Professor Glenda Gray ,President & CEO South African Medical Research Council
“We need to replace NPI and ABC with treatments and prevention”
Moderator: Tian Johnson
Complied by: Anna Matendawafa – with inputs from Wilfred Gurupira & Maaza Seyoum
Webinar Recordings & Supplementary Materials:
Date: 23 July 2020
Professor Glenda Gray is a global leader in the scientific and research landscape. A long-time activist and first female President and CEO of the South African Medical Research Council(SAMRC), whose mandate is to support the National Department of Health on the promise of a long and healthy life for all South Africans. Prof. Gray has been a strong voice for health activism and engagement with health institutions and the Government, a trailblazer who has lived through our nation’s “citizenship projects” for citizens as individuals and groups to exercise voice concerning health issues. Prof. Gray, alongside leaders such as Professor Malegapuru William Makgoba (who led an investigation into the Life Healthcare Esidimeni Scandal). She challenged the South African Government during South Africa’s AIDS denialist days. This period in our history was a significant health citizenship project, which saw her bearing witness to the death of mothers and babies as a result of HIV/AIDS in the early 90s. Prof. Gray sees humanitarian issues as tied to health issues as they carry threats to lives and populations’ wellbeing. A pediatrician by profession, our children’s health, and lives is something she has dedicated her life to improve. Today, Glenda finds herself at the helm of the SAMRC when the effects of COVID-19 have brought the world to a grinding halt. She is the Chair of the Research Committee of the Ministerial Advisory Committee on COVID-19 (her recent advisories focused on the effects of COVID-19 on the Education System). Glenda advises the Portfolio Committee on Health on the impact of alcohol on the pandemic’s health system. She works closely with former SANAC CEO and current Director-General of Health, Dr. Sandile Buthelezi reporting to Parliament.
Prof. Glenda Gray joined the webinar to strengthen the relationship between civil society and the SAMRC. She gave an overview of SAMRC’s mandate and work undertaken since the advent of COVID-19. The COVID-19 research and advocacy landscape is rapidly evolving and has not been free of controversy and an abundance of mixed messaging around transmission, risk prevention, mortality, and in recent weeks, the impact of alcohol availability and what we know currently about the vulnerability children. Prof. Gray had the opportunity to unpack all these issues on the webinar.
QUESTIONS AND ANSWERS
*This section contains a transcribed account of the Question and Answer Session
Under your leadership, what has the MRC done to specifically advance and support the black women scientists and broader transformation agenda? When I came to the Medical Research Council (MRC) in 2014, I analyzed whom we funded, where we invested, and how we funded. And based on that, I found that we funded a lot of the Ivy League universities Wits,
Stellenbosch and UCT and funded a lot of white men. And so over the years, we’ve changed that I’ve created two streams of research, one is research funding one for early-stage investigators. So what was happening was at the early stage, investigators in our country weren’t getting chances because they had to compete with people who knew how to write grants and had much practice. And so these poor people weren’t getting into the door. So we split our funding streams to have an early stage investigator funding stream and a mid-career to the late-stage funding stream. We also realigned our peer review to consider being a woman being from a historically disadvantaged institution. We looked into issues of race and all our researches, internationally peer-reviewed. And over the last five years, we’ve managed to reduce to increase demand. So half our funding goes to women first of all, so that’s a good thing. And we’re meant to significantly increase the amount of funding that goes to black scientists, and that’s all available. In our annual review, you can see year on year how we’ve improved so, and this is an indicator. So you know, we track our progress so that we report our progress in our annual performance plan, and we measure our progress every quarter. Also, I’ve done another thing, as I’m concerned about the lack of women and black scientists in midcareer to senior science positions. So I created a program where we award mid-career scientists and research money to catapult them into scientists that will become leaders. And this has worked because most of the people that we funded in that area have become SARChI (South African Research Chairs Initiative ) chairs have developed extramural units and have gone on to the next stage of science.I also made sure that way, there’s no this there’s no win with this where there’s a deficit in sex parity. I have stopped men applying. I have only made the grants available for women. And so we had a situation where we have extramural units, and I was concerned that not enough women were applying to be an extramural unit. So, we called until we have parity. And we will only allow a woman to apply for those extramural units. And once we have equality, then we will open up the competition again to men. So I am committed to making sure that women scientists advance. I commit, I have a track record, which is evidenced by our review, that we’ve made significant progress in terms of transformation since being the President of the MRC. So I think I’ll stop this I’ve kind of like given you an array of the stuff we’ve done generally around COVID and also our commitment to research translation and capacity Development.
