FAIR TR AnsnATIonAl InvesTIgATIon
               20 07

                     The indifferenT indus Try
                      Big Pharma, essential medicines and Africa’s sick

                                                                          FORUM for
                                                                          I N V E S T I G AT I V E

1         Preface and declaration of interest                                                                                                        page 3

2         Executive summary                                                                                                                          page 4

3         Malawi: Hospitals are places where you go to die                                                                                         page 10

4         Zambia: Wonder pills take centre stage as ARVs stay out of reach                                                                         page 18

5         ‘This product has been tested in Brazil’: misleading the authorities in Kenya                                                            page 25

6         DRC: A land of obscure labs, pharmaceutical goldmines and silent health officials                                                        page 28

7         South Africa: Government denial as an obstacle in the struggle                                                                           page 31

8         The denial of HIV/Aids in Africa                                                                                                         page 35

9         Transnational Investigation team                                                                                                         page 38

          Glossary                                                                                                                                 page 40

About the Forum for African Investigative Reporters (FAIR)
The Forum for African Investigative Reporters (FAIR) is a professional as-               –   facilitating access to information on Africa archived interna-
sociation of investigative journalists in Africa. Its mission is to enhance,                 tionally, as well as access to a network of internationally based
deepen and build investigative journalism as a profession throughout                         colleagues;
the continent.                                                                           –   initiatives to support aspiring African investigative journalists
FAIR was established in May 2003 by investigative journalists from six                       through training and placement;
African countries on the basis of the awareness that, firstly, investiga-                –   support for, and promotion of, methods of best practice in African
tive journalists have a vital role to play to enhance the African public’s                   investigative journalism
right to information about all matters of social development and social             FAIR now counts 50+ investigative journalists in 16 countries in Africa.
justice; and, secondly, that African investigative journalists at present           This is FAIR’s first Transnational Investigation.
face many obstacles, ranging from lack of encouragement and low pay                 The FAIR Transnational Investigation was made possible by the
to life-threatening situations.                                                     Netherlands Institute for Southern Africa (NIZA)
FAIR’s areas of focus are:
    –   Independence from undue editorial pressure, physical threats
        and constraints on time and resources;
    –   Access to information and information resources as well as to
        training and career development opportunities;
    –   Support through peer networking, advice and solidarity; through
        media legal defence funds and trauma counselling where
                                                                                    FAIR Transnational Investigation | January 2008
FAIR works to achieve its goals through:
    –   professional support for African investigative journalists;                 Edited by Eveline Lubbers
    –   provision of resources and networking services for African inves-           Designed and produced by Compress
        tigative journalists;                                                       Photo credits: cover & pages 17, 23, 26
    –   facilitating cross-border partnerships in investigative stories
        throughout Africa;                                                          w w

                                                            FA I R D o s s I e R | J A n uA R y 2 0 0 8

                            Preface and declaration of interest

During the course of this Transnational Investigation                  that people we knew and loved could not get diagnosed
(TI) two members of our team died and one became                       properly, could not get the medicines they needed and
severely ill. Hilary Mbobe is waging a valiant                         were exposed to dangerous quack cures peddled by
battle against cryptococcal meningitis as well as a                    those who prey on those desperate for medicines.
compromised immune system as this preface is written.                      In investigating the pharmaceutical industry, and
Our South African TI team member, Zakeus Chibaya,                      finding the sector lacking in corporate responsibility, we
died in August this year after severe pneumonia                        do not exonerate our own governments, which are often
attacked his weakened immune system. Our Zambian                       weak and plagued by corruption. We accept also that
colleague Isabella Chimangeni had succumbed to a                       ignorance and denial are damaging factors that cannot
number of infections three months earlier, just after she              be blamed on an industry alone. We are, however, aware
had agreed to join the team.                                           that the pharmaceutical industry advertises itself as a
    The ravaging by disease and death of the very team                 ‘lifesaving’ one and that it boosts numerous corporate
tasked with investigating lack of access to medication in              social responsibility (CSR) programmes.
Africa underscores how much we, as African journalists,                    CSR is a concept whereby companies consider the
are part of the African public we serve. We do not                     interests of society by taking responsibility for the
observe Africa from another planet: we are here. We are                impact of their activities in all aspects of their opera-
affected, damaged and killed by the same phenomena                     tions. It implies voluntarily taking further steps to
and conditions that affect, damage and kill ‘ordinary’                 improve the quality of life for employees and their
Africans. As journalists, we do not benefit from the                   families as well as for the local community and society
extraordinary luxuries, private jets, private doctors and              at large.
American and Swiss clinics our ruling elites have access                   Disconcertingly, our team found that, instead of
to; we battle and suffer next to our readers, listeners                pharmaceutical suppliers to our countries being a force
and viewers. As the voices of the African public, we are               for good, they often, consciously or unconsciously,
that public. We see, report on, interpret and experience               collude with the bad. Sitting in an office in Geneva, New
disease and death.                                                     York or even Sandton, one does of course not see what
    This is why we have a massive personal interest to                 we have seen and continue to see around us.
declare in this Transnational Investigation. We chose                      We hope that with this dossier, we will help to open
the subject for this TI over other currently pressing                  the eyes of many who did not ‘see’ properly before, and
issues which have gathered momentum internation-                       who are in a position to change perhaps some of the
ally, such as human trafficking and resource exploita-                 above.
tion, not because these are unimportant, but because
it was clear to us that the dying taking place all around                   November 2007
us – in our villages, cities, hospitals, circles of friends                 FAIR TI team
and families – was more important. As was the fact

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                executive summary

                                  The indifferent industry
                             Big Pharma’s patents keep treatment from Africa’s sick

                                                                  The large pharmaceutical companies – often referred
                                                                  to as Big Pharma – hold on to a policy of protecting
                                                                  their patents, the high prices and corresponding huge
• Hundreds of thousands Congolese men,                            profits. This stubbornness collides with advertised
  women and children suffering from malaria                       commitment to fight Aids in Africa and hampers more
  can not afford the malaria tablets sold in                      extensive distribution for Aids treatment. This is all the
  the DRC by Belgian company Dafra Pharma                         more grim since many of these medicines were tested
  and promoted by top health officials.                           on African volunteers – the very people who will never
                                                                  see the drugs they helped develop.
• In Malawi, one of the poorest countries in the                     As a consequence of this situation, millions of
  world, every hour ten HIV positive people die,                  Africans in despair are tempted to rely on quack
  whilst many could have stayed alive with the                    remedies such as pesticide injections, Chinese vitamins
  help of new anti-retroviral medicines (ARVs)                    that result in kidney damage, and a plethora of immune
  and essential fungicides made by Gilead and                     boosters advertised to cure Aids.
  Janssen-Cilag. Despite years of promises,                          Strategies to break the monopoly of Big Pharma and
  these big pharmaceutical companies have                         their expensive brand cures depend largely on the pres-
  failed to register their drugs to make them                     sure exerted by civil society groups to allow the produc-
  available in most African countries.                            tion of generic versions of essential drugs.

• Merck Sharp & Dome and Abbott
                                                                  PR talk and India
  are accused of unfair competition
                                                                  Advertised commitment by some pharmaceutical in-
  practices in South Africa.
                                                                  dustries ‘to help develop local manufacturing’ of ARVs
• When the ARV Viracept, made by Roche,                           seems disingenuous. Local manufacturers have not
  was recently recalled, 20 000 Africans on                       been and will most probably not be able in the foresee-
  treatment saw their lifeline interrupted,                       able future to produce a viable quantity or quality of ARV
  with possibly fatal consequences.                               medication compatible with World Health Organisation
  Roche claimed it has been adequate in                           (WHO) standards. The cost of importation of raw mate-
  providing information, but refused to take                      rials – sometimes also patented – and the condition of
  responsibility in furnishing a replacement                      the infrastructure are not the only reasons for this fail-
  – although alternatives were available.                         ure. The idea of local manufacturing in Africa – which
                                                                  attracted African and international Aids activists a few
• The major pharmaceutical Novartis went                          years ago - has been overtaken by the massive growth
  through great lengths to try and patent its                     of the pharmaceutical industry in Asia – notably India,
  drug Gleevec in India. Had it succeeded,                        Thailand and China – who are now able to export large
  many generic versions of medicines would                        quantities of cheap generic ARVs to Africa.
  have been blocked from reaching Africa                             The recent actions by Big Pharma show that the atti-
  and other poor parts of the world.                              tude of the industry is not swayed by this shift in the
                                                                  global market. The sector, supported by US government
                                                                  policy and US representatives in the client countries,

                                          FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                    executive summary

continues to maintain its patent protection policy on                   that is generally off-patent in developing countries. In
essential medicines. The few concessions made by the                    this light, Gilead’s claims are nothing but PR talk.
industry in the form of lower prices for some medicines,
do not materialise fast enough to save the people in                    Patents continue to rule
need of Aids cures now, and in the near future.                         Promises made at the 2001 Doha World Trade Organi-
                                                                        sation (WTO) conference, where member countries
It would help, but it isn’t there: Tenofovir                            undertook to relax patent rules so that developing
Several African countries have taken part in new ARV                    countries could import cheaper generic medication in-
trials in the hope to be the first to access the drug.                  stead of expensive brands, have so far not materialised.
Malawi was among five countries that initially took                     Essential drugs are still largely unaffordable and in-
part in clinical tests to see if children could be spared               accessible to the people who need them.
from HIV infection, when mothers and babies received                        Instead, a mainly US-based lobby linked to the phar-
an ARV called Tenofovir during labour or for a short                    maceutical industry continues to pressurise African
time following birth.                                                   governments to buy patented drugs. As a result, Zambia
    Tenofovir Disoproxil Fumarate is marketed as                        still buys almost exclusively brand ARV medication
Viread® by Gilead Sciences, one of the world’s leading                  with its limited means. In South Africa, Merck Sharp
pharmaceutical firms. Today Tenofovir is widely used                    & Dome and Abbott continue to dominate the market
in Europe and North America. The WHO recommends                         with their expensive Atripla (MSD) and Kaletra (Abbott)
it for poor countries too. But Tenofovir is still not avail-            medicines.
able in Malawi. In South Africa, Aspen’s generic version                    Pressure groups like Médecins Sans Frontières (MSF)
is, according to the ARV availability pressure group, the               and increasingly African governments themselves are
Treatment Action Campaign (TAC), still too expensive                    calling for more flexible patent rules. At a recent meet-
and consequently not available in the public health                     ing in November 2007 of the intergovernmental work-
sector.                                                                 ing group of 16 African countries in the WHO, many
    The most recent time Gilead made promises to                        participants declared themselves for such flexibility.
provide their ARVs for an acceptable price, was in the
summer of 2006. The company contracted 11 Indian                        Medicines and the religious right
generic drug companies to produce generic versions of                   In Zambia and South Africa, FAIR found that a particular
Tenofovir. The aim was to decrease the costs of ARVs by                 role is played by the American Presidential Emergency
encouraging competition. Gregg Alton, Gilead’s general                  Plan for Aids Relief (PEPFAR) policies. PEPFAR is the
council, told the authoritative Bloomberg News, ‘We’re                  main developmental medical programme from the US
going to teach them everything they need to know to                     in Africa. PEPFAR spends a lot of money on the acqui-
make the product.’                                                      sition of ARVs, with the bulk of medication bought by
    Not everybody perceived it this way, though. The                    this fund still sourced from the ‘big five’ pharmaceu-
advocacy group Knowledge Ecology International (KEI)                    tical multinationals. The fact that those companies
believed Gilead unfairly controlled Aids drug ingre-                    accounted for a substantial percentage of President
dients and filed a petition with the US Federal Trade                   Bush’s election campaign complicates the issue. Favour-
Commission. KEI accused Gilead of controlling the                       ing established pharmaceutical companies means dis-
market for the Aids drugs Emtricitabine and Tenofovir,                  criminating against many generics.

                                                FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                  executive summary

    PEPFAR’s connection to US conservative, religious-                goes into paying American experts who came to run
right governing circles is also expressed in the 2006                 NGOs in Zambia. According to the Health Minister, the
directive that no less than 30 per cent of the budget is              Americans purchase services, material and medica-
earmarked for ‘abstinence only’ campaigns in Africa.                  tion more expensively than necessary from the US and
PEPFAR money may not be used for condoms – in the                     Europe. ‘Whilst this situation is an indictment of the
face of a growing body of evidence that this approach is              Zambian government itself, it also shows that Zambia’s
harmful to Aids prevention efforts.1                                  main Western partner, the US, is not helping as much
   Mwiika Malindima, HIV/Aids specialist at the                       as they could,’ summarises Zambia’s FAIR investigator,
Zamcom communications institute in Lusaka, says:                      Zarina Geloo.
‘In Zambia, PEPFAR funds the Catholic Church Aids
efforts, which do not include information about safe                  Free access not always free
sex or condoms; and Aids training courses have to                     Additional problems with access to essential medica-
spend one day talking about abstinence.’ Local NGOs                   tion are the continued weakness of African distribution
in Zambia are forced to perform creative bookkeeping                  systems, and the insufficiency and impracticality of
when it comes to dealing with the latest conditions for               many donor-funded structures. When ARVs are avail-
use of PEPFAR funds. ‘We accept their money and use it                able for free, the additional lab tests, like the liver test
for its intended purpose. We use other funding to buy                 and viral load test that are an essential part of ARV
condoms, so it does not bother us. We need all the mon-               treatment, are often too expensive.
ey we can get, so we do not really complain,’ explained                  Rural areas depend on scarce health centers that are
Shumba Nkonde from a local care group in Lusaka.                      often difficult to reach. Many can not afford the cost
   Other organisations, for instance in South Africa,                 of travel, often for themselves plus a companion. Nor
had to face the consequences. Early in 2006, loveLife                 can they afford to stand in waiting lines, sometimes for
lost a third of its funding when the Global Fund with-                days – if they can manage the effort to begin with. Not
drew its support. The organisation empowers young                     everybody can afford to go on ARVs and have proper
people in South Africa in the field of safe sex and                   food essential to properly digest the medication; access
sexual education. The group is credited for positive                  to reliable drinking water can be a problem too.
results such as increased condom use and a decrease                      ‘The government should not advertise “free service”
in teenage pregnancy amongst youth in places where it                 when all it gives are the drugs,’ the Network of Zambian
has run activities. The loss of American funding had far              People Living with HIV/Aids says. Often these costs drain
reaching consequences. Several joint projects of South                what little extra money is available to a family. In many
African health NGOs with loveLife had to be cancelled.                cases, the ill family member or the caregiver, usually a
Five or six organisations could not partner with loveLife             woman, would otherwise have been a wage earner.
because ‘it was going to cost them their funding’. CEO,                  The FAIR findings on this specific topic overlap with
David Harrison, believes the new political wind from                  other research analysing how therapy affects the every-
the US in its PEPFAR policy now also affects decisions of             day lives of people who are fortunate enough to access
the Global Fund. His fears are confirmed by reports in                ARVs. Contracting the HIV infection, and living with
the American press about faith groups urging Congress                 Aids needs to be understood not just as a health issue,
to cut funding for the Global Fund because of its pro-                but as a socio-economic issue as well.
motion of condoms. 2
   Zambia finds itself in the curious situation that large            Counterfeit pills and quack cures
sections of its health care infrastructure are virtually              The fact that essential medicines remain out of reach of
run by the Bush administration. In the words of Health                most Africans has created vast opportunities for quack
Minister Brian Chituwo: ‘PEPFAR is a mini-ministry                    cure peddlers and the sale of counterfeit products.
of health. It has set up its own parallel [American]                      Quack peddlers were found in all the countries
structure, and it refuses to be monitored or to adhere                investigated by the FAIR team. In Zambia, large doses
to the Zambian donor harmonisation process.’ Hardly                   of a vitamin, selenium, are pushed as an Aids cure by
any of the PEPFAR funds pass through government                       a Canadian salesman. A partnership of an American
hands. Chituwo said that 90 per cent of the money                     ‘health practitioner’ and a local Zambian weekly edi-

