Latest news with #BoitumeloSemeteMakokotlela
News24
15-07-2025
- Health
- News24
SA gets R520m to buy the twice-a-year anti-HIV jab... but there's a snag
SA has accepted an offer of just over $29 million from the Global Fund to Fight Aids, TB and Malaria to buy the twice-a-year anti-HIV jab, lenacapavir. . But there's a snag: the country isn't getting extra money from the fund to buy the medicine. It has to use cash from a grant that it has already been awarded and that was cut by 16% in June. South Africa has accepted an offer of just over $29 million (about R520 million) from the Global Fund to Fight Aids, TB and Malaria to buy the twice-a-year anti-HIV jab, lenacapavir, that research shows could help to end Aids in the country, says health department spokesperson Foster Mohale. But there's a snag. The country isn't getting extra money from the fund to buy the medicine; it has to use cash from a grant that it has already been awarded and that was cut by 16% in June. Moreover, the fund, at this stage, won't tell the health department – or any of the other eight countries it has selected for early roll-out – how much they're paying lenacapavir's maker, Gilead Sciences, for the product. Boitumelo Semete-Makokotlela, the CEO of the country's medicine regulator, the South African Health Products Regulatory Authority (Sahpra), told Bhekisisa it is aiming to have lenacapavir registered in South Africa before the end of the year. According to the national health department's head of procurement, Khadija Jamaloodien, the lenacapavir funds from the Global Fund will become available in October, when the rollout period of South Africa's next grant, known as Grant Cycle 7, kicks in. But rollout – likely in early 2026 – can only start once Sahpra has registered the medicine, the country's essential medicines list committee has reviewed and recommended lenacapavir, procurement processes are in place and health workers and clinics have all they need to hand the drug safely to patients. Two studies released last year showed the medicine completely protects young women from contracting the virus and works almost as well for men, transgender and gender-nonbinary people. In fact, a modelling study shows that if between two and four million HIV-negative people in South Africa use the jab every year over the next eight years, the medication could end Aids as a public health threat by 2032. Ending Aids as a public health threat means reaching a stage where fewer people are getting newly infected with HIV than the number of people with HIV who are dying (increasingly for other reasons than HIV, for example old age). According to the latest Joint United Nations Programme on HIV and Aids (UNAids) report, which was released last week, 170 000 people got newly infected with HIV in 2024, while there were 53 000 Aids-related deaths. The Global Fund money for South Africa is, however, not nearly enough to put two to four million people per year in South Africa on the lenacapavir jab (see price explanation below) – and even if it was, the country's health system won't be able to roll the medicine out that fast, scientists and policymakers say. Will the US help to pay for the jab? The fund's offer follows the body's announcement on 9 July, that it has the 'ambition' to finance enough lenacapavir for two million HIV-negative people – in the low- and middle-income countries it supports – over the next three years. But fulfilling this ambition will depend on whether the governments of wealthy countries give enough money to the fund in its next replenishment round. The US government's Aids fund, Pepfar, was originally going to help to pay to roll out lenacapavir in poorer countries. And, although some activists say it's still possible for the US administration to come on board (lenacapavir is mentioned in President Donald Trump's budget proposal for the next financial year, but is understood to be only for pregnant and breastfeeding women), it's not clear at all how this might happen after the Trump administration's drastic cuts to funding for HIV projects in countries like South Africa this year. The Global Fund's offer, however, is a way to get branded, 'bridging' doses from Gilead to South Africa while the world waits for cheaper generics to become available around 2027. 'We now stand at a moment of reckoning and a moment of choice,' Mitchell Warren, the executive director of the international advocacy organisation, Avac, told Bhekisisa at the 13th conference on HIV science in Kigali this week. 'While a lot of the choices over the last six months have been made by an American politician [Donald Trump] who doesn't care about the pandemic or science generally, our choice is to make decisions based on the science that we all now know. Which is that lenacapavir is our most potent opportunity.' Countries have to budget just under R600 per dose Jamaloodien, however, cautions further discussions with the Global Fund and Gilead will be needed about the governance around the pricing of the product. 