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Court ruling orders South Africa to provide nevirapine
Newsdesk Court ruling orders South Africa to provide nevirapine However, Haroon Saloojee of the Save Our Babies Campaign is cautious about the verdict. He feels that the constitutional court has entrusted the government to take full responsibility to actually implement the policy when
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Popperfoto
After nearly a year of intense courtroom battles, South Africa’s constitutional court has quashed the government’s appeal to overturn the high court order that nevapirine must be provided in hospitals state-wide. “[The] government is ordered without delay to remove the restrictions that prevent nevirapine from being made available for the purpose of reducing the risk of mother-to-child transmission (MTCT) of HIV at public hospitals and clinics that are not research and training sites”, it said in the decision read out by Chief Justice Arthur Chaskalson. The constitutional court declared that the government’s refusal to immediately expand its pilot programme violated the nation’s bill of rights that guarantees the right to health care. Geoff Budlender of the Constitutional Litigation Unit told TLID, “it is a pity that the matter had to go to court. It would have been better if the government had done what was right without the necessity of litigation. But the fact that it is possible to go to court to resolve these issues shows the power of our new Constitution, and is a victory for constitutionalism.
No more courts—just give the drug.
there is evidence that in reality this may not happen. “In an interim verdict 6 weeks ago we were told the government was ordered to provide the drug to sites where the capacity existed. But I have had a number of calls from doctors,
particularly at rural centres, where the capacity has existed but provisional authorities have come and inspected the hospital and then not permitted the drug be used. This is clearly an infringement of the court order so there is some reason for concern. But I am also an optimist and in view of the seriousness of the constitutional court's judgement, the government will indeed goahead”, he says. As far as providing the drug, Saloojee insists that in an urban setting close to 80% of hospitals could start immediately while in rural areas it would be closer to 10–20%. The government needs to take the responsibility to communicate the constitutional court decision to all parts of the health-care system. While it will be the duty for individual doctors at hospitals to inform their local authorities of the need for nevirapine this is just a short term solution. A long-term plan will require the government to roll out a comprehensive MTCT programme. Sallojee concludes: “The government needs to provide a plan to say that it is going to progressively realise the rights of these children. How that will translate into action, we wait to see.” Pam Das
Miltefosine presents new hope for leishmaniasis patients 6 years after it was prioritised for development in Tropical Diseases Research (TDR), miltefosine has been approved for use in India for the treatment of visceral leishmaniasis, it was announced recently. Miltefosine, the first oral drug for treating visceral leishmaniasis (kala azar, or “black fever”), is the product of a close collaboration between the Government of India, the drug’s manufacturer Zentaris, and TDR, as part of a programme spearheaded by the World Bank, the UN Development Programme, and the WHO. Originally tried for use in the management of cutaneous-cancer patients, miltefosine proved to have limited effectiveness due to the high dosages needed for treatment. In-vitro studies showed that the drug had a
452
marked effect against Leishmania donovani and Leishmania infantum in far smaller doses. Typical therapy for visceral leishmaniasis is parenteral pentavalent antimony given for 28 days but this is toxic and expensive. The parasite that causes leishmaniasis has also developed a level of resistance. Miltefosine, a membrane signalling pathway inhibitor, was moved swiftly through from initial stages of research to implementation research largely because it is one of the TDR’s targeted diseases, one of the several neglected diseases that take a huge toll on people in developing countries but which receive little attention from the western world (Lancet Infect Dis 2002; 8: 494–501). It is expected that the drug will be of massive benefit in India, which, along with Brazil, Sudan, and
Bangladesh, contributes to 90% of the global burden of visceral leishmaniasis. The Government of India proposes, on completion of Phase 4 trials, to use miltefosine as first-line treatment in its National Leishmaniasis Control Programme, which aims for success by 2010. A preferential pricing scheme for public-sector use in developing countries is in place. India’s Minister of Health, who had the disease as a child, called miltefosine a breakthrough, adding that: “This is a crucial weapon. It is easy to handle by the physician in rural areas, and it is equally effective in children”. A combination of new strategies is needed to tackle neglected diseases but miltefosine is an example of an important first step. Rachael Paterson
THE LANCET Infectious Diseases Vol 2 August 2002
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Popperfoto
After nearly a year of intense courtroom battles, South Africa’s constitutional court has quashed the government’s appeal to overturn the high court order that nevapirine must be provided in hospitals state-wide. “[The] government is ordered without delay to remove the restrictions that prevent nevirapine from being made available for the purpose of reducing the risk of mother-to-child transmission (MTCT) of HIV at public hospitals and clinics that are not research and training sites”, it said in the decision read out by Chief Justice Arthur Chaskalson. The constitutional court declared that the government’s refusal to immediately expand its pilot programme violated the nation’s bill of rights that guarantees the right to health care. Geoff Budlender of the Constitutional Litigation Unit told TLID, “it is a pity that the matter had to go to court. It would have been better if the government had done what was right without the necessity of litigation. But the fact that it is possible to go to court to resolve these issues shows the power of our new Constitution, and is a victory for constitutionalism.
