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Access and affordability: South African launch of critical medications drives equitable access

In putting healthcare in South Africa under the microscope, Covid-19 has exposed many weaknesses inherent in the country's fractured socio-economic environment. Yet, even before the pandemic reached our shores, equitable access to healthcare posed a significant obstacle for South Africa - a side effect of a tumultuous past.
Access and affordability: South African launch of critical medications drives equitable access

With the advent of the Covid-19 pandemic, existing challenges have been further exacerbated. South Africans are grappling to access critical medication at a price that they can afford, as the impact of the pandemic and its resulting economic consequences start to bite.

It is within this context that leading pharmaceutical company Cipla has recently introduced a range of treatments in South Africa, with an overarching view of helping to address issues of access, affordability and holistic patient care. Our efforts span four spheres of healthcare: immunotherapy; biosimilars; a tetanus vaccine; and a medicine for people living with HIV (PLHIV) to prevent developing tuberculosis (TB).

Reducing the TB disease burden

TB continues to be the single largest contributor to death in South Africa, with 58,000 TB-related deaths in 2019 - an estimated 36,000 of which were HIV positive. Two of the biggest issues in reducing these figures are access to medicine and adherence to a medication schedule.

The solution, we believe, may lie in a drug called cotrizid, which is now available from Cipla. Cotrizid is taken to prevent TB (prophylaxis) and other opportunistic infections that my occur in people living with HIV. The South African Health Products Regulatory Authority (SAHPRA) recently approved this innovative fixed-dose combination medicine, which combines sulfamethoxazole, trimethoprim, isoniazid and pyridoxine (vitamin B6) into a single tablet.

The significance of this is that it increases treatment compliance, as patients only need to take one pill - rather than a cocktail of tablets, as was previously the case. In recent trials, cotrizid has shown notable efficacy in preventing TB, particularly during the crucial early months of HIV treatment, when patients' CD4 count is low and their risk of infection is highest .

As CEO of Cipla South Africa, I believe that access to medication is not just about price, but also about helping to reduce the pill burden to help improve patient compliance. We're pleased this inexpensive product can now be made available locally, given the prevalence of HIV and TB in the country.

Cheaper immunotherapy

Good news in the realm of blood cancer treatment, is that Cipla recently received regulatory approval for lenalidomide, a medication used to treat multiple myeloma (MM) and myelodysplastic syndromes (MDS). It is a lifesaving immunomodulatory drug that activates and increases the number of immune system cells that identify and attack cancer cells .

Previously, the cost of this essential drug has been prohibitive in South Africa, ranging between R60,000 to more than R100,000 per month. Many medical aids did not cover the cost in full, leaving patients to pay out-of-pocket, making the medication entirely unaffordable for many. One of the saddest facts revealed in our research is that family members of patients would often travel to India to purchase the same medication, because it was available at a fraction of the cost compared to South Africa. Now, Cipla is proud to offer this treatment locally in South Africa at an average of 75% less than the current price of the originator.

About 20 years ago, Cipla brought down the price of antiretrovirals. In the same way that Cipla pioneered access to affordable medication for HIV, we hope that by ensuring affordable access to this critical cancer medication, we make an equally profound difference in patients' lives.

A new partnership in biosimilars

Further, Cipla South Africa has entered into an exclusive partnership with innovative biopharmaceutical company Alvotech, to bring key biosimilars to the country. Two biosimilars for oncology and three for treating auto-immune diseases will now be available from Cipla South Africa, as part of our efforts to broaden the range of medical options available.

Biologics, or biological products, are medicines made from living organisms through highly complex manufacturing processes and have revolutionised the treatment of both life-threatening and chronic diseases, such as cancer; rheumatoid arthritis; inflammatory bowel disease; diabetes and cardiovascular diseases. In contrast, a biosimilar is a biologic that is highly similar - but not identical - to another biologic medicine (known as a reference product). They work as well as the original drug and are used the same way, for the same condition.

Due to the complex production processes, the cost of biologics is often higher than chemical drugs. But, in the long term, biosimilars will help to reduce the cost of medication in the same way that generics do - making them a key priority area for Cipla.

Tetanus vaccination

In partnership with the Serum Institute of India (SII), Cipla has also launched a tetanus toxoid vaccine into the country that can be used for the prevention of the infection in infants, children and adults. Our partnership with SII means Cipla can play a meaningful role in addressing the issue of vaccine shortages in South Africa, and we hope to continue doing more.

Tetanus is a serious bacterial infection that causes painful muscle spasms and can lead to death. It is a potentially fatal infection that affects the nerves, and our vaccine can easily prevent the infection, for which there is no cure. Cipla's new tetanus toxoid vaccine will be distributed to hospitals and clinics in 5ml vials, which deliver 10 doses each, and last for up to 28 days once opened.

But, more recently, Cipla realised that we can - and should - play an even bigger role in healthcare in South Africa. To this end, we have joined forces with the Department of Health and the United States Agency for International Development (a co-funder of the project), to contribute to the Central Chronic Medicines Dispensing and Distribution programme.

Sha'p left, as the project is called, is a collection of 42 mobile units where patients can pick up their antiretrovirals and other chronic medication, in their communities. As a result, patients won't have to travel far and/or take a day off from work each month to access the medicines they need, making a welcome difference to many people.

In the context of Covid-19, it is easy to forget where South Africa's real battle lies: we must not lose sight of the fact that HIV, TB and cancer still present a significant number of fatalities. We cannot forget this, even amidst a global pandemic.

When prices are high, we strive to drive them down, increasing access. When prices are low, our focus shifts to one of compliance. Cipla sees a future in South Africa where good health is expected - not for the few, but for the many. I look forward to working harder to help realise this vision.

2 Feb 2021 08:40


About the author

Paul Miller is the CEO of Cipla South Africa