'We have a transparent pricing system, guided by the Public Finance Management Act. Even if we procure medicine with Global Fund money, we have to follow the same rules that the Treasury requires us to follow with tenders, which includes revealing the price at which the medicine is bought,' Jamaloodien says. In a Global Fund letter sent in early July to the nine early rollout countries – South Africa, Zimbabwe, Eswatini, Lesotho, Zambia, Mozambique, Kenya, Uganda and Nigeria – the fund asked the governments to budget for $60 (about R1 076) per patient per year ($30, or R576, per six-monthly dose), to buy lenacapavir. But in the document, which Bhekisisa has seen, the fund makes it clear that the amount 'reflects the country contribution only, to be used for budgeting purposes, and should not be considered the product price'. Jamaloodien has confirmed to Bhekisisa that the health department did receive such a letter. The letter also states that the gap between the price that the fund pays Gilead per patient per year and the $60 that countries will pay for with their Global Fund grants, will be covered by private sector funding, which Hui Yang, the fund's head of supply operations, confirmed to Bhekisisa will be paid for by a $150-million (about R2.68 billion) donation of the UK-based Children's Investment Fund Foundation to the Global Fund. Furthermore, says Jamaloodien, South Africa's letter instructs the country to submit its first order, for planning purposes, by 30 September under an 'agreed procurement mechanism'. Why does Gilead not want to talk about LEN's price? Lenacapavir, also referred to as LEN for short, was registered for HIV prevention – also called PrEP – by the US medicines regulator, the Food and Drug Administration on 18 June, and is sold in that country for $28 218 (around R505 269) per person per year under the trade name Yeztugo. The US is the only country in which LEN has been registered so far as PrEP. For low- and middle-income countries such as South Africa, Gilead, however, said it will have a 'not-for-profit' price such as the one they negotiated with the Global Fund, but isn't allowing the fund to make it public. Several scientists and activists at the HIV science conference, have, however, told Bhekisisa the rumoured not-for-profit price that Gilead has negotiated with the Global Fund is $100 per person per year, and Avac, confirms it in its analysis of events. But neither Gilead or the Global Fund have confirmed this amount. If South Africa budgets for $60 per person per year, the $29.2 million that Global Fund says we can use to buy lenacapavir, translates to putting and keeping around 400 000 people on the medicine over three years (Global Fund grants run for three years at a time). Gilead argues that because the not-for-profit price is based on the actual cost of making lenacapavir, and shipping it to countries, it can't declare that cost. 'Gilead doesn't publicly disclose manufacturing costs for any of our medications,' Caroline Almeida, Gilead's head of public affairs, told Bhekisisa in Kigali. But activists don't buy this argument. 'Gilead's secrecy will obstruct civil society activism for lower drug prices and keep prices high in middle-income countries [such as South Africa] where Gilead negotiates prices directly,' the Health Justice Initiative and other activist groups said in a press release last week. Avac has identified 16 top lenacapavir markets, of which South Africa is – by far – the largest because of the country's high number of new HIV infections. The country's 170 000 new infections in 2024 is 13% of the 1.3 million new HIV infections around the world in 2024. And research released by Wits RHI on Tuesday in Kigali shows South Africans are open to using the jab: 56% of just over 1 700 participants in a survey in Tshwane, Mthatha and Gqeberha, who were already using public sector HIV prevention services, said they would take a lenacapavir shot. But for LEN to be affordable, activists argue, Gilead needs to be open about its price. 'Such secrecy undermines the power of buyers to negotiate affordable prices and violates the human rights of all people to access information and lifesaving tools,' activists said in last week's press release. Warren concludes: 'Pricing transparency has been a long-standing challenge, as companies try to balance their commercial pricing and marketing strategies with their global public health strategies. We clearly need a new model or compact for pricing that helps break the cycle of small thinking and limited impact.'