What is the MRC doing to ensure that the COVID-19 response does not take over communities’ general health services?
Okay, that’s an excellent question. Something that has concerned us is that you know that we do this for 30 years. Every year, every week religiously, MRC puts on its website the previous weeks’ mortality rate. And so, this report has been critical because it’s tracked specific vital periods in our time. So there was a time in South Africa where people did not believe that HIV causes AIDS. And if it weren’t for these people every week, putting out the death reports, we would not have been able to prove that HIV causes AIDS. So people who put out this report showed an increase in mortality in people who never happened before in women, yet young men and women were in their 20s and 30s. This evidence led to gamble to show HIV causes AIDS and led to evidence that showed how ARV has worked in our country by charting these death rates. Over time, we were able to see the advent of ARV rollout, how we increase life expectancy, and how the dynamics of this change in our country. These reports have also shown us how infant mortality rate changes. We were able to alert the Government that neonatal mortality rates hadn’t changed, and their maternal mortality was similar. So, these reports are like what we call the canary in the coal mine. And they help us alert the Government and the health system about what’s not working. The kind of intervention we did about two years ago showed the Government that neonatal mortality wasn’t changing. It wasn’t changing because children were dying because of poor obstetrical care. And because of poor care in the first 28 days of life. It was a significant highlight in that we must have been tracking in because of COVID. We’ve been tracking TB and HIV diagnosis and TB for viral load and immunization rates to alert the Government that we are not diagnosing enough TB. We’ve decreased our amounts of viral loads and CD4 count at this moment in time, which means people aren’t accessing care. And so that’s an important indicator. We also are concerned about immunization rates. And we have seen a decline in immunizations in this period. And so what we have to do is we have to alert the people to say, this is what’s happening. People may be too scared to come to the clinics. And that’s why they’re keeping away, and we have to try and change the narrative that people who have chronic diseases, children who need to be immunized are getting to the clinics, and having data is very powerful. Information is the most prominent advocate. When you have data, you can have the evidence to show anybody what is changing and what is right and what is wrong with the health system.
So, Glenda, you as other members of the ministerial advisory committee, have been on the news regularly. You, like the rest of us, are navigating a new and rapidly evolving situation. Could you share some of your reflections on how the scientific database, evidence-based messaging has come forward, how you report and share, and how it has landed? Thoughts from you on that.
I can say I don’t think I’ve ever learned so much separately in my life, and I don’t think I’ve ever known that’s what I thought I knew last week was wrong. And what I know this week is new. And I think as scientists, we only have we have to realize it. COVID-19 is a rapidly evolving epidemic. And the things that we held to yesterday or last week may no longer be right, and we need to adapt or die. And so I think that’s an important thing I believe is with COVID. There has been an obsession with news and, once the news felt that obviously, there are always people who want to sell their newspapers and still want to get the most hits. There’s going to be people who wish to distort for coverage, you know, or want to make controversies or people be provocative. And so that’s always going to happen. And this epidemic is a hit it’s living as this has happened since the Spanish flu. COVID is different from HIV in that this is rapid HIV took years to unfold. We had months to years to manage people who were HIV infected and with COVID-19 concentrated on being contagious. Virus transmission is rapid, even though people are asymptomatic mostly. There are older people and have comorbidities that will get sick, and these deaths are unexpected. And so there’s much interest as you know, we’ve never had to wear masks in our country. We’ve never had to be isolated. We never had to have social distancing. We’ve never had to practice NPI (Non-Pharmaceutical Interventions). So, you know, this is a surreal world that we’re living in our life has, since January our lives have changed completely. And so obviously there’s going to be interest in this. Scientists, you know, it not only in South Africa but globally, scientists are being called on to help pave the way, and we’ve seen in a scientist all over the world been called in we see Tony Fauci. We see Debbie Burks and her scarfs. And we see the stories of the UK scientists. We see reports of the scientist in China, the ophthalmologist that alerted the Government who died, you know he was detained when he first called out that there was this unknown pneumonia that was going on. So there’s always going to be an interplay between science and politics and science and the media. And, you know, in an epidemic like this, unfortunately, scientists are the go-to people. They’re the people that are trying to decipher the information and trying to give the best advice. Remember, their bus can change anytime because what we thought we knew, maybe we don’t know anymore, you know, there was a time when Tony Fauci never wore a mask. And now he wears a mask. There was a time we never wear masks. You know, we were the first one of the first countries to start wearing masks in public. And this was in early May, Early, I’d have to check the date was in May, I think it was even earlier than that. So we were one of the first countries outside Asia to adapt and have the public wearing masks. And, and so things do change all the time.