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                 executive summary

tor promoted an injectable ‘Aids cure’ that turned out               Dr Nazaire Nseka Mangani, director of the Kinshasa
to contain pesticide. In the case of the herbal prepara-             University Clinic, told the FAIR team. Because the DRC
tion Canova, heavily promoted in Kenya, it was found                 authorities failed to act, the clinics started a joint cam-
that the makers untruthfully claim that the remedy has               paign offering free tests for people with kidney prob-
been clinically tested in Brazil and proved to cure Aids.            lems to investigate the dimension of the damage done.
Similarly, in South Africa and the DRC, obscure ‘vita-                  Government officials in the DRC seem to be particu-
min’ potions have kept people away from seeking ARV                  larly fond of Chinese vitamin boosters giant Tianshi.
treatment. Whilst vitamins as such do not hurt, FAIR                 Tianshi operates in several African countries in classic
found that unscrupulous quack cure salespeople such                  pyramid style, recruiting consumers as sellers of their
as Dr Matthias Rath in South Africa actively discour-                products, and charging them considerable sums of
age people – especially the HIV positive – from seek-                money for the privilege to be part of the ‘Tianshi family
ing professional medical treatment. In all investigated              of love’. Contacts between DRC government represen-
countries, FAIR found that deaths had resulted from                  tatives and Tianshi are so warm that a DRC delegation
abandoning treatment in exchange for a ‘wonder’ cure.                recently visited China and brought back a Tianshi con-
    The wonder pills usually look very attractive. Herbal            tingent in order to further establish their operations in
preparations are not subjected to the same scrutiny as               the country.
regular medication. The packaging of the gels, tablets                  Despite endless attempts, the FAIR team in the DRC
and syrups is colourful and the labels all promise to                could not get access to the Health Ministry to get an
boost the body’s immunity and fight diseases which                   answer to the question why the government seems to be
beset all people, but could be life-threatening in people            promoting some products and not others. Sources on
living with HIV or Aids. Take a pill and your body will              the periphery of the health department were adamant
gain strength, the leaflets say, implying that your body             that the reason why, in general, there was no transpar-
will have the strength needed to fight off opportunistic             ency regarding such matters, was that ‘pharmaceutical
infections, thereby reducing your chances of dying of                companies are gold mines for the government’.
Aids-related illnesses.                                                 Similar situations, where immune booster compa-
    The immune boosters have become an ominous                       nies have made inroads through friendly relations with
euphemism for ‘Aids cure’. Even the respectable phar-                prominent individuals in government, were found in
macy chain, Dischem, in South Africa now sells a home-               other countries.
brand vitamin advertised to counter ‘immunodeficien-
cy syndrome’.                                                        Black market
    Little is done by governments, and even less by the              The managing director of the Kenya Laboratory Supply
pharmaceutical industry, to counter quack cure propa-                Center, Narshibhai Ghedia, said a significant number
ganda in Africa. Consequently, even highly educated                  of medicines sold locally are fake. Between 20 and 30
people rely on these often costly ‘miracle drugs’; FAIR              per cent of the medicines entering Kenya currently
found journalists, lawyers, Members of Parliament and                are either counterfeit or illegally imported from Asia,
even medical doctors taking or promoting them, add-                  especially India, China and Pakistan; a small part
ing to the belief that they help. In Kenya, foreign and              comes from underhand dealers in Europe. Some are
local herb sellers have become so powerful and well-to-              labelled in languages other than English, and users can
do that they sponsor radio shows on illnesses and treat-             therefore not follow the instructions. Some are genu-
ment, advertising their own products.                                ine, but stolen medicines, which run the risk of being
                                                                     damaged as a result of not having been properly stored.
A Chinese ‘family of love’                                           This may result in the development of resistance to the
Other than nutrients that are normally part of a bal-                treatment. Also, treatment interruption caused by the
anced diet, Chinese herbal products have been found                  arbitrary appearance and disappearance of stolen and
internationally as well as by local doctors to sometimes             illegal medicines on the street, can nullify the effect of
contain damaging chemicals such as diethylene gly-                   the treatment and build up resistance.
col, which causes kidney and liver damage. ‘We had to                    Drug pilferage and corruption play a major role: in
treat many Chinese product users for kidney damage,’                 Malawi and Kenya the regulatory authority boards

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                   executive summary

roche and corporaTe social responsibiliTy: The eThical pracTices of a pharmaceuTical company

The pharmaceutical Roche based in Switzerland                                its patients. The European Medicines Agency, which
offers an interesting case of corporate social                               regulates drugs for the European Union, suspended
responsibility practices. This multinational company                         Roche’s license to market the drug. Aids advocacy
claims wholehearted support for affordable access                            groups accused Roche of abandoning its patients,
to essential medicines in Africa. But how do Roche’s                         because the company did not provide a replacement
PR messages translate into practical achievements?                           for the drug, while in many places there were no
   Roche has set up a website dedicated to HIV                               ready, or affordable, alternatives available at all.
treatment, and proudly advertises its Technology                                The recall created panic in countries like Zambia and
Transfer programme assisting local ARV manufacturing.1                       Kenya. If Viracept was contaminated, other ARVs could
Roche has promised not to file or enforce patents on any                     be as well. There were fears that patients would stop
Roche medicine in the Least Developed Countries, and                         taking Viracept before health workers determined the
not to file patents on new ARVs in sub-Saharan Africa.                       best replacement drug, and interruptions in treatment
And, in what CEO, William M Burns, called ‘a unique step,                    can lead to the development of drug resistance. Nkandu
unlike any initiative undertaken by Roche,’ the company                      Luo, a former health minister, now an HIV/Aids consultant
promised ‘to help as many manufacturers as possible in                       told ‘Government should be speaking to
these hardest hit countries by sharing our knowledge,                        Roche because damage has been done. Roche should
so that they can learn and benefit from our technology.’                     take responsibility for distributing contaminated drugs.’2
   About 50 countries, virtually any developing country                         Roche had not been acting responsibly or ethically
with an HIV/Aids problem, were invited to contact Roche                      at all for many years, as emerged in the months after
to join the programme. In June 2007, Roche announced                         the recall. The contamination was found only after
that it had signed agreements with two companies,                            reports from patients that the Viracept tablets had an
in Zimbabwe and Ethiopia – bringing the total to five                        unusual smell; apparently, internal safety procedures
companies across Africa since the Technology Transfer                        and quality tests had not detected it. A human error
programme had been launched 17 months earlier, in                            in cleaning processes at Roche’s manufacturing plant
January 2006. However, none of these five had started                        in Switzerland was the original cause. The mistake
production when FAIR contacted Roche-headquarters                            resulted in a large quantity of ethanol remaining in
in September 2007. Furthermore, the ARV in question                          processing equipment. Roche was aware of the fact
– Saquinavir – is, according to independent health                           that the chemical reaction of ethanol with the active
consultant, Wilbert Bannenberg, a relatively old-style                       ingredient of Viracept was potentially dangerous. It
drug (approved in 1995) and no longer in demand.                             could cause cancerous tumours and genetic mutation
   Asked why Roche gives countries in Africa false                           hazardous to unborn children. However, the precise
hope about local generics, spokesperson Maria                                level at which this containment is harmful to humans
Vigneau in Basel responded that ‘local production                            was not known. Despite this, Roche had continued to
is what the African governments want, and we can                             manufacture Viracept since it was granted marketing
only assist them on the basis of what they want.’                            authorisation in 1998. The company did this – knowing
   The real test for Roche’s Corporate Social                                that the harmful compound would be present – without
Responsibility competences was the total recall of                           any research into the risks of toxic contamination.3
its ARV Viracept, contaminated with a dangerous                                 In light of the confusion, despair, disinformation
chemical in June 2007. The scope of Roche’s recall                           and continuing price and patent wars, experts agree
was extraordinary, if not unprecedented, global health                       that a massive effort, coordinating the expertise of the
officials said in the New York Times. Dr Lembit Rago, an                     WHO, African health departments, donor institutions
official at the WHO, called the recall ‘sort of a disaster’                  and the pharmaceutical companies interested in
for patients in very poor countries. The recall left tens                    growing the African market for essential medication,
of thousands of people worldwide with the painful                            is necessary. Such an effort may, however, still take a
choice of discontinuing a lifesaving medicine, or using                      long time to materialise. Asked if the pharmaceutical
a drug that might contain a dangerous contaminant.                           industry could not embark on a joint corporate social
   Roche was seriously criticised by the WHO in Geneva                       responsibility programme with other interested
and the European Medicines Agency in London                                  parties so that expertise, well-equipped labs and
for not providing information considered essential                           generic medication could be increasingly made
for safeguarding public health: which countries the                          available to the African public, Maria Vigneau of Roche
tainted medicine was shipped to, the concentration                           said: ‘We are a private company and rather a small
of the contaminant and what the company will do for                          player. Such efforts should be made by the WHO.’

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                          executive summary

       Roche may have a point. With less than 5 per cent                            2      ‘Low-key recall of Aids drug hits world’s poor’,
    of the market, the company could not be expected                                       23 July 2007, New York Times; ‘Zambia: Aids drug recall
                                                                                           creates panic’, 19 June 2007, PlusNews; ‘Kenya bans use
    to take the initiative in such a partnership. Sadly, the
                                                                                           of recalled HIV/Aids drug’, 10 August 2007, Reuters.
    other big pharmaceutical companies approached                                   3      ‘Viracept continues to spiral’, 8 Aug 2007, Lab
    – GlaxoSmithKline, Boehringer Ingelheim, Pfizer,                                       Technologist News, The
    Abbott and Gilead – did not respond to FAIR emails                                     authorities have demanded toxicological studies to
                                                                                           establish more accurately what levels of the contaminant
    and phone calls asking to explain their corporate
                                                                                           are dangerous to humans. On 15 October 2007 the EU
    social responsibility programmes in Africa.                                            released the suspension of Roche’s Viracept license.

    1    Roche HIVwebsite: ‘Access to
         healthcare, Helping where help adds the most value’
         med.htm and ‘Aids Technology Transfer Initiative
         Fact Sheet’ at

hold the country’s laws and police forces responsible                         of the hapless individual: in Washington DC, USA, where
for being too lenient with drug offenders. However, it                        the mighty industrial pharmaceutical industry lobby
is unlikely that arrests and confiscation would stop the                      resides; in the offices of the European governments and
practices, created as they are by scarcity combined with                      the international donors and lending institutions.
strong demand and despair among the population.                                   Further thorough analysis of the (lack of) politi-
                                                                              cal will to take responsibility for the situation on this
Conclusion                                                                    level seems therefore imperative, as is the need for civil
As a result of lack of access to essential medicines,                         society pressure. The only way to obtain concessions
combined with lack of information, millions of people                         from the side of Big Pharma has proven to be pressure
in Africa still rely either on nutrition – and vitamin-                       brought on this industry by activist groups and NGOs.
related products, or on counterfeit medication in a des-                      But with the situation as desperate as it is, the weight of
perate, and often unsuccessful, battle to fight disease.                      higher authorities – like governments, the World Trade
This happens even whilst most diseases afflicting this                        Organisation and the United Nations – will have to be
continent – such as malaria, TB and HIV/Aids – are now                        added if a turning point is to be achieved.
    Only continuous access to proper and properly stored                           FAIR, 2007
medication, combined with an effort by governments
and the pharmaceutical industry alike to make reliable                        Notes
information on sickness and treatments available to all,                      1.    Genevieve Clark, of the Terrence Higgins Trust, Oxford University,
is likely to turn this situation around.                                            UK, concluded that sex abstinence programmes do not stop risky
                                                                                    sexual behaviour or help in the prevention of unwanted pregnancy.
    Thus far, research and programmes have placed
                                                                                    Clark’s Oxford University team reviewed 13 US trials involving over
a lot of responsibility on the shoulders of the sick.                               15 000 people aged 10–21. The study was published in the British
Communities and individuals in Africa have been                                     Medical Journal.
                                                                                    (BBC News, 2 August 2007, ‘No sex programmes “not working”’,
surveyed, tested and researched; they have been inter-                    
rogated about their beliefs, their cultural practices, eat-                   2.    The Boston Globe, 1 December 2006, ‘Faith groups urge cuts to Aids
ing habits, their sex lives, their ‘success’ in adhering to                         fund, allege opposition to Christian efforts’.

treatment, their ‘Aids awareness’ and such like.
                                                                              FAIR thanks international independent health consultant, Wilbert
    However, little research has been done on the level                       Bannenberg, for sharing with us his expertise on health, illnesses, and in-
where the decisions are made that affect life and death                       dicated medicines and treatment.

                                                      FA I R D o s s I e R | J A n uA R y 2 0 0 8

                     Hospitals are places where you go to die
                                    Mabvuto Banda, Hilary Mbobe & Bright sonani

It’s the month of June; winter in Malawi and a bad                    but more effective and modern second line-treatment
month for most of the sick in hospitals across the coun-              is out of reach at US$ 12 000 per patient. Angela Chipeta,
try. Fred Chikapa shivers as he talks, his eyes closed. A             Zone Manager for ADRA, a Christian relief agency, says
short chat reveals that Chikapa’s faith in his doctor is              that cheap or even free anti-retroviral drugs are not
wearing thin. ‘I don’t know what I am suffering from                  entirely doing the job anymore. ‘When patients develop
and the doctors tell me the hospital has no medicine for              resistance to first line regimes, we need the second or
me,’ he says.                                                         third line treatment. Often these drugs are not even
    Every morning, as the sun rises over Queen Elizabeth              available because they are too expensive to get into the
Hospital – Malawi’s biggest referral hospital – hordes                country.’
of patients, guided by their guardians, go outside at                     FAIR found that a series of donor-driven policies,
the hospital grounds to get some fresh air. Inside, the               corruption, political interference and greed by big
wards are crowded. Those who are too sick to walk lie                 pharmaceutical companies are among the reasons per-
on their beds while others sleep on the floor. The dirty              petuating the crisis.
unpainted walls, worn out mattresses and patched up
bed sheets and blankets, indicate years of neglect by                 Trials and promises
the authorities                                                       Malawi was among five other countries that took part in
    ‘Most of these patients you see cannot be treated,                clinical tests for a new generation of prevention therapy
because we cannot get them the medicines they need.                   (pre-exposure prophylaxis, abbreviated PrEP). The test
Even if we send them away, they are too poor to buy the               was set up to see if children could be spared from HIV
drugs,’ Dr Sam Banda says, as he makes his morning                    infection, when mothers and babies received ARVs dur-
rounds in the male ward. ‘My job is to save lives, lessen             ing labour or for a short time following birth. The drug
pain where I can. But sometimes this is impossible,                   tested was Tenofovir Disoproxil Fumarate marketed as
when there is not even Aspirin in stock.’ For most of                 Viread® by Gilead Sciences, one of the world’s leading
these people, the hospital has become their hopeless                  pharmaceutical firms. The trials were conducted by a
home.                                                                 US-based public health organisation, Family Health
    Dr Banda is not the only one frustrated by the per-               International, and started in February 2005. In October
petual drug crisis in the country’s public hospitals.                 of the same year, however, Malawi halted the trials out
Another doctor, Sundress Msuku, tells the same story at               of fear the tests would cause resistance to Tenofovir.
Ntcheu rural district hospital in the central province of             Several African countries did go through with the tri-
the country. With so many avoidable deaths in hospital                als, in the hope that they would be the first to access
and over 16 000 people dependent on him, Dr Msuku is                  the drug.
bemused by the crisis. ‘We have drugs this month and                      Tenofovir proved to be good: an option for patients
nothing the next. This nonsense has become the norm                   starting anti-retroviral therapy for the first time, as well
in our hospitals, despite the millions of dollars coming              as for those who require access to newer drugs after
into the country to change the situation.’                            they develop resistance to prior first-time regimes. The
    Malawi, an impoverished southern African nation,                  World Health Organisation (WHO) also says the drug
is no stranger to shortages of essential medicines and                has few side-effects as well as low levels of fat loss (a
medical supplies in hospitals. HIV treatment costs                    problem with some ARVs). Today Tenofovir is widely
around US$ 200 for first line drugs per patient per year,             used in Europe and North America to replace ‘old’ ARVs

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8

such as AZT and d4T. The WHO now recommends the                          of the Southern African HIV Clinicians Society, said
use of Tenofovir in poor countries too.                                  the approval was a ‘massive step forward’, but told
   Sadly, the medicine is still not available in Malawi,                 Business Day that the drugs remain ‘way too expensive
or in most of the African countries that participated in                 for the public sector’. Nathan Geffen of the Treatment
the trials, in spite of promises by Gilead Sciences; and                 Action Campaign explained that the Aspen prices are
in spite even of its much advertised Access Programme                    higher than the price at which patients were previously
for the drug, which it launched in 2002. According to                    accessing Tenofovir through a complicated importa-
this Programme, the drug would be made available                         tion process.
in 68 developing countries at preferential prices. In                       Gilead had nevertheless again made substantial
March 2005, Gilead said that the number of countries                     promises in September 2006 to have their ARVs avail-
to benefit from the reduced prices was to be extended                    able at an acceptable price. The company negotiated
from 68 to 97. Until now however, the promises have not                  contracts with 11 Indian generic drugs companies to
materialised.                                                            assist them in producing generic versions of Tenofovir.
   In October 2005, Médecins Sans Frontières (MSF)                       This time, Gilead aimed at decreasing the costs of ARVs
says in its journal that Tenofovir was registered in only                by encouraging competition. ‘We think they can beat
6 of 97 eligible countries. Other sources speak of only                  our prices, and we would love to see that happen,’ Gregg
2 out of 99 countries. Registration is a condition for                   Alton, Gilead’s general council, told the authoritative
selling a medicine in any country. In order to register a                Bloomberg News, adding: ‘We’re going to teach them
drug, a company has to submit required safety and effi-                  everything they need to know to make the product.’
cacy data to the national drug regulatory authorities in                    Again, the truth was a different one.
each country. Gilead promised to do this, but has not                       Although Tenofovir is not patented in South Africa,
done so to date.                                                         competitors’ room for manoeuvre on price is limited,
   If a drug is not registered in a country, special authori-            the expert Aidsmap website concluded. ‘All generic
sation to import a drug can sometimes be requested.                      producers holding voluntary licenses from Gilead are
Rules governing this process vary widely, are often very                 obliged to buy the specialised chemicals used in pro-
complex and only available to institutions – not to indi-                duction of the drug from approved manufacturers who
vidual doctors. MSF Malawi obtained permission and                       have also signed licensing deals with Gilead obliging
ordered the drug through MSF procurement centers in                      them to sell these chemicals only to voluntary license
Europe, but it takes months for the drug to be processed                 holders.’ This restriction is designed both to ensure
for importation.                                                         the quality of Tenofovir ingredients and to control who
   Malawi Pharmacy, Medicine and Poisons Board                           can sell generic versions of Tenofovir in middle-income
(PMPB) executive director, Wynn Chalira, acknowl-                        countries. For developing countries, in the end, this
edged the importance of Tenofovir in the fight against                   solution is in no way cheaper.
Aids. He is happy that South African pharmaceuti-                           Gilead unfairly controls the market for Tenofovir,
cal Aspen signed an agreement with Gilead to make                        the US-based advocacy group Knowledge Ecology
a generic version of the drug for use in sub-Saharan                     International (KEI) stated, as well as for another off-
Africa. And nearly 18 months after submission, in April                  patent ARV, Emtricitabine. To have the company inves-
2007, the generic version of the drug had finally been                   tigated, KEI filed a petition with the US Federal Trade
licensed in South Africa. Dr Francois Venter, president                  Commission in February 2007. The petition contained

