World AIDS Day Teleconference Transcript

Asia Russell (Health GAP Coalition):
Ok, I'm going to get things started. As you've learned we're all on this call together, unlike the UNAIDS reporters call that just ended, this is a low tech operation. So I'll run through after I've introduced folks on what the schedule of the conference call is for the next hour.

My name is Asia Russell, I'm a member of Health GAP Coalition—the Global Access Project—a US based AIDS activist coalition. I'm also a member of the group ACT UP Philadelphia. I'll be the moderator today and also be presenting. This call, in anticipation of World AIDS Day 2000, is meant to update journalists on struggles for access to affordable HIV medication happening around the world.

On this call we'll bring you an update on the struggle for affordable HIV medications and discuss major issues and campaigns in the US and around the world to demand affordable drug access. Specifically we will talk about the attention grabbing “Big 5� drug company and UNAIDS announcement 6 months ago and its true impact on getting drugs into poor countries and into people's bodies. People will be discussing current drug donation programs such as the one Pfizer has been negotiating with South Africa.

And for any journalists rolling over from the UNAIDS call, we'll offer our analysis on UNAIDS' ongoing partnership with industry and what that sort of partnership entails for creating or impeding true access to life extending medications.

The presenters for this call are Dr. Anne-Valerie Kaninda, she's a medical adviser with Médecins Sans Frontières/Doctors Without Borders. Also Mark Heywood, Treatment Action Campaign, a grassroots AIDS activist organization from South Africa. And again myself, Asia Russell, and that's the order in which we'll be presenting.

Just to get the housekeeping stuff out of the way. The schedule for the call is as follows: we'll each take about 7 minutes to provide opening statements and following that time there will be a question and answer period, and then we'll just conclude with closing remarks. The question and answer period will probably last until 5 of 2:00. In addition, when the question period opens, if people could just state their name, where they are, where they are reporting for, and since there is no formal queue, I will try my best to moderate people as they ask questions and allow themselves one or two follow up questions. So let's go ahead and begin with opening statements from panelists and start with Dr. Anne-Valerie Kaninda.

Dr. Anne-Valerie Kaninda (Médecins Sans Frontières/Doctors Without Borders):

Good morning, or good afternoon everybody. I would like to start with just reminding everybody of the following statistics that have been released by UNAIDS today. While there are more than 36 million people infected worldwide, 25 million of these people live in sub-Saharan Africa. And I can credit to the issues that are very important, first we recognize that prevention activities are crucial in fighting this epidemic. We want to emphasize our experience, our field experience, our medical field experience, which has shown that prevention-only strategies often fail. For instance, when you are talking about Uganda, where there are a lot of prevention-only activities that have been going on which have often been mentioned as a success story. Well it's a success story, but it's a country that still has a prevalence if infection, which is over 10% of the population. So it's a success story, but only up to a certain point.

The other thing is that when you offer treatment, it is really a formidable enhancer for prevention activities. People will come and get tested for HIV. They will want to know if there is some way they can get some treatment and have some hope. Otherwise, if you are in a country where you have no treatment access, the only reason to get tested is to have a death sentence. Then why would you go get tested? So treatment really enhances prevention activities.

The availability of treatment also provides tremendous incentive for countries to mobilize resources and change their infrastructure. We have seen that in our field experience. When we're talking about treatment, we're not only talking about basic care treatment. What we know, also from experience so far, is that the only treatment that will make a difference in terms of morbidity and mortality, is antiretroviral therapy. It is what has happened in the West. It is only when antiretroviral therapy, and especially triple therapy, became available in 1996, that we saw dramatic reductions in terms of morbidity and mortality for people living with HIV/AIDS. We have seen the survival of people increase and the quality of life of people increase dramatically. If we're talking about treatment, let's talk about the things that really make the difference.

Now if we get to the big announcement on May 11. The Wall Street Journal reported that UNAIDS and 5 drug companies were offering to slash the prices of HIV drugs for people living in poor countries. What we see today, there's been a lot of PR around these announcements for pharmaceutical companies. What we see today from UNAIDS and the big 5, these initiatives from the 5 companies—they haven't done enough.

