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South Africa approves plan for universal access to antiretrovirals
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Leading the way in African home-based palliative care UN highlights North Korea in appeal for aid Novel Ebola vaccine begins first human trials European Parliament votes to fund stem-cell research FDA chief attacks Canada’s drug price controls Medicare overhaul wins Congressional support News in brief Northern Uganda humanitarian crisis shocks UN chief
South Africa approves plan for universal access to antiretrovirals
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
outh Africa’s approval of a national HIV/AIDS treatment plan to provide free antiretrovirals to all who need them ends years of bitter struggle for drugs in a country where AIDS kills about 600 people a day. After the Cabinet announcement on Nov 19, Health Minister Manto Tshabalala-Msimang told reporters that there would be one antiretroviral “service point” in each of the country’s 53 health districts within a year, increasing to one service point in every local municipality within 5 years. South Africa, heavily criticised in the past for its lack of leadership on HIV/AIDS, is regarded as having clout in Africa, and it is hoped that the decision to adopt a treatment plan will encourage neighbouring countries to follow suit. News of the Cabinet’s approval of the plan was welcomed by researchers, the public, opposition parties, and the Treatment Action Campaign, which has been at the forefront of a civil movement protesting against government delays in providing free antiretrovirals. Salim Abdool Karim, Deputy Vice-Chancellor for Research at the University of Natal, said the plan was “superb”, but added that many “bridges had been broken” in the fight for treatment. Researchers have been caught between policymakers and civil
S
society. “Now we can come together for the greater good. There can no longer be squabbling”, he said. According to Anthony Mbewu, executive director of research at the Medical Research Council (MRC) in South Africa, the high cost of antiretrovirals had prevented a treatment plan being established until now. “Five years ago it cost US$10 000 for one patient a year. The price is now between $150 and $200.” He said the cost
“Now we can come together for the greater good. There can no longer be squabbling” of implementing the plan would be $45 million for the remainder of the fiscal year 2003–04, rising to nearly $700 million in 2007–08. An estimated 400 000 to 500 000 people in South Africa fulfil the criteria for antiretroviral treatment—a CD4 count less than 200 or an AIDS-defining illness. However, Mbewu said the number of people treated will depend on how quickly the drugs can be obtained, the infrastructure, and the number of people presenting for treatment. Projections are that about 50 000 people who are eligible for treatment will present at the service points in the first year, which, according to a recent study (see Lancet 2003; 362: 1267–74), could allow
patients to survive for at least 10 years. An added benefit is that improved survival will enable parents to take care of their children for longer—reducing the number of orphans and cutting welfare costs. A UNICEF report released this week (Nov 26) on the orphan crisis in sub-Saharan Africa notes that HIV/AIDS is “orphaning generations of children—jeopardizing their rights and well being, as well as compromising the overall development prospects of their countries”. The report adds that in 1990 fewer than 1 million sub-Saharan African children under age 15 had lost one or both parents to HIV/AIDS, and that this figure will soar to 20 million by 2010 unless urgent action is taken. According to an MRC report on the orphan crisis due to the HIV/AIDS epidemic, provision of antiretrovirals could halve the number of maternal orphans in the country. “The impact of the rollout on orphans will depend on how quickly and how effectively treatment is handled”, the report’s lead author Debbie Bradshaw told The Lancet. In addition to providing antiretrovirals, the goverment has pledged to invest funds to upgrade the national health-care system via “recruitment of thousands of professionals and a very large training programme to ensure nurses, doctors, laboratory
THE LANCET • Vol 362 • November 29, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
AP
Government also pledges to upgrade health system via recruitment and training of many health-care workers
Activists protest against delay in provision of antiretrovirals
technicians, counsellors, and other health workers have the knowledge and the skills to ensure safe, ethical, and effective use of medicines”. The government has also committed to a huge public education campaign, improved prevention efforts, and better treatment of opportunistic infections. Karim is concerned however that, in spite of prevention strategies, the incidence of HIV and other sexually transmitted infections is still “unacceptably high”. Stigma and discrimination remain a stumbling block, he said. “The availability of antiretrovirals could be a catalyst to encourage the widespread uptake of voluntary testing and counselling as a mechanism to counter stigma and discrimination”, he added. Adele Baleta
