A year ago, on April 19th 2001, the 39 pharmaceutical companies that had attempted to overturn the Medicines and Related Substances Control Amendment Act dropped their lawsuit against the South African government. The disputed law intended to make medicines more affordable through mechanisms including parallel importation, generic substitution and price controls. It was a landmark victory for South Africa, and one that resonated in the whole of the developing world struggling to access much-needed medicines.

The South African court case sparked a number of international developments in the area of global patent rules and pharmaceutical pricing aimed at improving access to life-saving medicines.

The 4th WTO Ministerial Conference in November 2001 in Doha adopted the “Declaration on TRIPS and Public Health”, which affirmed the sovereign right of governments to take measures to protect public health. This declaration is a crucial achievement: it gives primacy to public health over private intellectual property and clarifies WTO Members’ rights to use TRIPS safeguards, in particular the use of compulsory licensing and parallel import to overcome prohibitive drug prices.

The global debate on access to medicines has also encouraged generic and brand name drug companies to offer key medicines at lower prices, bringing treatment within the reach of people in developing countries. Today, the cheapest generic combination therapy offered to developing countries costs a little over 200 USD. Three years ago the price of triple therapy was 15,000 USD.

The leadership of the South African government during the Pretoria court case a year ago was key in opening new windows of opportunity for developing countries to address health needs, in particular in the area of HIV/AIDS.

But in South Africa the celebration of this anniversary will be bittersweet. The South African government still refuses to make ARV treatment available to the people who need it, even now that there are new opportunities to address price barriers.

MSF is committed to supporting developing countries in making access to needed medicines a reality. The MSF AIDS care project in Khayelitsha, Cape Town, has helped demonstrate that it is possible to use antiretroviral therapy (ART) successfully, even in poor South African townships. In clinics opened in 2000, MSF currently treats 110 people with ART, and a total of 2,500 people are treated for opportunistic infections. New prevention and treatment programmes run by NGOs, individual doctors and activist groups are mushrooming in other parts of the country as well.

But as long as the South African government does not face up to its responsibility and start treatment programmes, the majority of the patients will remain untreated – almost five million South Africans currently live with HIV/AIDS.