This is the collected version of a series of articles first published on Politicsweb between September 14 and September 21 2007:
Chapter 1: The secret history of the ANC's response to the HIV/AIDS epidemic
The involvement by the ANC of Mbeki in the promotion, protection, and development of Virodene - an ‘African solution' for the African HIV/AIDS epidemic - is one of the most important, but least understood episodes in recent South African history.
The story sprung to prominence in early 1997 after the South African cabinet announced that a possible cure for AIDS had been discovered. It subsequently dropped out of the public consciousness after the Medicines Control Council blocked trials of the drug in South Africa.
A great deal of new information has trickled out over the past few years about how the Virodene developers then went overseas to have the drug tested - first in the United Kingdom and then Tanzania - and who funded them.
In broad terms the ANC's involvement in the financing of the Tanzanian trials has been on the public record since mid-2002. However, over the weekend Fiona Forde reported in the Saturday Star that much of the money for these trials had been directly "sourced from the Presidency" between 2000 and 2001. The article added that "on numerous occasions, money was collected from ‘the Presidency, in the Union Buildings' in briefcases and ‘always in US dollars, and always $100 bills'."
Yesterday, the Treatment Action Campaign called for "a judicial investigation into the activities of the presidency around Virodene." There is as much chance of President Thabo Mbeki allowing this, as there is of him instigating an unfettered investigation into the arms deal.
Even now, with so much material in the public domain, the full significance of the whole Virodene affair seems to escape informed opinion. The main issue is not - as many seem to assume - that procedural short-cuts may have been taken in the testing of the drug in Tanzania. The key question is whether the emotional and financial investment in Virodene by top ANC leaders, contaminated the South African government's response to the HIV/AIDS epidemic.
Between October 1998 and March 2002 - the exact period in which Virodene was being tested - the ANC blocked the provision of anti-retrovirals through the public health care system in South Africa. This action resulted in tens of thousands of newborns unnecessarily contracting HIV from their mothers.
The Virodene affair then goes to the heart of whether Mbeki is fit to serve a third term in office; and why he has little choice but to try and hold onto power.
To understand each part of the story it is necessary to have some sense of the whole. The following series of articles will therefore try and trace the development of Virodene from to its conception in 1995 to 2002 when the definitive scientific verdict was issued on its efficacy.
In reading the following account one should bear in mind that throughout this period the promoters of Virodene remained true believers. The originators of the drug were able to draw into their enterprise the ANC leadership, the National Intelligence Agency (which sought to protect this "national asset"), and also various prominent Western scientists.
I
On October 8 1995 the Sunday Times reported on a discovery by South African scientists which it said, "arguably matches, or even surpasses, the first heart transplant performed by Professor Chris Barnard in 1967". Olga Visser, a cardio-vascular perfusionist at Pretoria's H F Verwoerd Hospital, working under the head of cardio-thoracic surgery, Professor Dirk du Plessis, had supposedly discovered a formula in which donated hearts could be saturated, before being frozen.
"While much testing lies ahead" the article stated, "indications are that the formula will allow for the freezing of a donor heart for years, after which it will be unfrozen, made to beat and save the life of a needy recipient." The article quoted Mrs Visser as stating: "Scientists have for years tried this and got nowhere and here I started and there were no huge setbacks." She added, "It is unbelievable, the concept is perfect. But we still have many months of research and hard work ahead of us before we can perfect it to such an extent that it can be used in human transplants."
In the same month Olga Visser also discovered what she thought were the anti-viral properties of her chemical solution. A later company document described her route to discovery:
"Whilst researching new methods for viable organ preservation...Olga Visser developed a novel cryo protectant solution containing N, N Dimethylformamide (DMF)...with which rat hearts could be treated, cooled to minus 196°C, thawed and returned to full function... During this research and following an extensive [DMF] literature search for cryo patent purposes, she discovered the clinical use of polar compounds, including DMF as possible antiviral agents."
In December that year Visser and her husband, Jacques Siegfried "Zigi" Visser, established a company Cryopreservation Technologies (CPT) to patent and develop these compounds. Nothing would directly come of the discovery of the cryo-protectant qualities of this solution, as other scientists were not able to successfully recreate her experiment.
The news of this discovery did lead to an introduction to the Minister of Health, Nkosazana Zuma. The Visser's brought the possible anti-viral properties of these polar compounds to her attention in early 1996, and in July of that year, they met again to present a proposal to conduct clinical trials on HIV/AIDS patients.
By this stage the research team was composed of Professor du Plessis; Dr. Carl Landauer, also of the University's medical faculty; and, Olga and Zigi Visser.
In their agenda for the meeting they reported that "unofficial clinical trials on informed, consenting patients" had already shown "extremely encouraging results". They suggested that after extensive background research the scene was now set for "official intensive in vivo testing" of the substances.
"Conclusive proof of effectiveness of treatment" could be available with three to six weeks of the commencement of such clinical trials. The document added that the minister's involvement and support was "vital for SA to win the race towards the cure for AIDS" and thereby ensure that "not only the scientific prestige, but also the original idea and patent remain South African".
In mid-January 1997 the researchers requested an urgent meeting with Minister Zuma, to bring her up to date with the results of these trials, to introduce her to some of their patients, and to inform her of their future plans. "The results far exceed what we anticipated" they wrote. Their treatment, they said, was "far superior and effective than any known treatment to date worldwide; It is effective at any stage of infection. (Terminal cases are and have been reversed); Patients have regained heath and picked up as much as 10 kg within one month; Results are fast (within one to two weeks) of starting treatment."
II
Nkosazana Zuma arranged for Deputy President Thabo Mbeki to present the researchers to cabinet. In their presentation, on January 22 1997, the Virodene researchers claimed that they had discovered a possible cure for HIV/AIDS, which they had named ‘Virodene P058'. They made various extravagant claims for the drug saying that: it had "destroyed the virus in a test tube"; when given to humans "appeared to reverse full blown AIDS to HIV positive"; fought "HIV in areas other drugs cannot reach it, such as in the lymph glands and the brain"; had "minimal side effects"; and their findings "could lead to a cure by the turn of the century".
Olga Visser claimed that her solution "destroyed" the virus. "This had never been done before with a chemical which could also be safely administered to people. Medicines developed previously only succeeded in temporarily reducing the virus count."
Two HIV/AIDS patients testified of their remarkable recovery under the treatment. As Mbeki commented in a press conference afterwards, "The AIDS victims described what had happened to them as a result of the treatment. They were in the cabinet room, walking about, perfectly all right. It was a worthy thing to see because the general assumption is that if you get to a particular point with AIDS it really is a matter of time before you die."
At the end of the presentation, the cabinet "stood up in spontaneous applause".
Mbeki said that the government would look favourably on the researchers request for R3.7 million to continue their studies. "It was like a church confessional", Jakes Gerwel, Director General of the Presidency would later comment "The patients said they were dying, they got this treatment, and then they were saved! The thing I will always remember is the pride in South African scientists." Cabinet resolved that government should assist the Virodene researchers in pursuing their research.
The financial attractions for the ANC government of this cure for HIV/AIDS were obvious. The researchers said that their drug would cost between R80 and R160 a month, compared to combination therapy using anti-retroviral drugs which (at the time) cost up to R4000 a month. And as a newspaper report noted, at the time, if the researchers were correct South Africa may have chanced on a cure "that will be worth billions to the country".
Equally importantly Virodene promised to psychologically validate the new ANC government. The day after Virodene was presented to cabinet Olga Visser described it as a "medicine developed in Africa for Africa". Salim Karim, director of HIV prevention and vaccine research for the Medical Research Council, told the Washington Post in 2000 that, "The cabinet...believed the discovery would validate South Africa's black majority in much the same way that Christiaan Barnard's first successful heart transplant in 1968 affirmed apartheid South Africa to the world."
Quarraisha Karim, the first director of South Africa's national AIDS program, was quoted in the same article as saying:
"There was this sense that this drug would be the thing that offset the perception . . . of Africans as substandard and less than capable. All eyes were upon [the ANC] and the expectations were very high and they were really trying to find their feet but they didn't want to exercise caution. This was driven by this need to show the world: 'Yes, Africans can do this. We can do this. Virodene became our redemption.' "
In April 1997 Mbeki proclaimed the dawn of the African renaissance: "Those who have eyes to see, let them see. The African Renaissance is upon us. As we peer through the looking glass darkly, this may not be obvious. But it is upon us."
III
The first Professor Peter Folb, the chairman of the Medicines Control Council (MCC), had heard of Virodene was when a reporter called him and told him about the presentation to cabinet and asked what he thought about this drug. He told the reporter that he knew nothing but would find out, and phoned the MCC secretariat and asked if they knew anything. They said that the research workers had come in one day in 1996 and said they were intending to do a study and they just wanted to let the MCC know. Someone had made a record and a piece of paper had been deposited stating that this was their intention.
In a 2004 interview Folb stated that this was not the normal way they needed to go about getting approval. "They did not get approval. They [later told the MCC that they] got approval from the Minister which was unheard of and illegal."
The MCC immediately called the researchers to a meeting in Pretoria on January 24 1997 at which it was decided that the provision of Virodene would be stopped and the trials suspended until the MCC could carry out a review. The researchers agreed to comply.
After the meeting Folb stated that "the drug will be discontinued and the patients will come off it, until we have reviewed the situation. We need to look at their results and safety, and have a proper review of the whole story". The inquiry would report no later than February 5. Callie Landauer said the suspension of the trial was just a technicality, "They're just going to make sure that all the technical measures that were taken to treat the patients are correct".
