‘It took me three seconds to decide’ — Dr Fareed Abdullah reflects on three decades at the coalface of public health
Biénne Huisman chatted to Abdullah about providing antiretrovirals in the time of Aids denialism, National Health Insurance, working as a medical doctor, and the toll HIV has sadly taken on his own family.
Over the past three decades, Dr Fareed Abdullah has been at the coalface of South Africa’s response to HIV, tuberculosis (TB), and more recently, Covid-19. In this time, he proved himself a health sector pillar — unafraid to shun political party lines when they clashed with his clinician’s integrity. Recently he spoke out against the proposed NHI [National Health Insurance] legislation, while back in 1999 he helped pioneer the roll-out of Aids treatment in the Western Cape, in defiance of then president Thabo Mbeki.
“I was the head of the Aids programme [in the Western Cape’s health department],” he recalls, “and we started providing AZT (an antiretroviral) to pregnant women in Khayelitsha. And I kid you not, we placed the order for AZT. A week later, Mbeki and then health minister Nkosazana Dlamini Zuma said they would not provide AZT as it’s toxic.
“So here I was — someone who’s a part of the liberation movement — an ANC person in the administration. And I was faced with a simple, but difficult dilemma — follow the party line or do the right thing as a doctor. It took me three seconds to decide what to do. I had the authority at that time — public servants had authority — the authority to do things, to order a new drug, to start a new programme. So we continued with the treatment programme and national couldn’t stop it because we really understood the powers that provinces have. Constitutionally, a province can set their own policy and we jealously guarded the right of the province.”
Spotlight interviewed Abdullah in a boardroom at the South African Medical Research Council [SAMRC’s] headquarters in Parow, Cape Town. Abdullah has been the director of SAMRC’s Aids and TB research office for the past five years.
Evicted from Pageview
Originally raised in Pageview in Johannesburg, Abdullah’s parents were forcibly evicted when he was seven years old. At the time, black residents were forced to Soweto and Indian residents to Lenasia. The Abdullah family moved to Overport in Durban. Here, Abdullah graduated from the University of KwaZulu-Natal’s medical school in 1987, after which he obtained an Honours in public health at the University of Cape Town in 1994.
Speaking of his family, Abdullah grows pensive. His wife is Swiss, but moved to South Africa in 1980. They have a son and a young granddaughter but to date, Abdullah has not publicly spoken of his other son, Richard, whom they adopted when Richard was eight years old.
Richard succumbed to an Aids-related illness in 2012, aged 27, after refusing to take the very life-saving treatment his father brought to the Western Cape and South Africa.
“I was the head of the Western Cape Aids programme and my own son contracted HIV,” says Abdullah. “It’s a great irony, isn’t it? He contracted HIV when he was 20. I’ve never really spoken about this publicly, although it’s never been a secret. I guess the kind of thought I have around this is that HIV affects every family in South Africa, you know? And you think that it wouldn’t be this close. But it is.
“So ja, I started the treatment programme in Cape Town, but he refused to take treatment. I think he was struggling with life… it was just very difficult for him.”
Richard died at George Hospital on the Garden Route in the same year that saw Abdullah become the CEO of the South African National Aids Council (Sanac).
“George Hospital, a hospital that I had upgraded over 10 years into a specialist hospital, from a district hospital before,” says Abdullah. “My wife and I were with him for the last week, at his bedside. And his brother. I had just started at Sanac, actually. Richard had HIV but he actually died of TB. So that’s what kills South Africans who have untreated HIV. They get a TB/HIV co-infection and then they die.”
Abdullah reaches into his wallet for a photograph of a smiling young man. “I keep a picture of him,” he says. “That’s him.”
As CEO of Sanac, Abdullah says he drew on experience gleaned in Europe. For two years he was a director at the International HIV/Aids Alliance in the United Kingdom and for three years he headed HIV, TB and malaria funding for Africa at the Global Fund in Switzerland.
“At the Aids Alliance a lot of their work was with sex workers and drug users,” says Abdullah. “I learnt a lot about the ‘key populations’ as we call them. My biggest project was working with drug users in Ukraine. Ukraine has the biggest drug-user HIV epidemic in the world. And the reason is because heroin grows everywhere. It’s ubiquitous. Every garden has poppies growing, people make homemade heroin very cheap. I travelled to Ukraine many times and spent a lot of time in Kyiv. I have wonderful friends there, who I’m very concerned about right now.”
Building systems at Sanac
At Sanac, he built financial and administrative systems while introducing programmes on “key populations” (groups who are at a higher risk of contracting HIV). Essentially, Sanac’s role is to coordinate South Africa’s national response to HIV, TB and STIs.
“It became clear to me that we needed special programmes for sex workers, men who have sex with men, drug users, and transgender people,” he says.
Carefully considering his response, he reflects on his controversial 2017 replacement as CEO of Sanac by Dr Sandile Buthelezi, now Director-General of the Department of Health.