1811
Leading the way in African home-based palliative care UN highlights North Korea in appeal for aid Novel Ebola vaccine begins first human trials European Parliament votes to fund stem-cell research FDA chief attacks Canada’s drug price controls Medicare overhaul wins Congressional support News in brief Northern Uganda humanitarian crisis shocks UN chief
South Africa approves plan for universal access to antiretrovirals
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
outh Africa’s approval of a national HIV/AIDS treatment plan to provide free antiretrovirals to all who need them ends years of bitter struggle for drugs in a country where AIDS kills about 600 people a day. After the Cabinet announcement on Nov 19, Health Minister Manto Tshabalala-Msimang told reporters that there would be one antiretroviral “service point” in each of the country’s 53 health districts within a year, increasing to one service point in every local municipality within 5 years. South Africa, heavily criticised in the past for its lack of leadership on HIV/AIDS, is regarded as having clout in Africa, and it is hoped that the decision to adopt a treatment plan will encourage neighbouring countries to follow suit. News of the Cabinet’s approval of the plan was welcomed by researchers, the public, opposition parties, and the Treatment Action Campaign, which has been at the forefront of a civil movement protesting against government delays in providing free antiretrovirals. Salim Abdool Karim, Deputy Vice-Chancellor for Research at the University of Natal, said the plan was “superb”, but added that many “bridges had been broken” in the fight for treatment. Researchers have been caught between policymakers and civil
S
society. “Now we can come together for the greater good. There can no longer be squabbling”, he said. According to Anthony Mbewu, executive director of research at the Medical Research Council (MRC) in South Africa, the high cost of antiretrovirals had prevented a treatment plan being established until now. “Five years ago it cost US$10 000 for one patient a year. The price is now between $150 and $200.” He said the cost
“Now we can come together for the greater good. There can no longer be squabbling” of implementing the plan would be $45 million for the remainder of the fiscal year 2003–04, rising to nearly $700 million in 2007–08. An estimated 400 000 to 500 000 people in South Africa fulfil the criteria for antiretroviral treatment—a CD4 count less than 200 or an AIDS-defining illness. However, Mbewu said the number of people treated will depend on how quickly the drugs can be obtained, the infrastructure, and the number of people presenting for treatment. Projections are that about 50 000 people who are eligible for treatment will present at the service points in the first year, which, according to a recent study (see Lancet 2003; 362: 1267–74), could allow
patients to survive for at least 10 years. An added benefit is that improved survival will enable parents to take care of their children for longer—reducing the number of orphans and cutting welfare costs. A UNICEF report released this week (Nov 26) on the orphan crisis in sub-Saharan Africa notes that HIV/AIDS is “orphaning generations of children—jeopardizing their rights and well being, as well as compromising the overall development prospects of their countries”. The report adds that in 1990 fewer than 1 million sub-Saharan African children under age 15 had lost one or both parents to HIV/AIDS, and that this figure will soar to 20 million by 2010 unless urgent action is taken. According to an MRC report on the orphan crisis due to the HIV/AIDS epidemic, provision of antiretrovirals could halve the number of maternal orphans in the country. “The impact of the rollout on orphans will depend on how quickly and how effectively treatment is handled”, the report’s lead author Debbie Bradshaw told The Lancet. In addition to providing antiretrovirals, the goverment has pledged to invest funds to upgrade the national health-care system via “recruitment of thousands of professionals and a very large training programme to ensure nurses, doctors, laboratory
THE LANCET • Vol 362 • November 29, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
AP
Government also pledges to upgrade health system via recruitment and training of many health-care workers
Activists protest against delay in provision of antiretrovirals
technicians, counsellors, and other health workers have the knowledge and the skills to ensure safe, ethical, and effective use of medicines”. The government has also committed to a huge public education campaign, improved prevention efforts, and better treatment of opportunistic infections. Karim is concerned however that, in spite of prevention strategies, the incidence of HIV and other sexually transmitted infections is still “unacceptably high”. Stigma and discrimination remain a stumbling block, he said. “The availability of antiretrovirals could be a catalyst to encourage the widespread uptake of voluntary testing and counselling as a mechanism to counter stigma and discrimination”, he added. Adele Baleta
1811