Despite the suspension of testing, and the first rumours that drug was in fact DMF - a toxic industrial solvent - the government remained enthusiastic about the potential of Virodene. One anonymous "cabinet insider" told the Mail & Guardian that it would be "better for government to ‘own' the drug so it could be used cheaply and quickly in state hospitals, rather than to allow pharmaceutical companies to develop it overseas for sale at a high price".
At a press conference on her return from a trip to Cuba on February 4, Minister Zuma stated that the researchers should receive government funding "after certain technicalities are dealt with". She explained that "the reason I took them to the cabinet ... was because their research has not only produced exciting results, but also had implications for manufacturing at an affordable price".
Asked whether she gave permission to the researchers to test Virodene on patients - as Zigi Visser had told the press - she said she had encouraged them to continue with their work. "If that qualifies as permission, then I gave it to them." She added that she did not have a duty to keep an eye on scientific procedures, "the researchers know the procedures and it is their duty to adhere to them".
The following day the MCC announced the results of their review and banned any further provision of the drug to patients. In a statement the MCC revealed that the "formula contains a highly toxic industrial solvent which may cause irreversible fatal liver damage".
No further testing of the drug on humans would be allowed until its safety and efficacy was proven. "The serious and unresolved safety issues in the use of Virodene must be sorted out before any further work can be considered and before patients who previously received Virodene may be further exposed to the drug."
IV
A committee comprising officials from the University of Pretoria and the Gauteng health department investigated the conduct of the research and reported at the end of February. According to their report the researchers had proceeded with clinical trials without the requisite permission being obtained from either the Ethics or Research Protocol Committee (ERPC) of the University of Pretoria or the MCC.
The committee found that at the start of the trial the researchers had no specific evidence that would indicate that DMF was either a protease inhibitor or that it would inhibit HIV in a clinical trial. Pre-clinical experiments had been carried out at the end of 1995 at the National Institute of Virology. They had not yielded any results before they were terminated; because the researchers had found articles purportedly showing the anti-viral characteristics of DMF. No animal trials were conducted, and the researchers proceeded straight from there to testing the substance on human subjects.
According to the report the researchers quoted "at least eight literature references" to substantiate their claim that "DMF has proven efficacy as an anti-viral agent". Only one of these articles actually referred to DMF. This particular article found evidence that DMF, "at a concentration of about 9 grams / litre" - a dosage 100 times greater than that proposed in the clinical trial - would partially "inhibit the replication of" but would not kill, the human herpes virus (which is unrelated to HIV).
The report noted that the researchers' confusion about the "antiviral effect of DMF" was based on the mistaken assumption that the substance belongs to a group of HIV protease inhibitors. They appeared to have reached this conclusion on the basis that DMF was similar to "another polar component, dimethylsulfoxide (DMSO), which they claim is a ‘known' protease inhibitor."
In fact DMSO was commonly used as a solvent for protease inhibitors when they were screened for HIV protease activity. DMSO did not inhibit HIV protease activity even at relatively high concentrations (of 10 or 20 gram / litre). It was only at 80 gram/litre that such activity would be inhibited by about 50 percent.
"On the basis of this evidence" the report noted, "the researchers then come to the surprising conclusion that DMF also has anti-protease activity, and they subsequently used it in the clinical trial at a concentration of 0.1 gram / litre, which is still only 1% of the concentration at which DMSO is known NOT to inhibit the HIV protease."
The report noted that DMF was "an industrial solvent" which had been shown to cause liver damage. The toxicological reports cited by the researchers had described the toxicity of DMF "as low when given as a single oral dose". There were several unresolved issues of toxicity when it came to the clinical trial. These included the effect of DMF during long term exposure through a skin patch; and the possible difference in toxicological response in patients with weakened immune systems. The report noted that according to the "best guidelines for the limit of industrial DMF exposure" the occupational exposure limit should not exceed 15mg/m3 over an 8hr period or a total daily exposure of 150mg/day.
The report stated that the amount of DMF exposure considered safe by the research team, had been miscalculated at 100 mg /litre. Moreover, the researchers had not given patients a single dose, but had administered DMF through a skin patch containing approximately 14g of the substance, over a period of eight hours. Even though the DMF concentration in the blood "may never have exceeded 100 mg/ litre at any particular time" the report pointed out "it is obvious that the total accumulated exposure to DMF over an 8 hr period would have exceeded the prescribed 150mg/day occupational exposure safety limit, by far."
The report expressed concern at the lack of toxicological expertise in the research team. The researchers had made basic errors such as miscalculating the starting point for potential liver toxicity at a blood concentration of 500mg/litre when the actual exposure rate was 50mg/m3; and, they had referred to the units of environmental exposure as being the equivalent of mg/litre instead of mg/m3 (mg/1000 litre).
The report stated: "It is very difficult to imagine that experiments, involving such a high level of exposure to a toxic substance under such untested conditions, could ever be considered without the approval from an expert body". The report did note that there "was no obvious evidence of liver damage" in the patients who had enrolled in the trial.
The report was highly critical about the conduct of the Virodene pilot study itself. A valid clinical trial requires the existence of a proper, statistically relevant control group. In a double blind study neither the patients nor those conducting the trial know which patients are receiving the drug being tested, and which are receiving the placebo.
There were numerous problems with the conduct of the Virodene trial. Eleven patients had apparently enrolled, although four had subsequently dropped out. The report questioned the wisdom of Olga Visser providing "emotional support" to the patients "in view of the fact that she is the main stakeholder of the Virodene PO58 patent". There was no control group. Only the first participant had been a referral. Once the dramatic "success" of this first experiment "spread by word of mouth... other HIV-infected people became aware of this and some ‘begged' to receive treatment".
The report noted dryly, "The placebo effect can be expected to have played an important role in a study in which patients were selected in such a non-random manner." It did not however "attempt to analyze the outcome of the trial nor the significance that should or should not be attached to the results that were obtained. Experiments that have been carried out in a secret, non-transparent manner without the benefit of proper controls or peer review do not lend themselves to such analysis."
In a subsequent interview with the South African Medical Journal Professor du Plessis, the most senior member of the team, acknowledged that the Virodene researchers knew "sweet nothing" about medicine research. In July the University of Pretoria disciplinary committee found Du Plessis and Landauer guilty of misconduct for testing the drug on people without following correct procedures. Olga Visser was not subject to the committee as she was not a member of the University.
This damning report should probably have been the end of the whole affair. And it probably would have been, were it not for the fact that the Virodene researchers continued to enjoy high level political support.
Chapter 2: How Mbeki and Nkosazana Zuma allied with the Vissers against the MCC
In early 1997 the Medicines Control Council - which had halted the Virodene trials as soon as it heard about them - was an independent and highly professional body. While Peter Folb was the chairman, the two senior civil servants were Johann Schlebusch, the registrar, and Christel Brückner, his deputy. At this time, it should be remembered, many of the "levers of state" power had yet to be captured by the ANC. Over the course of the year the Virodene researchers would attempt to prevail upon the MCC to allow the human testing of the drug. They were able to persist with these efforts because - as this article will try and document - they enjoyed the support of both Deputy President Thabo Mbeki and Health Minister Nkosazana Zuma.
I
For the medical establishment, it soon became evident that the 1996 pilot study of Virodene had broken all the ethical and scientific rules. Minister Zuma - who was intensely suspicious of that establishment - remained supportive of the Virodene researchers and deeply invested in the whole enterprise. A day after the MCC announced their decision to halt further testing on February 5 1997 Zuma said that she would still support giving the researchers government money to continue with their research. "Any glimmer of hope to get treatment should be encouraged by all of us," she told journalists.
By contrast Folb stated that initial research results had given no indication that Virodene had any effect on the HI virus "We're not in a position to even suggest it is effective" he said. "There is no one in the world who knows if [Virodene] can offer even a glimmer of hope. No patient is going to be exposed to this chemical until we know if it could be acceptable."
Behind the scenes Zigi and Olga Visser continued to lobby Minister Zuma. In early March -after the University of Pretoria and Gauteng Health Department had issued their report - Zigi Visser addressed a letter to Minister Zuma contesting its findings. He also requested permission to provide "mercy treatment" for those in the advanced stages of AIDS; and for those patients who had been on Virodene to continue with this treatment. Behind the scenes they channelled information to Zuma which they though buttressed their case. There is no evidence that this request was granted.
The Virodene researchers were clearly confident of their political support from very early on. On June 10 1997, Zigi Visser wrote to an American businessman that the MCC's rejection of Virodene was of little import:
"MCC approval will be obtained, but this will happen when it happens. Even if it takes the minister to replace the head of the MCC [who] is thought to be unreasonable. We have the president and cabinet support."
In late August Zigi Visser wrote another letter addressed to Zuma which thanked her "for her brave support of this research, which quite possibly will turn out to be the only hope for this pending epidemic."
II
The MCC refused to relax its requirements. In late July it rejected a research protocol from the Virodene promoters. After the decision was announced their press officer, Larry Heidebrecht, warned that the team would resume its clinical trials in another country if the MCC rejected a further submission. In early August the researchers submitted another protocol. The researchers appeared confident that they had finally complied with the MCC's requirements-stating on the submission of their protocol that they foresaw "no further delays for approval".
Behind the scenes Minister Zuma tried to pressure Folb into lifting the ban on Virodene. As Folb stated in a 2004 interview for this author's doctoral research:
"She had been asking me and cajoling me and threatening me. And she was saying that here was a chance to cure AIDS and I - because she kept on refusing to accept that this was a management committee decision [of the MCC] - she was telling me that I was playing God ... That I had no right to stop a cure for AIDS when people were suffering, and so on."
