Trusting medical experts
Some of South Africa’s most respected and influential scientists have been engaged for weeks in a bitter spat over the government’s vaccine roll-out, or lack thereof. On the one side are academics from the universities of Witwatersrand, Cape Town and KwaZulu-Natal. On the other, the head of the vaccine arm of the advisory committees set up supposedly to provide the best possible scientific advice to shape the national response to the Covid-19 pandemic.
Perhaps because the barbed exchanges have been conducted through editorials and correspondence in the normally sedate pages of the august SA Medical Journal (SAMJ), the matter has gone virtually unremarked upon. That’s unfortunate, because the dispute goes to the heart of the government’s inability to heed expert advice, even when it has solicited it.
Despite the initial assurances of President Cyril Ramaphosa and Health Minister Dr Zweli Mkhize that the process of using science to inform policy would be transparent, it has been anything but. And, as is invariably the case with the ANC government, ideology and ministerial clout were quickly shown to trump rational thinking.
The first scientist to publicly break ranks was Professor Glenda Gray, president of the SA Medical Research Council (MRC). In a media interview she noted that child malnutrition cases had, during the pandemic, increased at Chris Hani Baragwanath Academic Hospital.
This prompted a rebuttal from Mkhize and his health director-general, Dr Anban Pillay, calling Gray a “liar” and demanding that the MRC board investigate her conduct. So much for the cut and thrust of scientific debate.
Although Gray won the battle when the MRC backed her up, she lost the war. Within months, the most outspoken medical scientists on the ministerial advisory committee (MAC), were peremptorily axed in what Mkhize, with Orwellian cynicism, described as a “strengthening” of the committee.
Gray got the chop, as did Professor Shabir Madhi, head of vaccinology at Wits, Professor Francois Venter of Wits, and Dr Angelique Coetzee, chair of the SA Medical Association.
Last month, an SAMJ editorial – co-written by Madhi; Venter; Wits infectious diseases expert Dr Jeremy Nel; Professor Alex van den Heever of the Wits governance school; Professor Mosa Moshabela, dean of nursing and public health at UKZN, and Professor Marc Mendelson, an infectious disease expert at UCT – labelled the reasoning on the AstraZeneca vaccine as “muddled”, “misguided” and raising “deep ethical concerns”.
Professor Barry Schoub, head of the MAC vaccine committee and the government’s medical rottweiler, responded with undisguised anger. In a rebuttal SAMJ editorial, he lashed his impertinent critics for their “loathsome … distasteful, uncalled-for, and damaging” activities in daring to question publicly the health department’s actions. To do so served only one purpose, wrote Schoub. That was to damage “the fragile trust of the public”.
Undaunted, the sceptics responded in this month’s edition of the SAMJ, dismissing Schoub’s response as “a distraction from a bigger problem”. “South Africa’s vaccine strategy is being decided without appropriate levels of transparency, by individuals with a track record of questionable decision-making.”
The to-ing and fro-ing in the SAMJ is not an arcane matter. That Schoub, and by implication Mkhize, believes that the public is so intellectually delicate as to crumble when experts debate the wisdom of policies that affect every South African, is extraordinary.
Just for the record, it’s not a robust debate that makes us feel insecure and distrustful. It’s “experts” who want to take life or death decisions in secret, free from scrutiny.
That Schoub, and by implication Mkhize, believes that the public is so intellectually delicate as to crumble when experts debate the wisdom of policies that affect every South African, is extraordinary.