All the most outspoken medical scientists serving on the South African government's Ministerial Advisory Committee (MAC) on COVID-19 who found themselves at public odds with government actions have been peremptorily axed in what Health Minister Dr Zweli Mkhize describes as a "strengthening" of the committee, writes MedicalBrief.
Among those who on Friday last week received a one-paragraph letter telling them that their services were no longer required were Prof Glenda Gray, CEO of the SA Medical Research Council (SAMRC), Prof Shabhir Madhi, head of vaccinology at the University of the Witwatersrand and leader of SA's first two Covid-19 vaccine in trials, Prof Francois Venter of Wits, and Dr Angelique Coetzee, chair of the SA Medical Association(SAMA).
All, at various stages, have been quoted in the media making assessments that could be construed as critical of government's response to Covid-19, with News24 describing Madhi, Venter and Gray as “leading voices in criticising some of the regulations promulgated by government”. Among the issues with over which there has been vocal disagreement have been the effect of the hard lockdown, the closure of schools, taxi occupancy regulations, and the government's secrecy over the scientific advice they had been given.
At least 14 of the 50 MAC members have been now told their services are no longer required. Mkhize is reported in the Citizen as saying that “the strengthened MAC will still maintain a degree of continuity, retaining many of the experts from the original clinical-biomedical MAC, including the incumbent chair Prof Abdool-Karim, Prof Marc Mendelson, Prof Sthembiso Mkhize, Prof Rudo Mathivha and Prof Nombulelo Magula, amongst others.”
The move came as a surprise. Initially, a fortnight ago, Mkhize announced that the MACs would be “pulling in” social and behavioural scientists because of “the changing pattern of the pandemic”, and that there would be a new MAC established to focus on vaccine development. Nothing was said about the planned removal from the MAC of some of SA's top scientists.
In response to the Mkhize letter, Venter told News24 that it was done “with no warning or explanation … It is not like the epidemic is anywhere over. Government really needs to embrace transparency, and explain jetting in a crowd of WHO experts, an inexplicable curfew, or disbanding an expert panel that didn't rubber stamp decisions made behind closed doors.”
SAMA's Coetzee that while she understood the need to make the MAC smaller and have more involvement of people on the coalface – nursing groups and others – “the letter, arriving as it did out of the blue, was perhaps not the best way to go about the exercise of dissolving the committee”.
“One of the most important things is, if you look at another MAC, that it should be the public sector out there or the private sector advising the minister, and we should maybe have less people working for the [Department of Health] advising the minister,” Coetzee told News24.
It is no secret that Mkhize has been chaffing over MAC advisors differing in public from some of the more controversial aspects of the government's handling of the pandemic. When Gray stepped out of line she faced a broadside from Mkhize and the Health Department.
Gray had, in her personal capacity, in an interview criticised the government’s harsh lockdown regulations as “unscientific” and claimed that childhood malnutrition cases were increasing at Chris Hani Baragwanath Hospital. This prompted a sharp rebuttal from Mkhize and a demand from the then acting Health director general, Dr Anban Pillay, who called her a “liar” and demanded that the MRC board investigate her conduct.
The MRC board initially apologised to the Ministry of Health and the MAC for Gray’s comments, saying it would institute a fact-finding investigation into the “damage” the comments may have caused. The following day MRC board said it had discussed the matter with Gray and found she had not breached any of the MRC’s policies.
The about-turn followed an outcry from public commentators, researchers, academics, and organisations, both locally and abroad. Daily Maverick described the response of the scientific community in backing Gray as “unprecedented”, with more than 300 leading scientists and academics, included deans of faculties, other MAC members, former Unisa vice-chancellor Barney Pityana and University of the Witwatersrand vice-chancellor, Prof Adam Habib, coming out in support of Gray.
In the Citizen report, following media speculation, Mkhize clarifies that the MAC has not been disbanded. “As we find ourselves in an extremely fortunate position of achieving effective transmission control, the true test lies in our ability to maintain low transmission rates. This requires a more holistic approach to case management, preventive measures and public policy.