Since she was not making progress she asked Folb to speak to Deputy President Mbeki. "I saw myself" he said "as being brought by the teacher to the headmaster". At the meeting at Mbeki's residence in Cape Town in August Folb explained the scientific reasons for the MCC's decision. At the end of it he thought that Mbeki had been persuaded. He [Mbeki] "expressed himself as having come to the conclusion that I had been entirely reasonable fair minded, objective, scientific. And I thought it was all over."
At the meeting it became clear to Folb that Mbeki was having contact with the Virodene researchers. He offered to meet with him - if Mbeki so wished - in order to clarify and explain the points he had just made. Two weeks later he was summoned to a meeting in Pretoria at the Deputy President's residence at 7 pm on a Friday evening. Folb commented:
"I went to his home and about sixteen to eighteen people came from the investigators including a lawyer, and they came with papers and files as if they were coming to the MCC with their argument and science. And I was amazed at the arrogance, not so much with myself, for I was used to these kind of people, but with Mbeki. They walked around that house as if they owned it."
Both Zuma and Mbeki were present at the meeting. According to Folb Zuma asked if he would please discuss all this again with the MCC at its next meeting and to phone her afterwards, and she would communicate the decision to the Deputy President, who would then be in Switzerland.
In their meeting on September 5 however, the MCC once again rejected the protocol, much to Zuma's distress. The MCC stated that safety issues had not been addressed, efficacy remained unproven, and there were outstanding problems with the dosage, stability, concentration, purity and dependability of the final preparation.
On October 8 1997 Zigi Visser wrote again to Minister Zuma. He noted that "subsequent to our conversation" on September 24 1997 "I have met again with the DP [Deputy President] on the following Sunday September 28 1997 to resolve the MCC rejection. We reached an agreement with the DP...as to strategy and the way forward." He requested a face-to-face meeting as the "contents of the outcome of the meeting cannot be conveyed by fax." Visser also stated that "according to the DP we can not lose two or three weeks on resubmission of protocol, but should go straight to appeal via the Health Minister on the trials. Mercy treatment is self explanatory, and needs no endorsement."
Members of the research team travelled to Europe where they commissioned reports from European specialists in an effort to buttress their position. These were handed on to Zuma and Mbeki as they became available. The Virodene researchers now formally appealed to Minister Zuma to overturn the decision of the MCC.
On October 30 1997 The Star ran an article, seemingly sourced from the minister's office, which stated that the Virodene team had been abroad; found an (unnamed) foreign toxicologist who believed the toxicity levels of the drug were acceptable, and that they had now appealed to the minister herself. Zuma was quoted as stating:
"The people who work with Virodene are adamant they have something they think can work, but until it is tested it will be very difficult to know. Recently, they have been abroad and they now have a report from one international toxicologist who was recommended to them by the MCC, which has disputed [the finding about the toxicity] of the drug. The toxicologist said that, everything being equal, they could go ahead, but monitor [the effect of the drug], which is normal for scientists. That process is still on, but it hinges really on the MCC to give them approval for the research to be done".
In an interview at this time, Mbeki told Die Burger that he thought young Afrikaners were eager to help overcome South Africa's problems. He referred in particular to the Vissers who - whatever the problems with their research - were, he said, amongst the "most exciting people" he'd ever met.
III
Sometime in October the minority shareholders of Cryopreservation Technologies (CPT) - who included the two medical doctors on the team, Dirk Du Plessis and Carl Landauer - became aware of the illicit provision of the drug in South Africa.
Before a meeting of the members of CPT on October 29 1997 Zigi and Olga Visser - who were the majority shareholders - were presented with a series of questions, some of which related to the illegal distribution of Virodene. In question 11 they were asked particulars of: "To whom Virodene was sold and/or given and/or dispensed"; "Where Virodene is manufactured"; and, "Under what authority Virodene is manufactured and/or sold and/or given and/or dispensed to other entities."
At the meeting itself, the Vissers agreed to answer all questions except this one. The reason, they presented, "for not disclosing information under 11 is due to a confidentiality agreement with the Deputy President of South Africa".
Landauer would later tell Rapport newspaper that Zigi Visser had claimed that he got "secret" permission from Mbeki and Zuma to restart testing on humans, but that he did not believe this.
On November 4 Zigi Visser addressed a letter to Mbeki which requested a meeting to discuss various issues around the development of Virodene. These included the issue of indemnity or amnesty in regard to Virodene.
On November 20 it was reported in the press that Virodene was being illegally distributed to AIDS patients, and that the MCC had raided the offices of Olga Visser. According to the statement issued by Folb the following day, the MCC had "received reliable reports of widespread administration to patients with HIV infection and AIDS of Virodene" and that an investigation had been initiated. The statement noted that the provision of Virodene "as a medicine is illegal and unethical" and the MCC had "accordingly, handed the matter to the police for urgent investigation and appropriate action".
IV
In early December - shortly before the MCC were due to meet again to discuss yet another Virodene protocol - Zuma told a media briefing that she wanted the power to overrule the decisions of the MCC so that unregistered drugs could be provided to dying patients. "One day I will have the power to overrule the MCC" she said. "There should be no one on earth, not even the president of the country, with powers to refuse patients the right to use drugs of their choice if it will make a difference to their lives. But in this country surprisingly, the MCC has such powers."
She added that it "breaks my heart to see the number of letters I receive from patients who are dying wanting Virodene to be administered to them. I often cry in my office as I feel powerless. I am, however, convinced that one day I will have an enabling law that will allow me to overrule the MCC."
A few days later her spokesman, Vincent Hlongwane, announced that Minister Zuma was considering introducing legislation that would allow "compassionate" access to unregistered medicines. Hlongwane said Zuma was "not making a case specifically for Virodene", but that her comments should be seen "in context. There are patients who are dying and who strongly believe Virodene can help them. She wants to help people prolong their lives. Her main concern is that we do not have an alternative for these people."
Yet again, despite the heavy political pressure it was being placed under, the MCC turned down the researcher's application to test Virodene on people. The statement issued by the MCC reiterated its previous position: that the "product is made from an industrial solvent with unknown impurities, and is known to be toxic" and there had "been almost no good laboratory data on whether Virodene has any action against the HIV virus".
After the MCC's rejection of the Virodene protocols Zuma signalled her intention to remove certain members of the MCC board, including Prof Folb.
According to Business Day (December 12 1997) "Zuma said regulations to be promulgated next year would change the base of experts outlined in old legislation...and replace those members who had served on the drug regulatory body for more than 10 years". As the article noted this would lead to the removal of Prof Folb, and several other members who had served on the board for longer than that duration.
When asked about Virodene Zuma said she held the "same position as earlier this year", which was "to support every research effort that may give us a glimmer of hope in terms of AIDS. At the moment, no one knows if (Virodene) works." She added that she still supported the "compassionate" use of unapproved drugs, but emphasised that neither she nor the MCC had exercised available legal options in allowing even controlled dispensing of the drug. She denied supporting the earlier "illegal use" of the drug.
V
In early December 1997 the dispute between the different shareholders in CPT broke out into the open when the minority shareholders - including Landauer and Du Plessis - were granted an interim interdict by the Pretoria High court against the trade, dispensing of, or further research on Virodene by the Vissers.
This dispute - and the resultant court documents - would first reveal the extent to which Mbeki and Zuma were intimately involved in the day-to-day affairs of the Virodene researchers.
On Friday December 5 the Visser's were requested to attend a meeting on the Saturday with Mbeki in order to discuss (inter alia) the court application by the University of Pretoria scientists.
The meeting was attended by Mbeki, Minister Zuma, Zigi and Olga Visser, and others. In a subsequent affidavit Zigi Visser stated that Mbeki had made clear, at this meeting, that "the dispute which had arisen between the parties should be resolved as soon as possible". Mbeki gave instructions for Du Plessis and Landauer, the applicants in the court case, to be contacted, and he met with them the following day "for the purposes of resolving the dispute".
The following morning (December 7) Mbeki and Zuma met with both sides. "The purpose of this meeting", Zigi Visser explained, "was once again to ensure that the further development of Virodene was in no way to be jeopardised by the dispute which had arisen between the parties".
However, the meeting ended with the different parties agreeing to consult their legal representatives in order to seek out a resolution to the matter. The result was inconclusive, and no settlement was reached. Zigi Visser phoned Mbeki that evening to report that no progress had been made. Mbeki called him back, and said that he had arranged that Du Plessis would meet them at his residence on early Tuesday morning.
Only Mbeki, Zigi Visser, and Du Plessis would be present, with Mbeki acting as the mediator. According to Zigi Visser's version, the meeting took place and an agreement was reached.
Du Plessis was requested, by Mbeki, to record in his own handwriting the settlement which had been reached between the parties. The document, dated December 10, stated that "the primary goal and function of CPT cc is to further the development of ‘Virodene' to a tested, scientifically validated product for use in the management of HIV/AIDS" and the present "potential [legal] deadlock" had to be "resolved to the extent that the development" of Virodene was "not hindered in any way".
On request, Mbeki would appoint a manager from the public sector, who would have full control of the company for the following three months. At the end of this period the status of the manager would be re-evaluated and possibly extended. The salary of the manager, any staff members appointed by the manager, and the premises used by them, would be paid for by the government.
After the meeting concluded Du Plessis had the document typed and sent Visser and Mbeki copies. At about midday that day the parties' legal representatives met to discuss the agreement. But these proved inconclusive and the next day the proposed settlement was formally rejected. Instead, a neutral and well respected administrator from the private sector, Dr Hugo Snyckers, was appointed.
Mbeki later explained that his concern was (inter alia) that - if the dispute had not been resolved -the company which owned Virodene "could be auctioned to the highest bidder". If this "came to pass, the intellectual property represented by ‘Virodene' could fall into the hands of people who could shut down the research effort or sell ‘Virodene' at unaffordable prices, should it be licensed as efficacious medication."
