“When dealing with a previously unknown virus like Covid-19 we should always have DOUBT at the top of our thinking. Those making the policies and advising should always keep open the possibility that they are wrong. This allows us, in a context of such high levels of uncertainty, to adapt as we learn, as more data becomes available, and as we better understand the virus within our context.”  – Prof Imraan Valodia

This evening the Daily Maverick will host a discussion with Professor Shabir Madhi, a world-class scientist and a vaccinologist who has been increasingly critical of aspects of the strategy being followed by the Minister of Health, Zweli Mkhize and President Cyril Ramaphosa. As pointed out by Professor Salim Abdool Karim “different views are good and very much part of the scientific process”.

But one gets the sense that Madhi is having to raise his voice because he and other experts are not being heard or properly engaged with.

Some of the arguments of health experts critical of aspects of current strategy on Covid-19 can be found here, here, here and here. 

I would sum them up, in as compact a nutshell as possible, as follows: 

Because South Africa’s lockdown was not accompanied by an immediate and strategic scaling up of Covid-19 testing, in order to identify and isolate those infected, community transmission has become irreversible, containment is now impossible. Added to this the delay in implementing meaningful humanitarian relief measures has meant that millions of people could not comply with the lockdown even if they wished to. 

The lockdown was a partial success. It signalled the seriousness of the crisis and bought us some time to prepare emergency health services. But as a result of its shortcomings, the lockdown is now incurring a disastrous economic cost (some say R13-billion a day) and an unprecedented social cost – near-starvation amongst millions – but not yielding the health outcomes it was intended for. 

Therefore, it is better to significantly relax the lockdown whilst simultaneously increasing public health measures that are proven to have an impact on reducing transmission. This also requires a reconsideration of the mass testing strategy and steps to ensure its integration with other threats to health in SA, such as HIV, TB and even measles.

South Africa is now two months into a National State of Disaster that won near unanimous support at the outset. But one of the dangers with talking about a “war” on Covid-19, has been that those with different views can be turned into the enemy. It’s vital to remind the President and his Cabinet and, possibly even more importantly, the people who advise them who have great power to filter what their principals hear – that all expert voices and opinions count.

• So, it’s necessary to repeat a few truths here:
• Covid-19 is a completely new virus, our knowledge of it, and of the medical and social response, grows and sometimes changes by the day, we are in what the New York Times calls a “global ‘trial and error’ played out in lives”; so there’s nothing wrong with getting it wrong, as long as we have a system that permits us to learn, adjust and adapt.
• That makes truth-telling, transparency and accountability all important.
• A different opinion is not unpatriotic or counter to the national effort, but can be an essential check to the robustness of a strategy.
• Nobody in the scientific community or government should put their egos above the national interest.

Experts who are being politely but constructively critical of the National Command Council’s (NCC) current strategy are not Covid-19 denialists; those critical of aspects of the lockdown are not a right-wing Christian fundamentalist fringe, such as those protesting in parts of the USA; they are not anti-government or racist and, let it be said, even an opposition political party has a right to a differing view (as long as it does not opportunistically exploit its difference to create division or confusion). 

Instead, they are patriotic scientists and some of our best scientific experts.

The allegation that they are not being listened to is of concern and a contradiction of the government’s boast that its response is being driven solely by science – because the scientific method involves peer review and constant discussion until a hypothesis is proven. 

For this reason, South Africa needs a system, independent of government or business interests, that is continually assessing the evidence, the emerging scientific knowledge, and feeding this intelligence into our covid-19 strategies.

It would be best if the current Ministerial Advisory Committee (MAC) on Covid-19 was converted into an independent scientific advisory committee able to proactively support the Minister of Health and continually assess national and international evidence for its bearing on our strategy. Its deliberations and findings, the models on which it works, the evidence and information it draws from, should be publicly available. 

It is not acceptable that the modelling on which the government has based its decisions hasn’t been published for scientific scrutiny by those outside of the inner-circle and that a number of top modellers have been silenced by having to sign non-disclosure agreements (NDAs). This is bad for the quality of the models and bad for public understanding and public trust.