Glenda, do you feel that you and the MRC have the political support you need to execute your mandate.
I think that the MRC is an excellent resource for the Government. And we are data-driven, and we show evidence and sometimes the evidence, and it can be is scary enough. For instance, I’m sure you’ve heard on the radio and the news. That, you know, we’ve been tracking death. And since the beginning of the epidemic, we found, you know, excess deaths in comparison to what the Government is reporting. That’s understandable because people in the beginning doctors weren’t diagnosing COVID on the death certificates. People are dying before they get to the hospital and people who, and you may not be sure that someone has got COVID. Obviously, at a global level and local level, you’re going to underreport COVID. And so it’s going to be a catch-up. It was a good overview report COVID, mainly when there are infectious diseases. And so, you know, you present, basically the MRC is counting mortality. When mortality doesn’t match what the Department of Health got from COVID being an infectious disease, there will be a discrepancy. And so you’re going to have to explain the difference, and then you have to, you know, you have a public obligation to show it because we the money that we research we do is taxpayers paid by taxpayers and, we are open science. We know we subscribe to open science. And so we can’t hide our data. You see, we must show the data we collect and explain it as best we can. And so we do I, you know, I’ve been talking, so you know, sometimes I’ve talked five times with the minister. This morning I’ve spoken to him as there was a need to help with his speech’s information and budget speech and was taking data and in contact. We were making sure that we had the right numbers, or the case fatality rate, giving him information about what’s going on in Russia, UK, issues around mortality in the ICU, and so on. On many occasions, between working with the minister and his DG, sometimes up to three or four times a day, we contact. We also work very closely with the Parliament. So the Parliament has, we report in the MRC reports to Parliament. So we spent much time with Parliament working on the alcohol issues around alcohol and the curfew and bringing evidence. We got the evidence to Parliament about the decline in unnatural deaths with alcohol prohibition and curfew. And so we provided the evidence that led to I don’t want to say we were we said you know, we didn’t say we said that we recommended the curfew because of the mortality that was happening at night and on the weekends.We recommended alcohol control, which is different from alcohol banning, but we recommended trying to manage alcohol use in the country. We also gave information on the demographics of COVID infection and various age ranges and the mortality associated with COVID at different age ranges. It helped inform the Government on specific recommendations and support around school issues and give advice about based on what we see in South Africa and abroad, various strategies. So, I think that the MRC has a fantastic amount of resources and evidence that the Government uses all the time. Nkosazana Dhlamini Zuma phones Charles Perry all the time to get advice about tobacco and alcohol and work with the DG and the minister on death and mortality issues and as Bradshaw. And so yeah, I think that we are a resource. We received public money to research to help the country, and that’s our mandate.
So Glenda, if money wasn’t an issue, what critical work would you fund right now to give us the greatest return on investment to do an impact on COVID 19.
