Malegapuru Makgoba
a Second Look
The challenges facing science and its development today are no longer predominantly technical, but largely social. The future of science lies in three areas: ethics, communication and attending to societal concerns.
The need for science to be understood by the public and for scientists to communicate better, as well as the need for the public to make choices about what science has to offer in their daily life and participate in the scientific process, has never been greater than today.
No examples illustrate these challenges and dilemmas better than the revolution in biology (the human genome project) and the HIV/Aids epidemic that is sweeping sub-Saharan Africa.
Although the human immunodeficiency virus type 1 (HIV-1) first appeared in South Africa in the early 1980s, it wasn’t until the early 1990s that it started to spread significantly. There are currently approximately 4,7-million to 5,3-million HIV-infected South Africans, accounting for 10% of the total number of infections in the world. And about 35% of HIV-infected breastfeeding mothers in South Africa who are not receiving treatment will pass the virus on to their newborn infants.
Those children who manage to avoid infection face the bleak prospect of being orphaned.
Almost all the socio-economic improvements of post-independent Africa are being reversed, if not wiped out, by this epidemic. Life expectancy, which had risen from the mid-40s to the 70s, has already been reversed in some countries like Botswana and Zimbabwe. In South Africa the reversal of mortality trends from the old to the young, particularly young females in their mid-20s and 30s, is not only alarming but also a unique phenomenon in biology.
There is no doubt that the problems faced by developing nations, particularly in sub-Saharan Africa, require different approaches to those used by developed countries. Africa has different patterns of transmission, higher rates of infection, the presence of different opportunistic infections and higher frequency of sexually transmitted infections. In addition, virological and host factors may influence the dynamics of the spread, the latter being affected by poor socio-economic conditions and malnutrition.
However, these different approaches and factors are no licence for quackery such as the Virodene saga, alleged embracing of discredited, pernicious and dissident ideas, unethical practices and unscientific experimentation.
Several factors have fuelled the epidemic in South Africa. These include the lack of a public health policy between 1981 and 1996, poor implementation of a coherent public health policy on HIV/Aids since 1996, the continuation of the migrant-labour system in an era of globalisation and integration and the opening of South Africa’s borders to the rest of the world, resulting in the seeding of multiple epidemics of HIV.
Let’s remember that both South Africa and Thailand had a prevalence rate of 0,7% in 1990, but today Thailand fares better at 2% than South Africa at 22%.
The erosion of the independence of science by the state in which the autonomy of institutions and scientists is undermined for speaking the truth to power and authorities has taken place in many African countries. In fact scientists have been removed from office after criticising governments or their leadership. The nature of South Africa’s democratic culture is that civil society is encouraged. This is entrenched in our Constitution and something President Thabo Mbeki has publicly encouraged.
Whenever politics takes centre stage, manipulates science and scientific truths for its ends, opts for the wrong scientific advice, and erodes the independence and rigour of the scientific methods in any country, the consequences have been dire. History is replete with such examples. For example, in 1924 the United States Congress passed legislation that decreased Jewish immigrants from Poland on the wrong advice that “genetically inferior people, who would make bad American citizens, were more frequent in Southern and Eastern Europe than Northern Europe”.
Africa’s inability to have a strong science, engineering and technology base can be placed on unwise political choices. Some of Africa’s best scientists are haunted by the spectre of exile life, having been driven out of their countries by political interference.
The current political/scientific furore on HIV/Aids has much broader impact and implications than some were initially prepared to admit. The current controversies in Africa about HIV/Aids, its causation and origins have the following effects:
l Undermining all the good strategies that have a proven record of effectiveness;
l Sending mixed signals and messages to all those that have dedicated themselves to the alleviation and eradication of this epidemic;
l Having a negative impact on affected patients and families;
l Undermining and eroding scientists and the scientific method in developing countries;
l Discouraging young and talented people from taking science as a career option;
l Eroding investor confidence with dire economic consequences.
If, as Africans, we do not heed these examples and implications, history may judge us to have collaborated in the greatest genocide of our time by the types of choices political or scientific that we make in relation to this epidemic.
We cannot afford any more blunders or give mixed messages on these choices. Responsibility and clarity of common purpose, commitment and vision from all sectors are of the absolute essence. The dissidents with their theories will come and go, just as they did in the US and Europe. When they are gone, we Africans will remain, facing the consequences of this explosive and unrelenting HIV/Aids epidemic and the daunting challenges of the “African renaissance”.
No disease has challenged the ethical and moral principles of a society such as HIV/Aids. The areas that are of most concern are the ethics of vaccine development and clinical trials; anti-retroviral drugs for HIV/Aids patients; and the prevention of mother-to-child transmission.
The affordability and sustainability of these treatments within a society that prides itself on human rights and the promotion of equity and development have posed great ethical dilemmas.
The clinical trials for our vaccines (the VEE-based clade C vaccine) are due to start this year, in under-resourced communities, where people are at high risk of HIV infection. So human rights implications for participants and other members of the community need careful consideration on issues of resource allocation to HIV vaccine development, the protection of trial volunteers from the risks of participation and access to a successful vaccine.
Against this context of socio-economic calamity and the HIV/Aids pandemic there are opportunities for innovations, solutions and cutting-edge research. We have to critically look at the gender power relationships that govern human sexuality the very sexuality, morality and human rights and ethics that are being questioned. As we face the challenges of the “African renaissance”, the barrier continues to rise as a result of HIV/Aids.
Professor Malegapuru Makgoba is president of the Medical Research Council of South Africa. This is an edited version of his second James Hill Lecture to the National Institute of Health, Bethesda, Maryland