Life-prolonging antiretroviral (ARV) medication is in perilously short supply in Zimbabwe, and exorbitant prices have kept the scarce drugs out of reach for most HIV-positive Zimbabweans. Could local manufacture make them cheaper and easier to obtain?
Varichem Pharmaceuticals, a local pharmaceutical company, can manufacture ARVs but crippling foreign currency shortages have made it difficult to import the raw materials for the ARVs and the company was forced to stop production.
Galloping inflation and a drought of foreign currency have crippled the health sector, creating shortages of drugs, medical equipment, and personnel, who have migrated in search of better salaries and living conditions.
The Herald, an official daily Zimbabwean newspaper, reported last week that a one-month prescription of Stalenev 30, a common first-line ARV drug, now cost Z$85 million (about US$42.50 at the parallel exchange rate). Most Zimbabweans earn less than Z$3 million a month (US$1.5) or are unemployed. At private pharmacies the drugs can cost up to four times the price as at subsidised public dispensaries.
However, a recent announcement that Varichem Pharmaceuticals had upgraded its drug-manufacturing factory to meet international standards could offer a solution to Zimbabwe's cash-strapped government, which is battling to scale up its national treatment programme.
The United Nations Development Programme (UNDP) provided US$2.1 million for the upgrading process and trained Varichem staff to use the latest ARV manufacturing technology. Managing director Tobias Zangare said the ARV manufacturing plant now had to be tested and certified by the World Health Organisation (WHO).
But there was no consensus on whether manufacturing the drugs locally would make much difference. With construction of the ARV manufacturing plant complete and only awaiting WHO certification, the approval would allow them to apply for foreign funding to capitalise their operations.
"The most important thing is that we will be able to apply for funding from international donors such as the Global Fund to fight HIV and AIDS, Tuberculosis and Malaria," Zangare told journalists.
In the absence of local regulatory authorities, WHO has stepped in to provide a stringent quality assessment of its own, and passing WHO's prequalification scheme is a requirement for countries seeking funding for local manufacturing from the Global Fund.
Health and child welfare minister David Parirenyatwa welcomed the move, saying, "Once certified, Varichem Pharmaceuticals would be able to secure foreign currency orders and improve on production, thereby producing enough drugs for our people and for export to other countries."
AIDS activists remain unconvinced. Reverend Maxwell Kapachawo, head of the Zimbabwe Network of Religious leaders Living with or Personally Affected by HIV and AIDS (ZINERELA+), a rights group, told IRIN/PlusNews that Varichem Pharmaceuticals might not necessarily make ARVs more affordable.
"As a private company, their motive could be pursing profits and so I think government agencies could come in and play a role to ensure the life-prolonging treatment is available to ordinary people.
Kudzi Matombo (not her real name) told IRIN/PlusNews that she had been forced to use her personal savings to buy the expensive drugs, as she was still on the waiting list for free government ARV drugs.
"I am now depending on relatives and friends working overseas to send me money for ARV drugs because my earnings as a junior manager at a fast-foods outlet is not even enough to sustain me for basic needs like food, shelter and clothing."
Joseph Moyo, who tested HIV positive two years ago, said he welcomed the initiative to manufactures the drugs locally. "My assumption is that if the drugs are manufactured in Zimbabwe, then there is hope that they might be affordable."
According to government statistics, only 90,000 people are on ARV therapy, while close to 400,000 are in urgent need of ARV drugs.