Address by Naledi Pandor MP, Minister of Science and Technology, at the CAPRISA Scientific Advisory Board meeting, Zimbali Fairmont Hotel, Ballito KwaZulu-Natal
I will not go through the long list of distinguished attendees provided by the organisers, save to mention Deborah Birx, Head of PEPFAR, Dr Luiz Loures, Deputy Executive Director of UNAIDS, and Zac Yacoob, former constitutional court judge, and veteran of our struggle for freedom. Allow me then to welcome all distinguished guests present at this meeting.
I am honoured to address such an extraordinary gathering of HIV scientists. It's my pleasure to extend a warm South African welcome to you all.
I wish to thank Dr Loures and Dr Birx for their thoughtful and thought-provoking input.
Four years ago I addressed this gathering at the invitation of Prof Abdool Salim Karim. Since then he has not only continued to drive the R120 million a year CAPRISA, but he also found the time to transform our R271 million a year Medical Research Council in 2012 into a projected R648 million research organisation in 2016. That's a remarkable achievement. His stint at the MRC was a confirmation of his skills as a science leader. South Africa is immensely proud of you.
Thank you for inviting me to address you once more.
Four years ago there was a sense of optimism regarding the fight against HIV/AIDS. Four years later that sense of optimism continues to grow. Today we are talking about approximately 30 drugs that have been approved for use by people living with HIV/AIDS, and many more are in different stages of development. Today we have affordable testing, counselling and prevention services. Today we have strong scientific agendas pointing towards a vaccine and a cure.
South Africa has been able to put 2.6 million people on ARV treatment (42% of the people living with HIV). The increase in ARV treatment has resulted in a reduction in the number of people dying as a result of HIV infection and a significant reduction in the levels of mother-to-child HIV transmission rates.
Yet despite this, national HIV prevalence in pregnant women has remained within a narrow range of 29.1% and 30.2% for almost the entire past decade. This calls for intense work to find a cure.
We still have over 1000 new HIV infections each day. And adolescent girls and young women are at highest risk of acquiring HIV. We must focus on prevention and pay greater attention to data and acting on it, as Dr Birx stressed.
We have a wealth of data available to us from excellent research done by the HSRC and other institutions. I often worry that we do not sufficiently mine this data to develop new evidence-based interventions to our challenges.
CAPRISA's work is very important to empowering and protecting women. If we are going to meet the UNAIDS Fast-Track strategy to end the epidemic by 2030, we have to empower and protect women. At the moment, prevention options for women remain limited. As has been said by others, the most widely advocated prevention method is the “ABCCC” strategy - Abstinence, Be faithful, Condomize, Counselling, and Circumcision.
However, women are often unable to successfully negotiate condom use with their male partners. So we need another way.
We need to think more. We need to assess whether we are doing all we can, whether we are looking at every angle.
The Department of Science and Technology has taken up the challenge of addressing our priority health needs by generating innovative solutions. To this end we are funding the Strategic Health Innovation Partnerships (SHIP) programme within the South African Medical Research Council.
CAPRISA and the MRC must take a leadership role in developing health innovations. South Africa and Africa must not simply be a consumer of health technology, but must play a leadership role in developing innovative solutions to tackle our country’s and Africa's health priorities. Our government is very supportive of international collaboration as we see this as an essential aspect of science. But we are not supportive of the kind of collaboration that reduces South African researchers to data and sample collectors for scientists in the North or as supplicants seeking funds. South African and African scientists must play leadership roles in developing new technologies.
I believe it is correct to have this ambition for our scientists, but I'm also alert to the significant hurdles we must address to arrive at our stated objectives. We need to improve investment in research in Africa, support research in higher education and expand and grow the number of institutions and researchers. The DST strongly supports research undertaken by AIDS and TB researchers in South Africa.
I am also keenly looking at other areas of research on prevention in other science disciplines. What are education researchers proposing, creative arts researchers and so on.
The DST has funded studies on tenofovir gel. It funded the ground breaking CAPRISA 004 study that provided proof of concept that antiretroviral drugs prevent sexual transmission of HIV, the follow-on CAPRISA 008 implementation study and the FACTS 001 confirmatory study. In light of the recent disappointing results of the FACTS 001 study, and its impact on the development of tenofovir gel, it's more important than ever that alternative methods of HIV prevention are developed for women.
We must also explore whether there are other strategies to consider implementing while we do the necessary scientific research to develop health-based interventions.
We must learn from our successes, as well as failures, and we need to persevere.
While the evidence that antiretrovirals work in preventing HIV infection is compelling, in practice we have learnt that not all people are able to take the tablets or use the gels as prescribed. This throws up new challenges –we need good socio-behavioural science to be undertaken in parallel with biomedical research so that we better understand what people are willing to do to protect themselves from HIV.
We need to know what people know, what their perceptions are, and what interventions they will accept.
The World Health Organisation recommends antiretrovirals for HIV prevention in gay men and in discordant couples, but it does not recommend antiretrovirals for women in the general population. We need new strategies to prevent HIV in women. We need to pursue alternative strategies with vigour.
As new antiretroviral drugs continue to be developed, a major advance is the formulation of highly potent drugs in slow release long-acting injections. A major advantage of these long-acting formulations is that women would only require four injections a year. I hope this HIV-prevention injection will be available for use in the health system soon
It is particularly exciting to see new developments in research on HIV vaccines. The discovery of the CAPRISA 256 antibody has created newfound enthusiasm for active and passive immunisation as a HIV prevention strategy.
The DST has committed to providing support to research towards an HIV vaccine and to supporting the development of broadly neutralising antibodies as key components of future vaccine research.
It's also critical that we make every effort to train the next generation of scientists. We all have to rise to this challenge of building a strong science base in South Africa and especially to strengthen scientific capacity in the AIDS and TB research sector. Training medical students and doctoral candidates is very high on the Department of Science and Technology’s agenda and we want to see even more of these initiatives getting underway.
I was very pleased to hear the young scientists reporting on the work they are doing.
The UNAIDS Fast-track report says that the world is embarking on a Fast-Track strategy to end the AIDS epidemic by 2030. The report states and I quote: “to reach this visionary goal after three decades of the most serious epidemic in living memory, countries will need to use the powerful tools available, hold one another accountable for results and make sure that no one is left behind.” South Africa is committed to supporting and conducting research to achieve this goal. And through organisations like CAPRISA, South Africa is conducting world class research to help the world end the AIDS epidemic as a global health threat by 2030.
As I conclude, I wish to highlight a few issues that continue to concern me.
- The absence of clear references to the social sciences and humanities in our search for solutions, despite behaviour being such a strong indicator of what must be altered. There is a base of work we can draw on.
- Inadequate collaboration with education stakeholders.
- Insufficient critique and scrutiny of the high cost of drugs and other areas of complexity.
- A lack of reflection on popular culture and its contribution.
I wish you well in your deliberations over the next two days. May you make the UNAIDS goal of "zero new HIV infections, zero discrimination and zero AIDS-related deaths" a reality.