If we look at the number of countries that have negotiated price reductions to date for antiretrovirals, there's only one: it's Senegal. So what we're doing is calling on these big 5 multinational drug companies to basically reduce their price of their AIDS drugs by at least 95%. People living with AIDS in poor countries, cannot afford the medicines that prolong and improve the quality of their life. MSF/Doctors Without Borders is really challenging these drug companies to deliver on their promises and respond to this demand by the first week of 2001, at the latest.

Q:

What did you say your deadline was? I'm sorry.

A-VK:

We're really challenging the drug companies to deliver on their promises and respond to this demand by the first week in 2001.

Q:

Which promises are you referring to specifically?

A-VK:

Their announcement that they would “slash their prices� for HIV drugs for people living in poor countries. And we are now calling, MSF is calling for at least 95% reductions for their AIDS drugs in poor countries.

Q:

You said by 95% for all people living in poor countries and not just any one country?

A-VK:

Oh yes, yes, for people living in poor countries, we're not selecting just one country.

(Clarification: As a first step, MSF is demanding an immediate, short-term solution—reducing prices by a minimum of 95% of US wholesale prices. This reduction should be unconditional and apply to all AIDS drugs for the developing world in order to reach people with HIV/AIDS as soon as possible. Developing countries should not have to negotiate such reductions company-by-company, drug-by-drug. This complex and time-consuming system prolongs the process of getting drugs to patients who desperately need them and diverts precious human resources from national AIDS programs.)

And for instance in practice, that means that Glaxo Wellcome should make its drug AZT/3TC available for at least $1 a day. Bristol-Myers Squibb should charge at least 49 cents a day for d4T instead of $9.80. And Merck should charge at least 65 cents for efavirenz.

Q:

Could you go through that once more?

A-VK:

Glaxo should make AZT/3TC combination available for at least $1 a day instead of $19.60.

Q:

That's Combivir.

A-VK:

Combivir, yes.

Q:

Are these statements anywhere to facilitate reporters getting access to them?

A-VK:

Yes they are. You can actually call our Communications Director, Kris Torgeson, here at MSF who has the whole statement.

Q:

Could you go through those three statements again?

A-VK:

Bristol Myers Squibb should charge at least 49 cents a day for d4T instead of a present $9.80 and Merck should charge at least 65 cents for efavirenz instead of $13.20.

Q:

And the $13.20, these instead of prices are prices based from the United States?

A-VK:

These I believe are the general worldwide prices. I can get back to you on that.

(Clarification: These prices are the best approximate available for US wholesale prices, and they have been cited in UNAIDS and MSF reports, as well as on several websites, including www.globalrx.com and www.hopkins-aids.edu.)

Q:

What's the Bristol-Myers drug?

A-VK:

d4T

Q:

And Merck?

A-VK:

Efavirenz

Q:

And the proposed price for efavirenz is what?

A-VK:

We are calling for at least 65 cents.

Q:

Are you basing the prices on what you know they can be made for?

A-VK:

We are basing those on a 95% reduction compared to the current price. But we also know that when we look at some of the antiretrovirals that are produced generically, for instance in Thailand, and when you compare those with how much you are charged by the brand name pharmaceutical companies, these prices can be achieved. Yes, when you look at the difference between the generic price and the brand name price of the drugs, these are definitely reasonable requests.

Q:

At the UNAIDS conference, I believe Peter Piot said that the Senegal prices that were negotiated are lower than the generic prices. Would you like to comment on that? That price is going to be lower than what you're talking about.

A-VK:

Yes, well, if the pharmaceutical companies can deliver prices which are cheaper than the generic prices, then that's good. If they can make the prices affordable and within the reach of people in poor countries, it's good, but so far Senegal is the only country to have negotiated the price reductions to date. We are more than 6 months after the May 11 announcement. Meanwhile people are still dying and suffering from AIDS in poor countries.