Okay, if money were no object, I would do. If money wasn’t an object, I do lots of things. First of all, you want better to articulate the natural history of COVID-19 in South Africa. To understand the transmission and the factors that make people more or less contagious, you can give good public health advice. Two, you’d want to make sure that we could have a rapid diagnosis at the point of care. So when you arrive at the hospital and don’t know whether you are COVID positive or not, someone can prick your finger or put a swab up your nose, and in 20 minutes, you have a result. That is enough to help the doctors and then invest in treatment, so we, the people who get to the hospital, don’t die and then look at therapeutics to invest in therapeutics, in treatment antivirals and then to invest in vaccine development so we can be part of the global endeavour. So we are putting money in, but when you look at the amount of money the National Institute of Health (NIH) puts in, it’s minuscule compared to that. Then, the issues, the psychosocial, cultural changes, depression, and gender-based violence. You see gender-based violence, and we’ve seen depression amongst children. We’ve seen cognitive issues, hunger, and malnutrition, and to address these issues, some of the structural and problems but also some of the things we took for granted in our country and we’re not isolated families are isolated communities are isolated. We can’t mourn like we used to mourn, we can’t greet like we used to greet, and we can’t do our religion like we used to do in the past, so those all have huge effects on the psyche of a country. There are substantial mental health issues associated with this and psychosocial problems and medical issues, so we can’t just see COVID 19 as a contagious virus. This virus has changed everything we do. And all of that has consequences.
What in your mind presents the most promise or gives you the most hope for a potential solution to COVID in current research? What stands out to you, whom do you have your eye on, particularly in the sea of research.So I want two things I want antiviral, an antiviral where you could take. So if you’ve got COVID-19, you could take this antiviral, and it would stop you from shedding and you would get well, and you wouldn’t have to go to the hospital. So I would want an antiviral, and also like a prevention strategy. So I would want something that stopped the virus’s repropagation so that we could end the epidemic. And so we need treatments that may be just much like HIV, we need treatment, and we need prevention and the condom, which is the NPI, so, the NPI is very hard. NPI is a non-pharmaceutical intervention. It’s the mask, it’s the physical, social distancing, and it’s the hand hygiene. And so that’s like entry-level. And it’s our condoms. It’s our abstinence; it’s ABC. And ABC is just tough to keep up, so we need to replace NPI and ABC with treatments and prevention. Do you think that SA went into lockdown too quickly? Has SA met the WHO yardsticks/measures in easing the lockdown
You know, you, it’s so hard to say so, in the beginning, you know, so you look at places like Sweden, and at the beginning of the epidemic, everyone was saying, wow, look at what they are doing I like them, but then you look at how they have one of the highest death rates in Europe. And you know, they had a different strategy. You see, they believed in herd immunity and going out , and so that part of the epidemic, maybe they got right. And part of the pandemic they got wrong. They believe it is essential to get as many people exposed, but the unintended collateral damage was high mortality in older people. Then you had Germany that was very good immediately; they banned any gathering over two people that they implemented immediately. Maybe that’s the Germans, six feet rule that everybody had to be six feet away from everybody else. And, but then they also had a high ratio of beds, ICU beds, and hospital beds. So they had one of the lowest death rates in Germany, I mean, in Europe, and then you had Britain that has, even though they have outstanding healthcare, they have one of the highest death rates in the world 14% as compared to say, 3.8% of DC United States. So if you look around, maybe the only people who have done an excellent job are people in South Korea, Singapore, and Vietnam, but even they have struggled. And the only thing that works is to track and trace and keep your community transmission at low rates. And that means you have infrastructure that can find every person in your country and track contacts and put you into isolation and quarantine. And that’s impossible everywhere, besides very few amounts of countries in the world. And so if you look at the United States, that’s a devastating epidemic. It’s just getting worse and worse and because there’s been resistance to wearing masks and social distancing. And there’s been confusion about NPI and opening up. And then you look at countries like South Africa. We mimic if you look at Colombia, Peru, Brazil, Italy, India, we follow the lower-middle-income country trajectory, where we have can’t contain our community transmission.We can’t contain our community transmission because we don’t have enough testing. So we underpenetrated testing than enough testing, then you have ten days turnaround time, it becomes tough to control your epidemic. I don’t know of any country besides living in South Korea or Singapore that we could emulate. Given our doctor to nurse ratio, fragile health system, our testing, and lack. So, it’s very hard. And then you look at issues around the economy. You see that every economy has started because of COVID and so I think what you have to do, each country has to look at itself and close off its mind and listen.WHO (World Health Organisation) gives advice, and it’s generic advice, and maybe that advice is not fit for you. Countries need to find strategies that work for them, not looking at emulating the first world. And so, did we? We don’t know whether when you look back. If we look at our epidemic now and you look back and think okay, well, maybe it could have been a difference. Some people do say we should have closed down later. We should have closed down when our testing system was up and running. Maybe the whole closing down didn’t take into account that we couldn’t get food to people, and we couldn’t make people poverty secure, and that also affects your outcome. If we could get food to people and make people more financially resilient and food resilient, our result would be different. And so it’s kind of like, you know, the grass is always greener on the other side. And I think we’re going to have to say that, you know, what is our grass? And how do we make our grass greener?
