E-DRUG: Village Voice on free fluconazole
[copied from DRUGINFO, a South African based
Amid all the jubilation over the Pfizer offer, there have also been
some sober voices raising concerns. Without detracting from what
is a real change, and a welcome one at that - it is worth
considering this one incident in the context of making "access"
truly broad, sustainable and global.
The article below, from the Village Voice, is reproduced in terms of
the doctrine of "fair use". Taken from the TAC list, with thanks.
Discipline Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
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GIVING IT AWAY: An American Pharmaceutical Giant Offers to
Donate an AIDS Drug to South Africa
The Village Voice - April 4 - 10, 2000
In an unexpected move, the pharmaceutical giant Pfizer offered last
weekend to donate a crucial drug to South Africa. Called
fluconazole, it treats one of the most feared AIDS opportunistic
infections, a painful and lethal brain disease known as
The offer gives hope to South Africa's 3.6 million people with HIV,
because studies show that almost 10 percent of AIDS patients
contract cryptococcal meningitis, and, bereft of medicine, most
South African doctors have been forced to send patients with the
illness home to die. Yet Pfizer's proposal, which is limited to South
Africa, sidesteps the larger issue of how to make drugs available
throughout the developing world.
Pfizer's move comes in the wake of a worldwide campaign
orchestrated by the Nobel Prize-winning M decins Sans Fronti res,
ACT UP, and the South African activist group Treatment Action
Campaign. This coalition had demanded that Pfizer lower the price
of fluconazole--also known by its brand name, Diflucan--by about
90 percent, to match the price of a generic version of the medicine
made and sold in Thailand. The Thai price is about 70 cents, while
the South African government pays about $7.50 for the same dose.
Donating the drug "is more than we asked for in some ways," said
Zackie Achmat of Treatment Action Campaign. He added that
activists were in a meeting with lawyers preparing to petition the
government to take legal action against Pfizer "when the call came
through" from the drug company. "It floored us," said Achmat.
The South African government, which has recently criticized
pharmaceutical companies for profiteering, was more reserved. It
welcomed Pfizer's offer and agreed to meet with the company. But
health ministry spokesperson Nothemba Dlali said the government
feared that the donation might be only temporary--in which case
South Africa would have to deal with thousands of patients
demanding that the government pick up the tab when the drug
would no longer be free. "The intention is good," said Dlali, "but we
wonder in what position it will leave the government."
Activists, too, cautioned that donations are not a sustainable way
to solve the desperate dearth of drugs in the developing world and,
in particular, sub-Saharan Africa, where more than 23 million
people are infected with HIV. In a statement released by M decins
Sans Fronti res, Kenyan physician Chris Ouma said, "We're very
happy for the South Africans, but for me, as a Kenyan doctor, and
for the Kenyan patients dying from cryptococcal meningitis, it
doesn't help much."
Providing fluconazole at no cost does not alleviate the other
problems that undermine health care in South Africa. For example,
hospitals in some parts of the country routinely face shortages of
basic drugs, such as those used to treat tuberculosis.
Nevertheless, doctors in South Africa were jubilant, if only because
most of them can currently do nothing to treat cryptococcal
meningitis because fluconazole is far too expensive. "The bottom
line is money," said Florence Tleane, a doctor at Natalspruit
Hospital, which serves three large townships outside
Johannesburg. "If the drug is free, we would definitely treat
So new is Pfizer's offer--made by hand-delivered letter--that at
press time even the company was unsure of many details. But Dr.
George Flouty, medical director of Pfizer's public health program,
said that the company wants to model the fluconazole donation on
its current program to combat trachoma, the world's leading cause
of preventable blindness. To treat that illness, which is confined
almost wholly to the Third World, Pfizer donates its antibiotic
Zithromax, but only through programs that comprehensively
address the illness with education and efforts to clean the water
supply. Similarly, said Flouty, "We don't want to just air-ship
fluconazole to South Africa. We want to ensure proper diagnosis,
treatment, and follow-up."
Follow-up is one of the most crucial aspects of treating
cryptococcal meningitis in AIDS patients, because once the initial,
acute attack is treated, people with HIV must take fluconazole
every day or the disease almost always returns. Will Pfizer donate
the drug just for the initial treatment or also for the prevention of
relapse--which could hugely inflate the company's cost? Flouty
said such "nuances" were still being worked out, but added, "I'm
going to go out on a limb here. If that's the right thing to do, I think
we would want to do it."
Why would Pfizer donate the drug rather than reduce the price?
"It's better to give it away," said Hemant Shah, a stock analyst who
tracks pharmaceutical companies. "Otherwise you can have a 60
Minutes show asking why the product in South Africa is cheaper
than in the U.S." Instead of negative press, Pfizer can now reap
public-relations benefits for its charity. Merck, for example, has
garnered excellent publicity for its long-standing program that gives
away Mectizan for river blindness.
But already, activists are asking for more. "This is limited to South
Africa and to people with cryptococcal meningitis," said Eric
Sawyer, a veteran ACT UP member who recently infiltrated Pfizer's
corporate offices in New York. "But people also die of esophageal
thrush," another common AIDS illness that fluconazole treats.
"Access needs to be broader and sustainable and global," said
Sawyer. Indeed, the donation may pressure other companies to
offer discounts or giveaways, and it could pave the way for
negotiating two-tiered pricing for fluconazole throughout Africa.
Pfizer's offer hangs on its ability to negotiate an acceptable
program with the South African government, which may prove
difficult. In 1998, Glaxo Wellcome offered a 75 percent discount on
its drug AZT, which can reduce mother-to-child transmission of
HIV. But South Africa has rejected that offer. And recently
President Thabo Mbeki's spokesperson, Parks Mankahlana,
compared pharmaceutical companies to "the marauders of the
military industrial complex," and Mbeki himself, in a letter to a
prominent South African doctor last month, defended his decision
not to provide AZT to pregnant women by accusing "many people
in our country" of sacrificing "all intellectual integrity to act as
salespersons of the product of one pharmaceutical company!"
The South African government's stance on AZT has angered and
alienated AIDS workers, locking the two sides into an adversarial
relationship. But Pfizer's offer could "break the logjam," says
Achmat, noting that the health ministry has invited his group to
discuss the fluconazole proposal. "We will be working very closely
with the department of health," he predicts, "and we will be looking
at all drugs, not just this one."
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