World-renowned clinical infectious diseases epidemiologist and co-chairperson of the ministerial advisory committee on Covid-19, Professor Salim Abdool Karim, reflects on the milestones and challenges in dealing with the coronavirus.
A YEAR after the identification of the first patient with Covid-19 symptoms in South Africa, and as the country continues to deal with the effects of the pandemic and the more than 50,000 deaths, we spoke to world-renowned clinical infectious diseases epidemiologist and co-chairperson of the ministerial advisory committee on Covid-19, Professor Salim Abdool Karim. The professor reflected on the milestones and challenges in dealing with the virus.
There were many milestones achieved in the fight against the pandemic. What was the first crucial one?
The first was when the president declared the state of disaster and then shortly thereafter declared the lockdown. That was a seminal point in the epidemic because it indicated that we were taking this disease seriously, acting quickly, not wavering or prevaricating but we were acting decisively. We acted bravely because to take that kind of action before the first person even dies, it takes real committed leadership brave enough to stand up and defend their actions. That was so important to me because we haven’t dealt as well with other epidemics, especially HIV. It marked a significant shift in how we as a nation were taking this disease seriously.
What was the approach in communicating the effects of the pandemic?
This started on Easter Monday, April 13, when the president asked me and Minister of Health Zweli Mkhize to take the nation into our confidence and explain what this epidemic was. That was an indication of how science was playing an important role in guiding the epidemic response. There was a very important plan and I presented our eight-stage response in great detail. It also signified, more importantly, that the public should always expect a truthful, transparent and proactive approach to communicating with them because this kind of open communication builds trust and confidence. This approach was critical and it also gave the media an opportunity to fulfil its obligations to educate the public.
How would you describe the effort South Africans have made in the fight against the disease?
The point at which the first results of the vaccine became available was crucial. That changed my mindset. Until we had that information that a vaccine was available, I had serious doubts that we could make a vaccine against coronavirus.
We had never done that before. It indicated to me how the world can pull together, how science can work with communities and a whole range of governments and can achieve great things. I am reminded how we as a country moved mountains during this epidemic and we are so busy self-deprecating that we forget what we achieved. One of these examples was how the Cape Town International Convention Centre was turned into a fully fledged 800-bed hospital with oxygen at every bed.
It takes us years to plan a hospital but we had teams of staff and all of the infrastructure, built in six weeks. That is the power of this nation. We watched how in Wuhan, China, they built a 1,000-bed hospital and we said only the Chinese can do that, but we built one at the ICC. We had 500 patients in there at one stage.
What lessons have we taken from Covid-19 in terms of pandemic preparedness?
The first big challenge was that we, and many other countries, did not have an epidemic response unit in the country. There were no clear lines of who was in charge. In our case, the president took charge, delegated to the minister of health and there was an inter-ministerial committee chaired by the deputy minister and the governance became clear. But normally, you would have an epidemic response unit that is actually in charge of the operational side of the response. On a day-to-day basis, this makes it clear who is in charge.
In Sweden and Canada they have the public health agency. In those cases it is very clear, it is a government employee who is a technical person who knows what to do. We didn’t have one. If we had a person in that position then we would have had an integrated surveillance system, a readily established system through which all the laboratories nationally would feed their data into, every hospital would report their admissions into, every death would be reported into this system. We had to build all of it from scratch. To me that was a key lesson.
Next time around, we have to have an epidemic response unit with all these systems in place. With Covid, we have learnt how to do this and we have to find someone who is responsible to lead the epidemic response unit.
How big an obstacle was the spread of disinformation regarding the pandemic?
There is a lot of disinformation and conspiracies and they get amplified through social media because nobody has to be truthful on social media. This was a real challenge and it became worse when people of a scientific background were spreading disinformation or they were simply lying. After the first wave, eminent scientists were saying we had now achieved herd immunity and there was no need to worry about a second wave.
Then, of course, there’s a whole group of people that refuse to accept that there is a scientifically rigorous process by which we determine what drugs we use. It was a big lesson about how active clinicians who have taken the oath are the ones promoting all these unproven medicines. People were promoting an anti-scientific approach.
How can we plan and prepare better for future pandemics?
We have to do better in laying the foundations in biotechnology and specifically to build a unit to be able to create a vaccine from scratch, and not just to test other people’s vaccines. We should also make our own vaccines because the next epidemic that comes along, we need to be able to make our own so that we are not standing in a queue begging for the vaccines. That for me is important. A crisis is an opportunity to build for the future. To build better. Now, we are in a much better position because we have learnt so much from dealing with Covid.