Asia Russell:

This is Asia Russell again. We should move to the next presentation and we can revisit some of these issues during the question and answer period.

Q:

Can you just spell the name of the Dr. who was just speaking.

A-VK:

Dr. Kaninda. Dr. K-a-n-i-n-d-a, Anne is the first name.

AR:

The bottom line is that based on experience, the drugs can be made accessible as a result of competition brought on by generics access and based on deep, deep discounts. This is the heart of activists demands—these medications can become affordable and accessible. Multiple effective strategies must be used to realize this urgent goal, but the main point is we need real reduction of price and this needs to be sustainable, broad, and free from conditions imposed by pharmaceutical companies.

Q:

Can you spell your name as well?

AR:

Asia like the continent, R-u-s-s-e-l-l. We can move to the next presentation and revisit these matters later in the question and answer bit. Next is Mark Heywood of the Treatment Action Campaign in South Africa.

Mark Heywood (Treatment Action Campaign):

Good evening. As Asia said, my name is Mark Heywood and I am the deputy chair person of the treatment action campaign in South Africa. I am phoning from Johannesburg. I am speaking as a replacement for Zachie Achmat who is the chairperson of the Treatment Action Campaign who couldn't make this call this evening because one of our volunteers called Queen from Capetown died this afternoon of an AIDS-related illness. This is the third person in five days to have died from an AIDS-related illness who are actively involved in our organization. All of these people have died within kilometers of first world hospitals, and have died simply because the medicines that could treat them are unaffordable. Therefore unavailable. The ages of the three people that have died are 22, 33, and 25 or 26. This is the situation that we are dealing with in South Africa now.

I have worked in AIDS for the last five years and in the last two years I have seen us cross from HIV epidemic to an epidemic of repeated illness and death among large numbers of people. Earlier this evening I was in the final meeting of the AIDS Consortium, which is an organization based in Johannesburg, where there was a memorial for people who have died this year. And amongst the 100 people there forty or so people read out names of people that they have known who have died. This is the situation we are facing here: an AIDS epidemic, an epidemic of illness and death. The Treatment Action Campaign is an organization based in South Africa that now has the support of all the major trade union federations in this country as well as the major non-governmental organizations and the general public's support. What I am about to report to you about our intensified action on these issues is a plan that has widespread public support. I want to talk about three issues. The first is the Pfizer donation of Fluconazole to the South African government. The second is the Treatment Action Campaign's unlawful importation of a generic version of Fluconazole from Thailand. And the third is the position of the Treatment Action Campaign in the price reduction negotiations with the major pharmaceutical companies with the assistance of UNAIDS.

Move to the first issue. At the end of March this year as a result of the campaign of the Treatment Action Campaign to call on Pfizer to either reduce the price of Diflucan/fluconazole to the equivalent of the generic price or to give the TAC or the South African government a voluntary license. Pfizer announced an offer to give the South African government Fluconazole free for people who cannot afford it in the public health sector. When we inquired with Pfizer the details of this offer we discovered that it was only patients with AIDS who had cryptococcal meningitis and not for other conditions which required this drug. We continued our campaign and we now understand that Pfizer is about to sign a public agreement with the South African government on December 1st, which will make the drug available for the public health sector for cryptococcal meningitis and for candidiasis, which, for those of you are not medical doctors, is a severe fungal infection of the esophagus and so on and so on.

We are prepared to welcome this offer, this donation, but what we regret is that it has taken nine months for this donation to become any kind of reality. And even if it is signed on December the 1st it is not going to be immediately available to people who suffer from these conditions. The second thing is that Pfizer is still limiting the offer to the public health sector. And yet in South Africa many poor people with HIV and AIDS use the private health sector, use general practitioners, private clinics, NGOs. We therefore are critical of the offer and do not accept it in the terms with which it is being made available.