                                                FA I R D o s s I e R | J A n uA R y 2 0 0 8

several charges: Gilead’s licenses split and tied-up the               ment with the Brazilian Health Ministry in May 2006
market for active pharmaceutical ingredients; Gilead                   to reduce the price of Viread in Brazil by approximately
sought royalties on approved sales even when patents                   50 per cent,’ KEI reported in its March 2007 research.
were not in force; and Gilead was preventing additional                   MSF now has 11 000 people on Aids treatment in
sales in unapproved markets even where the two drugs                   Malawi. Roughly 1 600 people will need to switch to
and their combinations are not patented.                               newer drug combinations in three years, which, the
   In other words, Gilead’s scheme kept and keeps                      organisation estimates, will take up 70 per cent of the
prices artificially high for everyone.                                 entire treatment budget. Many newer drugs are not even
   Although the details are complicated, the general                   available, because companies do not make a priority of
scenario is familiar, patent expert David Bollier sum-                 registering them. ‘There is little hope of establishing a
marised in his blog: ‘Taxpayers support development                    more stable supply of Tenofovir in the short-term, as
of a new drug. Drug company gains exclusive patents                    Gilead has still not submitted its file for registration in
over it. Drug company uses its patents, trade policy and               Zimbabwe or Malawi,’ says Dr Moses Massaquoi, head
market power to charge exorbitant prices and corners a                 of MSF in Malawi. ‘It’s simply unacceptable that we have
market of captive consumers (sick people) – assuming                   to wait many years to use medicines that are commonly
they can pay. Not only does Gilead’s ingenious licensing               used in wealthy countries, if we get them at all.’
scheme raise the price of Aids drugs in more than 150
developing country markets, says KEI, it also soaks US                 Drugs and political power
taxpayers a second time: when the US government buys                   In the process of trying to improve the situation of drug
the drug. (The US government is the largest purchaser                  availability in the country, the donor-driven policies in
of Aids drugs in the developing world.) So American                    Malawi sometimes lead to delays in the procurement of
citizens are paying for emtricitabine as the original                  drugs. Even when drugs can be sourced locally, prefer-
investor, as a government purchaser, and as individual                 ence has been given to buying from outside. A case study
consumers.’                                                            by FAIR on an importation chaos that started late in
   In this light, Gilead’s claims such as those of senior              2006 reveals many systemic pitfalls and shortcomings.
vice-president, Gregg Alton, in seem to be                   When medicines in Malawi were running out in 2006,
nothing but PR talk: ‘Our endeavour is to provide the wid-             international donor agencies pressurised the Malawi
est possible access to our drugs for HIV/Aids patients.’               government to engage UNICEF to procure emergency
   If it wanted, the US government could insist on                     drugs for the country. Local pharmaceutical companies
changes in the Gilead licensing practices, KEI says. The               say this was done without proper tender procedures.
federal government could (and in KEI’s view, should)                   Now, the local companies say, this chaos has resulted in
insist that Gilead permits more competition and great-                 current drug shortage. They blame UNICEF.
er efficiencies for both products. Unfortunately, the                     UNICEF has been the major procurement agent for
Federal Trade Commission decided not to intervene as                   government for ARVs and other drugs under the Global
long as the harm was only to foreign consumers or US                   Fund for some time, but this was supposed to be a tem-
taxpayers, but not to US consumers.                                    porary situation. In 2006 the Ministry of Health togeth-
   Needless to say Tenofovir is still not available in                 er with its collaborating partners – the World Bank and
Malawi, not in its branded version, nor in generic ver-                the British Department for International Development,
sion. Meanwhile, Gilead has started renewed trials for                 DFID – agreed that UNICEF would only procure drugs
Tenofovir’s effectiveness in fighting mother-to-child                  and laboratory reagents for tests only on an emergency
transmission. Two countries were selected for these tri-               basis.
als, Brazil and Malawi; in both countries the company                     Whether Malawi had the capacity to take over
started recruiting patients in September 2006.                         routine procurement is not certain, however. Recent
   Brazil did not accept this situation any longer. In                 research published in the Missing the Target report in
2005, the government declared that they were consid-                   August 2007 concluded that although the government
ering issuing compulsory licenses to permit the manu-                  hired a consultant to sort out recurrent problems, the
facture of Tenofovir/Viread. ‘As a result of discussions               Central Medical Stores (CMS) have not yet built enough
with the Brazilian government, Gilead reached agree-                   capacity to take over.

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

   An emergency existed in September of 2006. The                           clearing and delivering charges from forwarders to CMS
Ministry of Health discovered that within a month over                      warehouse, where international companies were not.
120 of essential drugs and medical supplies were going                         Fourth, locals were obliged to pay 17.5 per cent value
to be out of stock at the Central Medical Stores. Action                    added tax (VAT) on raw material needed to manufacture
needed to be taken. On the 20th that month the Ministry                     drugs. This surtax was subject to refund. Unfortunately,
asked the World Bank for a ‘no objection’ to procure                        the process of claiming refunds from the Malawi
drugs and medical supplies valued at US$ 1.1 million.                       Revenue Authority is unduly long with the result that
UNICEF went ahead and air freighted the drugs into the                      money, which would have been usefully invested in
country – against huge costs.                                               drug manufacturing, is tied up with the authorities.
   FAIR investigations revealed that the UN agency                             And lastly, for a local supplier, payment was to be
brought in drugs that could have been accessed locally                      effected in local currency 30 days after delivery with a
at a much cheaper price.                                                    10 per cent advance payment against a bank guarantee,
                                                                            while an international supplier would be paid at sight
                               Import price     Local price
                                                                            – meaning when the supplier shipped the goods.
Drug name
                               (US $)           (US $)                         Twenty-nine suppliers were pre-qualified, and soon
                                                                            afterwards two foreign pharmaceutical companies and
Paracetamol 500mg              5.54 / unit      2.80 / unit                 one local company were selected. Missionpharma, a
                                                                            Danish supplier specialised in providing generic drugs
Fansidar sulphadoxine 500mg/   29.07            16.50
Pyrimmethamine 25mg            per 1000 units   per 1000 units
                                                                            from India to Africa; and Premium Way, an Indian
                                                                            pharmaceutical company. The local company was the
Chloramhenicol 250mg           20.76 / unit     12.50 / unit                country’s only prescription drugs manufacturer, SADM
                                                                            Pharmaceuticals Limited.
Moxycilin                      22.98 / unit     ± 1.00 / unit
                                                                               Details of the tender procedure reveal the process
                                                                            was not very well organised. Out of the US$ 28 million it
                                                                            bid for, SADM was awarded less than a million dollars.
Handling and airfreight charges had cost close to half                      And out of the four products awarded, SADM manufac-
a million dollars – almost 45 per cent of the total cost                    tures only one. Missionpharma bid for US$ 18 million,
of the drugs. At the end of the day, the involvement of                     but was given US$ 24 million for two years of supply.
UNICEF meant that for the same money, fewer drugs                           Nevertheless, Missionpharma declined to supply a
were brought into the country.                                              very important Malaria drug (quinine hydrochloride
   More drugs were needed. A tender to supply drugs                         300 mg) despite tendering for it. This was considered an
for two years was published – marked 031/SW/G/01/06                         act against the tender regulation, which states that ‘if a
– to start the bidding procedure. Again, the tender pro-                    bidder refuses to supply any product it tendered for, the
cedure favoured international suppliers.                                    bid bond should be forfeited’.
   First, the tender regulations demanded the can-                             The conflict that followed grew into a major dispute,
didates to supply per the American pharmaceutical                           putting people depending on the medication at huge
authority, the US Pharmacopoeia, whereas most local                         risk. Malaria is Malawi’s number one killer in children
suppliers have their products registered with the                           aged under five years of age.
Malawian PMPB or under the British Pharmacopoeia.                              Local manufacturer SADM was asked to supply the
   Second, local pharmaceutical companies were asked                        quinine instead of Missionpharma, but refused to do
not to bid in US dollars. This put them at risk against                     so until the latter was penalised. Because of several
currency fluctuations, because they now had to import                       irregularities and the failure to level the playing field for
raw materials using dollars. This is against the regular                    the local manufacture, SADM lodged an appeal against
importation practice whereby local manufactures are                         the tender in January 2007, and asked the World Bank
allowed to bid in dollars and are paid in the local cur-                    for a reevaluation. The company also filed complaints
rency (Kwacha) equivalent to the exchange rate on the                       against the Medical Buying Board at CMS, who failed
day of payment.                                                             to respond; and against the Minister of Finance, who
   Third, local manufacturers were required to pay                          responded to only one concern. In a reply to SADM’s

                                                   FA I R D o s s I e R | J A n uA R y 2 0 0 8

    Malawi has been severely hit by the HIV/Aids                                        Malawi is receiving over US$ 15 million annually
    pandemic, with circa 14-15 per cent of the 13 million                         to fight the HIV/Aids pandemic from the US
    population living with HIV/Aids, one of the highest                           PEPFAR programme. Additionally, Malawi currently
    HIV prevalence rates in the world. The Ministry of                            receives more Global Fund resources than any other
    Health has calculated that the Aids epidemic kills 10                         country for malaria, tuberculosis and HIV/Aids.
    people per hour. The Global Fund and the National                                   Malawi ranks 165th of 177 countries on the UN
    Aids Commission – the government organisation                                 Human Development Index, it remains one of the poorest
    tasked with fighting Aids in the country-estimates                            countries in the world, with a per capita GNP of US$ 160
    that 940 000 people live with the HIV virus.                                  according to Global Fund statistics – 76 per cent of the
         In 2005, Malawi launched a US$ 196 million plan                          population lives on less than 2 per cent a day. Malawi is a
    to distribute free antiretroviral drugs under a five-year                     landlocked country and has a narrow economic base with
    programme paid for by the Global Fund against Aids,                           no significant mineral resources and high costs of
    tuberculosis and malaria. Fifty sites across the country                      external trade. It depends heavily on donor support.
    were identified to receive the drugs: in 2006, 103                                  A human resources shortage in the health sector
    were realised. But in February 2007 the Ministry of                           is the most important problem. There is an average
    Health admitted that only about 80 000 people had                             vacancy rate of around 50 per cent for all professional
    been reached out of an estimated 190 000 people                               health worker posts sector-wide; qualified nurses prefer
    waiting for treatment. This is well below target.                             to work for NGOs or migrate to European countries.
         The government spending represents around US$                                  Furthermore, most second- and third-line
    12 per capita on health annually (9.1 per cent of the                         ARV cures are protected under the patent laws of
    GNP) – far below the US$ 36 per capita recommended                            Malawi. The excessive cost of patented medicines
    by the WHO, and among the lowest in Sub-Saharan                               (20 to 100 times the marginal cost) denies people
    Africa. ‘Spending US$ 12 per capita on health … we                            the right to safe and affordable medicines for other
    are not going to make a dent in the fight against                             diseases as well, including malaria, meningitis,
    HIV/Aids,’ Health Minister, Marjorie Ngaunje, admits.                         tuberculosis and other opportunistic infections.

appeal, dated 17 May 2007, the World Bank representa-                        previous opposition, takes its place. A usual first step
tive in Malawi, Timothy Gilbo, shifted the responsibility                    for such a new government is to get rid of old contracts
for the procurement process to the Ministry of Health.                       and the accompanying connections, and replace them
Meanwhile, however, the World Bank has decided to                            with their own.
give a ‘no objection’ and several companies including                           Missionpharma had appointed an agent in Malawi
SADM signed the contracts to deliver the much-needed                         who had convenient political connections in State
drugs – with at least six months delay.                                      House. This agent was YB Enterprises, a company
   Procedural mistakes were not the only factors hin-                        owned by Yusuf Matumula, a business associate of
dering the process of medicine procurement in this                           former President Bakili Muluzi. Matumula also was the
case. Political preferences, too, played a role in derang-                   chairman of a football club owned by the former presi-
ing Missionpharma and Premium Way, who – in the                              dent then; both were members of the United Democratic
end – did not get any of the tenders. Both companies                         Front – the then ruling party. ‘Missionphama is one of
had gotten into problems in Malawi after the elections                       our clients, among other international drug suppliers,’
in 2004. Missionpharma had links to the former gov-                          Matumula confirmed his relationship with the Danish
ernment, and apparently had fallen out of grace now.                         company, but denied that his connection had resulted
Premium Way was found guilty of corruption ten years                         in the tender being influenced by corruption. ‘It was
ago, and this was still being held against the company.                      because they offered cheap generic drugs that we need-
   International companies doing business in Africa                          ed in the country,’ he said.
befriend the government of the day. This becomes an                             The Indian company Premium Way, rejected in the
issue when that government is out of office, and a new                       same recent tender procedure, had had problems under
one, especially if it’s a government formed from the                         the former government. It was then called Fieldyork,

                                                    FA I R D o s s I e R | J A n uA R y 2 0 0 8

but had changed its name in Malawi to Premium Way to                  ity supply is erratic due to frequent power cuts. The
avoid a government ban, top-level government officials                high cost of transport and telecommunications too
say. ‘This company previously worked under the name                   remains a serious constraint to industrial develop-
Fieldyork. It was banned from doing any business in                   ment. ‘Consequently, generic pharmaceutical products
this country after a presidential commission of inquiry               manufactured in Malawi are generally more expensive
found the company guilty of corruption in the mid-                    than those imported from elsewhere, for example, from
nineties,’ the source said. The case has been revived                 India,’ the TRIPs researchers concluded.
since and court documents obtained by FAIR reveal                        Shortages of essential medicines, particularly ARVs,
Fieldyork was fraudulently awarded a contract to sup-                 occur often, predominantly in government hospitals.
ply notebooks to the Ministry of Education back then.                 Hospitals run out of ARVs and cannot deal with the
Former education minister Sam Mpasu was implicated                    growing demand, despite all the money allocated for
in receiving kick backs from the company. An internet                 the roll out. For HIV/Aids patients, constant availability
search confirms that Premium Way and Fieldyork have                   of medication is central to ARV therapy as resistance
the same directors, and share the same physical address               to certain courses of drugs can develop quickly in the
and telephone numbers in London.                                      absence of consistent treatment.
     The World Bank received complaints from the                         A partial solution could lie in general expert advice
Malawi government about these corruption claims.                      and assistance from international pharmaceutical com-
As a result, the tender procedure was stalled yet again,              panies to the Malawian health sector. Such assistance
resulting in a serious drug shortage.                                 could help the Malawian authorities to differentiate
   The whole affair begs many questions. Should pro-                  between complex medicines (like ARVs) that need to be
cedural mistakes and corruption claims be allowed to                  sourced from outside and simpler essential drugs (like
affect the supply of essential medicines in an emergen-               painkillers) that could be produced locally. A pharma-
cy situation? Missionpharma, for example, has a good                  ceutical dialogue could perhaps even help to overcome
reputation for delivering medication at a good price.                 present bureaucratic and procedural hurdles; it could
Should their contacts with the former government be                   result in restructuring presently under-equipped labs
held against them? And to what extent can ‘good gover-                and clinics; and a local Malawian market for both local
nance monitoring’ turn from an asset into a hindrance                 and foreign pharmaceutical companies could be built
in this kind of situation?                                            up in the process.
   It has also to be taken into account that according to                It is, however, not likely that such a corporate social
the Health Systems Resource Centre of the Department                  responsibility programme will be forthcoming from
for International Development, production of essential                the international pharmaceutical sector at any time
medication is not a serious option for Malawi at this                 soon. Requests for interviews on CSR in Africa, directed
moment. The TRIPs report (see additional source docu-                 to seven Big Pharma manufacturers that failed to make
ments, below) concluded that the lack of a guaranteed                 essential drugs available in Malawi (including Gilead,
market is an important factor. It is doubtful whether                 Pfizer, Abott and GlaxoSmithKline) submitted early
local companies can depend on the Malawi govern-                      September had not been answered in November.
ment to keep them in business: this case study alone
shows that government tenders are not predictable and                 ‘If you drink Mchape, you’ll also protect your
when available the orders are in small volumes. Local                 girlfriend’
manufacturers are, therefore, perhaps understandably,                 ‘Because more and more people are failing to access
reluctant to make major investments in materials and                  the right medicines, the business for concoctions said
research in the absence of a ready market. Also, the                  to cure Aids is thriving in the major cities,’ says Angela
small number of private medical institutions does not                 Chipeta, Zone Manager for ADRA, a Christian relief
warrant major investments in drug manufacturing.                      agency.
   According to the same TRIPS report, additional                        Many concoctions that claim to cure Aids are on
problems in Malawi cause decisive disadvantages vis                   offer in Malawi. The first one, in 1995, drew people from
à vis local manufacture. The cost of electricity, the                 all corners of the country and gained international
only source of industrial energy, is high and electric-               coverage. It was known as ‘Mchape’, which literally