Linked to this it is vital that the Covid-19 Information hub, which President Rampahosa said is based at the CSIR, be made accessible to the public urgently, and that the process and personalities informing decisions in areas as diverse as schooling, the economy, food and water security and what we are allowed to buy, is made transparent and public.

Until a week or so ago, President Ramaphosa’s leadership and bravery had won him near-universal support – from the poorest of the poor to the richest of the rich. Without fuss and endless indabas, an undeclared social compact was born with the objective of saving lives and saving South Africa.

But that compact is now clearly fraying at the edges: evidence of non-compliance with certain aspects of Level Four of the lockdown is a vote of declining confidence; the wave of legal action against the government is evidence that trust is breaking and that citizens are back to old ways to try and assert and protect rights against a recalcitrant government.

No sensible person disputes that, to overcome Covid-19, we must make sacrifices and accept a reasonable limitation of our rights. Yet a growing number of people are concerned that they don’t understand (and the government is not sharing) the evidential scientific basis for certain decisions, such as the ban on tobacco. 

The fact that the NCC, whose military moniker is going to the head of certain of its members, feels that it does not need to justify its decisions is evident in the arrogant and rude response of the Director-General and Secretary of the Cabinet, Cassius Lubisi, to the 27 April letter from Advocates Nazeer Cassim and Erin Richards, who had sought clarity about:

“possible risks of constitutional and democratic malfunction arising from what appears to be the questionable establishment, structure and functions of the NCC, as well as the noticeable lack of transparency from Government about the body.”

Let’s be clear. There are rough days ahead in which we are going to see death, disease and panic. But if a pattern of questioning the bonafides of critics is entrenched it will be bad news for national unity in the response to Covid-19. Ultimately, it will leave the government with a choice: a continued lockdown enforced by brute force and fear, or a meaningless lockdown honoured only in the default. 

Neither is what we want, and the worst thing is that with either option, Covid-19 would be the winner.

In a time of crisis, freedom of expression and freedom of the media to amplify voices is a necessity, not a luxury. It establishes one of the crucial links between society at large and the decisions that the government makes on behalf of our collective. 

In South Africa that freedom is embedded in our Constitution. 

It is arguable that it was the suppression of freedom of expression by medical doctors and the media in China that got us into this Covid-19 mess in the first place. Not, as the denialist Trump would have it, as a result of a conspiracy by the Chinese government to manufacture a virus, but a conspiracy to silence its own health professionals and media.

Today, as we enter a more intense phase of the Covid-19 epidemic, with numbers and deaths now rising much more rapidly, this is one of the most important lessons South Africa must take on board. 

At this moment we need the sum of all our considerable scientific wisdom and expertise, not the best of some of it and the silencing or stigmatising of inconvenient voices. 

We must draw on all our strengths because there’s a huge amount at stake.

At stake is our politics, democracy and future of our children. 

If the government of President Ramaphosa is unable to mitigate the worst harm of Covid-19 or to prevent the complete collapse of our economy, it will fall to populist and corrupt elements who hover in the wings, currently without a stage or relevance.

At stake is our economy. 

Not the already broken, already unfair economy – we don’t want that back. But the foundation and architecture that our current industries and corporations provide to the millions fortunate enough to work in them, and for the millions more that an inclusive economic policy, as promised twice recently by President Ramphosa, must be put to work.

At stake are tens of thousands of lives put at risk by SARS-Cov-2, particularly of older people and people who – often because of socio-economic inequalities and diseases of poverty – have pre-existing diseases which predispose them to Covid-19.

However, also, at risk are the lives of thousands of children who although not at risk of severe Covid-19, are being indirectly affected by missing out on immunisation against life-threatening vaccine-preventable diseases; who are being placed at risk of malnutrition as the lockdown forces even more households below the poverty line, and whose education is being compromised by the closure of schools.  

At stake, therefore, is nothing less than our dreams of a democratic, socially just, equitable South Africa; and the future of our children. 

Lose all this and we risk becoming a failed, conflict-ridden state, where the haves will be forever at war with the have-nots, and where the have-nots will be the fodder of thieving demagogues and populists who will promise heaven only to deliver hell.DM

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