South African doctors condemn nevirapine decision

Julian Meldrum, Julian Meldrum
Published: 04 August 2003

Leading South African researchers Professors Jerry Coovadia and Salim Abdool Karim yesterday condemned the decision of the South African Medicines Control Council (MCC) to withdraw the license for use of nevirapine in prevention of mother to child transmission unless it receives new efficacy data within 90 days (reported here).

Professor Coovadia said he was "left breathless by the decision by the MCC to question the validity of the scientific results on nevirapine". The PMTCT programmes in more then 20 countries, which have treated more than 30,000 women, are founded on nevirapine, he noted. All of the global authorities are backing the strategy. There had not been a proper discussion between the MCC and researchers in the field and he found it "simply incredible" that this had happened, despite the fact that many of the trials which demonstrated the safety of the approach (or could shortly yield answers to some of the outstanding questions) were carried out in South Africa.

Perhaps more surprisingly, the South African Department of Health also complained that they had been unprepared for the MCC announcement and had only learned about it at the same time as the media. Dr Nono Simelela, the widely respected adviser on HIV and AIDS policy at the Department of Health, observed that they didn't have a "plan B" and implied they were scrambling to come up with one, in case nevirapine could not be used to meet the government's obligations to roll out a treatment programme as required by the courts.

South African AIDS Conference opens

Professor Coovadia was speaking prior to the opening of the first South African National AIDS Conference in Durban.

The organisers were clearly delighted and proud of the standard of the abstracts submitted for the conference, by biomedical researchers, although the social science contribution appears somewhat weaker. South Africa has succeeded in attracting a relatively high proportion of international funds from major grant-giving institutions such as the US National Institutes of Health, the Bill and Melinda Gates Foundation and the Wellcome Trust. A new research institute here in Durban, primarily for AIDS research, is equipped to international standards and has few equals in Africa – only the Botswana/Harvard institute and the leading centres in Uganda could match it.

However, with a few exceptions, such as the South African AIDS Vaccine Initiative, sponsored by the South African Medical Research Council and linked to the International AIDS Vaccine Initiative (IAVI), it is clear that with research agendas shaped by external funders, the level of ownership of the research and its results by the South African government is generally low.

Professor Coovadia called for a deeper exchange between the scientific community responding to HIV and AIDS and policy makers within South Africa. The biggest problem was that a wealth of information is coming out, but it isn't being translated into action from governments or NGOs on a scale to match what is being found. A "huge gulf between research and implementation" has emerged, which needs to be addressed.

Perhaps he really meant that the government needed to listen more carefully to the expert advice it receives. At the same time, he wanted to see less confrontations and more consensus on policy in relation to HIV and AIDS. To some extent, as he told the SABC news, he felt this was now happening.

Further news reports from the South African National AIDS Conference will appear throughout the week on this website.

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