If there’s one thing keeping Professor Koleka Mlisana awake at night right now, it’s that 30-odd per cent of people eligible for vaccination remain stuck in the limbo of hesitancy.

“There are the people who are neither here nor there and we need to find a way to get through to this big group to understand that without them we are not going to get herd immunity — that concerns me,” says Mlisana, who is co-chair of South Africa’s Ministerial Advisory Committee (MAC) on Coronavirus.

Mlisana, though, is not easily overcome with panic or hopelessness. Not even as the third wave of Covid-19 has surged with devastation this winter. After over 40 years in health sciences, the microbiologist by training and executive manager of academic affairs, research and quality assurance at the National Health Laboratory Services (NHLS) trusts in science and the advancement of technology. She also looks for silver linings.

“The key message is there will always be emerging diseases, infectious diseases,” she says. “What becomes important is how prepared we are for the next epidemic. What have we learnt from the previous epidemics and how do we use advancing technology to improve our responses?”

Preparedness, she says, should be about improving and ramping up messaging and information about vaccines. It’s communication that needs to be delivered to South Africans in local languages other than English. There should also be budgets and instant access to human resources to meet the demands of programmes like weekend vaccination drives. It should not be the last-minute scramble because of government red tape. All this builds confidence and helps break through vaccine hesitancy, she says.

HIV in the ‘90s

In the 1990s, she was part of the groups of scientists researching the devastating unknowns of HIV, looking for answers even as the virus kept claiming lives. Mlisana was head of the HIV Pathogenesis and Vaccine Research Programme under the Centre for the Aids Programme of Research in South Africa (Caprisa). Her research focussed on understanding the body’s response to acute HIV infection.

Those years of being a scientist were about doing her research work while constantly having to synthesise a flood of new information. It was also fighting a ticking clock, denialism, stigmas, taboos and then political delay when antiretroviral treatment was prescribed.

There are clear similarities between the HIV/Aids response and the Coronavirus response in South Africa. Lessons that should be learnt hold those silver linings for Mlisana.

“We made mistakes, we had to fight the denialism and we know that we moved too slowly in some instances and missed out on providing antiretrovirals to the public sector, and as a result, we had so much loss,” she says.

But responding to the HIV/Aids crisis, she says, also meant scientists and doctors learnt to move faster to establish diagnostic frameworks and to do clinical trials. They also gained a different perspective about urgency, collaboration, and their role in advocacy for patients’ rights and public health priorities.

It’s why even though Mlisana stresses that the mandate of the MAC is about its middle word “advisory”, it has an equal responsibility to not be timid about holding government to critical timings, making science clearer to the public and decision-makers, and collaborating with experts from other disciplines.

‘Overwhelming responsibility’

Two things though have helped, she says of taking on the co-chair role – a role she adds that she “would not have put my hand up for because it comes with overwhelming responsibility”. The first has been bringing her combination of skills, expertise and experience to the fore and the second is building a strong team of modellers, clinicians and other scientists around her.

Mlisana has over the years merged her medical and clinical training with research, also with her time in academia (as head of the department of medical microbiology at the University of KwaZulu-Natal), as well as positions of management and leadership in the private and public sector. She serves on the South African Medical Research Council and was already on the committee on antimicrobial resistance within the MAC when Coronavirus hit.  

It’s a combination that’s honed different skills sets — including non-medical ones like the ability to identify and support talent for building strong teams and recognising her blind spots and weaknesses.

“I wouldn’t say I’m there yet, but I think from what I’ve gone through in my life, I’ve got a little bit of understanding of how to manage people’s egos. You give them the space that they require, but at the same time, they need to know when to get them to stop by putting up boundaries,” she says of the inevitable heated debates that come with decision making around the moving target of Covid-19.

Rural Eastern Cape

It helps too that Mlisana grew up as one of four kids in rural Eastern Cape, raised by a single mom after her dad died shortly after her youngest sister was born. There were obvious sibling rivalries to negotiate but also the deep bonds of kin in standing together and also the need to get on with things.

In her teen years, there would also be lessons from disappointments and getting savvy; making Plan Bs work out. Mlisana did well at school but had to repeat her matric exams because of a leaked exam paper that affected several schools in the region. But in being delayed and having to rewrite some of her papers, she ended up switching directions from applying to do a BSc at the University of Fort Hare to studying medicine at the University of Natal that had a “black section” in the apartheid era.

The Plan B would see her qualify as a doctor, but not before failing her second year and then having to find the resolve to continue. She would also fall in love with the fellow doctor she would get married to, and they would have their first child as Mlisana was finishing her final year.

“A lot of my decisions about my career were determined by our family situation at the time and came about as chance,” she says. As her husband specialised in paediatrics, she took up a post in microbiology, training as a registrar.

Mlisana says “culture and society meant a woman adjusted her career to her husband’s.” But she adds that for her, the empowerment was in “making peace with the decisions and agreements so that I was comfortable and so that it wouldn’t cause resentment.”

Today the couple has celebrated a 40th wedding anniversary and has raised three grown children who have made them grandparents to five little humans.

Framed photos of these family members in her office at the National Laboratories in Modderfontein make up her fuzzy Zoom chat backdrops, rather than trophies and certificates to mark firsts and accolades — even though she’s notched up some significant achievements. These include being the country’s first black microbiologist; co-author of over 130 academic articles and that she regularly takes the podium at international research congresses.

The next generation

For Mlisana, what’s more important is what still lies ahead, who is still coming after her — the next generation of scientists and researchers. Grooming and mentoring girls for education as well as young women scientists she says are close to her heart.

“It is not just mentoring, but it’s believing in someone, having confidence in their potential,” she says of true investment in raising up more young women.

Of course, she says, in an ideal world milestones for women or black people would not be outlier stories, just the ordinary stories of achievement and fulfilment. But the world is not there yet. There’s work to do, awareness to raise and also no comfort in sugar-coating realities of obstacles, barriers and structural inequalities that still exist.

“There were times in my career when being the first black microbiologist in the country I was so conscious of being the different person in the room that you read things into everything, about how you are received and how someone else was received, and sometimes I read that erroneously. So I had to train myself not to find myself sucked into that hole,” she says.

She has also had to master the art of pushing back on tick boxes that masquerade as transformation. Mlisana calls out the lazy effort of making politically correct appointments of black women into senior positions without proper support structures. In her view, it amounts to a failed exercise all around.

Her journey has been about finding her voice, it’s not to shout “I’m here, I’m here”, she says, but about turning up her volume, so her message is clearer and her intention clearer still.

Right now, her voice on the MAC is about making science and data-oriented input clear, heard and understood. It matters because it saves livelihoods and lives; this is ultimately exactly what she signed up for. DM/MC

*This is the first in Spotlight’s four-part Women in Health series featuring the remarkable contributions of South African women to medicine and science.

*This article was produced by Spotlight – health journalism in the public interest.