VI
According to the 1999 Public Protector's report on the matter Folb had been named as a respondent in the case between the different parties in CPT and had received the court documentation as a result. In these documents he saw a reference to a promise made by the Vissers to give the ANC a share in Virodene. A memorandum dated November 11 was headed: "Contracts entered into by M.O.P. Visser & J.S. Visser on behalf of the Corporation (CPT)". This document included the lines: "13.2 Gen. Joshua Nxomalo to get 1% for ANC introductions work; 13.3 The ANC is to receive 6% shares in the CPT to be registered subsidiary pharmaceutical company".
Another line (14.2) stated "we decided to remain with the SA Government until all laws are passed and let the SA government finance the project."
Folb then wrote to Zuma expressing his concern that the ANC, or members of government might be seeking "improper advantage" from the Virodene company, and had "requested the Minister's explicit assurance to the contrary".
Folb's letter resulted in a flurry of correspondence between Zigi Visser, Minister Zuma, and the ANC. Zuma wrote to both CPT and the ANC stating she was unaware of any such proposal. In turn George Chaane, the ANC's Legal Co-ordinator, wrote a letter to Zigi Visser, dated December 10 1997, also denying any knowledge of this matter. "You will perhaps be kind enough to inform this organisation, at your very earliest", the letter stated, "the person or persons from the ANC who you have been dealing with as well as indicate under what authority they purported to deal with you."
In his reply to Minister Zuma (December 11) Zigi Visser denied that any member of the government had been promised a shareholding in Virodene. "The description ‘ANC' was the wrong choice of phrase and RDP might have been more accurate in this instance, however not complete...The people under consideration for the future allocation of these shares ... generally happen to be members of the ANC by political alliance, but not members of government." He sent an almost identical letter to Chaane on the same day.
On December 12 Visser sent a follow up letter to Chaane stating that the purported share allocation to these ANC individuals "was done without their knowledge or consent". In addition, "I hereby confirm that the ANC has had no dealings whatsoever with me nor my companies or businesses; that the ANC aligned people referred to in my fax, held no mandate from the ANC and were never asked to produce any."
VII
In early January Callie Landauer said, at a meeting of CPT, that he had sent a letter to Minister Zuma and Deputy President Mbeki requesting a meeting for Dr. Snyckers. Snyckers subsequently met with Mbeki and Zuma and reported back to members of CPT. According to the minutes of a meeting on January 26 he said that "both continue to be supportive but we must do things properly (MCC). Their concern is to ensure an affordable supply of the treatment for Southern Africa." He added that he could approach Dr Zuma "if further assistance is required". At a meeting of CPT in February Dr. Snyckers distributed notes of a meeting he had held with Zuma in Cape Town. He asked the members of CPT whether "they had wanted him to ask the Minister to overrule the Council" but, according to the minutes, Landauer had said that this was not their intention.
Chapter 3: How the MCC was eventually taken out; and why Virodene was nonetheless still banned in SA
The previous article documented how between February 1997 and January 1998 there had been a on-going struggle between the Virodene researchers - backed by Health Minister Nkosazana Zuma and Deputy President Thabo Mbeki - and the Medicines Control Council, headed by Peter Folb. The MCC had refused to allow the testing of Virodene on humans, and it had also called in the police when it discovered that the substance was being illegally distributed. The Virodene promoters had, in turn, upped the political pressure on the MCC; all the while trying to work out a way of breaking its resistance. This long running battle eventually reached crisis point in March 1998.
I
The degree of the involvement of Mbeki and Minister Zuma in the affairs of Virodene, was exposed by Mike Ellis, a Democratic Party MP, on March 2 1998. On that day he called a press conference in parliament in which he publicised the court papers which had flowed out of the dispute between the minority and majority shareholders in Cryopreservation Technologies (CPT).
In particular, he pointed to the memorandum which suggested that the ANC had been promised a six percent share in Virodene. This, Ellis said, showed that there were "very strong grounds for suspecting" that various interventions "by senior members of the Cabinet" in Virodene "were made to advance the financial interests of the ANC".
Ellis said he was writing to the Public Protector, Selby Baqwa, to ask him to investigate whether the ANC had a financial interest in Virodene. He also requested that he look into Mbeki's and Minister Zuma's efforts to promote the drug; as well as their involvement in the affairs of Cryopreservation Technologies.
The ANC's response was threefold: Firstly, they categorically denied any financial interest in the development of Virodene. In an interview with Rapport however Carl Landauer said that he believed the Vissers had promised the ANC a six percent share.
Secondly, the ANC defended their promotion of Virodene as a cure for AIDS. While denying any financial interest the ANC insisted that they would "continue to encourage research into the development of an anti-AIDS drug in the context of the global fight against the AIDS epidemic. It will be unfortunate if it were to be found that those opposing further research into the Virodene P058 AIDS Drug are in fact motivated by opposing interests rather than the welfare of AIDS victims."
And, thirdly, they went on the offensive against both the DP and the MCC. Zuma told a reporter from The Star that the DP did not care for the majority of South Africans but "for the few that they represent". "The DP hates ANC supporters. If they had it their way we would all die of AIDS". Mbeki meanwhile claimed that "The DP cannot hide its pathological hatred of the ANC. Let us, however, not be deflected by activities of those who have no interest in the welfare of our people."
The National Working Committee of the ANC, meeting on March 3 1998, discussed the matter and released a statement accusing the DP of holding the "ANC and the masses it leads in utter contempt". "Unlike the DP, when the ANC pursues the needs of the sick and the vulnerable, it is driven not by interests of pecuniary gain, but because it cares." It accused Ellis of consistently pursuing "the interests of pharmaceutical monopolies and other forces opposed to health policies and programmes of the government."
On March 5, the ANC produced the letters between Zuma, the ANC, and the Vissers - produced in December the previous year - which, it claimed, proved that the alleged share allocation "did not in fact exist. Neither was the ANC aware of such a shareholding nor did it consent to it." It accused the DP of hoping to "frustrate further research into the development of an anti-AIDS drug as it does with all measures aimed at social transformation":
"The ANC will not allow itself to be diverted from its mission of creating a better life for all. As a consequence, the ANC will continue to encourage further research into the development of an anti-AIDS drug to address the plight of AIDS victims primarily because the ANC Cares! In this regard, we call on the MCC to expedite the process that will allow for clinical tests to be conducted on Virodene to determine once and for all the efficacy of the drug against the AIDS epidemic."
II
The ANC proceeded to up the pressure on the MCC. On Friday March 6 ANC Secretary General, Kgalema Motlanthe, held a press conference, where he accused the MCC of having ulterior motives in banning tests on Virodene and implied that it was doing the bidding of pharmaceutical manufacturers. "The rationale of the MCC should be questioned" he stated, "I surmise that the council is driven by other interests than concern for proper control of medicines".
He said the rejection of the Virodene protocols should be seen in the context of rival pharmaceutical companies jockeying for position. "We can only surmise that perhaps there is more at stake than meets the eye. This is a highly contested terrain." When asked why the ANC had such an interest in Virodene he replied: "Because this is a major issue-it confronts the entire humanity. If society is on the brink of a major breakthrough on the scourge of AIDS, [it is wrong] if there is no will and readiness to bring this work to a conclusion."
Motlanthe said decent researchers were being "hounded like criminals" and accused the MCC of "playing god". "Given the devastating effects of AIDS the research must be brought to its logical conclusions", he stated. Motlanthe also dismissed the view that Virodene was toxic as "any medicine had side-effects".
The following day an article by Thabo Mbeki, entitled "The War on Virodene" was sent to all the Sunday newspapers in the country. In the article Mbeki denied the ANC had any financial interest in the drug, but launched a passionate defence of the Virodene researchers, and his government's involvement.
"The Virodene researchers themselves have had unbounded contumely heaped upon them. As expected, the Minister of Health has not been spared the poisoned barbs. On top of all that, researchers been subjected to a provocation by a person who falsely claimed to have fallen seriously ill as a result of being treated with Virodene. Hot on the heels of this fraud, night raids directed at some of the researchers were carried out by investigators in search of information about alleged criminal behaviour. Shots have been fired at one of the researchers by unknown gunmen, leading to the need to provide armed protection. How alien all these goings-on seem to be the pursuits of medical research! In our strange world, those who seek the good for all humanity have become the villains of our time!"
The great sand storms generated by all these vexatious proceedings have served to obscure the fact that what confronts us all is the pressing crisis of an escalating pandemic of HIV/AIDS. Two thirds of those affected world-wide are in Sub-Saharan Africa, including a 2 800 000 strong South African contingent. Often I have wondered whether those who have generated sand storms with the greatest enthusiasm, did not, in fact, seek to achieve precisely this result!"
Mbeki then quoted supportive statements by the various foreign scientists, who had been approached by the Virodene researchers. "Alas", he continued, "the MCC, still refuses to accept the application [for clinical trials], despite its knowledge of the unanimous opinion" of these scientists. Mbeki then launched into an attack on the MCC:
"To confirm its determined stance against Virodene, and contrary to previous practice, the MCC has, with powers to decide who shall live or die, also denied dying AIDS sufferers the possibility of ‘mercy treatment' to which they are morally entitled. I and many others will not rest until the efficacy or otherwise of Virodene is established scientifically. If nothing else, all those infected by HIV/AIDS need to know as a matter of urgency. The cruel games of those who do not care should not be allowed to set the national agenda."
In his response Folb stated that the MCC had solicited more than seven independent reports both locally and internationally that unanimously backed their decision not to allow human experiments. "The MCC has never agreed to the use of Virodene in human trials and will not do so until the basic requirements are met". "This in no sense precludes ongoing research and experiments", Folb added, "though not on humans, and I want to reassure people, the government and the cabinet that the MCC has continued to discharge its duty in the interests of public health and with no other purpose in mind."
