Amid the uncertainty of the early days of the pandemic, Professor Shabir Madhi often stood out for his clarity of thought in making sense of rapidly evolving scientific evidence, writes Biénne Huisman for Spotlight.
He became known to many for leading the charge in two of the first Covid-19 vaccine clinical trials conducted in Africa – for the AstraZeneca and Novavax vaccines. At a time of scientific uncertainty, he was often quoted in the press, gaining a reputation for keeping his cool and calling things as he saw them based on available evidence.
He spoke out against the politicisation of science and was a staunch advocate for access to vaccines, especially for older people at higher risk of severe illness and death.
He wasn’t afraid to ruffle feathers, openly criticising government’s Covid-19 vaccine communication efforts and arguing that it should take vaccines to the people, rather than the other way around.
He called for the ending of strict lockdowns, before many others did.
Reflecting on his reputation for not holding back on his beliefs, he admits to “having a short fuse, especially when people are talking nonsense – or what I consider to be entirely off the mark”.
What may be less obvious to the public, is that Madhi’s healthcare impact precedes Covid by decades.
Internationally respected for his research into paediatric infectious diseases, his work has helped to save the lives of hundreds of thousands of children and informed World Health Organisation policy – notably relating to the pneumococcal conjugate vaccine (to prevent pneumonia and meningitis) and the rotavirus vaccine (to prevent diarrhoeal disease in children).
His work continues. Just last year a landmark study, led in South Africa by Madhi’s Vaccines and Infectious Diseases Analytics Research Unit at the University of the Witwatersrand (Wits), found that immunisation of pregnant women safely protected their unborn babies from respiratory syncytial virus (RSV). As Spotlight reported at the time, researchers estimate the vaccine can save thousands of young lives.
Speaking to Spotlight over Zoom from Wits in Johannesburg, where he is Dean of Health Sciences, Madhi relayed his love of treating children – who “most importantly, don’t lie, and who are the most vulnerable”.
‘Accidental vaccinologist’
Madhi, who has been described as an “accidental vaccinologist”, says he never intended to become a physician, let alone a professor in vaccinology. At medical school at Wits, he nearly dropped out after a month.
Growing up in Lenasia, he wanted to become an engineer. But born to a mathematics teacher father and a stay-at-home mum, money was tight. His only opportunity to attend university presented itself via a bursary in medicine.
“I only really started to enjoy medicine once I specialised in paediatrics,” he said. “But more importantly, that’s when I realised the huge potential that existed in medicine to make a difference, particularly the potential for vaccines to make a big difference over a short period of time – not on an individual level, but at a community level. And that’s what really drove me into the space of research.”
While doing his paediatric training at Chris Hani Baragwanath Academic Hospital (he obtained a master’s degree in paediatrics from Wits in 1998), it struck him that the leading causes of death among children were entirely preventable.
“Back then, close to 750 000 children were dying of measles globally; half of those deaths were happening in Africa, despite the vaccine for measles being available since the 1970s. South Africa was one of the countries with a poor public immunisation programme; up until 1992 it didn’t have a public immunisation programme.”
In 2009, in a first for this continent, pneumococcal and rotavirus vaccines were finally officially rolled out in South Africa.
“While I was training at Baragwanath, there was a ward just for children with gastroenteritis or diarrhoea,” he recalls. “But six months after we introduced the rotavirus vaccine (in 2009), we shut down the diarrhoea ward at Bara and probably every other diarrhoea ward in the country.”
Contributing internationally
Today Madhi’s CV is long. He sits on scores of scientific advisory committees, attending conferences and delivering talks around the world.
Since 2019, he has served on a global panel of experts convened by the WHO, the Strategic Advisory Group of Experts on Immunisation (SAGE), of which he now is deputy chair. He also chairs the SAGE working group on polio.
“I’m really enjoying SAGE at the moment,” he says. “This is where I think I am making a meaningful contribution. It is an eye-opener to the different types of research taking place globally; but also the type of challenges we face in ensuring children are adequately immunised.
“It’s great to be working on new vaccines, coming up with new vaccines; but that’s a meaningless exercise unless you can ensure those are getting into the arms of children – because that is what saves lives. So yes, dealing with issues around implementation and advocacy.”
SAGE requires frequent trips to Geneva, where the WHO is based.
Our discussion turns to the amount of travel required for a researcher to remain “relevant and competitive”. With typical candour, Madhi outlines challenges faced by researchers from the global south.
“I think coming from South Africa, from the African continent, it’s more of a challenge for researchers to establish themselves, for various reasons. First, to become known in the international space, you probably need to deliver so much more than what is expected from our northern hemisphere counterparts.
“Then in addition to the inconvenience of needing to travel so often, there are subtle things with which people in the northern hemisphere don’t have to deal. Needing to get visas and dealing with customs officials when entering countries, for example.
“It can become an extremely unpleasant experience, and you really need to swallow your pride given what is blatant racism at times. For example, nowadays I refuse to fly through Germany because the customs office in Frankfurt is probably the worst I have encountered…”
Local challenges
The discussion turns back to South Africa, and health challenges in his home province of Gauteng. Here he has also tried to make a difference, but it hasn’t been plain sailing.
On a floundered memorandum of agreement (MOA) signed between Wits and the Gauteng Department of Health in June 2022, Madhi says: “The bottom line unfortunately; the Gauteng Department of Health simply doesn’t have stability of leadership. At the level of the MEC in particular; I mean since I’ve been dean, there have been about four or five heads of department. And it becomes difficult to follow through with any of these programmes.”
Madhi adds that Wits executives had worked on the memorandum for seven years. The agreement set out a plan to combine university and government resources in “academic health complexes” for enhanced service delivery. But the Department of Health put it on hold three months later, after a related Public Service Commission inquiry.
“They convened this big workshop, spending probably a mini fortune, to basically facilitate the establishment of an MOA, not just between Wits and the Department of Health, but between the Department of Health and many other academic hospitals in the province.
“Because of the intervention, the Department of Health said it wasn’t going to implement our MOA until that particular commission concluded its work. But since then, there’s been absolutely no report from that meeting.”
Not afraid to speak out
On social media, Madhi speaks out about atrocities being committed in Gaza. He says leadership holds no place for neutrality.
His leadership style, he said, was honed during childhood. “Not being afraid to speak out, it does get me into trouble quite often,” he laughed. “I think that’s just part of my upbringing, being an activist during apartheid in the Lenasia Youth League and other activist organisations. My upbringing was, when things are not what they’re meant to be, you speak out; you champion the right cause.”
These days Madhi lives in Northcliff with his wife and two children. His favourite football team is Arsenal and a book he says he recently enjoyed was The Covenant of Water – a three-generation family account set in India, by physician and author Abraham Verghese.
See more from MedicalBrief archives:
Madhi: Dump global plan to vaccinate 70% against Covid
Madhi lashes DoH and calls for end to State of Disaster
Madhi’s plea to government: Don’t waste the AstraZeneca vaccine