Health Minister Dr Manto Tshabalala-Msimang appears to have turned her back on the Clinton Foundation, which has been assisting her department to develop the country’s antiretroviral (ARV) drug treatment programme.

This is despite the fact that the foundation brokered an anti-retroviral
drug deal that potentially gives South Africa access to the cheapest drugs in the world.

The foundation also provided substantial technical support to the task team that developed the ARV rollout plan which was approved by Cabinet in November.

It was also expected to help the Department of Health with the accreditation of health facilities earmarked to provide the ARV drugs, but this has not happened.

Well-placed sources say that Tshabalala-Msimang has had a fall-out with Ira Magaziner, chairperson of the Clinton Foundation AIDS Initiative.

When asked for comment on this, ministerial spokesperson Sibani Mgandi simply said: “We appreciate the major contribution made by the Clinton Foundation in the development of a Comprehensive Plan for Management, Care and Treatment of HIV and AIDS.

“The approach we have taken with regard to implementation is to mobilise all stakeholders and donor community to support the plan. This support will be   sourced and channelled to specific areas where the Department requires support in implementation process.”

There has been speculation that the Health Minister has been under pressure from the Bush administration to end its exclusive relationship with the Clinton Foundation on the AIDS treatment plan and drug procurement.

However, this has been rejected as “complete fabrication” by Judy Moon, the US Embassy’s press attache in Pretoria.

“We are delighted by the role which the Clinton Foundation played in
negotiating with the drug firms. The outcome was very helpful for all of us active in fighting HIV/AIDS,” said Moon.

She added that the HIV/AIDS epidemic was too big for any one organisation or government to tackle alone and that “we need collaboration not competition”.

While Magaziner has confirmed that the foundation had not been active in this country since Cabinet approved the plan in November, he said that he hoped the foundation would be able to help again “soon”.

“The Minister of Health has conveyed to us that she wishes to involve us and other international partners in providing technical assistance in the implementation of the care and treatment programme, and that she will be in touch with us shortly to convey the activities she would like us to perform,” said Magaziner.

“We therefore hope and expect to be working again in South Africa sometime soon.”

The Department of Health is expected to issue tenders from today (13/02/04) for companies to supply the antiretroviral drugs needed for the rollout, and it is not clear whether it will go with the companies associated with the Clinton Foundation.

However, Magaziner stressed that the agreement his Foundation reached with drug companies “explicitly includes” drug purchases by the South African government.

“The Clinton Foundation formulator partners, Ranbaxy, Cipla, and Aspen will bid [for the South African tender] and are required by our agreement with them to bid at or below the prices specified in their agreement with us,” he said.

“Our partners Matrix and Hetero, who supply the active pharmaceutical
ingredients to these companies for antiretroviral drugs, will provide these at the low Clinton Foundation prices, helping to enable the three
formulators to bid at the low prices.”

The Clinton Foundation has also brokered a deal with three companies that make viral load tests (which test how much HIV is in a person’s body) and two companies that make CD 4 tests (that test a person’s immunity).

These companies are able to “provide a comprehensive package including equipment, consumable materials, training and a service contract for prices that are up to 70% lower than those now available in the market place”, said Magaziner.

“The National Health Laboratory Service has already issued a tender in
alignment with the Clinton Foundation agreement to these five suppliers and will reap the benefits of this agreement. Again, the suppliers have agreed to bid at or below the Clinton Foundation negotiated prices,” he added.

Meanwhile, government’s HIV/AIDS head, Dr Nono Simelela, told Health-e’s Khopotso Bodibe that government is “cognisant of the fact that relying on one supplier is not the route to go”.

“We also know with the pharmaceutical industry, it’s not one company that manufactures what we need so, obviously, we have to source from different people.

“We have also built into the plan the fact that somewhere along the line we might need to change [drugs] if we develop resistance, or if people don’t respond properly.

“So, those companies need to be ready to change strategy with us. We can’t bind ourselves to something that says we’ll buy from one company the same drug for the next three years. What if that drug is not working? What if there’s a problem?”

E-mail Kerry Cullinan