This then relates to the second point I would like to make, which is Fluconazole is currently sold to the African public untendered for 28 Rand per 200 mg tablet. If you buy it in the private sector in the pharmacy it cost over 100 Rand for a 200 mg tablet. In October, the chairperson, Zackie, went to Thailand and bought 5,000 pills at 1.77 Rand per tablet, unlawfully or illegally returned to South Africa to supply doctors to distribute to poor people who could not otherwise afford the drug. I would like to draw your attention to 1.77 opposed to the cheapest 28 Rand available in the public sector. I would also like to point out Fluconazole is not an antiretroviral drug. We, because of the request by our government that we act within the law, surrendered those medicines to our Department of Health and also applied for permission under our Medicine Control Act to have an exemption of the use of those medicines by medical practice in Capetown.

Tomorrow afternoon we are meeting the chairperson of our Medicine Control Council to receive the formal response to our application. If that response is a refusal to grant permission of use of this medicine we will do two things: We will prepare for legal action to challenge the refusal. The second is that we have an intention to continue with the unlawful importation of medicines which are affordable in order to save the lives of people who have HIV and AIDS, or to alleviate the illnesses of people who have HIV or AIDS. We will make that announcement depending on what the Medicine Control Council says to us tomorrow afternoon.

The third issue I want to deal briefly with is the question of price reductions. The Treatment Action Campaign believes the price reductions by pharmaceutical companies should be unconditional and should be announced immediately. We do not support that these reduction should be dealt with on a country by country basis. We feel faced with the emergency occurring in Africa or Asia and other developing countries that the pharmaceutical companies have it within their power to announce unconditional worldwide price reductions, with a view to making essential medicines available to the largest number of people possible in accordance with available health infrastructure. We do not believe that the price reduction should be conditional to governments giving up their power to use things like compulsory licenses to bring competition into pricing on these essential medicines. And we support the position that has been adopted by the ministers of health in the fourteen countries of the Southern African Development Community which states that “whilst they will accept price reductions and donations they will not do so on the basis of conditions that give away national autonomy.�

The final thing I will say on this is that the thing we find so sad about this is in a country like South Africa is that Glaxo Wellcome, which has 37% of the world's market in antiviral drugs, is closing down possibly the most modern pharmaceutical manufacturing plant in Africa by 2003. This is the plant just outside of Johannesburg. This is a plant that has the technology to produce many essential medicines for a large part of the Southern African region. We're concerned that actions like that contradict PR actions that are currently being engaged in around the yet to be felt price reduction. That is all I think I have time for.

AR:

Thanks Mark. I will say a few words, after which time we will open for questions. Again I am from the Health GAP Coalition a US based organization made up of organizations that are fighting domestic policy that impedes access to AIDS medication in poor countries, and fighting for improvements to make access to life extending medications to treat HIV a reality and not just an exercise of smoke and mirrors from drug companies and UN agencies such as UNAIDS.

I will mention a few points briefly, and in addition can direct you to a Health GAP report card reacting to the state of drug company price reduction schemes can be downloaded from www.globaltreatmentaccess.org . The announcement from the pharmaceutical companies of a statement of intent with UNAIDS is not been received kindly by the Health GAP Coalition for some of the reasons already discussed by Dr. Kaninda and Mark Heywood. There is no proof as yet that the cumbersome nature of the country-by-country promised price reductions will result in significant access to antiviral medication. We are concerned that developing nations have little leverage in negotiating with incredibly powerful drug companies according to the initiative's structure—that is, UNAIDS has the cards stacked against them. There is no proof that these price reductions alone will be sufficient to address the overwhelming crisis in lack of access to medication. We are in a situation where 95% of people with HIV have little to no access to medication that would extend their lives and treat HIV and its complications. There are other tactics that must be employed by people with AIDS in poor countries—increasing affordable drug access through importing and manufacturing generics HIV medications, as has been done to powerful effect in Brazil. The US government must play a primary role in promoting global access by endorsing this strategy.