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8

means ‘the cleaner’, and it was concocted by a tradi-                   for this new drug. In the meantime I have to live and
tional healer by the name of Mr Chisupe. The village                    look after my four children,’ Ethel says as she lies in bed,
where Chisupe sold his potion, Machinga in the south,                   her sickness and desperation apparent. ‘This is the rea-
got overcrowded with thousands of people a day who                      son why I am now taking Malawix,’ she says pointing
came from far to get a sip. They were sleeping every-                   to her four children sitting on the floor looking forlorn
where. The Ministry of Health did not condone the cure                  and lost. Mwale’s brother, Madalitso, in Lilongwe buys
publicly, but in secret – according to a report written by              the drugs for her in a last ditch attempt to save her life.
two health officials – its ministers and employees also                 ‘I wish we could get the other line of treatment to have
sought treatment in Machinga. Tacit support was also                    my sister live another ten years,’ he says. ‘But now that
provided by the government. In the interests of public                  seems like a dream and I have to look for alternatives.’
safety, pit latrines were built, barrels of safe water were
delivered and a bore hole dug.                                          The drug lords
    The two health officials who wrote the report were                  It is not only the health sector that needs to be built up
specifically worried about the rumors that accompa-                     in Malawi. Systems need to be put in place against med-
nied the Mchape ‘cure’. ‘Mr Chisupe’s messages about                    icine pilferage and counterfeiting as well. The shortage
changes in lifestyle to prevent infection, which are sup-               of drugs and the problems with the supply create op-
posed to accompany the “medicine”, have been lost.                      portunities for smugglers, thieves and forgers. Some
Instead we hear that Mchape makes you “immune” to                       even seem to enjoy protection at the highest level.
the virus – as a kind of vaccination. What is more, they                    In downtown Blantyre, the illegal drug business is
say you can immunise the next person you have sex                       thriving. Vendors sell the popular ‘wonder pills’ and
with. This is a licence for carefree sexual behavior with               openly display all sorts of medicines from antibiotics
disastrous consequences. Bar girls are replacing the                    to genuine ARVs. Most of the drugs have government
question, “Do you have a condom?” with “Have you had                    stamps, proof that they have been stolen from a hospi-
Mchape?”’                                                               tal. One of the vendors, popularly known as ‘Dr Amon’,
    Many of the people who have taken the drug died                     admits that some of the drugs he sells are stolen from
and their relatives have been testifying how they were                  Central Medical Stores, government’s sole drug pro-
duped into believing that the drug could cure Aids. The                 curement agency.
‘Mchape-fever’ has been a wake-up call for Aids control                     Dr Amon sells medicines originating from as far
programmes in Africa.                                                   as India, with some coming from Mozambique and
    Other concoctions have continued to emerge. A tradi-                Zimbabwe. He has probably been amongst the vendors
tional healer ‘discovered’ an ‘Aids cure’ called ‘Chambe’               selling medicines marked MEDMOC, a Mozambican
in the slums of South Africa. FAIR established that after               drug manufacturing company, thousands of which
the local authorities in South Africa banned the potion,                flooded the streets recently. It caused the Mozambican
the healer went on to sell it in Swaziland and later came               consul, Maurinho Kuyeri, to state in a Malawian news-
to Malawi. The Poisons Board in Malawi has warned                       paper that a syndicate led by Malawians has been steal-
people against ‘Chambe’, but it has failed to get its mes-              ing drugs in his country.
sage through. The demand continues to be strong.                             Dr Amon makes an average of about K 20 000 a day
    Other than traditional healers with extravagant                     (about US$ 150). It is good business in a country where
claims, an even bigger problem to the Malawi health                     65 per cent of the population lives on a dollar a day. He
authorities is the increasing market for cheap and                      even sells medicines for sexually transmitted diseases;
accessible ‘wonder pills’ that are slowly replacing con-                they are reportedly very popular with the youth.
ventional HIV treatment drugs. A pill called ‘Malawix’                       ‘These drugs come from all over the place. The dis-
is prominent and is heavily advertised to cure Aids. The                tribution is so complex and well organised that even
Pharmacy, Medicine and Poisons Board fails to control                   when we go on the market and confiscate them, they
the sale of this pill.                                                  reappear in huge quantities,’ executive director for
    Ethel Mwale, 36, has been taking Malawix since she                  the regulatory authority board, Wynn Chalira, says.
was told that she was resistant to ARV treatment and                    Chalira admits that corruption plays a major role in the
needed another drug combination. ‘I am still waiting                    trade. He holds the country’s laws responsible for being

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
too lenient with drug offenders. ‘We can’t fight this                  Source documents
trade when the fines for such culprits are so low and the              Chapter on Malawi, written by a Malawian study team of experts, and
sentences too lenient,’ he says. But do the culprits even                  published by International Treatment Preparedness Coalition
                                                                           (ITPC), in Missing the Target #4: Time is Running Out to End Aids
get arrested? Clearly, Chalira stays away from blaming                     – Treatment and Prevention for All! July 2007. (referred to as the
the police or the control systems at the Central Medical                   ‘Missing the Target report’.)
                                                                       A Survey of Policy and Practice on the Use of Access to Medicines-Related
                                                                           TRIPs Flexibilities in Malawi report compiled by the Health Systems
   Drug pilferage contributes to the problems with the                     Resource Centre (HSRC) of the British Government’s Department
ARV roll-out. Chalira: ‘People are developing resistance                   for International Development (DFID) published in 2004. (Referred
                                                                           to as the ‘TRIPs report’.)
because they buy ARV drugs stolen from hospital and
                                                                       ‘Help wanted: Confronting the health worker crisis to expand access to
which have not been properly stored. Subsequently,                         HIV/Aids Treatment: MSF experience in Southern Africa’, Médicins
they develop resistance against first and second line                      Sans Frontières, South Africa, 24 May 2007.

drugs, and decide to go for “miracle concoctions” as
their only hope.’
   In 2006, a man known as ‘Malawi’s drug lord’ was
arrested with a car full of ARVs from UNICEF. This was
the most notorious drugs case involving corruption in
Malawi’s recent history. The court case revealed how
the drugs were stolen from public hospitals and from
the country’s Central Medical Stores. Despite all the
drugs and medical supplies found in his warehouses
across the country, the man is still free and stolen drugs
continue to flood the streets. Health activists are con-
cerned that this may mean that there is support in high
places for his syndicate.

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

                                Wonder pills take centre stage
                                 as ARVs stay out of reach
                                                            Zarina Geloo

Zambia began its roll-out of free anti-retroviral drugs                 attached to HIV/Aids prevents people from seeking
(ARVs) in 2003 with much fanfare. All 200 000 people                    ARVs. The Treatment Advocacy Literacy Campaign
living with HIV and Aids (PLWHA) who needed the cure,                   (TALC) disagrees: ‘There are more people who need the
would receive ARVs. The first target was 100 000 people                 drug, than those who are scared of stigma. Numerous
by the end of 2005. According to most calculations, that                reasons keep people from going on ARVs. Transport, for
target may be reached by the end of 2007 – a whole two                  instance, is not free and many people simply cannot
years later. Another 15 000 people presently access their               afford that,’ says TALC’s Paul Kasonkomona.
medication through the private sector.                                     The TALC’s opinion is confirmed by the Missing the
    Research presented in Missing the Target in July 2007,              Target report findings. ARVs are available free of charge
calculated that approximately 33 000 people were on                     at a few selected points of service only. Yet transport to
ARVs by June 2005, and about 43 000 as of December                      and from these widely separated facilities is not free.
2005. The total one year later, in December 2006, was                   Other drugs, to improve the immune system and fight
slightly more than 60 000. Their conclusion: ‘This                      opportunistic infections, are free but only for a few
increase is less than what might reasonably be expect-                  months. Patients are also required to pay for X-rays,
ed considering the amount of donor aid that Zambia                      Missing the Target emphasised. Often these costs drain
receives, especially in comparison with neighbouring                    what little extra money is available to a family. ‘Having a
countries.’                                                             family member who is ill not only increases expenses in
    Among the intertwined explanations for the disap-                   general but also increases the workloads of family mem-
pointing state of affairs are a shortage of qualified staff             bers who remain healthy. In many cases, the ill family
to administer ARVs, a shortage of the drugs, including                  member would otherwise have been a wage earner.’
basic essential medication, and a lack of equipment                        The Network of Zambian People Living with HIV/
associated with treatment. Zambia has about 12 CD4                      Aids (NZP+), has complained that government should
counters including those in the private institutions;                   not advertise ‘free service’ when all it gives are the
government has six. Diagnostic substances necessary                     drugs. This organisation, that seeks to serve as the
to perform tests are in short supply and some rural clin-               voice of all those affected by HIV/Aids, emphasised that
ics have not been brought up to speed in ARV provision,                 adequate food intake is also an important condition for
nor do they offer the supporting tests before people go                 those who take ARVs.
on treatment. The lab tests, like the liver tests and viral                Judith Mambona cannot go on treatment because
load tests, are provided free to people with HIV, but are               her counselor told her she had to eat well and drink lots
expensive for government to provide, and often run                      of water as part of the regimen. ‘We can afford only one
out.                                                                    meal a day and even then it is not always nutritious, just
    Recently, former Health Minister, Professor Nkandu                  some nshima [a thick gruel made from mealie meal]
Luo, and National Aids Council director, Ben Chirwa,                    and a little bit of vegetables. Drinking water it is not
admitted that logistical and institutional frameworks                   always accessible.’ For Aids activist Winstone Zulu, too,
had not been properly put in place before the roll-out                  one of the reasons he stopped taking his ARVs was his
took off. Chirwa says that this should soon change as                   inability to easily access drinking water. Only 30 per
‘there have been trainings conducted and an upgrade                     cent of Zambia’s 11 million population has access to
in medical services is imminent’.                                       clean and safe water.
    The government also argues that the stigma still                       Many in Zambia cannot afford three meals a day.

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8

President Levy Mwanawasa recently told a group of                      report warned in July 2007. There is no information
heads of states that in his country ‘people ate in turns.’             about whether the contract will be renewed, a situation
One had breakfast, another in the family had lunch,                    that makes some people reluctant to enrol on ARVs.
while the rest had supper. The Lusaka-based Jesuit                        Not everybody is happy with the American pro-
Centre for Theological Research says the current cost                  gramme. Health Minister, Brian Chituwo, has always
of a food basket for a family of six in Zambia is US$ 110              had serious concerns over the management of PEPFAR.
a month – while the World Bank puts the average salary                 He started voicing his criticism when the initiative was
at US$ 100.                                                            announced in 2003; just after he was appointed to the
   Working with the World Food Programme, the                          Cabinet. He remains critical to this day. For instance,
Lusaka-based Center for Infectious Disease Research                    when he was interviewed by the BBC just before the G8
in Zambia issues food supplements to hundreds of                       summit in Germany, June 2007. The Health Minister said
people on treatment. Such initiatives may seem simple,                 he felt uncomfortable with the number of American-
but have extremely positive effects, Missing the Target                based NGOs that had suddenly sprung up in Zambia
concluded in July 2007.                                                – all connected to the administration of PEPFAR. And,
   The most important lesson learned from ARV roll-                    although Zambia receives significant financial support
out to date, according to the report, is the significance              from PEPFAR and other sources, the support does not
of getting more people on ARVs. ‘The provision of treat-               extend to interventions such as prevention of mother
ment in a number of centers has proved to be a factor                  to child transmission, or voluntary counseling and
in reducing the number of deaths, the number of work                   testing.
hours lost to sickness and the number of broken fami-                     Carmen Martinez, the American envoy to Zambia,
lies headed by single parents or grandparents. In turn,                rapped Chituwo across the knuckles for expressing dis-
these developments have helped reduce stigma and                       pleasure and she continues to defend the PEPFAR pro-
discrimination because HIV and Aids are no longer                      gramme. She claimed more than half of the Zambian
necessarily perceived as a death sentence.’                            PEPFAR budget directly supported ARV drugs and ser-
                                                                       vices, laboratory infrastructure, mother to child care,
PEPFAR                                                                 counseling and testing support. PEPFAR’s support not
Zambia is one of 15 focus countries of the US President’s              only targeted the strengthening of the Zambian public
Emergency Plan for Aids Relief, known as PEPFAR.                       health system on all levels, she said, but also supported
Under this plan, Zambia received US$ 149 million                       successful partnerships with numerous Zambian
in 2006 and is expected to receive US$ 200 million in                  organisations. She maintained only a very small per-
2007 to support a comprehensive HIV/Aids prevention,                   centage of funding was retained in the United States for
treatment, and care programme. The Zambian Centre                      administration costs.
for Infectious Disease Research dispenses ARVs in 16                      Chituwo, however, has refused to apologise and
clinics in Lusaka, and in hospitals in Mongu and                       continued to point out publicly how 90 per cent of that
Sesheke. This programme has the largest number of                      funding went into paying American experts working
people on ARVs (more than government and any other                     for American NGOs, and into purchasing services and
provider of anti-retroviral therapy), but there is concern             material from American companies.
about sustainability given that the agreement with gov-                   Chituwo’s main gripe, however, remains the lack
ernment ends in December 2008, the Missing the Target                  of control of Zambia’s elected government over what

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

PEPFAR does and how. The Global Fund programme,                        Maureen Mwanawasa. The Zambian First Lady had
for example, allows Zambia to choose where to buy                      nothing but kind words for PEPFAR and the American
drugs and has the World Bank pay for them directly.                    support to the health sector.
With PEPFAR, however, the Americans choose the kind                       True to its conservative mandate from the US presi-
of drugs and their suppliers. The PEPFAR money goes                    dent, PEPFAR focuses on prevention, and advocates
to American NGOs set up in Zambia to utilise these                     abstinence rather than the use of condoms. However,
funds, such as the Health Communication Project,                       local NGOs are pretty creative when it comes to dealing
Zambia Prevention Care and Treatment, Rapids and                       with the latest conditions for use of PEPFAR funds. ‘We
the Society for Family Health. These NGOs buy drugs                    accept their money and use it for its intended purpose.
from American companies and distribute them to the                     We use other funding to buy condoms, so it does not
district health management boards together with other                  bother us. We need all the money we can get, so we do
necessities for treatment, care and prevention. None                   not really complain,’ explained Shumba Nkonde from a
of the funds pass through the hands of the Zambian                     local care group in Lusaka.
   Chituwo also expressed his disquiet with the                        Procurement
way PEPFAR interacts with the government’s Health                      The ARVs through the public health system are bought
Department. Zambia, he told FAIR, is undergoing                        by the Zambian government, and paid for by the Global
a ‘donor harmonisation process’, where donors get                      Fund. But where to buy the drugs? The procurement
together with government to decide on priorities in                    procedure is quite complicated. World Bank-accredited
order to curtail double funding or lopsided support.                   companies (like Roche, Ranbaxy, Pfizer and Abbott)
While Japan and other countries adhere to this process,                compete to supply drugs to Zambia through a tender
USAID does not. PEPFAR refuses to employ the moni-                     process. The WHO, UNAids and the government of
toring and evaluation tools advised by the Ministry of                 Zambia then undertake a vetting process until one sup-
Health. It insists on doing things its own way.                        plier is chosen.
   Summarising, Chituwo said: ‘PEPFAR is a mini                           The government does not admit it explicitly, but
Ministry of Health. It has set up its own parallel                     there is a limit to which Zambia can procure under the
(American) structure and it is very difficult to ascertain             Global Fund. ‘This would account for the fact that there
whether it is effective or not.’                                       are not enough ARVs for the number of people requiring
   But the government is not blame-free. Transparency                  them’, says an official who preferred anonymity.
regarding ARV roll-out is in short supply among all                       Furthermore, until recently only brand drugs were
stakeholders. As a result, the Missing the Target research             procured as per the preference of the strong US and
concludes that it is difficult, if not impossible, to know             pharmaceutical lobby in Zambia. But according to
when (or if) the government plans to achieve universal                 Ministry of Health spokesman, Dr Canacious Banda,
access and, consequently, there is no way to monitor                   ‘government has now understood it is cost effective to
progress. ‘Part of the problem seems to be that policy-                buy generic drugs.’ Soon the (Western, mostly American)
makers may operate less from a plan than on the basis                  brand names will be replaced with generics; of course
of individual discretion and whims. This greatly hin-                  this will increase the amount of drugs the government
ders efficiency.’                                                      can be buy for the same amount of money.
   When American First Lady, Laura Bush, visited the
country in the summer of 2007, there was very little                   Pharco
public discussion on PEPFAR. Instead, Bush announced                   Concentrated power and influence offer opportunities
an increase in funding to Zambia and also gave $ 300                   for those who have the right connections.
000 to the Organisation of African First Ladies, an                       In 1998, a company with a questionable history,
organisation that established a strong profile in the                  involving arms trade and covert operations, obtained
sexual abstinence campaign so favoured by the conser-                  a government contract to manage medical storage and
vative religious lobby around the American president.                  provisioning in the Zambian capital. The government
The American Embassy in Zambia organised only one                      had seemingly not looked into, or had been bothered by,
high profile visit for Laura Bush: with her counterpart,               the colourful past of the partly-Italian owned company,

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

    Zambia is a landlocked impoverished country with                            This constitutes 26.6 per cent of the GDP. The allocation
    80 per cent of its inhabitants living on less than                          to health is 10.7 per cent of the budget, translating into
    a dollar a day according to the World Bank. The                             2.8 per cent of health expenditure of the GDP. This is
    country suffers deprivations in all sectors.                                lower than the recommended WHO health expenditure,
       There are now an estimated 1.6 million people                            which should be at least 5 per cent of the GDP.
    with HIV/Aids and about 230 000 in need of                                     There is support, however, from other sources. Many
    ARVs. Early in 2007, there were approximately                               national governments and NGOs fund the fight against
    76 000 to 80 000 people on treatment, which                                 HIV/Aids in Zambia, but the principal donors have
    means that only a third are being reached. It was                           been the Global Fund, the US President’s Emergency
    envisaged that all 1 124 health institutions would                          Plan For Aids Relief (PEPFAR) and the World Bank.
    be able to give the triple therapy (Triomune, which                            In Zambia treatment has markedly reduced
    has Lamivudine, d4t and NUP). But this has not                              mortality rates, but serious inequities in access
    happened; only 52 centers are offering treatment.                           remain; availability of diagnostic tools, second-line
       Close to 1 million have died since the epidemic                          drugs and medication for opportunistic infections,
    was first identified in the 1980s, according to the                         as well as paediatric formulations is severely limited.
    UN Global Aids report of 2004. The WHO says                                 As a result, stock outs are frequent. Prevention of
    100 people a day die from Aids in Zambia.                                   mother to child transmission is largely unavailable
       The national budget in 2007 is US$ 3.5 billion.                          in rural areas, and poverty undermines access.