III
On March 24 1998 Peter Folb was removed as chairman of the MCC. Johann Schlebusch, the registrar, and Christel Brückner, his deputy, were summoned - one after the other - to the office of the Director-General, Olive Shisana. They were presented with two choices: they could either sign a letter of resignation - and receive a severance package - or they would be suspended immediately and charged with misconduct. Schlebusch was then escorted to his office. He was required to surrender his office keys and entry card, his computer and cellphone. He was only allowed to take his briefcase. The same happened to Brückner. The locks to their offices were changed, and guards were placed outside Schlebusch's secretary's office. Staff at the MCC were instructed not to make contact with them.
On Friday March 27 it was first reported, in the press, that these officials had been removed from their positions and barred from their offices. Folb told the Mail & Guardian that the MCC had effectively ceased to function and that "As far as has been explained to me, the operation of the MCC does cease forthwith." A departmental spokeswoman, Gonda Perez, denied that anybody had been locked out of MCC offices.
The Sunday newspapers reported that Zuma planned to announce the replacement of the MCC with a new regulatory body on the Monday. However, she was unable to do so as she did not have the legal power to disestablish the body. She said however that she supported the broad recommendations made by a review committee established in January, which had reported on March 24, and proposed a new drug regulatory body. She confirmed the reports that Schlebusch and Brückner were currently on leave. Zuma was quoted in newspaper reports as saying: "Its formation [the MCC] in the 1960s was not meant to be for eternity"; and that, "They [Schlebusch and Brückner] will not be in the jobs they [were] in, that is for sure."
What gave the Ministry the political cover to pursue such action was that Zuma had acted upon the recommendations of, what was described as, an "independent review committee". For instance, an editorial in the Financial Mail commented, "Though there is a need for cautionary statements, it should in fairness be noted that Zuma is acting in accordance with the recommendations of a review committee made up of international and local experts on the control of medicines."
The allegations made by the Committee on the alleged malfunctioning of the MCC were also extensively reported on in the press. Schlebusch was replaced by Precious Matsoso, a political appointee close to the Minister. At the end of April Helen Rees, another political appointee, was appointed as the new chairman of the MCC. Rees said that the axing of Folb as head of the MCC had nothing to do with his disagreements with the government over Virodene. "An independent committee was set up to examine the role of the MCC long before the controversy over Virodene broke out. That committee was chaired by experts recommended by Professor Folb."
The review committee had been established by Minister Zuma in January 1998. Although much was made of its ‘independence' it was not particularly independent in composition, nor did it display much independence in the manner in which it conducted its inquiry. The Commission was composed of two outside experts, Prof Graham Dukes, Emeritus Professor of Drug Policy Studies at the University of Groningen (The Netherlands), the only person whom Folb had recommended, and Dr Suzanne Hill, a Research Academic in Clinical Pharmacology at the University of Newcastle, Australia.
In addition, the team was composed of five locals - four of whom held line functions in the ministry of Health. The fifth was an advisor to the Minister. Folb would later testify that Dukes and Hill had made clear to him at the start of the inquiry that they were going for a "consensus" report and that they planned to call for his removal, as well as the removal of the registrar and deputy-registrar because they were part of the "old-guard".
The committee submitted two reports: a public one calling for the immediate suspension of the MCC and its replacement by another body (a recommendation that could not be implemented as it was ultra vires) and a secret report calling for the purging of the MCC's top officials.
The allegations made by the Review Committee against these individuals, and the MCC as a whole, were later examined at length during an arbitration at the Commission for Conciliation, Mediation, and Arbitration (CCMA), between the Department of Health and the Public Servants Association, representing Schlebusch and Brückner. The CCMA Commissioner found that the allegations made against the MCC by the Review Committee were without substance.
Furthermore, the departure of these officials had led to a collapse of the proper functioning of the MCC-a year after their removal the backlog in drug registration had quadrupled from between 400 to 800 to around 2600. "Schlebusch and Brückner had been unceremoniously removed from office," he wrote, "escorted from the premises and treated like criminals. In addition, no convincing operational reasons for this action have been shown."
The tribunal noted that the department "should have known from the outset that its conduct was wrongful and unfair, especially as far as the manner in which it had acted, is concerned. Notwithstanding this, it steadfastly refused to reinstate the applicants in their former positions." (The CCMA report can be accessed here.)
Despite this ruling the department continued to refuse to reinstate the two officials. The department took the matter on review - although it had no reasonable prospect of success - in an effort to delay their reinstatement. The application for review was duly dismissed by the Labour Court in August 2001. Schlebusch was then given his office back, but not his former duties. He was eventually prevailed upon to accept a severance package.
Although Brückner was eventually given back her office and her title, she was not given back her responsibilities. A new post of director of medicines registration had simply been created above her. She had applied for the position but one of her juniors was appointed over her. Nine-and-a-half years after her illegal sacking - and against numerous judicial rulings - she still has not been given back her responsibilities.
The whole breakdown of proper medicines control in South Africa - manifested today in all the bogus AIDS treatments currently n the market - can be directly traced back to the destruction of the MCC as an institution in early 1998.
IV
The Virodene researchers had clearly hoped that the new chairman of the MCC, Dr. Helen Rees, would be more sympathetic to their cause. Rees took a less combative stance in public. But, when it came to allowing the testing of the drug, she turned out to be, as one of the Virodene promoters put it, "worse than Peter Folb."
The basic problem facing the Virodene researchers - even as they began to address the MCC's concerns about toxicity - was that they were unable to produce a plausible description of how their compound acted against HIV. At a meeting between representatives of the MCC and CPT on January 27 1998 the researchers were told that the decision to reject the protocol (at an earlier meeting on January 22) had been unanimous.
Professor Antoine van Gelder - head of the clinical committee which had evaluated the protocol - told the researchers that their protocol "failed to show antiretroviral activity", lacked "efficacy data based on a scientific and ethical study" and lacked evidence for mechanism for the working of the drug. The researchers were also told that in the absence of any evidence that the Virodene actually worked "we find no basis to expose people or animals to this drug".
In 1997 the Virodene researchers commissioned Ana/lysis GmbH, a German company based in Frankfurt, to conduct in-vitro tests on Virodene P058. According to Andreas Immelmann, the researcher on the project, they submitted the compound to "in vitro cell culture and did not find any significant anti-HIV activity. Our conclusion was that this compound has no direct antiviral effect." (Financial Mail April 24 1998)
The only evidence that the researchers could produce for the efficacy of the drug were the results of the ethically and scientifically flawed 1996 pilot study. Although there were compelling reasons to completely disregard the results of the study the MCC decided, in December 1997, to do a "comprehensive review of all the available data on Virodene" to finally bring the matter to a resolution.
The Virodene researchers were requested to provide all original documentation from this study. Through the course of 1998 there was a long running battle between the MCC and the Virodene researchers for a full disclosure of this data.
It was the results of this audit - which was conducted by Van Gelder - which led, in December 1998, to the MCC rejecting clinical trials of Virodene once and for all. The MCC stated that "no acceptable evidence of efficacy on pre-clinical or clinical data was presented during the period 22 January 1997 to 10 December 1998, in which time the Virodene application was under review." Furthermore, "The clinical data that was presented to council to support the investigators' argument for efficacy contained duplications, incorrect figures and omissions". "As Virodene is unregistered, with no proven benefit for the treatment of HIV/AIDS, the use of the product is unlawful." Professor William Makgoba, head of the Medical Research Council (MRC), leant his support to the rejection of Virodene.
V
In January 1999 the Public Protector, Selby Baqwa, reported back to Mike Ellis. In his letter he stated that during the course of a preliminary investigation he could not "find any evidence that the Minister of Health; the Deputy President or any other person performing a public function have had any financial interest in the development of Virodene P058. Both the Minister of Health and the Deputy President became involved in this matter in their capacities as the Minister responsible for the National Health Department and the Chairperson of the Cabinet Committee on HIV/AIDS respectively."
Baqwa had invited verbal and written comments from the various parties involved, including: the Minister, the Deputy President, and the Medicines Control Council, and from the several different parties connected to the development of Virodene (or their legal representatives). The investigation could only be described as cursory.
He simply accepted the ANC's statements and correspondence at face value, and did not attempt to test their validity. After reiterating the ANC's denials, which had already been made public in March 1998, he announced that there was no need for a full investigation into the matter.
The last word on Virodene was seemingly uttered by Makgoba in September 1999. Presenting the MRC's annual report to parliament, he commented, "Virodene is nonsense. It does not have any scientific integrity".
VI
Despite the purge of the MCC, and decimation of its professional staff - the efforts by the Virodene promoters to have the drug tested in South Africa had been checkmated by Van Gelder's audit in mid-1998. At this point further investigation into the conduct of the Virodene promoters was undoubtedly warranted. Instead, the whole messy affair - embarrassing as it was to the ANC - was swept under the carpet. And so the whole Virodene saga was allowed to slip out of the public consciousness. Yet this was not the end of the affair, or of Minister Zuma's and Thabo Mbeki's involvement in it.
Chapter 4: How the involvement in Virodene led to Thabo Mbeki's AIDS ‘denialism'
It is now generally assumed that the ANC government's prolonged refusal to provide anti-retrovirals through the public health-care system was due to Thabo Mbeki's adherence to the ‘dissident' view of "HIV and AIDS." The problem with this explanation is, firstly, that it mistakes the cart for the horse; and, secondly, that the chronology does not fit. The opposition to AZT predated Mbeki's conversion to AIDS ‘dissidence' by about a year. The following instalment will try and identify the possible motives at play when the decision to block AZT was made. It will also document how Mbeki's involvement in Virodene led into his conversion to AIDS ‘denialism'.