Broad access must become a reality in the next several years. Already the world has been waiting moths and months while only one country, Senegal, has made their closed-door negotiation with drug companies.

We feel that putting more effort into ramping up broad and deep access to generic medication is incredibly important. No one feels there is a panacea, that there is just one strategy towards rectifying lack of access to medication. But in fact, as we all know from past experience in the US, there is clear political incentive for governments and drug companies to deflect attention from building up access to generics and instead to focus on the terms of insufficient, inefficient drug company price reduction programs. When drug companies have very successful PR coming from these programs and appear both to major stake holders and to their share holders that they are doing something to address lack of access to life extending AIDS drugs, they deflects attention from ongoing efforts in developing countries to gain access to generics. At this point, we know that the US government has a long and sordid track record of blocking generic drug access in developing countries. It is our opinion, without forcing our administration to make public statements that generic medication is extremely viable and crucial in rectifying lack of access, access won't be realized and we will continue to exist this plane of smoke and mirrors.

Finally, the US government's refusal to call for the cancellations of the debt owed by the world's poorest countries is directly impeding countries from developing effective strategies to increasing AIDS drug access. The US government can eliminate this obstacle by calling for an end to the debt for the poorest countries in the world. For example sub-Saharan Africa owes at least $220 billion to international financial institutions. In the face of overwhelming debt, countries cannot take the action necessary to create sustainable treatment action. It's not possible.

Ed Silverman:

This is Ed Silverman at the Newark Star Ledger and I must have missed something. Could one of you straighten me out? On one hand I am hearing a call to reduce prices across the board by 95% in a few weeks and on another hand I am hearing someone else say price reductions do not work. Did I hear wrong?

AR:

Actually the linkage is that generic competition results in decreased medication prices. Dramatic price reductions are just one part of a strategy to obtain affordable HIV drugs.

ES:

In other words, the unified message is that they need to reduce prices across the board and allow for competition because this would reduce prices as well. One or the other right?

AR:

Actually, both will result in price reduction. There is community substantial criticism of the cumbersome and potentially condition-laden process currently driven by the drug companies and UNAIDS, however.

MH:

Our view is that there should be drastic price reductions but price reductions should not be at the cost of the basis of the surrender of developing countries' rights to introduce competition of generic drugs. If you take a country like South Africa where there are 4 million people with HIV, who at some point are going to need access to drugs including anti-retrovirals, if Glaxo Wellcome reduces the prices of Combivir to $2 a day the generic producer can sell it to the South African government for $1.75 a day. And clearly given the numbers that we face it is in the interest of the South African government to have the option of purchasing or licensing of generic manufacturers.

ES:

Understood.

Reporter:

Are the donations of the moment conditional on countries relinquishing their rights?

MH:

It is not 100% clear. I met Glaxo Wellcome when I was in London two weeks ago and my impression was that there are conditions attached. One of the conditions is a condition that seeks a guarantee that the recipient government will do everything in its power to prevent the re-exportation of medicines to industrialized country markets, and that they will not dispute licenses around compulsory licensing. But I think that you need to investigate further on that.

AR:

I think this is an entirely appropriate question for journalists to ask the drug companies. You have to go one step further and wonder--once a developing country enters into negotiations with a powerful company like Glaxo Wellcome, how free they feel to move forward and investigate other possibilities to increase drug access, such as manufacturing generic versions of Glaxo's medications.

Reporter:

I would like to return to the infrastructure question. A couple of hours ago we heard Peter Piot say that even if you gave these drugs away, you couldn't get them out in the hardest hit countries in sub-Saharan Africa because the infrastructure simply is not there. Could the three of you address that issue?