– now named Pharco – which had under the name GMR                          was pressured into not supporting the Pharco produc-
operated as the covert trading arm of the South African                    tion so that the Western companies could continue
apartheid government and its secret services.                              having the monopoly,’ said the official who declined to
    In 2004, Pharco was trumpeted the first and only to                    be named. Sources at the WHO, however, indicate that
get a compulsory license to produce generic ARVs in                        the controversial, criminal history of the company is
Zambia and Mozambique. This was a victory for the                          now taken into account. Pharco only got the exclusive
worldwide campaign at the time, pressing for locally                       license through its connections with officials in the
produced generic ARVs that would be cheaper and more                       Ministry of Health – some of whom have since has been
accessible.                                                                charged with several claims of corruption.
    To date, however, no Aids medication has been                             Pharco has remained tight-lipped, refusing to say
manufactured. Pharco stopped the development of                            anything that might jeopardise its current produc-
their Triomune 40, even after it had run successful tri-                   tion of other essential drugs like antibiotics. Zambian
als. The government, a shareholder in the company,                         Aids campaigners, hesitant to accept that, according
now claim that the drugs would be too expensive. That                      to the WHO, production of ARVs is simply not viable
might be the truth today, with the successful produc-                      and would be too expensive in most African countries,
tion of generics in India and Thailand. Other reasons                      accuse the government for its ‘reluctance to partner
to abandon the production may have been of greater                         with local industry’. The Treatment Advocacy Literacy
importance. Pharco had counted on government sup-                          Campaign is now pressing government to give a reason
port and its influence to ensure that Pharco reached the                   why Pharco is not producing ARVs.
obligatory pre-qualification for its drugs with the WHO                       The puzzlement of local activists is understandable;
and the World Bank – but the process stalled.                              after all, the government announced its ‘Zambian ARV
    A Ministry of Health official who also sits on the                     manufacturing’ plans in 2004 with a lot of publicity and
Global Fund procurement committee thinks it was a                          pride. But the NGO, says the Missing the Target report,
matter of conflicting interests. Allowing Pharco to pro-                   should also reconsider their own position: ‘NZP+,
duce drugs would be seen as an act against the accredit-                   which seeks to serve as the voice of PLWHA (people liv-
ed companies who supply drugs under the Global Fund.                       ing with HIV/Aids), receives enormous financial and
‘I would not be surprised to learn that the government                     material support from different players, including the

                                                  FA I R D o s s I e R | J A n uA R y 2 0 0 8

government. Perhaps for this reason, its leaders rarely               “opportunistic infections?” It is the people like me (with
challenge government decisions and have little inter-                 HIV). So the message I am getting is that this will “cure”
est in seeking to reflect the concerns and needs of most              me, because it will cure what is making me sick.’
PLWHA,’ the report says, adding that Zambia ‘needs a                      Some immune boosters even state that their product
functional community advisory body that determines                    ‘defends the body against TB, shingles and meningitis’
funding priorities instead of’ – in a clear and scathing              – all common opportunistic infections in people with
reference to NZP+ – ‘relying on one executive director                HIV/Aids. Pharmacist, Angels Musonda, agrees there
and his or her loyalists.’                                            is too much emphasis on the immune strengthening
   The authors of the report, the International                       properties of some herbs, and that this is purely profit
Treatment Preparedness Coalition – itself a network of                driven. ‘Those who can afford it do not want to buy ordi-
grassroot organisations – are remarkably critical about               nary vitamins anymore; they want immune boosters
the role of civil society in Zambia. Their involvement is             because that is how the medications are packaged. But
crucial, the group emphasises, ‘because they know the                 the composition of immune boosters is rooted in vita-
primary needs of those living with HIV. Moreover, they                mins and trace elements the body needs. They have no
recognise that most statistics published do not reflect               magic ingredient.’ Some people believe they help keep
the true picture of what is happening on the ground.’                 the body stronger for longer, so the onset of taking ARVs
NGOs have a huge responsibility in their view. ‘They                  can be delayed, but even that has not been proved.
should conduct independent monitoring and evalua-                         The Poisons and Pharmacy Board has regulations
tion efforts to ascertain how government resources are                regarding the importation and selling of all drugs, both
being used, and hold national Global Fund policy-mak-                 synthetic and herbal. Drugs must not make miracle cure
ers accountable for ensuring that the funds are allo-                 claims, and must be subject to analysis to ascertain their
cated appropriately.’                                                 efficacy. ‘Herbal based preparations are not subject to the
                                                                      same scrutiny as ordinary drugs. That is why they prolif-
Immune boosters and miracle cures                                     erate in the shops,’ says pharmacist Musonda.
In a country where there are over 1.6 million people                      Treatment Advocacy Literacy Campaign co-ordina-
with HIV, and about 100 000 people accessing ARV                      tor, Felix Mwanza, laments the way messages of cures
treatment issued by the government, and general liv-                  are sent out. The organisation has therefore stepped up
ing conditions so low, other ‘solutions’ may seem more                its information dissemination. ‘While we cannot stop
attractive. Chemists and retail pharmacies in the capi-               people from accessing immune boosters, we want our
tal city Lusaka stock stacks of drugs, gels, tablets and              members to make informed choices, so we educate
syrups all promising to boost the body’s immunity and                 them on the importance of treatment literacy, good
fight diseases but which could be life-threatening to                 food and nutrition and a positive attitude.’
people living with HIV or Aids.                                           The TALC wants to ask the Ministry of Health for a
    The packaging of these wonder cures is colourful                  compulsory warning to go with all immune boosters
and the message is seductive: take a pill and your body               and food supplements explaining that these products
will gain strength. The implication is that your body                 do not cure or treat HIV, but only help to increase appe-
will have the strength needed to fight off opportunis-                tite or reduce the chances of catching some opportunis-
tic infections, reducing your chances of dying of Aids-               tic infection.
related illnesses. The immune boosters have become                        Still, miracle cures are out of the reach of most peo-
an ominous euphemism for ‘Aids cure’.                                 ple. Immune boosters – all imported from South Africa,
     Anna Phiri, a communications expert who has had                  India and the United Kingdom – range from US$ 15 to
the HIV virus for over 15 years, says there is a subtlety             US$ 50, while simply packaged vitamins go for any-
in the manner in which manufacturers and retailers are                thing between US$ 1 to US$ 4. Then again, simple fruits
packaging their immune boosters. Through the packag-                  and vegetables often provide the same nutrition. The
ing, immune boosters are ‘translated’ into Aids cures,                African potato is a garden plant which grows wild in
she says. ‘You are sold something composed of ginger                  most back yards, but when bottled and packaged from
and garlic packaged in many fancy forms and told it will              South Africa with a fancy screw top, labeled ‘Moducare’,
help you fight opportunistic infections. Now who has                  it costs about US$ 15 for a month’s supply.

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8

The Selenium man and the swimming pool                                 that Aids was a means to wipe out the black race, and
chemical                                                               that was why the cure was kept secret. Ngoma claimed
Howard Armistad sells the mineral Selenium. He care-                   his drug, Tetrasil, had been tested in the United States
fully avoids claiming that his product is a cure for Aids,             and proven to cure Aids within 21 days. ‘This is what
but this is implied in how he packages information on                  people in the West are given,’ he wrote in his newspa-
the drugs. Armistad is a very convincing salesman.                     per. Some in the medical profession (who did not want
He says people should take Selenium to delay going                     to be named) gave credence to Ngoma’s cure and said
on ARVs. For those that are already on treatment, they                 that Western doctors ‘would never accept a cure of Aids,
should take Selenium to make the ARVs more effec-                      because they wanted to continue having a market for
tive. For people not having HIV, they should still take                ARVs in poor countries’. Ngoma’s status as a newspaper
Selenium to prevent other conditions like cancer. He                   owner, and the fact that a pharmacy wanted to sell his
attributes his own healthy condition and his ability to                cure, helped to give his claim credibility.
remain strong ‘despite having HIV for over 20 years’ to                    The government tested the drug and found there is
Selenium. The underlying message is that Selenium                      no scientific basis for Tetrasil. Albert Mwango, a gov-
is something of a cure if it is able to delay the onset of             ernment specialist in HIV/Aids drugs, explained the
cancer or Aids for such a long period of time.                         basic chemical of Tetrasil is silver. In the medical world
    His aggressive sales pitch, however, got Armistad into             it is known as a disinfectant, in the United States it is
trouble. The Poisons and Pharmacy Regulation Board                     used to clean swimming pools. However, Ngoma had
impounded his Selenium because he was suspected of                     already raised enough interest in the drug and now
touting it as an Aids cure. It took a few years to dissect             claims people are clamouring for it. The damage has
the semantics in Armistad’s message, but finally and                   been done, and some people now believe there is a cure
very reluctantly early in 2007, the authorities released               out there.
the impounded products. The fact that Armistad also                        The TALC’s Clementine Mumba raised a huge out-
has friends in high places may well have helped. A                     cry against Ngoma for exploiting PLWHA for profit. She
member of the board of his company, Mumba Malila, is                   said it had created unnecessary confusion, as people
Attorney General in the Ministry of Justice.                           stopped taking their ARVs, exchanging it for this fake
    The Poisons and Pharmacy Regulation Board direc-                   cure. The campaign group forced the authorities to
tor, Anne Mwape, said as long as the drug does not have                issue an edict against the drug, and to refuse a visa for
harmful properties it can be sold. Armistad continues to               the foreign ‘doctors’ flying in to promote the product in
make a roaring business selling his product from door                  Zambia. As a result, the Ministry of Health instructed
to door, especially among people already with HIV.                     doctors not to prescribe Tetrasil to their patients. They
    Edgar Ngoma, the editor of a small tabloid called                  would face prosecution – a charge of manslaughter – if
the Weekly Angel, began touting an Aids cure in early                  they did. The government is keen to question Ngoma
2007. He vented an old and worn out conspiracy theory                  and his friend, a Professor Graves, who imported the

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

drug, but the two have not been in the country since                    is popular even though it is expensive for most people
the upheaval.                                                           at US$ 30.
                                                                           One of his patients, John Moyo, swears by the
Herbals, NEPAD and confusion                                            Sondashi formula. ‘Taking ARVs, you need to eat enough
There also has been a proliferation of herbal clinics,                  with the medication, otherwise you will feel bad. Herbal
mostly Chinese, claiming to treat Aids. Dr Tian is one                  cures are not toxic. So I do not need to worry too much
and by far the most popular. He claims to have success-                 about layering my stomach with food. Even if you do
fully ‘killed the virus’ in a number of people and he has a             not eat, you do not feel sick.’ Gender activist, Maureen
large following. Many people, including journalists who                 Nkoma, likes the Chinese preparations. ‘They suit me
do not want to be named, take Tian’s immune booster                     fine. There are no side-effects unlike when I was on
as an alternative to ARVs. ‘The beauty about herbal                     ARVs – which I think are too strong for me. I will start
products is that they rarely have side-effects whereas                  taking ARVs only when it is serious.’
ARVs – apart from being life long with repercussions if                    None of the doctors of those interviewed have warned
they are interrupted – do. I am doing well on Tian,’ says               them about the dangers of stopping and starting ARV
one journalist whose organisation offers free VCT and                   treatment, and the possible side-effect of resistance to
ARVs as part of its work policy to its employees. (Many                 treatment later on.
organisations in Zambia now have these policies.)                          The government refuses too take responsibility
    Recently, Ludwig Sondashi, a lawyer-turned-                         amidst the confusion. The Ministry of Health allows for
politician, claimed his Sondashi herbal formula has                     the provision of alternative treatment in its health pol-
been approved by the New Partnership for Africa’s                       icy, and this side of treatment is regulated by the heal-
Development (NEPAD) as a treatment for the HIV virus.                   ers association, the Traditional Healers Association of
He maintains that his formula ‘kills’ the HIV 1 subtype                 Zambia (THAPZ). This organisation vets and sanctions
c virus – which is the most common virus in Africa.                     their members; only recognised herbalists are allowed
NEPAD, the economic development programme of the                        to operate legally in Zambia. THAPZ has offices in
African Union, has, however, not said this. Its July 2007               major hospitals and clinics offering herbal medication
news release just mentioned Sondashi’s success in treat-                ‘for any kind of disease’ to people who do not want to
ing opportunistic infections in more than 1000 patients                 ingest ‘chemical compounds’. THAPZ, however does
with HIV/Aids in Zambia. According to the press state-                  not offer medicines as ‘alternative’ to ARVs, only herbal
ment, a team consisting of scientists from the National                 treatment for medical conditions including opportu-
Aids Council in Zambia, the University of Zambia,                       nistic infections.
South Africa’s Medical Research Council and the CSIR,
is at present merely studying Sondashi. The Zambian                     Source documents
University Teaching Hospital (UTH), which tests herbal                  Zambia chapter, written by Paul Kasonkomona and Felix Mwanza, in
                                                                           Missing the Target #4: Time is Running Out to End Aids –Treatment
preparations for efficacy, found that the Sondashi for-
                                                                           and Prevention for All! published by International Treatment
mula is non-toxic, but could not test the veracity of the                  Preparedness Coalition (ITPC) in July 2007. (Referred to as the
claim that it killed the HIV virus. However, the formula                   ‘Missing the Target report’.)

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8

                       ‘This product has been tested in Brazil’:
                         misleading the authorities in Kenya
                                                            steve Mbogo

A lack of data exists in Kenya, particu-                                               ARVs or not – costs between $1.50 in
larly on the Aids epidemic and how the                                                 government hospitals to US$ 18 in pri-
spread of the disease has been affected                                                vate hospitals. For children HIV testing
or decreased through antiretroviral                                                    is free in government hospitals but it
(ARV) programmes. However, ‘ARVs                                                       costs about US$ 90 in private hospitals.
have had a definite impact because                                                     Kenya’s annual average income is about
people are now living longer and health-                                               US$ 400.
ier lives,’ says Godfrey Baltazar, pro-                                                   For many people the tests associated
gramme manager at the National Aids                                                    with the free ARV-dispensation are still
Control Programme. He explains that this fact, and the                  too expensive. Patients have stopped taking ARVs when
resulting effect of people working (again) for longer and               they could not afford it any longer.
contributing to the economy, has not yet been docu-
mented because ‘the government decided to wait until                    Counterfeit products and untested drugs
at least 10 per cent of those infected were reached with                High costs of essential medicines have created oppor-
ARVs, before a survey could be carried out.’ Baltazar is                tunities for massive sale of counterfeit products. The
currently working on the national ARVs impact survey                    Pharmacy and Poisons Board (PPB) officially denies
together with the Centre for Disease Control, the WHO                   there is a problem, and claims all the drugs now on sale
and PEPFAR.                                                             in the country have been tested and approved. However,
    All in all, Baltazar sees reason to be optimistic about             in an interview,Dr Jayesh Pandit from the PPB told FAIR
the increased roll-out, though he adds, in a veiled ref-                that drugs do get into the market without testing, but
erence to PEPFAR’s preference for expensive patented                    refused to take responsibility stating that there is ‘little
drugs, that ‘if we get more funding from the President’s                the Board can do because their policing capacities are
initiative on Aids, we would definitely double the                      very low’.
[access to drugs of] number of people in need of the                          According to the managing director of Kenya
treatment.’                                                             Laboratory Supply Center, Narshibhai Ghedia, a signifi-
    The majority of the ARVs in Kenya are procured from                 cant number of medicines sold locally are counterfeit.
big pharmaceuticals recommended by PEPFAR, like                         Doctors interviewed by FAIR said between 20 and 30
GlaxoSmithKline, but recently PEPFAR has started to                     per cent of the medicines currently entering Kenya are
import from India too. Public money and funding from                    either counterfeit or illegally imported by unregistered
other donors allows the government to buy generics as                   firms and individuals, the so-called ‘briefcase trad-
well. Just like NGOs and companies, it imports from                     ers’. Most of these counterfeits are imported from Asia,
India and Brazil.                                                       especially India, China and Pakistan, while some are
    ARVs are free in public hospitals and dispensa-                     from underhand dealers in Europe. Some are labelled
ries, from humanitarian groups like Médecins Sans                       in languages other than English, making it impossible
Frontières (MSF) and in companies that provide medi-                    for users to follow the instructions.
cation to their employees. HIV testing, however, though                     James Alai, a pharmacist at Guru Nanak Hospital,
free in voluntary counselling centers, costs US$ 3 to                   said that the government should allow for the establish-
US$ 10 in public hospitals. Testing the CD4 cell count                  ment of private chemists in all public hospitals in order
– necessary to establish whether the person needs                       to sell approved drugs at controlled and affordable pric-

