Michael Berger
CROSSFIRE
Like most scientists, most South Africans in all probability, I have been puzzled and disconcerted by President Thabo Mbeki’s involvement in Aids issues.
These concerns have been validated by our president’s letter to other heads of state, currently available on the Internet in full from The Washington Post Web page and published in prcis form by our own Sunday Times (April 23 2000), which reveals a cast of mind that merits sober attention by all South Africans.
There are a number of features of the letter which deserve close scrutiny before attempting to draw some conclusions. Probably the least important for the purposes of this commentary is the science of Aids. Mbeki has, of course, no qualifications to make any pronouncements whatsoever on the question of HIV as the primary aetiologic factor in Aids. That is no reflection on his abilities, but simply follows from the highly technical nature of the field, requiring many years of study and involvement to genuinely be in a position to make anything other than ludicrous comment.
But Mbeki, of course, would agree that he personally cannot decide on the merits of the issue. He claims that all he wants is for the dissidents to have a platform to speak from and for others to listen. This sounds so reasonable and fair-minded; who could argue? But it is absolute nonsense. The views of Berkeley biochemist Peter Duesberg, the most significant of the dissidents, contrary to the claims in our president’s letter, have been widely disseminated in the scientific media, on the Internet through his website and through other channels. They have been addressed by other scientists in highly respected scientific journals, in detail. The same is true of the other dissidents to a lesser extent. The plain fact of the matter is that they have failed to convince their peers of the legitimacy of their position despite repeating the same arguments over and over again.
This also raises the overwrought and distorted political imagery bought to the debate. I quote directly from the letter to illustrate: ”It is suggested, for example, that there are some scientists who are ‘dangerous and discredited’ with whom nobody, including ourselves, should communicate or interact. In an earlier period in human history, these would be heretics that would be burnt at the stake.” Not satisfied with an ”earlier period in human history”, Mbeki goes on to say: ”Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and public because the established authority believed that their views were dangerous and discredited.” Mbeki then continues along these lines, ”The day may not be far off when we will, once again, see books burnt and their authors immolated by fire by those who believe that they have a duty to conduct a holy crusade against the infidels.”
It must be understood that these remarks are made about scientists and others who continue to occupy professorships and other academic and professional posts, who are free to publish their scientifically ”discredited” views over the Internet and elsewhere. Mbeki happily conflates vicious religious fanaticism and political oppression with the imperfect, but open and transparent, scientific culture. It perhaps explains why some United States officials were, at first, concerned that the document was fraudulent and did not emanate from the Office of the President.
Perhaps Mbeki believes that all scientists are free to say whatever they want, as often as possible, in whatever journal they should happen to chose. Clearly, he has not been subjected to the discipline of peer review and has little knowledge of the logistics and constraints of scientific publishing. It is accepted, despite its imperfections, because it is widely understood that given appropriate persistence and convincing evidence the truth will out. It is precisely the combination of freedom and critical scrutiny of evidence and interpretation which has made the scientific method so extraordinarily effective.
Duesberg and his followers have lost credibility not only because they are almost certainly wrong, but because they been acting utterly contrary to the scientific ethos. They are not going to be burnt at the stake, literally or metaphorically. The science on HIV/Aids has simply passed them by. No platform that South Africa can provide will change that fact. What it can do is to change issues of objective ”scientific” fact into a political football. Is that Mbeki’s intent?
Besides Mbeki’s egregious misreading of the scientific realities and extreme imagery, he ties his position quite specifically to South Africa and Africa as revealed in the previous quotes. He also goes on to write: ”This SAFA-AFP report [dated Paris, May 13 1999] quotes Dr [Awa] Coll Seck as saying: ‘In Southern Africa, the prevalence of the [HIV] infection has increased so much that this region could, if the epidemic continues to spread at this rate, see its life expectancy decline to 47 by 2005.’ (Interestingly, the five years to which Dr Coll Seck refers coincide closely with the period since our liberation from apartheid, white minority rule in 1994.)” Once again, Mbeki is not content with these references to our history of political oppression but writes as follows towards the end of his letter: ”It may be that these comments are extravagant. If they are, it is because in the very recent past, we had to fix our own eyes on the very face of tyranny.”
