The Journal Gazette
Tuesday, January 19, 2021 1:00 am

A national reset

South Africa's experience with AIDS offers instructive guide for trusting in science

Christer Watson

I am relieved we are having a transition to a new administration.

I am especially relieved that many positions of leadership for scientific agencies will be staffed by people with scientific expertise.

We should continue to be vigilant and demand that the leadership use the best information available, be open-minded about what tools might work and be skeptical that any political ideology is a guide for how nature works.

Having historical examples of scientific leadership, good and bad, helps me appreciate this importance.

One especially dangerous and sad example is how the government of South Africa addressed HIV in the early 2000s.

The history of South Africa is, of course, critical to understanding how terrible leadership can be maintained.

In 1994, the racist apartheid government of South Africa lost the nation's first free and fair election.

The African National Congress, which had led the fight for freedom, has won every presidential election since.

The hero Nelson Mandela was the first president and served from 1994 to 1999.

South Africans clearly trust the ANC's leadership in a way that is probably hard for me, and most readers, to relate to.

The president following Mandela was Thabo Mbeki, who served from 1999 through 2008.

During this period, HIV and AIDS became widespread in many parts of Africa, including South Africa.

For a variety of reasons, the virus killed many more people across Africa in the late 1990s and 2000s than it did, for example, in the United States. It was especially deadly in South Africa.

In 2009, about 19% of South African adults carried HIV.

In the United States, the number is currently less than 1%.

In the late 1990s, now-standard treatments for HIV were developed.

These standard treatments include using anti-retroviral drugs to prevent HIV from replicating beyond control. It also includes using the drug AZT to prevent a pregnant woman from passing the virus to her newly born child.

The government in South Africa delayed the widespread use of these treatments.

Mbeki emphasized that the newly developed treatments were Western-developed and claimed they were intended to weaken South Africa.

As evidence, Mbeki pointed to the British and U.S. governments' support for the treatment campaigns.

With the collective memory of British and U.S. government support of apartheid, this argument was persuasive.

As an alternative, the health minister at the time, Manto Tshabalala-Msimang, advocated lemon juice, beet root and garlic.

Local advocacy organizations, such as the Treatment Action Campaign, pressured the South African government to support the new drug treatments.

In 2003, the government did, with reluctance, start some treatments. The support, however, was not full and the president did not clearly advocate for the importance and effectiveness of the treatments.

The taint of a Western government solution was still widely believed.

A study from Harvard's School of Public Health analyzed the effects of this government policy. The study compared the death toll of the virus against two other nearby countries: Botswana and Namibia.

This choice was made because these two nations faced a similar prevalence of HIV at the time and had similar resources.

Based on these comparisons, the authors estimate that nearly 330,000 people died between 1999 and 2005 because of the South African government's opposition to the drug treatment. I find a quote from the published study, even in the dry language of science, deeply touching and sad:

“Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available [drugs] to prevent and treat HIV/AIDS in a timely manner.”

The lesson for us here is, I think, a delicate one.

We are not better than South Africans. We all have political beliefs, ways we think governments should work.

Nature, however, doesn't care about our beliefs. What works may surprise us.

We should be open-minded enough to accept whatever works. We should also be impatient with our leaders and demand what works immediately.


Christer Watson, of Fort Wayne, is a visiting assistant professor of physics at Purdue University Fort Wayne. Opinions expressed are his own. He wrote this for The Journal Gazette, where his columns normally appear the first and third Tuesday of each month.

Sign up for our Opinion newsletter

Sent daily