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8

es. Now, the two pharmaceutical bodies in the country                  promoters claim that it has been scientifically tested and
– the Pharmaceutical Society of Kenya and the Kenya                    proven to improve immunity levels. Dr Gabriel Mbugua,
Association of Pharmaceutical Industry – are forced to                 chief researcher at the Centre for Microbiology Research
use most of their resources to fight the problem of fake               at the Kenya Medical Research Institute (KEMRI), has
medication for common diseases like malaria, HIV/Aids                  accepted these claims, telling FAIR that ‘clinical trials
and tuberculosis.                                                      in Brazil, South Africa and Argentina indicate that the
   Much time is taken up by alerting the public to these               drug is highly effective’.
dangers, whilst the institutions would prefer to focus                    However, an internet search in medical journals
more on educating the public on nutrition and over-                    does not lead to any serious information about Canova.
the-counter prescriptions.                                             Pharmacists in South Africa who looked for references
                                                                       on the clinical trials purported to have taken place in
Wonder cures                                                           that country, could not find any. The only reference
Until 2004, the government tacitly allowed Kenyan                      found was in the United States-based online Journal
healers to publicly claim they could cure Aids. In that                of Genetic and Molecular Research, pointing out that
year however, the government ordered one (Western)                     Canova is not toxic. No scientific evidence has been
‘doctor’ to withdraw such advertisements for his clinic,               published yet about the supposed effectiveness in treat-
and then others – including some Chinese healers – fol-                ing Aids, or opportunistic infections.
lowed suit. The adverts now talk of ‘HIV management’                      According to Dr Pandit from the PPB, ‘people from
instead of ‘cure’.                                                     Canova in Brazil’ have been vigorously pushing it into
   Nevertheless, herbal Aids ‘cures’ still attract many in             the Kenyan market. The producers of Canova in Africa,
Kenya. One of the most popular ‘cures’ is Canova. The                  a company called Best Bet, have pressurised the Kenyan
remedy contains plants extracts, snake venom and cer-                  authorities to allow Canova on the market freely, even
tain metal substances, and originates from Brazil. Its                 when the KEMRI tests haven’t been concluded. Dr

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

Mbugua says about the company he partnered with in
South Africa: ‘They do not understand why the drug
should go through testing if it is in use elsewhere in the
world.’ He also revealed that people, including local                         In Kenya, about 1.3 million people were infected
                                                                              with HIV by the end of 2005, according to UN-Aids,
doctors, are smuggling the drug into the country. The
                                                                              translating into 6,1 per cent of the population. By the
Kenya PPB says it can do nothing because it has no polic-                     end of June 2007 about 157 000 people were on ARVs,
ing capacity and blames the practice on corruption.                           out of the 250 000 people who require treatment. The
                                                                              next target is to reach 229 000 people by June 2009.
Herbal cures                                                                     The US President’s initiative on HIV/Aids, PEPFAR,
                                                                              claims to have a major impact on the ARV roll-out in
Dr Njoroge James, the co-ordinator of the Institute of
                                                                              Kenya. However, the Kenyan Ministry of Health cannot
Herbal Medicine, intends to bring an academic angle                           yet provide documented evidence on HIV/Aids control
to the research on herbal medicines in Kenya. He has                          and management.
joined herbalists, medical doctors, pharmacists, and
researchers at the national universities to exchange
ideas on treatment for different diseases. The fact that
the WHO has accepted herbal medicine in the treat-                     unlikely that radio stations depending on such sponsor-
ment of malaria is a major step forward toward a ‘world                ing would risk losing their source of income by starting
turning herbal’ in Njoroge’s words.                                    to produce ‘fact checked’ medical programmememes.
   In May 2004, the WHO allowed Artemisinin, a Chinese                    ‘People confuse the herbal treatment for some
herbal remedy, as a treatment for malaria. However,                    opportunistic infections, with ARV’s. They see an
the WHO is concerned about serious side-effects in                     infection getting better and draw the wrong conclu-
cases where Artemisinine is the only ingredient used,                  sion: that this treatment has cured Aids,’ says Dr Jack
and advocates Artemisinine combinations such as in                     Githae, who tries to find a compromise between herbal
the new Asaq drug, developed as an affordable non-                     and conventional medical treatment. He explains to his
patented drug by the Neglected Diseases Initiative in                  patients that they should still use the life-prolonging
co-operation with MSF and Sanofi.                                      ARV’s whilst, for opportunistic infections, they can opt
   When it comes to HIV/Aids, Njoroge says: ‘We col-                   for extra herbal treatment.
laborate on the management and we educate each                            Githae adds that often it is conventional doctors
other as a network. To ensure that herbalists will refer               themselves who turn people away from ARVs. ‘They
patients who they cannot handle, we use lay language                   don’t have time for people. The patients need the oppor-
to teach them the behaviour of HIV, scientific analyses                tunity to explain in detail how they feel. It is important
and their interpretation.’                                             to know what is ailing them. The shaman, the healer,
   It is Dr Njoroge big wish to find an herbal treatment               takes time to listen. The last stage of our treatment is to
to cure Aids. The Institute has identified plants for                  administer the herbal concoction.’
immune boosting and found a plant for the treatment                       The lack of professional health staff to provide effec-
of opportunistic infections. A plant called muarubaini                 tive counselling is another reason keeping people from
could, Njoroge says, treat up to forty diseases. ‘This has             going to hospitals: it is not easy to find someone to
resulted in a drug called Virakil. People do claim to feel             attend to you, even after waiting for a long time. This
better when they take this.’ Again, the claims for this                is a problem ARV programmes everywhere in Africa
drug are high. But despite the repeated announcement                   have to deal with and it is in that situation that a des-
of clinical tests, such scientific research has not been               perate need for ‘alternatives’ arises. In the climate of
published yet.                                                         despair, propaganda for wonder cures will fall on many
   Kenyans can be forgiven for setting their hopes on                  receptive ears. The solution, according to social worker,
wonder cures. Correct information on ARVs, and how                     Agatha Mwangi, who works with HIV positive patients
they work is scarce in the country. Many radio stations                in a Nairobi slum, is ‘to mount an educational campaign
broadcast programmes full of praise for the various                    to end all the myths and fears’.
miracle treatments, sponsored by their promoters. It is

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8

            A land of obscure labs, pharmaceutical goldmines
                        and silent health officials
                            sage-Fidèle Gayala, Jean-René Mukawa & Mimosa-Gisèle Panzu

Popular self-proclaimed doctor, ‘Dr François’, in fact                 letters asking for specific details remained unanswered.
graduated from the High Institute for Trade in Kinshasa,               ‘Your quest is useless,’ said one official connected to
DRC. His office is painted a meticulous white in hospital              the office, who requested to remain anonymous. ‘The
fashion. In here, wearing a white lab coat and a stetho-               pharmaceutical producers are goldmines for the OCC.’
scope around his neck, he treats up to 30 patients a day.              He then referred to the state of wealth displayed by
‘I don’t need these instruments to consult my patients,’               many of the agency’s inspectors. A former press attaché
he admits. ‘External signs are simply important to reas-               at the Health Ministry adds that deputy minister, Azziz
sure my visitors that they are at a medical office.’                   Kumbi, did ‘all he could’ to personally control the phar-
    To examine his patients, François Kacingu invented                 macy sector in the DRC. ‘He used to say that there is a
a piece of equipment he calls the ‘tephal’. ‘This device               lot of money there -and he got it,’ the source said.
allows me to detect any possible illness from the saliva                   FAIR later learned that the Minister of Health himelf
of the patient. But before we can examine the spittle, it              had forbidden health officials from talking to public or
needs to be dried in another machine, called the dryer.’               press without his express consent. The team was there-
The tephal is a 30 cm box with mirrors on the far sides.               fore also unable to establish why the Ministry promotes
The mirrors allow François to detect ‘microbic signs’, he              a certain malaria medicine – Arsucam (manufactured
says. François also claims to sell the ‘best medication                by the Belgian company Dafrapharma) – over all oth-
to cure hernia, cysts and myoms without surgical inter-                ers. In a speech read out by top health official, Saba
ventions’ and he has, again self-proclaimed, similar                   Mashine, which was broadcast over all radio and televi-
powers in treating ‘conception problems, sterility and                 sion channels in the country on 2 June 2007, the Ministry
hormone imbalances’. Contacting ‘cured’ patients who                   stated that Arsucam was definitely the best medicine
had consulted ‘Dr’ François proved to be difficult. ‘Most              for malaria. Arsucam is considerably more expensive
of the people who get their healing here, do not come                  than other available and WHO-approved alternatives,
back to tell me,’ the ‘doctor’ explains. ‘They disappear.’             some of which are locally produced.
    The government agency tasked with supervis-                             As a result of the free-for-all medicines market in
ing pharmaceutical activity in the DRC is the Office                   the country, many Western, Asian, Nigerian and local
Congolaise de Contrôle (OCC). When asked whether he                    labs produce and/or retail medicines without a license.
would take his home-made medication to be tested by                    Some are based in houses where the lack of hygiene,
the OCC, François responded vehemently. ‘I cannot let                  even when observing from the outside, is obvious. Some
those thieves into my lab, or have them test samples of                merely import and repackage medicines from else-
my cures. They would steal my formulas to profit from                  where. This last practice could be due to onward-selling
my invention. They only have one goal when they come                   purposes, or simply fraud. Employees and sales agents
here: money.’                                                          connected to some of the labs made statements such
    ‘Dr’ François may have a point. When trying to estab-              as ‘We just produce something that looks, smells, and
lish a dialogue with health officials at the OCC office,               feels good.’ A former commercial agent of a lab called
FAIR learned that the institution is not exactly actively              BIS Pharmaceuticals, Vava Wasimbu, explained that no
engaged in supervising pharmaceutical activity as per                  research was ever done at their laboratory. ‘The effec-
its mandate. It does not have a laboratory equipped to                 tive ingredients of BIS products do not differ from any-
do competent testing of drugs and is unwilling to say                  thing already on the market,’ Wasimbu said. ‘The art is
what it actually does. FAIR requests for interviews and                to produce something attractive of acceptable quality.’

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8
    In the DRC the effort to tackle Aids takes place
    largely outside government structures. It is run by the
    Global Fund in co-operation with specially appointed
    government officials, MSF and the developmental
    organisation Co-operation Belge. It is relatively well-
    run, with US$ 34 million at its disposal. However, it has
    only put 9000 people on ARVs whereas it is estimated
    that 3.2 per cent of the 60 million DRC population is
    HIV positive. When it comes to the Defence Force,
    the estimate of the HIV infection rate is as high as
    60 per cent. Although it is difficult to obtain official
    statistics, several sources corroborate this estimate.
       The DRC experience shows more than any other
    that developmental aid alone cannot replace a sound
    state health infrastructure. Sadly, the country still
    seems a long way from achieving that dream.

    RIGHT: Photograph of a shop in Kinshasa. The slogan
    on the wall reads: ‘Health and prosperity: improve
    your health AND your finances.’ The shop sells Tianshi
    products. This company recruits clients as sales agents
    of its ‘medicines’ in classic pyramid-scheme style.

Another formula can change the taste or the solidity of                      stages of the procedure. I protested against the situa-
the product. Wasimbu: ‘We once spent an entire night                         tion, and then I was fired.’ FAIR spoke to many other
at the factory to prepare an eye-salve. We concentrated                      sources, who claimed that they were also fired after
on the right colour, texture and dissolution. During the                     having complained about lack of safety at the laborato-
night they went from a product that irritated the eye, to                    ries where they worked.
something presentable.’                                                          Whatever the labs do, they do with impunity. Dr
    Another example mentioned by Wasimbu con-                                Duduline Ndandu, president of the Doctors’ Union, is
cerns a food supplement for pregnant women called                            not surprised to hear about the lack of oversight. ‘When
Ferdrop. An earlier version of Ferdrop caused a wave                         I worked for the Ministry of Health I initiated a general
of complaints; it irritated the mouth and had a ‘sour-                       inspection of all the labs which are purportedly pro-
ish’ aftertaste. But instead of taking it off the market,                    ducing or retailing medicines in this country. But most
according to Wasimbu, all the director of the producing                      of them kept their doors closed at the appointed day.’
laboratory did was change the taste of the next batch                            Only two laboratories did allow FAIR entry to their
of supplements. A commercial agent of another lab,                           facilities. These two were Pharmakina (formerly a sub-
Christi Pharma, was blunt in his statements: ‘I don’t see                    sidiary of German pharmaceutical company Boehringer
why we need to test on animals; we only use ingredients                      Ingelheim) and Quinine. Both produce anti-malaria
already known. I admit we sometimes have problems                            medicines based on quinine. Quinine director, Tondele
with varying dosages, but that’s business,’ said the                         Diazolo, is unhappy with the government’s lack of sup-
agent, who requested anonimity.                                              port of this particular local industry. The propensity
    The unsupervised labs also endanger employees’                           of the DRC’s health authorities to establish ties with
safety, former pharmceutical agent Vava Wasimbu                              foreign companies rather than build local antimalarial
alleges. ‘We handled toxic products with our bare                            capacity also affects
hands. There was heightened radioactivity at some                                Pharmakina, which has a long history in the DRC

                                                    FA I R D o s s I e R | J A n uA R y 2 0 0 8

and has worked with several international pharmaceu-                       Some of the practices that the FAIR team ecoun-
tical companies is, with 1900 workers, one of the large                 tered included prescriptions based on interpretation of
employers in the province of Sud-Kivu. It produces its                  dreams that purportedly showed plants that would have
malaria medicine at a cost of US$ 1–2 per day to the                    ‘curative qualities’ for HIV/Aids and other illnesses.
buyer. Quinine’s malaria medicine, Nsansiphos, and                         Some traditional practitioners work with known
another local company’s product, Manalaria, fall with-                  herbal anti-malaria substances but dosage remains a
in the same price range. The three medicines have been                  problem. Some practitioners prescribe 10 millilitres,
registered in the DRC and have been accepted by the                     others 10 litres of the same remedy for the same ailment.
WHO. Yet, the Ministry of Health sees nothing wrong                     Varying dosages are also known to induce resistance to
with publicly promoting Arsucam, manufactured by                        the treatment.
Belgian Dafrapharma, even though this medicine will
cost the malaria sufferer US$ 5–7 per day.                              A Chinese family of love
    Dafrapharma’s products have been heavily criti-                     Chinese vitamin boosters giant Tianshi is very active in
cised. The company also produces and markets mono-                      the DRC. Like in several other African countries it oper-
artesunate drugs that are rejected by the WHO because                   ates in classic pyramid style, recruiting consumers as
they stimulate resistance of the parasite to the treat-                 sellers of their products, and charging them consider-
ment. It also remains a mystery why the new, effective                  able sums of money for the privilege to be part of the
and cheap malaria treatment, Asaq, specially developed                  ‘Tianshi family of love’. Other than nutrients that are
for wide distribution in poor countries by the Drugs for                normally found in a balanced diet, Chinese products
Neglected Diseases Initiative (DNDi), which was regis-                  such as Tianshi’s have been found internationally as
tered in the DRC in 2007, is still nowhere to be found in               well as by local doctors to contain damaging chemicals.
the country.                                                            In Haiti and Panama, and more recently in the United
    ‘Unfortunately, with our system in shackles, medi-                  States, Chinese vitamin producers were found to have
cation has become a product for the rich. Drugs are                     used high dosages of glycol dyethelene, which can
widely advertised products now, sold like the latest                    cause serious renal problems in their products, with
cars. Personally, I never prescribe those new products                  sometimes even fatal consequences.
to my patients. People with malaria get nothing but                         ‘We had to treat many Chinese product users for kid-
quinine, and it cures them,’ says Doctors’ Union head,                  ney damage,’ said Dr Nazaire Nseka Mangani, director
Dr Duduline.                                                            of the Kinshasa University Clinic. Because the DRC
    Like in all other countries in this investigation, the              authorities failed to act, the Clinic started a campaign
FAIR team registered many, many testimonies of peo-                     offering free tests for people with kidney problems to
ple having risked – or even lost – their lives at the hands             investigate the dimension of the damage done. This
of quack healers like François Kacingu. ‘I almost lost                  has, however, not caused government officials to inves-
my eyes because of those charlatans. I suffered from a                  tigate the Chinese products for sale in the country. On
cataract and I went to see no less than four fake prac-                 the contrary: they travel to China. A heavy delegation
titioners: Moman Kola, Kumu Kanga, Papa Bonheur                         including the director of the Ministry of Health recently
and François, but my condition only got worse,’ Toto                    took a tour along Tianshi installations. Representatives
Mangala explained. ‘Luckily I got operated in time; that                of the company were brought back to the DRC to further
saved me.’                                                              establish their operations. The Ministry of Health and
    ‘My sister Kathi was sero-positive, and doing well                  Tianshi put out a joint press release encouraging the
on triple therapy. But after she heard a speech from                    Congolese to buy Tianshi products.
Djalala, a Nigerian at the Vévé centre, she stopped the
ARV treatment. At this moment of speaking, she already
died,’ testified Georges Kadima.