MH:

In South Africa it is estimated that close to 10,000 people have access to antiretrovirals. Clinicians in this country believe that if we had significant price reductions in this country it would be possible to extend access to up to 300,000 within two years. That is not an insignificant effort to protect life. I started in my contribution by saying many people in South Africa are dying within walking distance to high-tech hospitals. Of course the infrastructure argument is a significant issue and it relates to what Asia said about debt relief to improve Africa's infrastructure. And it is not possible to get access to the most advanced drugs over night to all the people who will need them. But it is possible to get drugs to a large population of people quickly. I live and work in the southern African region: in Botswana there are hospitals that could diagnose and monitor the treatment of the drugs. The same is true in Namibia and the same is true in Zimbabwe. So between everything and nothing there is a significant something and that is what we are after.

A-VK:

This is Dr. Kaninda from Doctors Without Borders. Along the lines of what Mark just said, the infrastructure argument is really a blanket statement because every country is different and within countries there are striking differences between urban and rural areas. And it's used as an argument for not doing anything and this is totally unethical. Because, as Mark just said, there are things that we could do. We wouldn't be able to cover 100% of the population over night, I mean 100% of the people who would really benefit from AIDS drugs, this is for sure, but we could do significant things, really improve the lives of a significant amount of people. This is true for South Africa but this is also true in other countries as well. I think that the infrastructure issue is very over-emphasized. There are things that we can do within the constraints. Of course there are countries that have limitations and Doctors Without Borders being in the field is very aware of the constraints, but is really aware that we can do things.

AR:

It seems clear that this is often a ploy, the infrastructure argument, mounted by the very drug companies which are actually decreasing many countries' infrastructure by actions like the shutting down of plants such as Mark mentioned—it's ironic. In fact this is an argument the companies tend to use to justify inaction and to justify keeping drugs out of reach of people who need them most. How can we focus solely on developing medical infrastructure while HIV kills countless lab techs, nurses, and doctors around the world? How can infrastructure be the sole focus while schools face dramatic shortages in teachers due to death from untreated HIV infection?

If there are drugs that are made available there is synergy that accompanies their availability: James Wohlfensen, head of the World Bank has even said with drug prices so high, there is no motivation to build infrastructure. The converse of that statement is that accessible, affordable medication can kickstart the development of infrastructure. It is not as if these matters happen separately from each other; there must be cross-pollination. When drug companies insist that infrastructure is the biggest problem, not medication cost, it is as if gaining access to medication won't promote the development of infrastructure, when we know from experience, that this is not the case...(interruption)

Reporter:

I want to know why Glaxo Wellcome is closing the plant in South Africa.

MH:

Glaxo says it is part of a global reduction of manufacturing capacity. They apparently took a major survey and they believe that their plant capacity in South Africa is a surplus and the manufacturers can be just as successfully produced in developed countries.

Reporter:

Are there any AIDS drugs produced there?

MH:

As far as I know, AIDS drugs are made there but I am not sure which ones. We will be having a meeting in the very near future. I met with senior officials in London and asked that question and couldn't get a straight answer and was told to speak with the people in South Africa.

Reporter:

What is the price of Diflucan in South Africa?

MH:

Diflucan in the public sector is 28 Rand for a 200 mg tablet.

Reporter:

You don't know the translation?

ES:

The translation is $3.60 US dollars for one tablet.

MH:

In the private sector it is about 80 Rand before pharmacy markups and after it is over 120 Rand.

ES:

$12.85 is equal to 100 Rand.

MH:

It is a significant variation in price. The tablets we bought in Thailand cost 1 Rand 77 per 200 mg tablet. They were produced in a factory called Biolab which is a supplier for MSF among others in Thailand and has proper certificates of manufacturing and so on. So there is a significant variation in price.

AR:

That is, the Thai prices are about .29 cents US.

ES:

Given the bizarre attitude of the South African government towards AIDS drugs, if “Big Pharma� were to negotiate say an $800 per year price for a triple combination therapy, do you think that the South African government would accept that?

MH:

That is another issue. TAC recognizes that we have a battle on our hands to change the position of the South African government on the use of antiretrovirals. We are doing our best, and we believe we will succeed with that in the short to medium term. At the moment that is a difficulty, made worse by the fact that there is no communication at present between “Big Pharma� and the South African government, partly because all the members of “Big Pharma� are still engaged in a court case against our government to block something called the Medicines and Related Substances Control Amendment Act, which allows the government to use parallel importation but also makes generic substitution a requirement of pharmacists.