“It therefore became necessary to strengthen the MAC on Covid-19 so that it falls in line with its mandate to advise on effective mechanisms for the prevention of onward transmission of Covid-19. Recognising that the composition of the current MAC was focused on a biomedical approach, The Minister has taken a decision to augment the existing committee with various other experts from different sectors. Also to influence the behavioural change that is required to mitigate against the spread of Covid-19.
“The reinforced MAC on Covid-19 will consisted of bio-medical practitioners; clinical experts; specialists in ethics; the nursing profession; social scientists; re-searchers; and community leaders who will advise on interventions that should be considered in responding to the epidemic.”
Commenting in in his Editor's Notes in the Financial Mail, Rob Rose writes that the Health minister “ would have you believe it’s just a miraculous coincidence that the three most outspoken scientists happen to have been excluded from the new MAC. It’s a curious move: as an acclaimed HIV/Aids scientist, [Gray’s] not only the president of the MRC, but in 2017 was also named one of Time magazine’s Top 100 most influential people.”
He quotes Gray as saying that her relationship with Mkhize has healed and that she'd “like to believe that excluding me from the new MAC isn’t an act of retribution. Since May, the minister and I have developed a great working relationship, and we even coauthored a scientific paper.”
The FM asked Madhi whether he believed his exclusion was retribution for being so outspoken, to which he responded “I would hope not — it would be very infantile if that were the case. But I take the government at its word, that it believes it is at a different stage of the pandemic, and needed a different set of expertise.”
“Some of us became a political embarrassment for Mkhize, since we didn’t just roll over and praise the government ’s political decisions,” he told the FM. “They expected us to say: ‘Well done on the tobacco ban, well done on the booze ban’, and instead we pointed out how these decisions didn’t stack up scientifically,” he says.
Meanwhile, Business Tech quotes Prof Salim Abdool Karim as saying that if a second wave of infections hits South Africa in the same way it has hit European nations, tighter lockdown restrictions will be back – but this time, it will be on a local level.
He said that the government is currently setting up task teams to handle this type of lockdown, should it become necessary. This would finally see the implementation of the “district model” of lockdown that was announced by the health department in May 2020, when the virus was still building its presence in the country. Under the model, the country is split into 52 different districts, with each being assessed on its infection level.
At the time, districts that were seeing higher than five new infections per 100,000 population were considered COVID-19 hotspots, and were to face tighter restrictions. However, despite the model being developed, it was never put into effect, with many businesses and provincial leaders arguing that it was unworkable due to the integrated nature of many operations. Every move to a different level lockdown has been implemented nationally, since.
Business Tech reports that according to Karim, the government is now better prepared to use the system. He is quoted as saying that the problem with district model before was that it was difficult to police. To determine hotspot areas, the health department will look at more than just infection rates, but will also factor in other things, like the availability of beds, he said.
Daily Maverick quotes Mkhize saying some semblance of calm has since returned to the country, but adds: “At this point it is still very far from being over. The numbers are still very high but we are over the surge. Now is the time to look back and say thank you.”
Mkhize warned that the risk of a resurgence of infections remained. “We are not out of the woods yet but (what we have done) remains a tremendous achievement. “In my own family several people got sick, we have lost some. All of us now know COVID-19 not to be a story on the TV in the media. We know it is a tragedy. It is a tragedy that has hit all of us. All of us have gone through that journey of pain, of anguish, of anxiety,” the minister said.
“There have been huge sacrifices. A lot of businesses have been damaged. A lot of people lost jobs. A lot of people went hungry. That is the cost of COVID-19 on top of those who had to be laid to rest.
“We are entering a new normal. We will have to reconstruct our lives … We saved as many lives as we could. Now we must save livelihoods,” he said.
Deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine Professor Linda- Gail Bekker said she thought a vaccine would likely take another nine to 18 months “if all goes well”. “Perhaps it will be even longer for us to get it here in South Africa. Once it gets here, if it is efficacious and safe I think the uptake will be good. For the next six to 12 months, however, we will still have low level infections occurring throughout South Africa,” she said.
Full News24 report
Full The Citizen report
Full IoL report
Full Financial Mail editorial
Full Business Tech report
Full Daily Maverick report
MedicalBrief archives: MRC drops 'impulsive' and high-handed' investigation into Prof Gray
MedicalBrief archives: Mkhize says changes in pandemic brings changes to MACs