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                        south africa

           Governmental denial as an obstacle in the struggle
                                           Zakeus Chibaya & evelyn Groenink

 Frail-looking and walking with the aid of a stick, cold                 In the Western Cape, the picture is not much dif-
winter blowing outside, Mavhuto Tshivate entered                      ferent. Sifiso Mkululi, who is on ARV treatment in that
Helen Joseph Hospital, Themba Lethu ward, at exactly                  province, complained that ‘the nurses and doctors
5.00 a.m. The queue had already overstretched outside                 are few for us, and you have to arrive at the hospital at
the ward, snaking into the corridors of the hospital.                 around 4.00 a.m. to be attended and knock off at around
   Those who cannot afford medicines from the private                 5.00 p.m.’ He added that many patients, who cannot
sector, wait in queues. Of South Africa’s five million                afford to visit the hospital regularly, succumb to oppor-
people living with HIV/Aids, almost a quarter of these                tunistic infections.
are pregnant women and only 300 000 people are pres-
ently receiving public sector antiretroviral (ARV) treat-             Stigma, denial and disability grants
ment. More than 500 000 sufferers are on a waiting list.              In contrast, in rural Limpopo, the HIV/Aids clinic is
‘With my salary of R3 000 [approximately US$ 430] a                   strangely quiet. Dr Marga Vintges, who works for a
month, it is difficult for me to buy drugs from pharma-               medical NGO in the province, says she is struggling
cies. The drugs are expensive,’ says Tshivate, a single               to get people tested here. ‘Stigma and denial are still
mother from Alexandra Township. After not making                      attached to the disease,’ Vintges said. As a result, in
much progress while waiting in line for five hours,                   the village where she works, there is no waiting list
unable to stand much longer, Mavhuto is now leaving                   for patients who need ARV treatment and people can
the queue that is not much shorter.                                   access the medicines relatively quickly and easily. But
   Stronger patients manage to spend as much as 16                    this will likely change massively if and when, instead
hours in the queue, getting treatment only in the wee                 of quietly languishing and dying, the majority of
hours of the night. ‘You have to come early to spend one              Limpopo’s people living with HIV/Aids come in search
day before getting treatment. The health personnel are                of treatment.
incapable to help all of us. The pharmacy is also full of                 This would happen if the health sector introduced
people. You spend another whole day waiting for medi-                 provider-initiated testing, said Nathan Geffen from the
cation,’ said Thokozo Sithole, who is waiting for her CD4             Treatment Action Campaign (TAC). ‘Now people have
count results after having tested HIV positive.                       to volunteer to get tested. More people would get tested
   The ARV treatment facility at the Themba Lethu                     if their nurses or doctors said to them: “Look. You are
(Zulu for ‘our hope’) Clinic at Helen Joseph Hospital in              sick with TB and I think you have HIV. I recommend we
Johannesburg has seen the number of people seeking                    give you a test. It could save your life.”’
treatment tripling since its opening in 2004. Even with                   But the sad truth is that South Africa’s fledgling
relatively new premises, including eight confidential                 health care system would most likely collapse if every-
counseling rooms, nine doctors’ consulting rooms, a                   body in need of public sector treatment and medica-
training room, pharmacy and a spacious patient wait-                  tion would try to get it. There is a dire lack of health
ing room, the number of patients is overwhelming.                     care workers and many hospitals are already failing to
Over 3 700 patients started ARV therapy here in the first             administer patients with HIV/Aids or other chronic dis-
year and the clinic has provided ARV therapy to more                  eases such as TB, pneumonia and meningitis. Médecins
patients each week, while thousands of people with HIV                Sans Frontières (MSF) has reported that in South Africa
are monitored to get them on treatment when needed.                   alone, one million more patients need medication in
The waiting lists are growing.                                        addition to needing more health personnel to assist

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                         south africa

them with testing and monitoring.                                      countries, and to discourage pharmaceutical corporate
   The TAC has repeatedly warned that doctors and                      use of patent laws. Six years later, however, generic med-
nurses are over-burdened and that a plan is urgently                   ication – particularly for HIV/Aids – is still way out of
needed to train more health care workers and offer                     reach of most people in South Africa who need it. Strict
them a future in South Africa itself. Presently, thou-                 patent provisions continue to exist in South African law.
sands of nurses are leaving the county for much more                   This is partly due to pressure from the pharmaceutical
pleasant and better-rewarded working conditions in                     lobby, but also to persistent Aids-denialist beliefs at the
Australia, the UK and other countries. Rates of new                    highest level of the South African government. South
patients undergoing treatment are going down in South                  Africa’s president, Thabo Mbeki, has said many times
Africa. ARV therapy is also often delayed, which can                   that he does not have confidence in the ARV medicines
lead to death, because doctors are few and nurses are                  that are most needed in the country today.
not allowed to prescribe ARVs. It can take very long                      The TAC has booked some more legal successes in
before a patient is actually seen by a doctor.                         the meantime: ‘We won again in 2003 when we lodged
   There are an estimated 660 000 HIV/Aids orphans in                  a complaint with the Competition Commission against
South Africa now, and the number is set to still increase              GlaxoSmithKline and Boehringer Ingelheim for exces-
dramatically. A recent Department of Health study esti-                sive pricing and denying market access to competitors’
mates that 29.1 per cent of pregnant women were living                 recalls Jonathan Berger of the TAC’s Aids Law Project
with HIV in 2006. ‘Even if you get the most rapid scale-               (ALP). The companies had to agree to license at least
up [of prevention and treatment], South Africa will still              three other companies to produce (first generation)
face more than one million deaths by 2010,’ the head of                ARVs and, as a result, the prices of this early anti-Aids
the WHO HIV department, Kevin de Cock, stated.                         medication plummeted, in some cases by as much as
   In the meantime, growing poverty plays a role in a                  80 per cent. However, since then, much more effective
tragic new phenomenon: patients on ARVs stop tak-                      and easily administrable combination ARVs have been
ing medication in order to receive grants from the                     developed. Again, some companies are using unfair
Department of Social Services. People with a CD4                       competition practices to keep the prices of the new
count of below 200 qualify for a disability grant of about             medicines unaffordably high.
US$ 70 a month. At an Aids Consortium meeting in June                     The ALP has identified Merck Sharp & Dome (MSD)
2007, community-based groups said they had observed                    as a current perpetrator of unfair patent policies in
people stopping ARVs because they were scared of los-                  South Africa. Berger said ‘MSD’s Atripla with the crucial
ing their grants as soon as their CD4 count improved.                  Efavirenz component still costs US$ 613 per person per
In South Africa’s highly unequal society, the disability               year. This could be as much as 45 per cent lower if they
grant often operates as the only source of income for                  would extend the production licenses to competitors.’
poor families. As a result, many people with Aids are                  The ALP is also dragging Abbott to the Competition
forced to choose between receiving their disability                    Commission because of its continued blocking of
grant and accessing life-saving medication.                            generic fluconazole, an alternative to Kaletra. With the
                                                                       generic, the cost of one year’s maintenance treatment
The TAC, Big Pharma and the government                                 would fall from US$ 297 to US$ 104 per patient, the ALP
In 2001, the South African government, supported by the                has calculated. In contrast, Abbott’s expensive Kaletra
Aids activists of the Treatment Action Campaign (TAC),                 capsules will still get even more expensive: by 32 per
scored a historical legal victory over pharmaceutical                  cent over the next two years.
companies seeking to block the proposed introduction                      Local patent laws still obstruct parallel importation
of a law that would allow the country to import generic                of cheaper medicine from countries such as Thailand.
medication instead of only patented products. Faced                    Berger says that ‘our laws are still much stricter than
with massive resistance, sound legal argument and a                    they need to be, even stricter than in some developed
public outcry, the companies dropped the case.                         countries. Though the World Trade Organisation’s rules
   2001 was also the year of the DOHA declaration:                     allow for parallel importation and compulsory licens-
Western governments promised more flexible patent                      ing, our laws do not.’ Berger suspects a stalemate at
rules to allow the influx of essential medicines into poor             government level. ‘At the Department of Health, many

                                              FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                          south africa

people are in favour of generic medication but others,                  encouraged by the South African government. Most
at the Department of Trade, tend to lend their ear to the               South Africans are well aware that their president,
pharmaceutical industry.’ As a result of this conflict, the             Thabo Mbeki, does not believe that Aids exists. Mbeki, as
government position remains largely pro-patent. ‘At the                 affirmed by him again to his biographer Mark Gevisser
deciding level, there is a notion that the pharmaceutical               in June 2007, is convinced that the ‘HIV-causes-Aids-
companies mean well. There seems to be a view that if                   theory’ is a lie propagated by racist Western scientists
one just asks nicely, the big multinational will give you               and that the recent hundreds of thousands of deaths in
a voluntary license to produce generics. That argument                  South Africa (the numbers in 2007 stand at 800 deaths
misrepresents the truth about voluntary licensing: we                   per day) are the result of poverty alone.
have fought for it. Nice and goodwill just doesn’t get us                   The fact that the President himself is convinced, not
there. It was and is a struggle’, says Berger.                          only that Aids does not exist, but that ARV medication is
    Local South African generics manufacturer Aspen                     dangerous and toxic (and therefore the problem rather
Pharmacare is the main proponent of this ‘just ask                      than the solution), has impacted in a big way on South
nicely’ position, Berger says. ‘They are the sweethearts                Africa’s ARV roll-out. Mbeki has appointed the pub-
of the international pharmaceutical industry and have                   licly viewed as incompetent and allegedly often seen
routinely accepted license terms proposed to them by                    drunk, but loyal Manto Tshabalala Msimang as Health
the big companies. That means that they do not see                      Minister. In turn, the Minister – who at first accepted
themselves as an ally in the struggle for cheaper gener-                the general doctors’ and scientists’ views – has come to
ics and their own medication remains in the middle-to-                  behave like a denialist; promoting vitamins and nutri-
high price range.’                                                      tion as cures, and making statements about the ‘toxic-
    Ironically, Aspen itself owes much of its present mar-              ity’ of ARVs.
ket position to the TAC and its Law Project, Berger says.                   It is hence not surprising that the ARV roll-out in
‘The first licensing terms they received, and accepted,                 South Africa has been plagued by systematic national
would not allow them to export. We changed that. Now                    lack of managerial and political oversight – in short,
they are exporting.’ Nevertheless, the ALP continues                    a bit of a shambles. Additionally, the South African
to receive little support, from Aspen or generally from                 governments’ official denial of the existence of Aids
within the South African trade environment, for its par-                has most likely kept citizens in need of treatment from
allel importation and compulsory licensing efforts.                     seeking it as well. The lack of political will to deal with
    But there is some movement in Africa, Berger has                    the Aids crisis has of course immediate consequences
noted. ‘Within the intergovernmental working group in                   for the shortage in medical staff as well as no financial
which 16 African countries participate with the WHO,                    resources to solve the problem have been and will be
the pharmaceutical lobby lately seems less powerful.                    made available.
The participating countries increasingly say “sorry, but                    The Health Minister’s zealotry in promoting vita-
in our countries we just need affordable medication.’’’                 mins has resulted in her tacit support for German vita-
As a result, Berger hopes, a new agreement can open                     min merchant Matthias Rath, who successfully peddles
the African markets for generic drugs from India and                    his ‘Aids cures’ in all openness and without a licence.
Thailand in the near future, and each participating                     In a number of European countries his concoctions and
country could finally start to make their local patent                  practices are banned. Rath has established facilities
regulations more flexible.                                              in Khayelitsha, Nyanga and Mandela Park (Hout Bay)
                                                                        where people also purporting to be ‘doctors’ distribute
The quack cure peddlers and their allies                                his multivitamins.
After leaving the queue at Helen Joseph Hospital,                           People have died after stopping ARVs at Raths behest,
Mavhuto Tshivhase has headed for the the ‘immune                        according to the TAC and community-based organisa-
boosters’ and ‘Aids cures’ which are for sale in the                    tions in the townships. ‘My mother was recovering
streets. After all, Tshivate says, these medicines are                  very well when she was taking ARVs, but she suddenly
readily available and one can put oneself on ‘treatment’                stopped after having been persuaded to take Rath’s
immediately.                                                            medication. Everything changed. Her health deterio-
   The many who resort to these ‘alternative’ cures feel                rated drastically and she succumbed to pneumonia last

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                               south africa

    bush does iT aGain

    Through the US President’s Emergency Plan for                                 also affects decisions of the Global Fund. ‘The US
    Aids Relief (PEPFAR), the US administration has                               administration was opposed to our educational safe
    assisted more than 30 000 South Africans with                                 sex approach, preferring abstinence-only messages
    ARV medication, especially in KwaZulu-Natal.                                  towards the youth. At the US embassy to discuss
    However, local organisations funded through                                   our funding proposals, we were told quiet bluntly:
    PEPFAR increasingly feel the consequences of the                              “Don’t waste your time. We will not support you.”’
    programme’s definition of the Abstain, Be faithful and                           The loss of American funding had far reaching
    Condomise (ABC) strategy. Instead of following the                            consequences. Several joint projects of South African
    clear rules – abstain, be faithful and condomise – there                      health NGOs with loveLife had to be cancelled.
    is now a strong line against promoting condoms,                               Harrison cautioned those with PEPFAR funding, to
    instigated by a religious, conservative lobby close                           check if a partnership with loveLife was going to be
    to President George W Bush in the United States.                              acceptable. ‘There were five or six PEPFAR-funded
       This PEPFAR policy affects many groups in Africa;                          health NGOs; all of them without exception came
    the loveLife Programme in South Africa is but one such                        back to report that they could not partner with us
    example. The organisation empowers young people                               because it was going to cost them their funding.’
    in the field of safe sex and sexual education. The                               Harrison suspects that US pressure on the Global
    group is credited for positive results such as increased                      Fund may have had something to do with the withdrawal
    condom use and a decrease in teenage pregnancy                                of support for loveLife. ‘The Fund receives a lot of
    amongst youth in places where it has run activities.                          money from the US government. And the US has been
       Early 2006, loveLife lost a third of its funding when the                  pressurising everybody who was supporting us. Even
    Global Fund to fight HIV/Aids, TB and Malaria withdrew                        a meeting between us and the WHO was cancelled
    its support. This blow came rather unexpectedly,                              suddenly in early 2006, a few months after the Global
    after both a performance assessment and a technical                           Fund decision. The WHO and the Global Fund work
    review panel from the Global Fund had judged the                              closely together in Africa. Our contacts at the WHO
    impact of loveLife activities positively. No detailed                         told us that it was because the US intervened.’
    explanation for the withdrawal has been given.                                   The Global Fund press room did not respond to
       CEO, David Harrison, believes the new political                            questions on this issue emailed to it by FAIR.
    wind from the United States in its PEPFAR policy now

year in November,’ said Molly Tracey from Khayelitsha,                       countries, the company operates through a network of
where Rath’s agents ‘convert’ many sick people. Molly                        agents who are paid on commission, and who recruit
is now the single bread winner in her family, fending                        sick people in order to turn them not only into custom-
alone for six brothers and one sister.                                       ers but as fellow agents in a classic pyramid scheme.
    Oppositional attempts to end the activities of Doctor                    Tianshi claims that their medication is manufactured
Rath have not been successful to date. The TAC’s Aids                        from ‘Chinese HIV/Aids treatment’. One agent from
Law Project is preparing a case against the Department                       Zimbabwe claimed that business is brisk: ‘We are mak-
of Health in the Cape High Court for ‘failing to take                        ing a lot of money. Many sick people prefer our medica-
action against a clear violation of the Medicines Act by                     tions because they are cheap,’ he said.
Matthias Rath.’ Berger says ‘the Health Departments’ Law                        Only one locally produced, herbal mixture has
Enforcement Unit should have taken such action. But the                      undergone scientific testing – and failed. Ubhejane
people working on it were pulled of the case. The Port                       is produced in KwaZulu-Natal by traditional healer,
Health Authorities stopped imports of Rath’s products.                       Zebulon Gwane. The Medical University of South Africa
But they were mysteriously released a while later.’                          tested Ubhejane and found it did not have any effect on
    Another increasingly successful ‘Aids cure’ marketer                     the HIV/Aids virus. Nevertheless, its promoters still
is Tianshi from China. As in the DRC and other African                       market the herbal mixture as an Aids cure.

