As South Africa joins the list of countries with the fastest-rising number of COVID-19 cases in the world, its ongoing struggle with another health crisis — the HIV/AIDS virus — is back in the spotlight. This time the country’s medical leadership can apply hard-learned lessons from the AIDS crisis to today’s coronavirus pandemic.
At four months and counting the coronavirus crisis in South Africa is relatively young, but the country has been battling HIV/AIDS for decades. As of 2018, 7.7 million South Africans were living with HIV/AIDS. According to data from the Joint UN Programme on HIV/AIDS, 90 percent of those infected were aware of their status, 62% were receiving treatment, and 54% were virally suppressed. This data also noted that the domestic death toll had dropped by 50% between 2010 and 2018.
The coronavirus is a different phenomenon altogether. Though the virus was initially slow to spread — it didn’t reach 100,000 cases until the beginning of June — rates have since risen exponentially. Despite the renewal of a countrywide ban on alcohol which South African President Cyril Ramaphosa says will take pressure off the health care system — and which understandably is receiving mixed reviews — on August 1, South Africa passed the half-million mark for coronavirus cases.
Still, Dr. Barry Schoub, the now-retired founding director of the country’s National Institute for Communicable Diseases (NICD), remains hopeful that a solution for the coronavirus will be quicker in coming than HIV/AIDS, for which there still isn’t a vaccine.
“It’s easier to design a vaccine for the coronavirus than HIV,” Schoub told The Times of Israel recently. “There are two main reasons. One, the HIV virus itself is very, very changeable, mutable.”
The other big problem, Schoub said, is that HIV/AIDS infects the immune system at the cellular level. “It damages the cells of the immune system… It’s a double whammy, a double challenge,” he said.
Schoub, who is among the medical advisors to the South African Jewish Board of Deputies (SAJBD), noted that the NICD has the world’s largest HIV research unit. He himself has been a leader in the decades-long fight for an HIV/AIDS vaccine.
The current leadership of the NICD includes deputy director Dr. Lucille Blumberg, who is helping with the overall coronavirus response in the Rainbow Nation of a majority Black and minority white population.
In separate interviews, Schoub and Blumberg described responding to numerous infectious disease outbreaks in their careers, from Ebola to poliomyelitis. But the dominant public health crisis in South Africa during their tenures has without question been HIV/AIDS, and both Schoub and Blumberg indicate that the country’s experience in this regard offers an important perspective on COVID-19.
South Africa has the world’s highest number of HIV/AIDS cases, and as of July, it is in fifth place for total coronavirus cases, behind the US, Brazil, Russia and India. Yet experts said that the two crises require different approaches.
“I think the COVID-19 response has been more intense over a shorter period of time,” Blumberg said, noting its effects on the health care system and the economy. She noted that for HIV-positive patients, “[There’s] excellent treatment now,” Blumberg said. “People can live full lives.”
Schoub is a recipient of the Order of Mapungubwe, the highest civilian honor in South Africa. His medical achievements go back to the 1970s, when he founded the virology department at the University of the Witwatersrand. In 1999, he became founding director of the NICD, which he led from 2002 to 2012. In that role, he recruited Blumberg to lead a team to fight infectious disease outbreaks. At the time, she was the only member of the team. Now, as a deputy director of the institute, she participates in weekly meetings through the WHO, alongside colleagues from other countries, including Dr. Anthony Fauci in the US.
Schoub said that South Africa went into lockdown in March, but while the first five to six weeks were “really effective at controlling infection,” the socioeconomic effects proved too much and the restrictions were eased. He said that as people went back to work and returned to restaurants, theaters, houses of worship and social events, the virus spread. (Synagogues, which closed in March, have not reopened.)
In a July 2 post on the SAJBD Facebook page, Schoub noted that the only countries ahead of South Africa in terms of new cases all have much larger populations.
The Jewish community can also rely on additional medical input during the coronavirus crisis. Hatzolah, a Jewish volunteer EMT service, posts weekly updates on the SAJBD Facebook page. As of July 24, it listed 229 active cases, 519 closed cases and 745 total cases.
“With the initial swift action by Jewish communal leadership to close shuls, schools, [and] aged homes in mid-March, the infection rates and death rates in the community were extremely low,” Wendy Kahn, the national director of the SAJBD, wrote in an email. “Sadly with the easing of the country’s lockdown these rates have increased drastically including within the Jewish community.”
Double-time march to vaccine
Mary Kluk, the national president of the SAJBD and a vice president of the World Jewish Congress, told The Times of Israel that “obviously, South Africa has quite a sophisticated research and laboratory infrastructure because of HIV and research done around tuberculosis, a massive annual concern in South Africa. We have a great deal of understanding of infectious diseases.”
While the AIDS vaccine proves elusive, Schoub predicts that the world may see a coronavirus vaccine in a relatively short time.
“If everything goes well, mid-to-late next year for a vaccine being widely available,” he said. “I can’t see earlier than that.”
Among the potential COVID-19 vaccines in development is one from Oxford University which is in trials across the globe, including in South Africa. Schoub lists it as among the three efforts at the most advanced stage, alongside Moderna in the US and CanSino Biologics in China. The Oxford study is recruiting 2,000 participants in Johannesburg and Cape Town.
“It’s important that studies like this, for a vaccine, are validated in Africa,” Blumberg said. Although she forecasts that a vaccine “will happen sooner rather than later,” she does not predict it happening “in the immediate few months.”
However, she said, “I think the speed with which a COVID-19 vaccine is being developed and rolled out is unprecedented.”
“I think the lessons from the COVID-19 vaccine response are the huge financial support, I think it affects the whole world, everybody is working toward it,” Blumberg said. “HIV is a very different arena. In terms of the immune response, it’s a very different response with antiretrovirals, completely different.”
HIV is a political issue
Schoub and Blumberg said that one hurdle coronavirus researchers do not face is denial of the crisis itself, which they describe as a past problem in South Africa, where it was once said that HIV/AIDS is not caused by a virus.
“HIV was a huge political issue,” Blumberg said. “HIV denialism was massive.”
Schoub said that there was a “virus denial phase” during the government of then-South African president Thabo Mbeki.
“It was because, I think, of the stigma of catching HIV,” Schoub said. “The response to stigma [was] one of denial — that it was an economic disease, a disease of deprivation. Of course it is — indirectly.”
“The denial was unfortunate,” he said, calling it a “very negative phase in scientific independence.” However, he added, “That’s certainly not the case at this moment.”
Blumberg said that there is “no denial of COVID-19. It’s in your face. I think it’s a lot more open.” And, she said, “I think the government here is very different to what’s been happening in Brazil, even the US. We’ve recognized the problem, not denied COVID-19.”
As for how long the COVID-19 problem will last in South Africa, Blumberg said it is impossible to know at this stage.
“It will reach its peak in all areas, plateau and come down,” she said. “We will see COVID-19 for quite some time.”