“Between minister Motsoaledi and senior officials in the health department, they decided in their wisdom that I might not be the best person for that job,” says Abdullah. “You know, in those situations, you often don’t know exactly why. In my case, I think I have a pretty good idea. Firstly, Sanac suddenly became a real entity. A lot of money was coming through and I was uncompromising about making sure that money was used properly, that it went to the right people. Unfortunately in health and in the country in general, there are always people circling around money, trying to get their hands on it. And I think those people thought they’d be better off if I was out of the way.”
‘Unimplementable’ at present
Commenting on the proposed NHI legislation, Abdullah insists that first — as a priority — the public health sector needs to be improved, incrementally. Originally brought to the table by the ANC in 2009, public deliberations around the NHI Bill continued this year and Parliament’s Portfolio Committee on Health is currently considering the bill clause by clause. But Abdullah says the proposed legislation is “unimplementable” at present.
“A lot of the provincial health departments are completely dysfunctional and there’s a lot of corruption,” he says. “I don’t think you can solve those things — inefficiency, dysfunction, and corruption with the NHI reform.”
He shrugs, adding: “I think the ANC is going to push through the reform, whether it’s the right thing to do or not.”
In raising these objections, Abdullah is countering some of his former university peers. “I went to medical school with Aaron Motsoaledi and [Minister of Health] Joe Phaahla. So ja, I know them from those student days.”
Back in the wards
While working for the SAMRC, Abdullah also volunteers as a doctor at Steve Biko Academic Hospital — in his hometown of Pretoria — treating patients at the HIV clinic. With the onset of Covid, he joined the hospital’s frontline response team.
“I was putting up drips after 25 years of doing it previously, doing 12-hour shifts at my age,” he says. He is 58.
Abdullah’s observations at Steve Biko lead him to publish a report on 4 December 2021 — 10 days after Professor Tulio de Oliveira’s team announced the Omicron variant (read Spotlight’s interview with de Oliveira here). His report described Omicron as less severe than previous variants and made world headlines, including in The New York Times which reported: “Omicron is fast-moving but perhaps less severe. Researchers in South Africa, where the variant is spreading quickly, say it may cause less serious Covid cases than other forms of the virus…”.
“My two roles collided quite nicely,” says Abdullah. “I went into the ward for my first round with Omicron. There were about 25 patients. My first impression was that half of these patients are sitting up on their beds and they don’t have oxygen on. We’ve never seen that before. Normally you go into a Covid ward and you can hear the oxygen, you hear the ventilators beeping. We use something called high-flow nasal oxygen, which sounds like a vacuum cleaner, pumping 60 litres of air per minute into a patient’s nostrils. It was different so I started documenting it.
“Tulio’s team announcing the new Omicron variant scared the hell out of everyone,” he says. “My paper came out saying even though it looks like a freak horror variant, the disease presentation is milder.”
ARVs in Africa
Abdullah likes the word serendipity — or fortunate coincidences — of which there appeared to have been several in the course of his career. One such was the alliance formed between the Western Cape government, the Treatment Action Campaign [TAC], and MSF [Doctors without Borders] in rolling out Aids treatment in Khayelitsha in the early 2000s.
“My team in Khayelitsha was quite weak,” he recalls. “And suddenly it had become this controversial project. We just couldn’t afford to fail, because now we were standing up to the president. And lo and behold, serendipity is such a wonderful thing. Eric Goemaere [of MSF] walks into my office, saying ‘I heard you’re running an ARV programme here. We want to partner with you.’ And the reason they wanted to partner with us was because they wanted to show ‘big pharma’ that you can provide ARVs in an African township. Because a lot of the big pharma were saying at that time that people in Africa can’t take ARVs. They don’t have the discipline.”
Across the boardroom table, he recalls watching HIV-positive activist Zackie Achmat [co-founder of the TAC in 1998] tell former president Nelson Mandela – “No.”
It was 27 July 2002 — the height of Aids denialism under then president Mbeki. Madiba visited Achmat’s house in the seaside suburb of Muizenberg to implore the Aids activist to take ARV treatment.
“And of course, Zackie said to Mandela that he won’t take treatment and that Mandela should tell government to provide treatment to everybody — that he’ll take it only then,” recalls Abdullah. “I mean, to say ‘no’ to Nelson Mandela!”
True heroes of the fight against HIV in South Africa, says Abdullah, have been the TAC and MSF.
Presently, Abdullah serves as chairperson of the TAC’s board.
Earlier this year, Abdullah was awarded the French National Order of Merit by President Emmanuel Macron for his work as a clinical researcher and public health scientist in the fight against HIV and TB. DM/MC
Note: The TAC is mentioned in this article. Spotlight is published by Section27 and the TAC, but editorially independent — an independence the editors guard jealously. Spotlight is a member of the South African Press Council.
This article was published by Spotlight – health journalism in the public interest.
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