for u-landene. I nogle tilfælde kan det ikke
betale sig for producenterne at sælge medicin i u-lande. Et eksempel på
det, er den afrikanske sovesyge, der årligt rammer 300.000 afrikanere,
og kan behandles med et produkt, der har været kendt i mange år.
Markedet
for produktet har imidlertid ikke været profitabelt nok til, at de
store medicin-firmaer har villet producere det, og det gik i 1999 ud af
produktion - på trods af at det er en meget alvorlig sygdom. Først for
nylig er produktet kommet i produktion igen, da man fandt ud af, at det
er med til at nedsætte kvinders skægvækst. Dermed er markedsgrundlaget
for produktet stort nok til at virksomhederne sætter produktionen i
gang igen. Det er selvfølgeligt godt for de sovesygeramte afrikanere,
men samtidigt et godt eksempel på, hvordan det kan komme til at se ud,
når medicinalmarkedet bliver styret alene af markedskræfter, domineret
af nogle få store virksomheder.

Patentregler og nødsituationer

Der
er indenfor TRIPS-aftalerne muligt for et land at tilsidesætte
patentrettigheder i tilfælde af en nødsituation (”national emergency”).
Denne klausul har endnu ikke været benyttet, og er meget vagt
formuleret. F.eks. er det usikkert om et udbrud af spedalskhed i Indien
vil være dækket af klausulen, da der ikke direkte er tale om en trussel
for den nationale sikkerhed. Det samme er gældende for AIDS-epidemien i
det sydlige Afrika, som heller ikke er en national nødsituation, da
problemet har været under vejs længe, og regeringerne ikke har handlet
effektivt nok i situationen.

Stop retssagen

Uden
billig kopimedicin kan hovedparten af verdens fattige patienter ikke
købe medicin og mange af dem dør. Mandelas lov er et nødvendigt middel
mod den katastrofe, som AIDS i dag udgør i Sydafrika. Alle lande og
alle firmaer, som evner det, må hjælpe Sydafrika med at
håndtere AIDS-epidemien og bekæmpe den og andre livstruende sygdomme.
Det
er både småligt og skammeligt, at danske virksomheder bakker op om en
retssag, der handler om at forhindre fattige mennesker i at få adgang
til livsvigtig medicin. Novo Nordisk og Lundbeck må derfor trække deres
støtte til sagsanlægget tilbage.
Desuden forventer vi, at den danske
regering aktivt støtter de fattiges ret til egenproduktion og
parallelimport af billig medicin.

Livsvigtig viden må være det globale samfunds ejendom.