Q&A Sessions: The accidental vaccinologist

It was fate that led the man leading South Africa’s vaccine trials to become a medical doctor. Professor Shabir Madhi actually wanted to be an engineer. Madhi, now a professor of vaccinology at the University of the Witwatersrand and director of the Medical Research Council’s vaccines and infectious diseases analytics research unit, found studying to become a doctor so bad that a month into his degree, he begged to quit, but was denied. It’s as if the universe knew he would play an integral role, almost three decades down the line, in South Africa’s fight against Covid-19. 

You do not suffer fools gladly. This is evident in your responses to the lockdown, doctors spreading false narratives on re-infection and countries vying to be the first to release a vaccine. 

I sort of have a short fuse, especially when people are talking nonsense. Or what I consider to be entirely off the mark. When they make the wrong decisions, albeit for the right reasons, then I have a very low threshold to be diplomatic when I voice my opinion. I have somewhat enjoyed being in the limelight only to the extent that I can be able to inform people in public better.

You are respected across the world, especially your work in paediatrics. How did you gravitate towards this?

Children do not lie to you, most importantly. They are the most vulnerable, and I have always enjoyed working with them. The beauty of working with kids is when you get them to overcome their illness, they have decades, rather than another decade to live. When you are impacting the life of a child, you’re not just affecting the life of a child but the life of the whole family.

I think when I was doing my pediatric training here (at Chris Hani Baragwanath Academic Hospital) between 1992 to 1996, what was happening in South Africa was almost criminal in a sense. The leading causes of death in children were entirely preventable things. 

Close to 750 000 children were dying of measles globally. Half of those deaths were happening in Africa, despite the vaccine for measles being available since the 1970s. 

South Africa was one of the countries with a poor public immunisation programme. Children here were dying from things that children wouldn’t die from if they were from high- and middle-income countries with functional health systems.

So that’s the starting point, knowing that vaccines could have a considerable impact, firstly, in terms of not just preventing children from being hospitalised, but saving their lives. 

You have worked on creating some of the most important treatments and vaccines to help children. How did that come about?

My introduction to the world of vaccinology was more by accident rather than by design. I have to declare that. My father was a teacher and my mother was a housewife, so the only way to go to university was through a bursary, and the only ones available were for medicine. I wanted to be an engineer.

So, I went to medical school, and after one month, I decided this is definitely what I don’t want to do. The university agreed that I could change to engineering, but my funders weren’t, and I would lose my bursary. So I kept at it.

Ending up in vaccinology was also an accident. I was finishing my training in 1996, and Professor Keith Klugman, whose field of research was pneumococcal, was embarking on the most extensive vaccine study to be done on the African continent at the time. He was a microbiologist, and he needed a clinician to form part of his team. He advertised the position and Professor Glenda Gray encouraged me to apply for it because I didn’t know what I was going to do after my studying. This was a baptism of fire. 

From that fire, you have gone to save thousands of children’s lives. In fact, you say because of that, your work on Covid is not the most important work you’ve done. Can you elaborate?

Covid is the biggest issue for high-income countries but not for low- to middle-income countries. On the list of vaccines I have worked on it ranks maybe third. 

The work that we’ve done in the past, in my mind, has made a more significant contribution in terms of saving lives than the Covid-19 vaccine. So the first vaccine was the pneumococcal conjugate vaccine, which protects children from developing pneumonia and meningitis. When we were doing those studies, there were about 850 000 children that were dying each year with about 90% of the deaths occurring in low- and middle-income countries.

So if you add that up, 720 000 children were dying from pneumonia because of pneumococcus in Africa and South Asia, compared to the 700 000 people who have died from Covid. So over 20 years, you are looking at 14-million children dead.

Before we got the rotavirus vaccine, about 450 000 children were dying each year from that. When I was training at this hospital, there was a ward that was just for children with gastroenteritis or diarrhoea.

We did the first study of the rotavirus vaccine in lower- and middle-income countries. Based on our work and findings on the pneumococcal vaccine, this informed the World Health Organisation policy for the introduction of those vaccines into public immunisation programmes. South Africa was first on the continent to introduce both of those vaccines with its public administration programme in 2009, primarily because of the work that we did and the evidence that we were able to generate. Six months after we introduced the rotavirus vaccine in South Africa, we shut down the diarrhoea ward at this hospital and probably every other ward in the country. 

So the number of lives that were saved by those two vaccines on a cumulative basis of even five years will exceed the number of lives that were lost because of Covid-19.

How did growing up in Lenasia affect your career?

So much of my childhood was spent doing the door to door campaigns. My wife reminds me that I didn’t spend a lot of time at university.

But this sensitised me to issues on the ground. While I was a medical student, we started the Health Workers’ Association, and we used to run this clinic in the informal settlements every Sunday morning. The type of things that people were coming to seek treatment for reflect their experience of not being able to get primary healthcare. These were supposed to have been available to anyone in public healthcare.

What about those countries that are galloping ahead claiming that they have found the cure for Covid-19?

If we use the same benchmark that the Russians have used to license their vaccine, then right now we would have about 29 vaccines licensed already. The Russians have done small, phase-one studies where you can’t make any sort of conclusion in terms of the safety of the vaccine, or whether it protects against Covid-19.

The last thing that you want, especially with the emergence of the anti-vaccine lobby, is to introduce a vaccine that ends up causing harm. Suppose something ends up happening with the Covid-19 vaccine, in terms of safety. In that case, it could have enormous repercussions for the entire vaccine program, including life-saving vaccines that are given to children.

Scientists are already talking about the next pandemic. What is South Africa’s and Africa in general’s capacity to deal with the next epidemic?

The situation on the rest of the continent and in South African, unfortunately, is very sad. There is close to zero capacity and capability to actually develop vaccines from the lab and take it right through into clinical trials. 

There’s biotech in South Africa that has been in existence for over 25 years, but to date, unfortunately, they haven’t been able to develop any vaccine of their own. 

But the reason for that is exactly what you’re talking about, and that is inadequate training in the field of vaccinology and immunology. There are insufficient investments in terms of basic science. It’s not unique to South Africa; it’s a continental problem.

When the film Contagion 2 is finally made, and a Hollywood actor plays your role, will you allow them to wear that unflattering off-brown jersey you are wearing in an official photo that’s all over the internet?

Well, unfortunately, my wife got rid of that jersey just last year. She threw it away. She refuses for me to wear anything that is older than 15 years. But I still have my wedding suit, and I still fit in it. 

Professor Madhi wore that suit back when he wasn’t even sure that vaccinology would be his calling. Today he heads the country’s vaccine trials and is a world leader in his field, and that role fits him like his wedding suit.