Ms. Gray, we know that the President is addressing us today. Is there anything new we should expect, or will it be business as usual? I want to echo what Yvette is saying now is D day, and our Government does nothing much serious. Anything new that we should expect tonight from the President
When the President talks, he’s always got something to say. Okay, so he’s not just going to get on television and put his mask on. And I do think. I’m just speculating here that the most controversial thing is whether the school should close or remain open. We know there’s been much interaction with the unions and the Department of Basic Education. We’ve learned that they’ve been interactions with the school governing bodies with parents. And so I think that so my, I speculate that the ministers I mean that the President is going to announce probably a closing of schools tonight, and then that’s my speculation, or maybe he’s going not to disclose that schools are going to stay open. But there’s going to be an announcement whether schools open or the schools are closed. It all depends on who won the argument, so we’ll see. Should we start a bait?
COVID19 research has required much understandable speed. How does speed safeguard participants’ rights and ensure ethical conduct? One of the trials that haven’t been able to account to civil society is the TASK BCG vaccine for the COVID19 trial. Has SAMRC heard about this lack of accountability?
So, the MRC (Medical Research Council) was asked to fund the study. I said the first thing that we did with the study; we did a scientific review. And then we did advocacy. We did a community engagement review. And we did an ethical review of the study to help us make this decision. Because the issue is an effective program? Is it biologically plausible? Could you answer the questions? And then, you know, can you make sure that when you do enroll participants, they are protected and so the MRC as a funder should make sure that the studies they fund that we do we make sure that the standard of prevention is of high quality. And so we had many interactions with Task on, on whether they would be able to provide PPE, to healthcare workers, and if you can provide PPE to health care workers, then you know, when you know, you know, then could you is the study? Would you ever find an answer, and in the perverse thing don’t you know, if you have to if healthcare workers don’t have to wear or who aren’t wearing Personal Protective Equipment (PPE) properly. Then there are ethics for us, shall I say, for me as a funder, and well with the MRC is a funder is that we don’t want to put anyone’s lives at risk. If we have to fund research. The first thing that we would want to ensure if we ever had to fund a research project is to ensure that they would guarantee that we’re getting the best standard of prevention. So if you are doing a study in health care workers, and you want to prevent COVID infection. You have to ensure that the participants get access to PPE and good PPE and that in every case of seroconversion, you need to ensure that happened in the community or happened in the tea room but didn’t happen while they are taking care of the patient. And so we’ve had that. So that is that, a couple of others that are quite tricky. I mean, so we are busy, we’re going to be having a community engagement about an Ad5 vaccine. So previously, in the first generation of Ad5, we did a trial in South Africa. And we found that it increased susceptibility that increases susceptibility to HIV acquisition in men.In terms of the vector, we would never show whether it was the victim or the lack of envelope or the antigens that we chose, but following that, we never did any other work with Ad5 in HIV vaccines. Subsequently, there have been different iterations of the Ad5, which is being used in Ebola. And now they know the new generations of Ad5 are on what they call mole mute or immunological mute. And the question that we want to bring to the community is, is this something we should be doing in South Africa? And so the first week our first step has been, we’ve done a scientific review, first to do the scientific review, the scientists say no, then we don’t even have to go further. And we spoke to the scientists. Besides the other vaccines evaluated at a world level, some novel things had looked at spike protein, which looked at spark and something else. And then looking at the Ad5 have taken for dilutions and the question is this safe? The next step is to speak to the community and say, Look, you know, this is the vaccine; this is what it is. so the pros and cons, you know, what is your advice to us? Do we, as a country, do this? And if we do as a country, how do we manage, how do we monitor going forward? So, this is a partnership because we can’t make these decisions by ourselves. Because you, have to guide us, because, otherwise, you know, it’s going to be a problem and we have to look at the first generation vaccines work and if they don’t, and we’ve turned our back on something that could have worked, and then we’ve lost the year. And you know, if it does, is it worthwhile working, looking at in South Africa, then how do we make sure that we move slowly, so we don’t make mistakes. And then also, we have to look at about access. So a lot of the vaccine work that we’re doing, now we have to make sure that there will be accessible in the country. And so, some of these programs are saying; we will do tech transfer. And you know, by avec can be used to scale up. And so then you also have to look at, that is a possibility that if we investigate it if we looked at this Ad5, we could also produce it in South Africa. So, those are the kind of things that we have to engage in. When we make these decisions, now, we look at the ethics, we look at the regulatory we look at the community implications. Then we look at the science and all of those important that can’t think of one element of those engagements that aren’t important or, or stronger or, or less important than the other.
