Two veterans of South African healthcare politics and delivery have locked horns over the country’s early, hard COVID-19 lockdown, with the one accusing government of “cynical, contemptuous haste” in ignoring the top scientific caveats when announcing the shutdown, writes Chris Bateman for MedicalBrief.
This as the country counts the lockdown costs in healthcare delivery with government estimates of lives lost to COVID-19 virtually equaling those saved by the global lifesaving learnings the lockdown enabled – 15,641 deaths to date versus an estimated 16,000 lives saved by this December.
Mark Heywood pulls no punches
Mark Heywood is a veteran healthcare activist – think Section27 and the Aids Law Project – who rose to prominence during the Aids denialist years of former President Thabo Mbeki and the late health minister Dr Manto Tshabalala-Msimang. He says South Africa “rushed into lockdown with minimal thought about how to mitigate the implications. There was only one strategy and that was lockdown,” he contends.
Heywood told Medical Brief he was on the multi-stakeholder cyber-call involving the country’s pre-eminent scientists and pivotal stakeholders on 23 March this year when Dr Olive Shisana, the social development advisor in President Cyril Ramaphosa’s office, helped facilitate input.
“Everybody was there, Health Minister Dr Zweli Mkhize, the directors general like Dr Yogan Pillay, and all the top academics and scientists plus civic society stakeholders. It was a very thorough discussion, later summarised by Mkhize. The consensus was yes, lockdown in some fashion is necessary, but you have to do the following: 1,2,3 and 4,” says Heywood.
Yet at midnight that evening, President Cyril Ramaphosa announced that a lockdown would be instituted at midnight on 26 March, just three days later.
“That’s worse than window-dressing. It’s practising a deceit. To go to your best scientists and ask for advice and then hours later announce a far-reaching decision on the very thing you’ve asked for advice about – it’s contemptuous, in my view,” Heywood adds.
Olive Shisana strikes back
Shisana vigorously counters his charge. “Mark is wrong. I did not facilitate. I was invited by Dr Mkhize to speak to the stakeholders from whom his ministerial advisory committee was later drawn. I presented the plan the president had asked us to put together. We’d already spoken to a range of scientists and stakeholders; very knowledgeable people who helped us design it.
“Yes, I facilitated that initial process. The group on the 23 March discussed the plan and shortly afterwards the president announced it.”
However, Shisana adds – somebody from the meeting leaked the plan to the media before Ramaphosa’s announcement that evening. “There was no manoeuvre to do things that were not correct. Mark is so wrong when he says there was nothing done to protect the healthcare system.
“We based our moves on the COVID-19 experience in China, Italy and all over Europe, where they had a massive problem. We worked with our scientists and asked what do we need to do to protect this health system and the people of South Africa? We were also aware of the economic consequences.”
Shisana continues: “We’re not living on an island here, or in cloud-cuckoo land. We adapted the overseas learning to our own situation.
“It was a well thought out, calculated plan. Of course, as we go forward, we learn from new challenges and adapt. The pandemic takes a life of its own and we have to respond to developments on the ground. I actually think we came out better on our health system than we would have without a hard lockdown. It would have been overwhelmed to the point of becoming unusable. We also negotiated with the private sector to share resources.
“We’re not denialists!” she added.