No more courts—just give the drug.
there is evidence that in reality this may not happen. “In an interim verdict 6 weeks ago we were told the government was ordered to provide the drug to sites where the capacity existed. But I have had a number of calls from doctors,
particularly at rural centres, where the capacity has existed but provisional authorities have come and inspected the hospital and then not permitted the drug be used. This is clearly an infringement of the court order so there is some reason for concern. But I am also an optimist and in view of the seriousness of the constitutional court's judgement, the government will indeed goahead”, he says. As far as providing the drug, Saloojee insists that in an urban setting close to 80% of hospitals could start immediately while in rural areas it would be closer to 10–20%. The government needs to take the responsibility to communicate the constitutional court decision to all parts of the health-care system. While it will be the duty for individual doctors at hospitals to inform their local authorities of the need for nevirapine this is just a short term solution. A long-term plan will require the government to roll out a comprehensive MTCT programme. Sallojee concludes: “The government needs to provide a plan to say that it is going to progressively realise the rights of these children. How that will translate into action, we wait to see.” Pam Das
Miltefosine presents new hope for leishmaniasis patients 6 years after it was prioritised for development in Tropical Diseases Research (TDR), miltefosine has been approved for use in India for the treatment of visceral leishmaniasis, it was announced recently. Miltefosine, the first oral drug for treating visceral leishmaniasis (kala azar, or “black fever”), is the product of a close collaboration between the Government of India, the drug’s manufacturer Zentaris, and TDR, as part of a programme spearheaded by the World Bank, the UN Development Programme, and the WHO. Originally tried for use in the management of cutaneous-cancer patients, miltefosine proved to have limited effectiveness due to the high dosages needed for treatment. In-vitro studies showed that the drug had a
452
marked effect against Leishmania donovani and Leishmania infantum in far smaller doses. Typical therapy for visceral leishmaniasis is parenteral pentavalent antimony given for 28 days but this is toxic and expensive. The parasite that causes leishmaniasis has also developed a level of resistance. Miltefosine, a membrane signalling pathway inhibitor, was moved swiftly through from initial stages of research to implementation research largely because it is one of the TDR’s targeted diseases, one of the several neglected diseases that take a huge toll on people in developing countries but which receive little attention from the western world (Lancet Infect Dis 2002; 8: 494–501). It is expected that the drug will be of massive benefit in India, which, along with Brazil, Sudan, and
Bangladesh, contributes to 90% of the global burden of visceral leishmaniasis. The Government of India proposes, on completion of Phase 4 trials, to use miltefosine as first-line treatment in its National Leishmaniasis Control Programme, which aims for success by 2010. A preferential pricing scheme for public-sector use in developing countries is in place. India’s Minister of Health, who had the disease as a child, called miltefosine a breakthrough, adding that: “This is a crucial weapon. It is easy to handle by the physician in rural areas, and it is equally effective in children”. A combination of new strategies is needed to tackle neglected diseases but miltefosine is an example of an important first step. Rachael Paterson
THE LANCET Infectious Diseases Vol 2 August 2002
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.