So in the MRC, we say I worked a lot with indigenous knowledge systems. So we’ve been working a lot with various groups before COVID, on HIV, and with some with herbalists and people in Mafeking and Dundee. We usually do the first thing is to establish the in vitro potency and whether these plants could work against a pathogen. Once we’ve evaluated, and we’ve seen some activity, we then try and identify whether there’s any toxicity. And so whether first of all is a potent against the pathogen.Second of all, is there any toxicity, and then you do your animal work, and then you do your human work. And so whatever drug you use, whether it’s a chemical compound or a herb or a plant, everything has to go through steps to make sure that it’s safe and effective. And so we work very closely with people all over the world and all over the country. I get calls every day about a cure and get herbs sent to me in PostNet to evaluate? And so I take notes, of course, because I take the indigenous knowledge system very you know. And I take many calls and speak to many people who claim that their herb may work. And so we try and work with the Department of science innovation. There is a program that helps us evaluate these products. To take them along the essential steps, SAHPRA has specific regulations, and you need to follow them before you can test and evaluate these products in humans.
SA fares relatively reasonable in its health R&D but not yet there. What do you see as the role of CSOs in advocating for adequate investment to R&D? What are the side effects of overly relying on foreign health R&D funding?
Well that every country should fund its own research because every country knows what its problems are. And states should never take science as a luxury science is a necessity; it’s the way we get out of poverty; it’s the way we improve our life expectancy. And so for community activists and advocacy is to see why science investment is essential, and the value of local investment because if you’re taking donor money, you always are never, you still are poised to address other people’s interests. You always have to try and make sure that your interest in the part amalgamates; otherwise, there are always problems. And so, I’m a firm believer that countries should fund their research, and that we need to spend much time and with our Government to explain to them why science matters. We do a lot of this. Every time there is a budget cut.I go to Treasury, and I explain. I show them the correlation between life expectancy and health and how you increase GDP if you increase life expectancy. Sure, there is a direct association between GDP and some scientific productivity and show them examples of South Korea with Japan, post-war. Germany post-war, how investing in science made the country thrive. And so, we need a narrative that we take to Treasury. And you know, I’ve learned that you have to talk to the people who’ve got the money and develop a relationship with them, but we need much more money. You know, we are so under-resourced as a country when it comes to science. And so if you want to have a vibrant transformed science platform in the country, you have to invest in it. And there are many risks. And so we also find that obviously, science there are many risks and much soft money. You’re always looking for your salary. And sometimes it’s too risky for people, you who have many obligations to their families. Sometimes, it’s hard to follow a science career because there’s so much uncertainty about salaries and job security.
Can we use lessons from our HIV response and not the script because that was faulty?That is a whole lot of work without Community engagement. Where is the community any progress on the cure because African people believe in the indigenous medicines?The anti-vaxxers have huge political backing. What if we get a vaccine, and no one wants it?It is the peak. Why are kids forced to be in school when adults are afraid, as we did so by moving from a hard lockdown to a much more relaxed despite the country moving towards the pandemic’s peak?