The activist changing health policy on global scale
“Medicine is a social science, and politics is nothing else but medicine on a large scale,” wrote German doctor Rudolph Virchow in 1848. He posited that medicine must point out problems and their solutions.
This also defines the position of Professor Helen Rees, founder and executive director of the Wits Reproductive Health and HIV Institute, personal professor in the Wits department of obstetrics and gynaecology, honorary professor at the department of clinical research, London School of Hygiene and Tropical Medicine, and a fellow of Murray Edwards College, Cambridge University.
Along with her medical degree, she has an MA in social and political science. “Activist” defines Rees well; here is an individual who, through medicine, has consciously made a difference on a local, national and global scale.
She is an internationally renowned researcher and policymaker working in HIV prevention, reproductive health and vaccinology. Her ability to translate research into policy that changes lives has seen her chair over 100 global and national science and policy committees. This includes the World Health Organisation’s (WHO) Strategic Advisory Group of Experts (Sage) on Immunisation and the sage Working Group on Ebola Vaccines. (Sage is the highest global policy-making immunisation committee.)
Making a difference
How does one get from medical doctor to global policymaker? “It’s about wanting to make a difference, hard work and a conscious approach.” However, Rees is the first to point out that people and teamwork are everything. “I have been very fortunate to work with exceptional people throughout my career,” says the professor. Her early years saw her heading up paediatrics at Alexandra Township Clinic and working with anti-apartheid organisations. Her study to establish reasons for non-immunisation among Alexandra’s children was the start of her research into critical public health questions on sexual and reproductive health (SRH) and HIV. It was also the start of linking research to national and global health policies, including contributing to the ANC’s national health policy, focusing on women’s health.
Major African research institution
Rees founded the Reproductive Health Research Unit (RHRU) in 1994. A new research agenda for a new South Africa was needed. Consequently its core mission was to help formulate and support the implementation of new national health policies. Its initial focus was SRH, sexually transmitted infections (STIs) and HIV and expanded into immunisation.
RHRU moved to inner city Johannesburg in 2005. Partnerships with the City of Johannesburg, the Gauteng provincial government and other stakeholders created the Hillbrow Health Precinct. It’s a world-first project where derelict heritage buildings at the abandoned Hillbrow Hospital are restored for community-based clinical and social services, as well as training and research.
RHRU became the Wits Reproductive Health and HIV Institute (WRHI) in 2010. It is a collaborating centre for the WHO, Unaids and the Medical Research Council (MRC). There is also a significant teaching and training portfolio with Rees co-supervising PhD students.
WRHI is a major African research institution with extensive national and global recognition; it now has over 70 active research programmes.
HIV and STI prevention
Six million South Africans are infected with HIV and women carry the majority of this burden. Rees says that there is an urgent need to improve existing HIV prevention technologies, combined with a better understanding of how to get people in communities to use these.
“HIV prevention research, including microbicide studies in young women, has been a longstanding theme of my work,” says Rees. Started in 2010, the FACTS001 study is an example of an HIV prevention technology trial. It evaluated the effectiveness of a microbicide for HIV prevention and for prevention of herpes simplex 2, another common STI. It was the first big South African clinical trial led by a South African where everyone in the study was South African. Rees was protocol chair and principal investigator.
The results showed that tenofovir gel offered no HIV protection. However, due to the data gained about young women, it has moved the global HIV prevention research agenda for young women into a new era, with a focus on long-acting HIV prevention products. It has also given enormous insights into the lives of young South African women and why they are so vulnerable to HIV infection.
Focus on maternal health
As with her other research outputs, Rees’ maternal and women’s health research agenda has influenced national and global policy, programme and guideline development.
For example, she has conducted numerous studies reviewing unsafe abortion. A pre-1994 study with the Medical Research Council showed significant maternal death and illness due to unsafe abortions. The data was presented to Parliament and influenced national legislation and clinical management.
The repeat study, post legislative change in 2005, showed a dramatic decline in unsafe abortions — the first time this was ever shown globally. The innovative methodology developed for this study was adopted by WHO as a global best practice tool.
Under Rees’s leadership and in partnership with the Charlotte Maxeke Johannesburg Hospital (CMJH) obstetrics department, WRHI supported the implementation of the first integrated antenatal and HIV clinic at CMJH. Evaluations in 2008 showed that these types of services reduced maternal illness and death and there was a profound reduction in mother-to-child HIV transmission. These have also been globally adopted as best practice.
Beyond the above examples, Rees and WRHI have published extensively on other areas concerning maternal health.
HIV/STI acquisition and hormonal contraception
Understanding high-risk populations is key to developing interventions to reduce new HIV infections. Rees was co-primary investigator of the National Adolescent HIV and Behavioural Survey, the first national adolescent HIV study undertaken in South Africa.
In 2005, research from the groundbreaking national study showed astonishingly high rates of HIV among young women. The results changed the national dialogue on HIV prevention, led to further research and contributed to HIV prevention intervention. This included a major focus on young women and informed the creation of the loveLife programme.
There have also been a series of studies exploring the relationship between hormonal contraception and HIV acquisition. Rees is a lead investigator in the first randomised pan-African trial of contraceptive use and HIV acquisition (called Echo). It begins this year. “The result will evaluate the risk of acquiring HIV and pregnancy between three contraceptive methods,” says the professor.
She is concurrently the lead investigator on an adolescent contraception and STI/HIV trial supported by the Oppenheimer Foundation.
The debate on contraception and increased HIV acquisition risk has resulted in a review of the national contraceptive and fertility management policy. The WHO has also changed global guidelines for contraceptive use within the HIV context.
The question of vaccines
An HIV vaccine is the elusive philosopher’s stone within research. Rees says that broadly neutralising antibodies have been identified and appear to attack many of the HIV strains. The RHI will be involved in a proof of concept study looking, specifically, at the immune response.
Rees has a major interest in vaccines in general, particularly from a health systems and policy perspective and with a strong global policy focus. Her interest in women and vaccines include HPV and HIV vaccines, a new focus on maternal immunisation, and the development of a new Wits Flagship Centre for Immunisation. The latter is a first of its kind for the African continent.
The impact of Rees’ work hasn’t gone unnoticed. Her most recent accolade is the 2014 Harry Oppenheimer Fellowship. Although her awards are too numerous to mention, they highlight the recognition given to a health activist who continues to fight f