Mail & Guardian
18-06-2025
- Health
- Mail & Guardian
Elon Musk, depression and South Africa's cowboy ketamine clinics
What's ketamine all about? Bhekisisa recently spoke with Bavi Vythilingum, a member of the South African Society of Psychiatrists, who helped write the guidelines for ketamine use to understand more about the drug and how it works. (Wikimedia) 'To be clear, I am NOT taking drugs!' the richest man in the world The New York Times was lying their ass off.' Elon Musk — originally from South Africa and until recently the head of the Trump administration's so-called 'I tried prescription ketamine a few years ago and said so on X, so this [is] not even news. It helps for getting out of dark mental holes, but I haven't taken it since then,' he told The New York Times. Musk also In South Africa, treatment-resistant depression is Musk has openly talked about Because ketamine causes temporary ' These psychedelic effects, and the fact that ketamine can make people feel happier, are part of the reason why ketamine is also used as a street drug, often known as 'Vitamin K' or 'Special K'. Musk told The Don Lemon Show that ' In South Africa, In 2022, ketamine Bhekisisa the spray isn't available in the country. Some healthcare providers in South Africa are also administering the drug In the case of ketamine, the South African Society of Psychiatrists (Sasop) has But Bhekisisa's TV programme, Health Beat , Sahpra's chief executive, Boitumelo Semete-Makokotlela, Experts say unregulated use of ketamine is not only risky — it can be deadly, In an autopsy, authorities in Los Angeles found that Friends actor Matthew Perry, who played the character Chandler Bing and wrote about his Mia Malan recently spoke to psychiatrist Bavi Vythilingum, a member of the Bhekisisa 's May episode of Mia Malan (MM): Why are psychiatrists talking about ketamine right now? Bavi Vythilingum (BV): It's probably MM: Why does it work so fast? BV: We're not 100% sure, but we think that it's because it's MM: What is a BV: Glutamate is a brain neurotransmitter like serotonin and noradrenaline. Glutamate is situated throughout the brain and ketamine works on that receptor. MM : So it's something that helps you to feel good? BV : If you're taking ketamine, for example, for drug use, it would produce an altered state of consciousness, which can make you feel good, but can also be unpleasant. But certainly, for depression, MM: So who gets ketamine? Is it people who need to be helped immediately, and then you wean them off it? Or how does it work? BV: So there are two groups of people who would get ketamine: people who are MM: And if you then put such a patient on ketamine, explain to us what happens. BV: Most people who have ketamine will have what we call a MM: And for how long would that last? BV: For as long as we give the infusion. So usually about 40 minutes. Then they go home and they come back after two to three days for a total of about six infusions. MM: And what happens after that? BV: There's no MM: What about addiction? BV: We have to assess somebody very carefully for previous substance use and current substance use. So if somebody is an active substance user, even if they're not using ketamine — say they're an alcoholic — you'd be very cautious about giving ketamine. MM: Who can give ketamine? We have heard of many clinics that give it where it's not psychiatrists giving it, where a GP gives infusions. Is that legal? BV: It is technically not illegal, because any doctor can give any medication. That's a MM: What does ketamine treatment cost? And do medical aids pay for it? BV: You're looking at about R2 400 to R2 500 per infusion. The big cost of that is around personnel because you need an anaesthetically trained doctor and a nurse. MM: Do medical aids pay? BV: Medical aids are starting to pay. So your top-tier medical aids will pay for ketamine upon motivation, but the medical aids are reluctant to pay. And a big cause of the reluctance is all these so-called cowboy ketamine clinics. The medical aids are saying, quite rightly, that they don't know if ketamine is going to be given safely. This interview appeared in a recent episode of Bhekisisa 's monthly TV programme, . This story was produced by the . Sign up for the .