Reporter:

What other generic drugs are you considering importing into SA? You said if you don't get what you want from the Control Council, you may go ahead in importing other drugs. What are those other drugs?

MH:

First of all, to explain, the reason we imported the generic flucanozole was because we didn't want to encounter the arguments around infrastructure but we have doctors who are part of TAC who can prescribe and monitor appropriate use of antiretroviral drugs and drugs that would be considered for bringing into the country on humanitarian grounds would include drugs such as AZT, 3TC and Combivir.

David Brown:

This is David Brown from The Washington Post. Mark, could you spell your name?

MH:

Mark H-e-y-w-o-o-d.

Reporter:

How many pills/doses of flucanozole did Mr. Achmat bring from where?

MH:

Mr. Achmat bought 5,000 200 mg tablets of flucanozole. He returned to South Africa with 3,000 tablets. All of those tablets were surrendered to the Department of Health in good faith. 2,000 tablets remain in Thailand to be brought into South Africa depending on the response of the Medicines Control Council. The argument of the TAC is that we are not breaking the law, we use the legal defense of necessity, which is a defense that can be used to override or justify breaking the law in the interest of the preservation and protection of people's lives. We also believe that what we're doing is in accordance with the South African constitution, which is the supreme law in South Africa, which guarantees our citizens the rights of access to dignity and access to health care. We believe that is more important than the patent rights that are being contested here.

ES:

Are you objecting to any specific conditions that you objected to in the summer concerning Diflucan and what Pfizer wanted to do?

MH:

It seems to us that Pfizer has changed their position since the summer. First of all, they've extended the offer to cover candidiasis, which is a significant development. (Candidiasis is a severe esophageal or vaginal infection associated with HIV.) But we have not seen the dots and commas. At one point I was on the negotiating team with the South African government, and I was disinvited from membership of that committee. We are waiting to see the details, but we do know is that it is not on offer to the private sector, and it is only for South Africa. In southern Africa, where borders are very fluid, where people with HIV cross borders, where you have a regional, not just a national epidemic, that is not satisfactory for us.

ES:

What about the various conditions, the 2 years for example, how it can be monitored, where people can be treated and so forth?

MH:

We understand that the 2 year time limit has been dropped, for that we wait to see on Friday. Secondly we understand that the South African government has insisted that the implementation of the donation should not require the setting up of parallel systems for monitoring, and that it should be done within the framework of the existing health service infrastructure, which we should also support. But again I would have to stress that although we know that the deal will be signed on Friday, we do not know the final details of what is being signed.

(A few seconds lost due to tape change.)

MH:

�for use in mother to child prevention. We have not yet heard the outcome of their discussions. We are hoping that it will lead to the registration or at least the conditional registration of nevirapine. The South African government has moved its position on mother to child transmission and is now introducing pilot projects to test the operational issues around use of nevirapine in all 9 provinces in at least 2 sites per province with a minimum of at least 3,000 deliveries per site. That is a significant movement, but it is not sufficient as far as we are concerned. Nevirapine should be made available to every woman in South Africa who knows that she has HIV and is pregnant. We endorse what has been said by the WHO and UNAIDS in their October consultation that we have moved beyond the period of pilot projects, and we believe that even if South Africa needs to test the issues around implementation, that could be monitored in the context of expanding access to the drug on a nationwide basis.

Brad Nelson:

This is Brad Nelson from Newsday. You were talking about the expected announcement by Pfizer on Friday. Are you expecting other major announcements by pharmaceutical companies?

MH:

We don't know anything in South Africa.

AR:

We have not heard anything here. But we expect that it will happen. In the past year we've seen price reduction schemes amount to very elaborate public relations shows by the big companies. Anything to add, Anne-Valerie?

A-VK:

No, we're just waiting.

(Conclusion of teleconference)