I
In his defence of Virodene on March 7 1998 Deputy President Mbeki had stated that "Neither the ANC nor anyone in its leadership, whether working inside or outside government, has been or will be involved in any financial arrangement related to Virodene."
On May 15 Zigi and Olga Visser sent a fax to Mbeki. It stated that they had had problems raising funds "from investors prior to MCC approval, and now run the risk of having our world patents being abandoned due to lack of investments." They warned that patent fees fell due in late May 1998 which had to be paid if the patents were not to be lost. "Due to the time constraints, and urgency of this matter we request any possible assistance from the Deputy State President, in the form of introductions to possible partners/funders for a joint venture which will be beneficial to all."
Mbeki's response is not recorded. But on June 19 1998 the Mail & Guardian reported that Cryopreservation Technologies was going to be sold to a consortium of mysterious black investors. The article claimed, "The multi-million-rand deal was struck three weeks ago" at the end of May. The consortium which bought CPT was led by Ngengelezi Zaccheus "Zach" Mngomezulu and it included Joshua Nxumalo, who replaced Dr Snyckers as interim manager Both Mngomezulu and Nxumalo had deep ANC backgrounds.
In terms of the deal the patent and intellectual property rights to Virodene were to be bought from CPT for R5 million and would be vested in a company, to be called Virodene Pharmaceutical Holdings (VPH). R4.8 million was to be paid by the consortium, and R200 000 by Quinton van Rooyen, a Namibian investor proposed by the minority shareholders in CPT. The new owners would fund the development of the drug.
The basic structure of the deal was that the existing shareholders in CPT would receive thirty percent of VPH and Van Rooyen ten percent. The remaining sixty percent share was held by a company called UBE Trading which was established in July 1998. Mngomezulu, Nxumalo, and one John Waithaka, only held ten percent shares of this company. The structure of the deal was designed in such a way as to hide the identity of the ultimate owners and investors. There were apparently two further companies above UBE trading with ultimate control exercised, according to one account, by something called the "African United Trust."
On May 26 Waithaka had loaned VPH just under R700 000 for the urgent payment of the patent application fees that had fallen due. Mngomezulu secured the loan with a bond over his house. This money fell due the following year by which time just over R1m was owed. The repayment was recorded in a VPH receipt as "Mngomezulu Cash from TG". The Mail & Guardian later claimed that "TG" was a reference to the treasurer-general of the ANC, Mendi Msimang.
II
Up until March 1998 any real anti-retroviral treatment for HIV/AIDS was simply unaffordable for the South African government. However, in that month Glaxo-Wellcome announced that it was cutting the price of AZT by three-quarters for the developing world. This was after a clinical trial in Thailand revealed that a short course of the drug in the final weeks of pregnancy could reduce the risk of transmission of HIV from mother-to-child by around fifty percent. In July that year Rose Smart, head of the HIV, AIDS and sexually transmitted diseases directorate in the health department, announced that this treatment would be piloted in Gauteng, the Western Cape, and Kwa-Zulu Natal. A "short-course" of AZT would be provided to HIV positive pregnant women at the cost of just over R300 per patient. The projected cost of a nation wide roll-out was R80 million or 0,4% of the national health budget.
By the second half of 1998 Virodene was rapidly fading from public consciousness; and for this reason alone has been discounted in the literature as a possible factor in subsequent government decision-making. In reality, the promoters of the drug had simply taken its development underground and out of the country. Indeed, from their point of view, they were now making rapid progress towards the clinical trials needed to finally prove its efficacy.
In September 1998 Olga Visser and her team approached the health ministry in Botswana with a proposal to carry out a formal clinical trial of Virodene. They claimed that it was a safe and highly effective anti-retroviral agent which would transform the AIDS scene in developing countries if only given the chance.
In that same month Phase I trials of Virodene began at Guy's Drug Research Unit (GDRU) in London. According to a later company brochure a double blind, placebo-controlled study was conducted - on twenty healthy male volunteers (10 of whom received the placebo) - to evaluate "the safety, tolerability and pharmacokinetics of a single dose of Virodene® PO58."
By this time senior ANC leaders had clearly become deeply emotionally and financially invested in the development of Virodene as an African cure for AIDS. This created a massive conflict of interest when it came to assessing ‘rival' AIDS treatments from ‘competing' pharmaceutical companies. This conflict was sharpened by the Virodene promoter's belief that they had already fallen victim to the machinations of the big Western pharmaceutical companies. The MCC had blocked human trials of Virodene, it was believed, only because "other interests" had influenced their decision making. This was what warranted, in their minds, the purge of the MCC in March 1998.
On October 2 1998 it was formally decided by Minister Nkosazana Zuma, along with the various provincial health MECs, not to continue with the piloting of AZT for the prevention of mother-to-child transmission.
The R80m it would have cost to roll out this programme was to be spent instead on an anti-AIDS advertising campaign. This was launched on October 9 1998 by Mbeki in a nationally televised address. At this time Mbeki was not an AIDS 'denialist' as evidenced by the fact that the speech reflected a perfectly standard view of AIDS as a sexually transmitted disease caused by the HI virus. Mbeki stated, for instance, that "HIV spreads mainly through sex" and that "for many years, we have allowed the HI Virus to spread, and at a rate in our country which is one of the fastest in the world. Every single day a further 1 500 people in South Africa get infected. To date, more than 3 million people have been infected." Although the speech acknowledged that "There is still no cure for HIV and AIDS. Nothing can prevent infection except our own behaviour" there was perhaps an obscure reference to Virodene in the line: "We shall work together to support medical institutions to search for a vaccine and a cure." At this launch Minister Zuma announced the decision to put the pilot projects on hold. "It [AZT] is not cost-effective because we don't have the money," she said.
On that same day (October 9) Zigi Visser wrote two letters addressed to Deputy President Mbeki. The one informed him that the Botswana cabinet was on the verge of approving funding for Phase II trials of Virodene in that country. The other reported back on the phase I trials at GDRU. "The study is nearing completion," he wrote, "with excellent results and absolutely no toxicity at proposed levels of doses." He requested Mbeki's "urgent consideration for financial assistance (bridging capital) as this account has to be settled immediately to avoid suspension." The payment asked for from GDRU was for the sum of £95,423.
On Sunday (October 11) the Sunday Times reported as its front page lead Zuma's decision to block the provision of AZT. The headline was "Save our babies, Dr Zuma." The sub-heading was "Decision against drug treatment puts thousands of infants at risk." In the article Carol Paton wrote that "doctors are begging" Zuma to reverse her decision; the consequence of which would be that "200 babies a day will continue to be born with HIV" of whom half could have been saved by AZT.
On Wednesday October 14 GDRU's financial controller, Herman Patel, sent a letter to Zigi Visser acknowledging receipt of the money the previous day (Tuesday 13 October). In subsequent VPH accounts this R1m payment - along with a further R600 000 for patent fees in December - is coded as having come from "No2".
On October 27 the Department of Health released a press statement which reported that "The Inter-Ministerial Committee on AIDS, chaired by Deputy President Mbeki" had endorsed the October 2 1998 decision not to introduce the AZT for the prevention of mother to child transmission at this point in time. It stated that, "A detailed study in South Africa has shown that introduction of [AZT] would cost about R80 million resulting in a further strain on an already limited health budget."
III
This rationalisation, that the introduction of such AZT treatment was unaffordable, made no sense whatsoever. The arithmetic presented by Zuma to the Sunday Times was that thirty out of a hundred babies born to HIV-positive mothers would contract HIV at birth. The provision of a short course of AZT during pregnancy would reduce the number from 30 to 15. "If you take all that into account" Zuma said "and compare it to the benefit you would get from prevention then we really have to deal with prevention". In 1998 22,8% of pregnant women attending government ante-natal clinics were HIV positive. Thus, providing AZT during pregnancy would have reduced the number of HIV positive newborns from 6,8% of the total to 3.4%.
Zuma told the Mail & Guardian (October 16 1998) that while she could understand why a parent or doctor might want a different policy "I have to look at the whole picture. If you have limited resources, you may decide to put your resources into preventing mothers getting infected in the first place."
This reasoning was strongly disputed at the time. As Glenda Gray told Carol Paton "Here's a real way we can prevent transmission and the government is not intervening. They prefer incoherent campaigns instead of things that will really turn the tide against AIDS." She pointed out that "Whatever money you put in [to providing AZT] you get out, in terms of [saving on] the costs of treating HIV-positive babies."
It was also at this time that the final touches were being put on South Africa's multi-billion rand arms deal. On August 31 1998 a cabinet sub-committee, chaired by Deputy President Mbeki, had selected the preferred bidders for each of the strategic defence packages. It was this meeting which selected BAE's Hawk - the "non-costed option" - for the lead-in fighter trainer programme. This was despite the fact that it was twice as expensive as the better Italian alternative. On November 18 1998 the cabinet announced that it was going to be spending R4,7bn on purchasing these 24 Hawk training jets as part of the R29,8bn arms deal.
IV
From mid-November 1998 the Visser's requests for funding were re-directed from Mbeki to Max Maisela-a businessman and political confidante of the deputy president. Maisela was a member of Mbeki's "consultative council" in 1996 before being appointed chairman of the Post Office in 1998.
Between January 1999 and March 2000 approximately six million rand flowed through Maisela to the Virodene developers. Maisela would later tell Rapport that he had simply been a conduit for the money, which was not his or his company's.
Most of this money was spent on protecting the patent rights to Virodene, and on lawyers fees - after the minority-shareholders in VPH brought legal action against the majority shareholders. For some reason the June 1998 deal was never properly consummated, and the R4,8m purchase price was not paid across. However, Zigi Visser did direct his requests for the payment of this sum to Maisela as well.
