The world-class team leading South Africa’s battle against Covid-19

Twenty years ago almost to the day, scientists in South Africa were waging war, not against a rogue flu virus, but against those who were bent on denying lifesaving treatment to thousands of desperately ill people who had contracted the human immunodeficiency virus — HIV.

It was a war that drove committed scientists, doctors, legal activists and ordinary people to the edge of despair. But it was a war they had to win at all costs, even if it meant humiliation, castigation, widespread public protest, smuggling of drugs to save lives, jail time if need be. It was seen by many as a never-ending dance of death by powerful heads of state that threatened to extinguish a large slice of creation.

It involved bizarre diets of garlic and beetroot, midnight dallying on the internet with dissident scientists, a network of obfuscation and confusion that made a mockery of effective government and the concept of life-saving responses.

Fast forward 20 years to the Covid-19 pandemic and South Africa’s strident and swift response to the threat of disease is like chalk and cheese, one of the world’s most decisive responses to date.

One has to postulate that part and parcel of South Africa’s co-ordinated Covid-19 response has been dictated by the lessons learnt so many years ago when stalling tactics of immense and far-reaching proportions cost lives, millions of lives.

This article looks at some of those trailblazers, the men, women and children who fought to uphold the pillars of social justice and whose voices still resonate with a powerful resolve in the face of the current pandemic.

At the forefront is Health Minister Dr Zweli Mkhize who at the time of the HIV explosion had the unenviable task of negotiating an effective life-saving strategy in the face of government antipathy. It was the same minister, then the KwaZulu-Natal Minister of Health, who made a dramatic AIDS pledge to roll out an antiretroviral programme at the 14th AIDS Conference in Durban in the face of strong dissidence. 

At the time he said in his quiet understated way that it had to be placed on record that it was no longer an ideological issue.

Not surprising then that chairing his Covid-19 team of more than 50 expert advisers is his longstanding medical compatriot, Salim Abdool Karim, a clinical infectious diseases epidemiologist, considered one of the world leaders in HIV research. Like so many other scientists caught up in the “garlic and beetroot” era, Abdool Karim had to go the extra mile to concretise the idea that the rolling out of scientifically proven treatment and coming up with workable prevention strategies were the only solutions to avoiding a global catastrophe.

The word “traitor” still rings in his ears when he remembers the first World AIDS Conference in Durban and the accusations levelled at him by the then health minister Manto Tshabalala Msimang.

As the founder of the Centre for AIDS Programme of Research in South Africa (Caprisa) his expertise will include treatment and testing strategies for poorer vulnerable communities where resources are limited and the risk of infection is high.

His committee includes many of the top South African scientists and clinicians who are well-versed in how viruses spread and the challenges the country faces in the weeks and months ahead.

Top priority will be how individuals, families, communities and a nation work to slow the spread of the coronavirus.

Says Abdool Karim: “We have a multidisciplinary team on board, which includes public health practitioners, epidemiologists, clinicians and mathematical modellers.”

The committee, he explains, will be relying on the Chinese experience and is trying to avoid the pattern followed in Italy, where many deaths occurred. 

Covid-19, like HIV, has no cure and no vaccine. It is an area of science that Glenda Gray, paediatrician, HIV researcher and president of the South African Medical Research Council is acutely familiar with. As a key research adviser to the government, she will be facilitating funding to researchers so that they can increase surveillance of Covid-19 in hospitals and health settings in South Africa.

Given South Africa’s burden of HIV/AIDS and TB, the evaluation of the impact that HIV and TB have on coronavirus infection is, in her words, “absolutely critical”.

Gray was also one of the HIV warriors prepared to take on both the disease and its deniers.

When treatment is not forthcoming to save lives, social activism is at its height. No one knows this better than Mark Heywood and Zachie Achmat, whose protest mechanisms developed within the framework of the Treatment Action Campaign, became a global benchmark for community activism.

While no such intervention was needed in the current situation, it demonstrated the fact that communities, rich and poor, rise up when human rights are infringed.

Let’s now look at other originators of change beginning with one of the youngest activists, 11-year-old Nkosi Johnson, who on the eve of the first World AIDS conference in Durban made his heartfelt plea on a park bench outside the International Conference Centre, to give antiretroviral drugs to pregnant mothers to stop children like him getting the virus.

“I still have a lot of work to do to make people listen,” he said shortly before making his voice heard on the international stage. “I hope many years from now people will remember that you need to work quickly to save lives.”

The feisty campaigner died several months later.

Last week scientist and friend Gita Ramjee lost her life to the coronavirus after attending a conference in London.

She had an almost bulldog determination to see science taken out of its neat cubbyholes and put into meaningful action. Large-scale international clinical trials were her forté, her passion and her life’s work — in the case of HIV, looking for effective and affordable ways to protect women from contracting HIV. It will no doubt be the same type of methodology that will be used again to produce effective treatments and vaccines for the coronavirus in order to stop its present and future spread.

Ultimately, given the many, many unknowns, only time will tell whether all the interventions are correct.

The best we can state for now, say scientists, is that the decisions made and which are still being made, are the most sensible, based on what is currently known.

In other words, the Covid-19 response won’t be a walk in the park. Things won’t always go to plan. There will be shortcomings and shortfalls. There will be political infighting.

But in the end, as humanity emerges from this tunnel of darkness, it will be the lessons learnt on all fronts that will count. DM

Factfile:

Coronaviruses were identified in the mid-1960s and are known to infect humans and a variety of animals (including birds and mammals). Since 2002, two coronaviruses infecting animals have evolved and caused outbreaks in humans: Sars-CoV and MERS-CoV. In December 2019, a novel coronavirus (2019-nCoV) was first isolated from three patients with pneumonia, connected to the cluster of acute respiratory illness cases from Wuhan, China. Information on the epidemiological and clinical characteristics of the infection caused by 2019-nCoV is accumulating. 

Join Professor Salim Abdool Karim and Mark Heywood on Wednesday at 12:00 as they discuss the Covid-19 Pandemic in a live Daily Maverick webinar. Register here.

Liz Clarke, a former AIDS and health science writer for the Sunday Tribune, is now based in the Western Cape and writes in her private capacity for several publications, focusing on health science, education and technology.