                                                    FA I R D o s s I e R | J A n uA R y 2 0 0 8

                                   Denial of HIV/Aids in Africa
                                                         evelyn Groenink

The first people to deny that there was such a thing as                 fight against Aids. Later explanations by donors and the
Aids lived in California. They were found at the progres-               World Bank, who linked the epidemic to truck drivers
sive Berkeley university as followers of lecturer Peter                 and prostitution, did not help either, Epstein writes. ‘If
Duesberg. They considered themselves progressive and                    Aids victims were prostitutes or patrons of prostitutes,
supportive of the African struggle for development and                  who was going to admit being HIV-positive?’
against exploitation. They were upset by what they saw                     Epstein records how, as a result, ‘many Africans
as the ‘racist’ inferences that could be drawn from the                 reacted to the news of the sexually transmitted epi-
rapid heterosexual spread of HIV/Aids in Africa. How                    demic with a mixture of denial and conspiracy theo-
could the same disease affect Africans so much, while                   ries. Maybe the CIA had targeted Africans during the
in the West only the male gay community had suffered                    cold war with a scientifically engineered virus, perhaps
and died from it? Did this mean that Africans had more                  spread through vaccination campaigns. In South Africa,
adulterous sex than Europeans?                                          there was a claim that the apartheid government had
    The racist image of a virus that hurt Africans more                 targeted black South Africans for decimation through
than Europeans, combined with the complex nature                        the HIV virus.’
of the HIV virus itself, gave rise to the idea that there                  Epstein concedes that these ideas were possibly ‘not
simply couldn’t be such a thing. And ever since, denial-                that far fetched’; after all, in the apartheid years, an
ists have been saying that people are dying of poverty,                 evil racist medical programme was developed in South
starvation and TB; not Aids.                                            Africa, and ‘poison doctor’ Wouter Basson was tasked
    The dissidents’ argument that to accept a ‘racist’                  with finding germs and poisons that would hurt, prefer-
virus would in itself be racist, caught the attention of                ably kill, only black people.
South African president, Thabo Mbeki, in 2001. Mbeki,                      The track record of the Western pharmaceutical
an avid internet surfer, started to publicly deny Aids                  industry in Africa, does not inspire much confidence
immediately after coming across the dissidents’ numer-                  either. Damaging, or at best uncaring, medical experi-
ous websites. Most notably amongst Mbeki’s public                       ments have been conducted on African volunteers;
pronouncements on Aids was his speech at Fort Hare                      rewards or promises of access to medicines afterwards
University in that year. He said that to accept that a sex-             sometimes did not materialise. Some vaccination
ually transmitted HIV virus causes Aids, was to accept                  efforts have been conducted in a patronising way, lack-
that Africans are ‘promiscuous carriers of germs’ and                   ing proper explanation. Western doctors are said to
that ‘our continent is doomed to an inevitable moral                    be expensive and ‘cold’, whereas the local traditional
end because of our unconquerable devotion to the sin                    healer takes time to find out what is bothering their
of lust’.                                                               patients. Though Western medicine has helped to treat
    Mbeki, in refusing to accept these notions, was prob-               malaria, the same West has pressurised governments
ably not the only African to feel insulted. ‘Being accused              for environmental reasons to not use pesticides to fight
of promiscuity and having Africans labeled as the                       the malaria mosquito. Can Africans been forgiven for
equivalents of Typhoid Mary did not make their leaders                  thinking that the mosquito must live so they can eat the
or the general population all that receptive to messages                West’s pills?
from Western scientists on how to confront the epidem-                     And so it came to be that, in adopting Aids denial-
ic,’ as American researcher Helen Epstein writes in her                 ism, President Thabo Mbeki could rebel against two
latest work, The invisible cure: Africa, the West, and the              forms of race crime at the same time. First, he would

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8

not accept that black people were insulted; second, he                   18th century was directly connected to the Napoleontic
would fight the spread of suspicious, possibly toxic,                    Wars. The army itself was decimated by this veneral
‘white medicines’ in Africa. (Mbeki has said, and often                  disease, and Napoleon is said to have eventually died
implied, that ARV medication is toxic and that the phar-                 from it too.)
maceutical industry is the hidden force behind activists                     There are a few other practices, each and every one of
who campaign for access to such medicines. The accu-                     them if not induced, than at least fortified by colonialist
sation is, however, not very logical, given the fact that                preaching (notably 18th century British Victorianism)
these activists always fight with Big Pharma to lower                    that explain why the HIV virus turned out to be so ram-
their prices and allow cheap generic competition.)                       pant, not only in Africa, but also in other poor parts of
    Still, scientifically, there is no doubt that there is an            the world, such as India. First, and very damaging, is
Aids epidemic; that it is sexually transmitted through                   the Victorian reluctance to talk about sex and its failure
bodily fluids (mainly sperm and blood) that contain                      to recognise that sex exists as part of everybody’s life.
the HIV virus, and that it has ravaged, and is ravaging,                 If you do ‘it’ hurriedly, secretly, blindly and in the dark,
Africa much more than the West.                                          it is unlikely that either partner feels free to bring up
    Are Africans then unable to control their sexual urg-                the issue of condoms. Secondly, the same Victorianism
es, at least less able to do so than other people? Of course             (possibly merging with very similar conservative tradi-
not. The Aids-dissident advisor of president Mbeki was                   tions in Africa itself) instructed the woman not to enjoy
probably right when he described, rather lyrically, a                    sex: ‘lie back and think of England’ was the motto by
KwaZulu-Natal village he had visited as inhabited by                     which a ‘good woman’ lived.
‘decent church goers’ who were ‘not adulterous at all’;                      Not enjoying sex, even being terrified of it, physi-
it is only his conclusion, that ‘therefore they can’t have               ologically results in dryness in the woman. A dry
Aids’, that was wrong. And he came to this wrong con-                    vagina scratches easily. There is nothing the HIV virus
clusion because he did not see the full picture.                         likes better than a scratch. Which is why rape carries
    He did not see that the churchgoers in the village                   an infinitely higher HIV infection risk than consensual,
were all women, old folks and children, or that the men                  lubricated sex. Adding to this is the habit amongst many
all worked in a distant urban area and lived in labour-                  women to oversoap their vaginas. According to the same
ers’ hostels. That for 11 months a year, the men work                    Victorian beliefs, women’s genital organs are dirty and
in mines and factories and lead a cramped, unpleas-                      shameful; consequently, many women feel they have
ant existence. That their only relief is provided by                     to soap ‘down there’ more than the rest of their bodies.
after-work alcohol, and by the many women who hang                       In 2004, the South African magazine, Fair Lady, found,
around the hostels hoping for a few rands from the                       shockingly, that many women in that country even
men’s paychecks.                                                         use abrasive household cleaning agents such as Handy
    That is the men’s side of the story. There is a women’s              Andy and Vim, with scratches as a result.
side, too. They live in poverty; the only commodity they                     In Western Europe, in the 1970s, large-scale health
have to exchange for money is sex and they have chil-                    warnings were distributed amongst women against
dren to feed. Most often, they do not have the luxury or                 the use of vaginal soaps and deodorants because of the
power to say ‘no’ to a man who wants their ‘services’; let               danger of upsetting the internal bacterial balance and
alone that they would have the space to insist on con-                   the risk of itchy thrush and infection. Such warnings
dom use. There is little candlelight romance where life                  have so far not circulated on the African continent in
is miserable.                                                            a big way. In the current context of the HIV epidemic
    Millions of men work far away from their families                    it may, however, be significant to do so. Health report-
and perhaps an equal number of women having only                         ers could save many lives if they would only explain, as
one way to make ends meet. Add to that the many com-                     was done in the West, that cheap creams at the chemist
munities affected and uprooted by resource exploita-                     – and even simple yoghurt – will quickly get rid of itch
tion and civil war; the mass rape that always comes                      and thrush.
with marauding armies, and you have a scenario for a                         Doctors are generally aware that social conditions
sexually transmitted epidemic. (Similarly, the syphilis                  affect a persons’ susceptibility to disease. Having no
epidemic killing tens of thousands in Europe in the                      other water to drink than that from a polluted river

                                                FA I R D o s s I e R | J A n uA R y 2 0 0 8

leads to cholera; living in dust and grime, in cramped                  hold on to an idealised picture of ‘the African in his vil-
conditions with many others, opens the door for TB;                     lage’: the noble primitive, who never leaves his happy
(civil) war and destruction of communities are often                    surroundings, who needs to be ‘protected’ against ‘dan-
seen in history as the conditions for sexually transmit-                gerous’ Western medication and whose only need is a
ted diseases.                                                           bit more food and vitamins.
   The Californian dissident was possibly too caught                        This idealised Afrophilic image may be attractive
up in his dream about happy, singing, church-going                      to charitable progressives in California and a Keats-
African villagers, to see the effects of poverty, exploita-             quoting, pipe-smoking, deeply insecure South African
tion, and the ravaging of many communities by migra-                    president; it also, however, means death to HIV-infected
tion, human traffic and war. But can Thabo Mbeki                        people, who are told to believe in vitamins-only, and
– founder of the African Renaissance – and initiatives                  warned to stay away from ‘toxic’ Western anti-viral
such as the New Partnership for Africa’s Development                    medication.
(Nepad) and the African Union (AU) be excused on the                        ‘Toxic’ is of course an interesting concept. Antibiotics
basis of ignorance?                                                     are ‘toxic’ in that they kill good bacteria along with the
   Mbeki has often been accused of a lack of awareness                  bad ones. Nevertheless, if antibiotics had been available
of his own people in South Africa and of Africans in                    in the 18th century, tens of thousands in Europe could
general. Educated in the UK, Mbeki has admitted to a                    have been saved from syphilis. In Africa, in 2007, hun-
strong sense of ‘disconnection’ with his African back-                  dreds of thousands continue to die whilst worldwide,
ground. The question arises if maybe he would like to                   warehouses are full of medicines that could save them.

                                               FA I R D o s s I e R | J A n uA R y 2 0 0 8
                                                           TI Team

                             Transnational Investigative Team

Sage Gayala (Kinshasa, DRC) is a senior investigative                 Malawi Broadcasting Corporation and having started
reporter at Kinshasa’s weekly Africa News. He has re-                 his own business magazine in 2006, Mbobe has contrib-
ported on a vast range of issues of injustice in the DRC,             uted significantly to the development of a professional
including media corruption, wastage of voter educa-                   and independent press in his country. Fallen ill dur-
tion money, diamond exploitation and corrupt housing                  ing the course of the Transnational Investigation (see
contracts. He is a FAIR board member and heads FAIR                   Preface), Mbobe is now battling to regain his health.
outreach in francophone Africa.

                                                                      Bright Sonani (Lilongwe, Malawi) is a veteran of jour-
Jean-René Mukawa (Kinshasa, DRC) specialises in en-                   nalism in his country. Having worked for Malawi’s two
vironmental and developmental issues, serving as an                   leading media houses, Blantyre Newspapers and Nation
advisor on these matters to Kinshasa’s CNTV. He has                   Publications, since 1997, he is now news analyst and
reported in-depth on the situation of the displaced and               investigative reporter at the Nation’s Lilongwe bureau.
refugee communities in eastern Congo as well as on                    Sonani has received awards ranging from Outstanding
the growing number of Chinese companies doing busi-                   Human Rights reporter for the past ten years (1996–
ness in the country. He often works together with Sage                2006) to runner up in the MISA-Malawi investigative
Gayala at Africa News.                                                journalism awards (2006).

Mimosa-Gisèle Panzu Pemba (Kinshasa, DRC). Also                       Steve Mbogo (Nairobi, Kenya) is international corre-
at Africa News, Gisèle Panzu unearthed a number of                    spondent for and WorldPoliticsWatch.
housing and health injustices in the poorer areas of                  He reports generally on Africa, with a particular interest
the Democratic Republic of Congo’s capital. She con-                  in investigating Africa’s terrorism and security trends,
tinues to monitor dangerous and unsafe conditions and                 socio-economics, international relations, politics and
practices in the DRC’s health sector.                                 biotechnology. Mbogo is also a FAIR board member.

Multi-award winning journalist Mabvuto Banda                          Zarina Geloo (Lusaka, Zambia) has over 20
(Blantyre, Malawi) writes for Reuters, the UK Mail on                 years experience in reporting news and writing
Sunday and Sunday Times, and reports from time to                     features, mainly on health, in Zambia. She has researched
time for Sky News. In 2006, Mabvuto was named south-                  a variety of subjects ranging from corruption to gender
ern Africa’s investigative journalist of the year by the              and HIV and Aids, and also conducts media training for
Media Institute of Southern Africa (MISA).                            journalists on writing effectively on HIV and Aids.

Hilary Mbobe (Blantyre, Malawi) has led FAIR through                  Project manager and editor. Eveline Lubbers
2005 and 2006 as chairman. He won CNN journalist of                   (Amsterdam, Netherlands) was co-founder of the
the year and MISA’s John Manyarara investigative jour-                Jansen & Janssen investigative bureau, which monitors
nalism award in 2005. As a programme producer at the                  law enforcement agencies and supports social activist

                                             FA I R D o s s I e R | J A n uA R y 2 0 0 8
    Zakeus chibaya: a TribuTe

    Zakeus Chibaya joined FAIR in 2004, after he had                           Canada-based International Institute of Journalism.
    just conducted a series of in-depth interviews with                           For the FAIR Transnational Investigation, Zakeus
    demotivated Zimbabwean soldiers. Disappointed with                         Chibaya interviewed many people living with HIV/Aids
    the increasing lack of opportunities for investigative                     and documented their struggle to access medication
    journalism in Zimbabwe, he settled in South Africa where                   in South Africa. In doing this, he again faced South
    he, whilst studying journalism at the University of the                    African official intransigence in the shape of pervasive
    Witwatersrand, became involved with organisations of                       denial and stone-walling in the face of the epidemic.
    exiles and exiled journalists from his home country.                          Tragically, as he was reporting on neverending queues
       Chibaya wrote many investigative stories on                             of people waiting for treatment and medication, he
    Zimbabwe for the Zimbabwean and the Institute for                          himself fell ill and, quite possibly, the words from the
    War and Peace Reporting (IWPR). One of his stories,                        people he interviewed about ‘standing in queues until
    exposing the ill-treatment of refugees and migrants                        they couldn’t stand for much longer’, also reflected his
    in South Africa, was published internationally and                         own situation. His family and friends only came to know
    won him the ‘excellence in journalism’ International                       that he was battling the HIV virus after he succumbed
    Award for Solidarity with Refugees, awarded by the                         to pneumonia in August 2007. Zakeus was 30 years old.

groups against oppressive surveillance tactics. Lubbers
has published and edited numerous books and articles
in both activist and mainstream media. She recently set
up the website, dedicated to the moni-
toring and analysis of the PR-strategies of multinational

Coordinator. As co-ordinator of FAIR, Evelyn
Groenink (Johannesburg, South Africa) has co-ordi-
nated the Transnational Investigation in close co-op-
eration with her namesake Eveline Lubbers. Whereas
Lubbers managed the project, and directed and ed-
ited the content, Groenink liaised on all administra-
tive matters with the team. Based in South Africa, she
also assisted in finalising Zakeus Chibaya’s work when,
tragically, the latter succumbed to pneumonia during
his work for the TI.

                                                 FA I R D o s s I e R | J A n uA R y 2 0 0 8

AIDS (Acquired ImmunoDeficiency Syndrome): The                  Mother to child transmission (MTCT): Transmission of HIV
late stage of infection caused by a virus, the Human            from mother to child during pregnancy, at the time of birth,
Immunodeficiency Virus (HIV).                                   or through breast milk.
Anti-retroviral (ARV): A substance, drug, or process that       MSF: Médecins Sans Frontières (Doctors Without Borders),
destroys a retrovirus (such as HIV), or suppresses its          an activist organisation of medical professionals assisting
replication.                                                    health projects and campaigning for access to essential
Anti-retroviral treatment (ART): A treatment that may           medicines worldwide
prevent HIV from damaging the immune system.                    Neglected disease: A seriously disabling or life-
Artemisinine: a drug used to treat multi-drug resistant         threatening disease can be considered neglected when
strains of malaria. The compound is isolated from the           treatment options are inadequate or do not exist, and when
shrub Artemisia annua long used in traditional Chinese          their drug-market potential is insufficient to readily attract
medicine.                                                       a private sector response. Government response is also
Artesunate: Medicine based on artemisinine.
                                                                Opportunistic infection (OI): An illness that takes advan-
Asaq: New medicine to treat malaria, consisting of a            tage of HIV’s weakening of the immune system to cause
combination of artesunate (AS) and amodiaquine (AQ).            disease.
Recommended by the WHO.
                                                                Parallel importation: Importation of patented products
CD4 test: A blood test that measures the number of CD4          without the approval of the patent-holder.
cells in the blood; a good indicator of overall health and
how HIV is progressing.                                         Patent (patent protection): Title that confers upon the
                                                                creator of an invention (product or process) the sole right
Combination therapy (triple therapy): HIV/Aids drug             to make, use, import and sell that invention for a set period
therapy using a combination of drugs.                           of time.
Compulsory licensing: Provisions in patent laws that allow      PEPFAR: the US Presidents’ Emergency Programme for Aids
public authorities to grant licenses to a third party without   Relief.
the consent of the patent holder.
                                                                Pharmacopoeia: an authoritative document listing drugs
Drugs for Neglected Diseases (DND) Initiative/Working           and medicines, usually issued by a government.
Group: A multidisciplinary and independent group that
aims to stimulate development and availability of drugs for     PLWHA: People Living with HIV/Aids.
neglected diseases.                                             Quinine: an anti-malaria medicine derived from the bark of
Drug resistance: When an infection stops responding to          the Cinchona tree.
medication(s).                                                  Registration: Government authorisation of the production
Essential drugs: Drugs selected for their efficacy and safety   and marketing of a drug following proof of its safety and
to meet the priority health needs in a given country or         efficacy.
region.                                                         Resistance: See drug resistance.
Generic drug: A pharmaceutical product usually intended         Stigma: the holding of negative social attitudes towards
to be interchangeable with a branded product, which is not      members of a group (for example, PLWHA).
protected by a patent and therefore often cheaper.
                                                                Triple therapy: See combination therapy.
Global Fund (to fight Aids, Tuberculosis and Malaria): a
                                                                TRIPS: The World Trade Organisation’s Agreement on Trade
partnership between governments, the private sector and
                                                                Related Aspects of Intellectual Property Rights.
affected communities that makes financial resources to
fight malaria, TB and HIV/Aids available.                       Tuberculosis (TB): An infection which causes lesions on the
                                                                lungs and other tissues of the body, often developing long
HIV (Human Immunodeficiency Virus): A virus that steadily
                                                                after the initial infection.
weakens the body’s defense (immune) system until it can
no longer fight off infections such as pneumonia, diarrhoea,    UNICEF: United Nations Childrens’ Fund
tumours and other illnesses. All of which can be part of        VCT (voluntary counseling and testing) services: Voluntary
AIDS (Acquired ImmunoDeficiency Syndrome).                      HIV counseling and testing is the process by which an
International Treatment Preparedness Coalition (ITPC)           individual undergoes counseling to enable him/her to
was born out of the International Treatment Preparedness        make an informed choice about being tested for the human
Summit that took place in Cape Town, South Africa, in           immunodeficiency virus (HIV).
March 2003, and grew into a Coalition of more than 1 000        Viral load test: A test that measures the amount of HIV in
activists from over 125 countries.                              the blood.
Malaria: An infection caused by a parasite and transmitted      WHO: World Health Organisation
by an infected mosquito.
                                                                WTO: World Trade Organisation

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