The Visser's remained in close contact with Minister Zuma. Over the course of early 1999 they kept her informed of developments; providing her with the patent documents, accounts, the structure of the Virodene holding companies, status reports, and the results of the report from the Phase 1 trial at GDRU.
V
In December 1998 the Treatment Action Campaign (TAC) had been founded to campaign for (inter alia) equitable access to anti-retroviral treatment. From early 1999 onwards the government began to come under growing pressure for its strange and stubborn reluctance to provide AZT either for HIV positive pregnant women or as post-exposure prophylaxis for victims of rape. In January 1999 the opposition controlled Western Cape broke ranks with the other provinces and announced that it would go ahead with a pilot project in the township of Khayelitsha.
There was also increasingly critical editorial comment in the newspapers. The Saturday Star commented on January 30 1999 that "The cost of saving the life of the most pathetic, vulnerable human being - a baby - from a grim Aids death is surprisingly small: just R400. Yet Health Minister Dr Nkosazana Zuma doesn't seem prepared to pay it." In May 1999 it was reported that the health ministry was still resisting Glaxo-Wellcome's offer of a reduced price for AZT.
The possible trials of Virodene in Botswana had fallen through sometime in the first half of 1999, after the government there decided not to go ahead with them. For the next several months the Virodene promoters would have to play for time, until some other source of funding came online.
VI
On March 17 1999 Anthony Brink, an advocate from Maritzburg, published an article in the Citizen entitled "AZT a Medicine from Hell". Brink was an adherent of the ‘dissident' scientific view that the link between HIV and AIDS was unproven, and that the anti-retroviral drugs used to treat the disease were toxic.
The article commended Zuma for refusing to allow the provision of AZT to pregnant mothers, stating that while she had defended her decision on purely financial grounds, one day she would be commended for her "great prescient wisdom" in keeping this ‘toxic' drug from "pregnant women and their foetuses". The article also claimed that "several actions for loss of support have been launched against Glaxo-Wellcome in England and the US, arising out of the deaths of family members killed by their doctors' prescriptions of AZT". At the end of the article he listed his email address "for references and elucidation". He also stated that "an exhaustive literature review of the pharmacology of AZT is in press for publication in a special supplement to the medical journal, Current Research and Medical Opinion".
On March 24 1999 Zigi Visser wrote to Nkosazana Zuma enclosing Brink's Citizen article, and alerting her to the pending publication of the journal article. Olga Visser contacted Brink who wrote back to her to say that the review was in press as a 30 000 word special supplement to Current Medical Research and Opinion, April/May issue, and he would send it to her as soon as it was published. On April 27 1999 Zigi Visser wrote to Mbeki:
"As discussed, herewith enclosed is a very important article from the Citizen March 17 1999 page 6...Please note that an exhaustive 30,000 word literature review of the pharmacology of AZT is in press for publication in the April/May edition of "Current Research and Medical Opinion", of which I will obtain a copy for the Deputy President. This completely supports the Honourable Minister of Health's stance on AZT."
On October 21 1999 Zigi Visser sent two batches of documents to, now President, Mbeki. The one was a copy of the US patent for Virodene, which had been granted on August 10 1999. Visser stated: "With great pleasure and pride, I herewith enclose a copy of the granted US patent, which we prosecuted beating all objections raised by the examiners and being granted all claims without exception. This effectively means that we will beat any examining country's objections, since the US is known to be the strictest." The text of this patent gives some indication of why the Virodene promoters were so convinced of the drugs efficacy. It made the following claims about the results of the 1996 pilot study:
"Within the first 14 days of DMF [Virodene] treatment, there was marked improvement in general fatigue and in appetite. All the patients gained weight. Clinical improvement correlated well with disease status as assessed by viral load and CD4+ T cell count. For five out of eight patients, the relative PCR-measured viral load could be fitted to Gompertz curves; this analysis revealed an 88.8% decline in PCR-measured viral load after 42 days of DMF treatment. For seven out of eight patients, the relative CD4+ T cell counts could be fitted to Gompertz curves; this analysis showed a 73.4% increase in CD4+ T cell counts after 42 days of DMF treatment."
The other set of documents included the Current Research and Medical Opinion journal article and a copy of Brink's updated version of his earlier articles, entitled "Debating AZT." Visser noted that Brink "is running a case in which the scientific merits of AZT will be tried in the High Court in Pietermarizburg next March/April [2000], which could hopefully assist in banning AZT in SA." "For your untiring dedication and leadership in the fight against HIV/AIDS and corruption," he concluded, "we thank you." The following week in an address to the National Council of Provinces, on October 28, Mbeki referred to this material to justify the continued refusal to allow for the provision of AZT. He stated that:
"[W]e are confronted with the scourge of HIV-AIDS against which we must leave no stone unturned to save ourselves from the catastrophe which this disease poses. Concerned to respond appropriately to this threat, many in our country have called on the Government to make the drug AZT available in our public health system. Two matters in this regard have been brought to our attention. One of these is that there are legal cases pending in this country, the United Kingdom and the United States against AZT on the basis that this drug is harmful to health.
There also exists a large volume of scientific literature alleging that, among other things, the toxicity of this drug is such that it is in fact a danger to health. These are matters of great concern to the Government as it would be irresponsible for us not to head the dire warnings which medical researchers have been making. I have therefore asked the Minister of Health, as a matter of urgency, to go into all these matters so that, to the extent that is possible, we ourselves, including our country's medical authorities, are certain of where the truth lies."
The MCC was subsequently asked to produce reports on the safety of AZT. The ANC's 1999 Annual Report now complained, "AZT and the call to make it available to everyone seems to dominate the agenda. The ANC says no, and will not be pressurised into this direction, particularly given the unanswered questions regarding the efficacy and toxicity of these drugs" This argument represented a major shift in rationale from government's previous position-that it was simply too expensive.
This October 28 speech only signalled the beginning of Mbeki's conversion to AIDS ‘dissidence' or ‘denialism.' Mbeki himself would later tell Allister Sparks that his introduction to Brink's material was "the first time I became aware of this alternative viewpoint" on AIDS. However, over the following months he proceeded to immerse himself in the ‘dissident' literature on HIV/AIDS.
Chapter 5: How the efficacy of Virodene was finally put to the test, and why the war on anti-retrovirals ended
The previous article documented how Deputy President Thabo Mbeki and Health Minister Nkosazana Zuma put a stop to the provision of AZT treatment in October 1998 - the month after phase 1 trials of Virodene began in London. It also traced how Virodene led to Mbeki's introduction to the "alternative viewpoint" on AIDS. This final instalment concerns the confluence between Mbeki's challenge to the scientific orthodoxy of AIDS between 2000 and 2002 and the culmination of the Virodene project.
I
Thabo Mbeki's descent into AIDS ‘denialism' has been documented at length elsewhere. But, to briefly reiterate the chronology: President Mbeki began seriously exploring the ‘dissident' viewpoint on HIV/AIDS in November 1999 with the help of the journalist Anita Allen. In late January 2000 the president's office contacted David Rasnick, a leading proponent of the ‘dissident' theory on AIDS, and asked him to comment on various aspects of the science of HIV/AIDS.
At the end of February the health department announced that, at Mbeki's instigation, it was putting together an international panel of experts to re-assess various aspects of the science of HIV/AIDS. On May 3 cabinet announced the composition of the thirty member panel, of whom almost half were AIDS ‘dissidents.' Between July and October 2000 Mbeki began openly challenging the causal link between HIV and AIDS. It was only in mid-April 2002 that his government would suddenly relent in its opposition to anti-retroviral drugs.
At the time Mbeki's decision to challenge the science of HIV/AIDS was regarded as utterly inexplicable. An editorial in the Mail & Guardian (March 31 2000) asked, "Why has Mbeki embarked on this stubborn, silent crusade? There are no obvious reasons..." No-one knew then what we know now, namely that the ANC was still deeply involved in the development of Virodene. Even today the implications of that mind-boggling conflict of interest have not been factored into accounts of Mbeki's denialism.
Counter-intuitive though it may seem, Mbeki's long-running involvement in Virodene does help explain his receptivity to AIDS ‘denialism'. The Virodene promoters were clearly looking for reasons to justify their opposition to AZT - until their drug had finally been validated - and this is why they (initially) seized upon Anthony Brink's claims about its toxicity. Moreover, despite the (supposedly) miraculous results of Virodene as an AIDS treatment, the researchers could never show that their drug acted against HIV. This may have awoken Mbeki's doubts about the aetiology of HIV/AIDS.
At a deeper psychological level the decision to block the provision of AZT in October 1998 had - if the scientific establishment was to be believed - already resulted in thousands of newborns (avoidably) receiving the death sentence of HIV infection. The argument that HIV was relatively harmless, and anti-retrovirals poisonous, would have provided an easy answer to already difficult questions of moral responsibility. Lastly, what would have given Mbeki confidence to directly challenge the science of AIDS was the knowledge that the efficacy of Virodene - the African solution - was soon to be proven scientifically.
Coincidentally or not, it was also in November 1999 that the phase 2 trials of Virodene in Tanzania began to be put in motion. In a letter addressed to Max Maisela early that month Zigi Visser stated that there was a chance of trials being conducted in that country, but the protocol needed to be finalised and the laboratories prepared for testing. Visser also mooted the possibility that the renowned scientist, Luc Montagnier, could be brought on board "should the President [Mbeki] agree we use his services." On November 30 1999 he addressed another letter to Maisela dealing with the Tanzanian trials - which would be conducted by the Tanzanian Defence Force. He raised a sensitive issue, which had potential political repercussions, and asked: "Would you please brief the President for his opinion and guidance?"