Before going on to discuss the implications of the letter, it is valuable to mention briefly some points raised by Mbeki which do deserve attention, but which are well-known to those involved and do not require reiteration.
l The most important of these is that we cannot afford the drug-based, curative approaches of the West. Possibly even more important than the actual costs involved is the complexity of treatment. It is highly unlikely that we have the physician base, the social and medical infrastructure or the level of patient sophistication required to mount an effective curative programme considering the numbers involved. Thus, prevention is the only way; which includes, of course, highly targeted, drug-based preventative strategies.
l The second reasonable point made by Mbeki is that aspects of the biology, transmission and natural history of the disease in Africa differ from the West. The reasons are almost certainly multi- factorial and should be discussed and clarified by those with the expertise to make substantive contributions. Many of Mbeki’s references to scientific ”fact” in his letter are out of date or misleading.
l Finally, Aids prevention in ”Africa” – if one should use such an all-inclusive term for an ethnically and culturally diverse continent – merits consideration on its own terms, and simple translation of ”Western” solutions to here may not be optimally effective. I hardly think this assertion will raise too many caveats, unless it was being used to escape the hard but necessary choices required for effective action.
It is extremely difficult, faced with the abyss between what Mbeki actually wrote and the kind of letter which could have been appropriate and productive, to find a single, simple explanation. Is it simply a smokescreen to obscure the government’s failure to address the Aids issue convincingly in this country? Is the letter an attempt to pre-emptively condone future failure? These are possible explanations and should not be discounted, at least in part. But they do not wholly convince.
Does Mbeki see himself as fulfilling a moral imperative by providing a platform to dissidents who no longer carry credibility where it counts? If so, it would be a credible motive, however misconceived. As pointed out already, no platform he can provide will restore their status in the scientific Aids community. But before accepting this most benign interpretation of his stance, can our president possibly believe his own rhetoric regarding ”immolation by fire” and similar phraseology? Can he truly see the position of the dissidents as, in some meaningful sense, equivalent to the victims of apartheid? It defies belief or, alternatively, raises serious questions over our president’s grounding in reality.
On another tack, what does one make of Mbeki’s implicit denial of the relevance of Western science and Western solutions? Does it imply a belief that the West’s view of Aids in Africa represents a racist attempt to ”smear” African morals and culture? There is, indeed, a body of opinion, small and fringe though it may be, which claims that the current scientific view on the origin and spread of Aids in Africa is an attempt to portray Africans as immoral and addicted to sexual excess. By calling into doubt the central tenet of the current belief on the origins of Aids, namely, that it is a viral infection spread mainly by sexual contact, Mbeki is tacitly denying what he may see as a Western conspiracy against his continent.
It seems to me impossible to reach a single conclusion; the letter admits of so many interpretations. Possibly, it doesn’t matter and the president’s motivations and reasons for writing in this vein were mixed. Whatever the full answer, the letter is deeply disturbing. It demonstrates a capacity for justifying the most unreasonable of positions by a brew of implausible appeals to populist sentiments and prejudices. It suggests a racial-based perspective, not uncoloured by paranoia. It is quite possible that overseas investors will see a link between Robert Mugabe’s cynical pre- election end-game to the north of us and the kind of imagery employed by Mbeki in his letter.
But, more importantly, the mode of discourse reflected in Mbeki’s letter is no stranger to South Africa. Sober, reality- based assessment is cast aside in favour of ideologically driven rhetoric – as if the intensity of verbalised belief can supersede objective fact and rational argument, and displace any unwelcome, internal doubts. And so it can in a limited sense, but at a great price to a vulnerable society which harbours such modes of thinking. It is not a great step from the limited issue of Aids to the wider political playing field. Surely the stakes are too high, for our country and Africa as a whole, for us to afford such propensities in ourselves or in our political leaders?
Michael Berger is a retired professor of chemical pathology formerly at the universities of Cape Town and Natal