No other country on earth is thought to have more HIV-positive people than South Africa, with some 5 million people infected.
So when 39 international pharmaceutical companies unconditionally withdrew a lawsuit against the South African government aimed at barring the country from importing cheap anti-AIDS drugs, AIDS activists called it a "moral victory."
South African Minister of Health Manto Tshabalala-Msimang said the pharmaceutical industry's new stand illustrated "a broader movement for justice in healthcare - not just for South Africa, but for the whole world."
The case did prove the value of public pressure, experts say.
But the withdrawal of the case does not mean that South Africans with AIDS will have access to cheap anti-retroviral therapy anytime soon.
Dr. Tshabalala-Msimang explained in a press conference yesterday that the medicines in question - which transform AIDS from a death sentence to a chronic illness - remain unaffordable to most South Africans. In addition, this country does not have the infrastructure necessary to distribute the medicine and monitor patients on a wide scale. Furthermore, her government remains skeptical of the safety of these drugs, however widely they are used in Europe and the US.
The lawsuit was meant to stop South Africa's implementation of a 1997 law that essentially allows South Africa to shop around for drugs, buying them where they are cheapest.
While this case has been viewed as a test of the developing world's right to affordable life-saving drugs for its ailing people, in reality that battle is being fought country by country by the pharmaceutical industry, which has challenged many nations' plans to access cheap medicines.
But the case is undoubtedly a setback for pharmaceutical companies in what is likely to be a lengthy struggle over access to drugs and the broader legal issues. "If their intention was to safeguard patent rights, then it was a bit of a [self-inflicted wound]," says Justin Forsyth, Policy Director for Oxfam. The next challenge will be a legal case in Brazil.
The case will also reopen debate over world trade rules that govern patent law. One of the key aspects of the dispute, from the point of view of the pharmaceutical companies, was a commitment that South Africa's Medicines Act comply with World Trade Organization rules covering Trade-Related Intellectual Property Rights (TRIPS). These rules have come under attack from opponents of globalization, who see them as discriminatory against the developing world. "The next step will be to change TRIPS," says Mr. Forsyth. He noteds that the British government is already preparing two studies on the matter that may lead to reform of the rules.
Nevertheless, this South African case has benefited other third-world countries and some upper-income patients here. In the months leading up to this highly publicized and controversial contest, the pharmaceutical industry began offering their products at lower prices to deflect accusations of corporate greed. The price of some anti-retroviral therapies dropped from more than $10,000 per patient per year to a few hundred dollars. That alone, said Ayanda Ntsaluba, the Department of Health's director general, will make the drugs more affordable for individuals and private health insurance companies here and in countless other countries.
Yesterday's decision was seen as a public relations coup for the pharmaceutical industry. In what was previously a public relations disaster, the drug companies had replaced big tobacco as the corporate bad guy.
Activists from Pretoria to Washington demonstrated against the drug companies, alleging that they put profits ahead of people's lives. A few activists here went on a hunger strike. More than 260,000 people worldwide signed a petition calling on the companies to drop their suit. Newspaper headlines talked of first-world Goliaths picking on a tiny and poor third-world David.
Mirryena Deeb, chief executive of the Pharmaceutical Manufacturers Association of South Africa and the representative of the plaintiffs here, told a local reporter that she has been portrayed as a Cruella de Ville.
Ironically, while South Africa has been painted as the champion of the sick in the world media during the lead-up to this case, the government has been and continues to be criticized at home for its slow response to the AIDS pandemic.
President Thabo Mbeki, until recently, publicly stated he was not convinced that HIV caused AIDS. And the drug AZT, widely used to help prevent infection in incidents of rape, is still not provided by government clinics here, though this country has among the highest numbers of reported rapes in the world. Drugs used in other countries to stop mother-to-child transmission of the disease in pregnant women are also not available, though in some areas as many as 1 in 3 pregnant women are HIV-positive.
Tshabalala-Msimang defended the government's policy: "It is not correct to say that just because we don't provide anti-retrovirals that we're not treating people with AIDS. If you provide adequate nutrition and manage opportunistic infections, people with HIV can stand up and manage their lives."
This case does not appear to have altered this treatment policy. But the government's remaining reservations about anti-retroviral therapy may soon be addressed. The organization Doctors Without Borders has offered to run clinical studies of the safety of these drugs for the government in the Cape Town area. And an Indian manufacturer of generic copies of patented anti-AIDS drugs has asked the South African government for permission to import its products. If that is allowed, it will further reduce the cost of these medicines.
"This is yet another struggle we're facing," said Mark Heywood, National Secretary for the Treatment Action Campaign, a non-profit AIDS-activist organization. "We must now work to convince the government to include anti-retroviral therapy in its national health program."
Andrew Marshall contributed to this report from London.
(c) Copyright 2001. The Christian Science Monitor