On March 17 2000 Visser addressed a letter to Maisela informing him that "we have obtained the permission of the Minister of Health in Tanzania to conduct trials on patients with HIV/Aids." The Virodene team would be departing that week for a pre-clinical meeting.
It was really from mid-April 2000 that the serious money started flowing to the Virodene researchers to finance the trials. Over the following year a sum of between R30m to R40m was was spent on "Project V". The Mail & Guardian has previously claimed that it was the ANC who had arranged this funding - money then channelled (mainly) through Max Maisela to Virodene Pharmaceutical Holdings. The ANC Treasurer General, Mendi Msimang - husband of the Minister of Health - was said to have played a lesser role.
Fiona Forde recently revealed that this money was often picked up directly from the presidency; "on numerous occasions, money was collected from ‘the presidency, in the Union Buildings' in briefcases and ‘always in US dollars, and always $100-bills. One source claims to have done ‘the Union Buildings run' three times throughout 2000."
It is not clear where this money originated. But in their account the M&G did claim that - according to their information - the dollar bills had come from Wafic Said, the Saudi-born English businessman with close links to BAe. Said denied that he had personally invested anything in the project.
II
The actual testing of Virodene on humans began in September 2000 and ran until March the following year. It was a double blind, placebo-controlled trial, the purpose of which - a later VPH brochure stated - was to evaluate the "safety, tolerability, pharmacokinetics and efficacy of multiple doses of Virodene PO58 on 64 HIV/AIDS infected male volunteers." The trials were conducted by the Tanzanian military under the supervision of a clinical trial manager at two sites in Dar es Salaam: Lugalo General Military Hospital and Chadibwa Medical Clinic. According to the brochure the former site was selected as the main centre with the latter handling the overflow of patients.
As the trials were winding down the Minister of Health, Manto Tshabalala-Msimang, paid them a visit. The details were outlined in a fax sent to the minister's Cape Town office by Olga Visser on February 27 2001. The fax confirmed "that the main purpose of the visit, will be to inspect the sites where the Phase II Virodene Trials are taking place so that you will be in a position to obtain a clear picture of the progress and furthermore to avail yourself of the success of the Phase II Virodene Trials to date." It added that the minister's office must ensure that the visit "carries both the blessing and approval of the president of the Republic of South Africa and the president of the Republic of Tanzania".
In reply to a subsequent parliamentary question the minister acknowledged that she had visited both trial sites along with her advisor, Mr VR Mabope, and her private secretary, Ms N Zigana. She had been accompanied on her inspection by Zigi and Olga Visser; the purpose of which, she said, was "to evaluate the usefulness of Virodene."
Because the Tanzanian study was double-blinded neither the patients nor the researchers knew who was receiving Virodene and who was receiving the placebo. Olga Visser nonetheless claimed that it had once again performed wonders. On May 6 2001 Luc Montaigner - then in negotiations with the Vissers about performing in-vitro testing of Virodene - composed a draft letter to Maisela in which he reported on a meeting with Olga Visser two days previously. She had told him that half the 64 HIV infected patients in the Tanzanian trial "showed after a 6 week period of weekly applications of Virodene, a ten times drop in viral load in their blood and a significant increase of CD4+ T cells". "Such changes" Montaigner commented, "are generally not observed so quickly with classical antiretroviral therapy".
In another communication Olga Visser claimed that the "preliminary results have proved the safety of the Drug in HIV infected patients and anecdotal evidence of efficacy is indicated, however, we are presently awaiting the unblinding of the study and the completion of the statistical analysis of the study." In September 2001 Zigi Visser told the Mail & Guardian that "Our work is top secret so I can't say much, but large international pharmaceutical companies and elements of the media are afraid of Virodene. We have had excellent results so far..." (It is worth nothing that in an interview with Mark Schoofs of the Wall Street Journal in July 2001 Zigi Visser said he doubted whether "HIV causes AIDS and even whether the disease is transmitted through sex.")
III
In early 2002 the Mbeki-ites were still vehemently opposing the provision of any kind of anti-retroviral treatment by the state. Mbeki's denialist manifesto - Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics: HIV/Aids and the Struggle for the Humanisation of the African - claimed that both Parks Mankahlana and Nkosi Johnson had been killed by the "anti-retroviral drugs" they had consumed. This document had been distributed at a key ANC National Executive Committee held on 15 to 17 of March. The meeting effectively came out in support of Mbeki's opposition to the provision of anti-retrovirals - even if it did not completely side with his ideological justifications. The NEC affirmed government policy on nevirapine, and stated that anti-retrovirals "could not be provided in public health institutions" for either the victims of sexual assault or needle-stick injuries.
In March 1998 Mbeki had promised that he would not rest "until the efficacy or otherwise of Virodene is established scientifically." It was just over four years later - in around late March 2002 - that the promoters of Virodene received the report on the unblinded results of the Phase 2 trial in Tanzania, and the statistical analysis thereof. This revealed that Virodene was no cure for HIV/AIDS. It had no effect on the HI virus, although some marginal improvement in the CD4+ count seems to have been recorded. For those invested in Virodene these results were, quite obviously, a massive disappointment.
On April 17 2002 the cabinet announced an abrupt reversal of its policy towards anti-retroviral drugs. It stated that not only would Nevirapine be provided to all pregnant women (as it had been instructed to do by the courts) but also that anti-retroviral treatment would be made available to rape victims, something Mbeki had vigorously argued against in 2000. Business Day reported on the announcement under the headline: "Government stages a dramatic about-turn on its AIDS policy."
Mbeki would remain an AIDS ‘denialist.' His loyalists in government would remain sullen, suspicious, and obstructive when it came to anti-retroviral drugs; but deeply credulous when it came to the claims of snake-oil and vitamin salesman. But, the conventional war against anti-retrovirals was over, even if the ‘denialists' have persisted with guerrilla actions to this day.
As the saying goes, success has many fathers but failure is an orphan. Following the release of the report on the trials there was an acrimonious falling out among the promoters of Virodene. On May 2 - according to a later article in Rapport - Zigi Visser wrote a letter to President Mbeki asking for "urgent" financial help of R2 million to save Project Virodene. In it he acknowledged receipt of more than $3.5 million over the previous three years. He complained that both Mendi Msimang and Max Maisela were frustrating his efforts. "Our situation is critical and our loans have not been paid for the past three months". He asked if he could "sell the company because without support I cannot go ahead?"
In June Zigi Visser told the Mail & Guardian that he had no sympathy for Maisela, "he's a total cabbage." The newspaper reported that Visser still refused to identify the identities of the paymasters of the trials. He told them, "If at the end of the day the drug succeeds and Bill gates says he funded it, he's a hero. If it does not succeed, he looks silly. That's the problem."
In July 2002 it was reported that Olga Visser had withdrawn from the enterprise. In December she ceded all her rights in the various Virodene companies to the ANC-linked businessman and part-owner of VPH, Karim Rawjee.
IV
The involvement of the ANC in the Virodene trials in 2000 casts new light on many of the more bizarre statements of the presidency that year. Indeed, Mbeki seems to have often projected his own motives and conduct onto his critics and opponents. In mid-March, for instance, he wrote how he was "taken aback by the determination of many people in our country to sacrifice all intellectual integrity to act as salespersons of the produce of one pharmaceutical company."
In October 2000 the Democratic Alliance offered to provide AZT in the municipalities it controlled after the municipal elections in December. The ANC presidency responded by accusing the DA of treating black people "as guinea pigs" and of conning them "into using dangerous and toxic drugs that are detrimental to their own health." This statement was released a few weeks into the testing of Virodene on black Tanzanian soldiers.
Certain other statements by Mbeki acquire new meaning and significance when placed in this context. In his letter to world leaders (April 3 2000) - written shortly after the go-ahead had been given for the trials in Tanzania - Mbeki promised that, "We will not, ourselves condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV-AIDS."
In late July 2000 Tony Leon famously accused Mbeki of suffering a "near obsession" with finding African solutions to every problem, even if this meant flouting scientific facts about AIDS, in favour of "snake-oil cures and quackery." This touched a nerve. Mbeki responded on August 11 2000 by accusing the "white politician" (Leon) of openly speaking "of his disdain and contempt for African solutions to the challenges that face the peoples of our Continent." Little did Leon know that trials of Virodene - the "snake-oil cure" he was referring to - were due to start the following month.
V
To conclude, throughout the period in which the government was depriving South Africans of any access to life-saving anti-retroviral treatment through the public health-care system, senior figures in the ANC were secretly involved in the development of an alternative cure for AIDS. There can be no doubt that the decision-makers remained convinced that they had discovered a potential cure right up until 2000 and beyond. Why else secretly channel tens of millions of rands into funding the phase 2 trials of the drug in Tanzania? This means of course that at the time the decision was made not to provide AZT, there was an expectation that a cheaper and more efficacious treatment for AIDS was on the way. The investment in Virodene - whether emotional or financial - also created a deep conflict of interest. It is striking that the government put a stop to the provision of AZT within weeks of the launch of phase 1 trials of Virodene in London; and would only relent shortly after the results of the phase 2 trials proved the substance to be inefficacious.
An article in the Economist recently observed that what the siloviki in Russia "are claiming is a special mission to restore the power of the state, save Russia from disintegration, and frustrate the enemies that might weaken it." Yet such idealistic sentiments "coexist with an opportunistic and cynical eagerness to seize the situation for personal or institutional gain." Similarly, the mission of the Mbeki-ites has been to restore "African dignity," validate the black majority, and finally vanquish the "demon of white racism." But even on AIDS policy one can witness the same strange combination of high ideology and base self-interest.
ENDS
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