© 1999 Nature America Inc. • http://medicine.nature.com EDITORIAL VOLUME 5 • NUMBER 1 • JANUARY 1999 South Africa: Setting the wrong example December 1st was “World AIDS Day” also offered to hold that price for five Health Minister and should resign—or and despite the welcome attention this years. Indeed, interest in this program was else there is another agenda. Senior scien- brought to the cause of AIDS patients such that in separate discussions with tists in the US have speculated that everywhere, it is disappointing to see provincial departments of health for two Zuma’s decision is politically motivated. how little interest the Western media has South African provinces (Gauteng and Zuma is said to be the main backer of an shown in the real issue of the day— Western Capetown) treatment under the effort by the South African government to South Africa’s recent decision not to program was begun in the hope that this abolish intellectual property rights on treat HIV-positive pregnant women with provincial experience would form the pharmaceuticals, with a view to pursuing the anti-viral drug AZT. This is a regret- basis of a national policy. the local production of patented drugs. table decision and South Africa should This arrangement had a lot to recom- In the year 2000, South Africa will host quickly reconsider. mend it and put South Africa on the the 13th World AIDS conference. The UNAIDS has estimated that in 1997, brink of an important and innovative meeting organizers and financial backers more than half a million infants acquired policy that would cut infant infection must be aware that world wide concern HIV from their mothers. Geraldine Fraser- rates dramatically. As is so often the case for Zuma’s AZT decision is so great that http://medicine.nature.com • Moleketi, South African Welfare Minister, with HIV infection, there are complica- talk of a boycott is emerging. admits that South Africa has been slow to tions: AZT treatment only cuts infection South Africa is in a unique position of deal with the AIDS problem. In South rates by half and infection via breast feed- influence in sub-Saharan Africa. It has a Africa, infant deaths due to AIDS are ing is still a major problem. Nonetheless, comparatively good health, education expected to rise 20% by 2001, and Fraser- the ethical and economic arguments in and research infrastructure and an econ- Moleketi recently urged her government favor of the short course of AZT treatment omy that can support coordinated and colleagues to set aside additional funds to are overwhelming. Indeed Botswana, effective health policies. It also has ambi- implement new anti AIDS programs. who with an adult HIV prevalence rate of tions as a leader of countries in that Commenting on the problem of mother 25% face an even worse HIV problem, region. As such, neighboring countries 1999 Nature America Inc. to infant transmission, Peter Piot, Execu- have accepted Glaxo’s five year deal. As often follow South Africa’s lead and may © tive Director of UNAIDS, stated “The Nature Medicine went to press, Botswana do so in the case of AIDS. Its president, question is no longer when or if we were planning to implement the program Nelson Mandela, has been criticized for should act, but simply how”. on January 1st. failing to speak out about AIDS. He now In early 1998, a joint Thailand and US It was therefore alarming to hear in has an opportunity to show South Africa Centers for Disease Control study found October 1998 Zuma announce that South and the rest of the world how serious he that a simple four-week course of the anti- Africa would not be implementing the is about tackling this problem. HIV drug AZT, given to the mother prior program. The announcement has been As Glenda Gray, Co-director of the peri- to delivery and at three-hourly intervals met with anger and surprise, both in the natal HIV Research Unit of the Chris during labor can cut mother to infant South African press and by researchers Hani Baragwanath Hospital in Soweto, infection rates by half. Although AZT is the world over. Perhaps Nicoli Nattrass, remarked, “South African politicians must one of the cheaper anti-HIV drugs, it is an Associate Professor at the School of know that the whole world is watching still beyond the purse of many developing Economics in Capetown, summed it up them”. Any decisions today will have a countries. Aware of this, Glaxo Wellcome, best when he declared in the Johannes- ripple affect across the continent and pos- the maker of AZT, approached Nkosazana burg Mail & Guardian “It is economically sibly beyond. A simple decision by South Zuma, South Africa’s Minister of Health, illiterate and shockingly ill-informed to Africa to reintroduce routine AZT treat- to discuss preferential pricing as early as argue that we cannot afford to give preg- ment for all infected pregnant women 1996. On learning of the Thailand AZT nant women AZT”. would not only represent sound eco- trial, they entered into more serious dis- In explaining her decision, Zuma has nomic and health policies but would also cussions, resulting in Glaxo's offer to raised efficacy, economic and cultural open the door to a more ethical and make AZT available at 30% of the normal issues, none of which hold water. Either humane approach to those suffering the price. This would mean that the cost to Zuma simply does not understand the extreme discrimination, ill health and treat one expectant mother would drop arguments in favor of this treatment—in early death that come with HIV infection from nearly $200 to less than $60. Glaxo which case she is not up to the job of in Africa. NATURE MEDICINE • VOLUME 5 • NUMBER 1 • JANUARY 1999 1.