Wednesday: The battle for science

A great mystery: why is Thabo Mbeki, president of South Africa, in denial about the AIDS epidemic?

It is killing one thousand South Africans a day, infection rates are rising,it is expected to remove the most economically productive people from the population and cost effective treatment, and the money to buy it, exists. Yet, Mbeki has resisted the role out of ARVs at almost ever step, despite court cases enforcing him to do so, publicly denied the link between HIV and AIDS and put in place a health minster, Manto Tshabalala-Msimang who has promoted beetroot, african potato and quack’s herbal remedies, over ARVs. A few months ago Manto fell ill and her deputy, Nozizwe Madlala-Routledge, took over. She was a much needed relief, publicly tacking an HIV test in her first week in office and kick starting governments program to tackle the epidemic. This week Mbeki sacked her; claiming a trip to an international AIDS conference in Spain was unauthorised. The press and NGOs have been up in arms in response. So, answering why is Mbeki in denial has never been more pressing.

I went to a talk on Wednesday by someone who doesn’t know either. But she has looked closely at the rise and effects of Mbeki’s denialism. Nicoli Nattrass, a professor in economics, thinks that the most devastating effect has been over the value of science. Under Mbeki not only have alternative therapies been promoted publicly before ARVs but the institutions that should be responsible for protecting the pubic from unscientifically supported medicine have been sidelined. For example it was in 2002 the Medicines Control Council rightly impounded untested pills promoted by an American Matthias Ratth at the port when they arrived, only for the decision to be over turned by the Health Minster. There are a whole series of quacks selling treatments unregulated across the country. Many of the government broads responsible for managing the epidemic apparently lack scientific expertise. This has left patients confused about which treatments work and public health messages based on the science of the epidemic treated with ambivalence.

The actual reasons for Mbeki denial continue to rage. Is it two fingers up to western ideas, part of his African renaissance, accepting only “ Africa solutions to Africa problems”? Is accepting the scale of the epidemic untenable to Mbkei because answering why the epidemic has been so severe in Africa is so difficult and prone to value judgments? Has AIDS hit his personal life? Is he too proud to admit he was wrong in the past? Or does he truly disbelieve contemporary science? What ever the reason is, the way forward is not only to speak out against Mbeki’s denialism and government inaction but also to promote the understanding of science and the institutions which uphold it. For example alternative remedies need to go undergo randomised control trials, and there needs to be much more public education about the epidemic and the reasons for its scientific basis. The professor drew parallels to the Republican war on science in the US and the situation echos the campaign led by Ernest Hart, editor of the BMJ, against quacks at the turn of the 19th century in the UK. Complacency, it seems, about the founding principle of science cannot be assumed at the early part of this century either.