Nearly 15 years ago, South Africa’s Constitutional Court faced a monumental decision: whether or not to provide HIV-positive pregnant women and their babies with treatment to protect the infants from contracting the virus from their mothers during birth.
The court ruled in favour, affirming South Africans’ rights to life-saving medicine — and ensured that science formed the basis of the country’s HIV response.
Those sitting on the court may not have known it at the time, but their landmark decision accelerated a nationwide trend toward support for South African science and research.
Since then, South Africa has become a leader in testing and developing evidence-based solutions to address major scientific challenges, from maternal mortality to pneumonia and malaria.
South African researchers and leaders are hard at work developing and delivering innovations that could turn the tide on HIV and also make significant gains against tuberculosis (TB), which is the most common illness South Africans with HIV develop.
In the past few months alone, we’ve seen exciting advances with several important HIV prevention tools. The first HIV vaccine efficacy trial in over a decade just launched at six sites across the country. Research is also underway on the potential of broadly neutralising antibodies — which are produced by the human body to fight organisms that cause disease — to prevent HIV infection.
And scientists from Cape Town to Durban are working to answer basic but difficult questions about TB, including how the TB bacterium is transmitted and what puts one person at higher risk for infection than another.
Innovation goes beyond the lab. South Africa was the first country in Africa to approve a daily pill to prevent HIV. This form of prevention is known as pre-exposure prophylaxis, or PrEP. The government recently rolled out PrEP to sex workers.
As part of the United States government’s Dreams programme, researchers in South Africa are working to break down the social and structural barriers facing young women at risk of contracting HIV.
Through TB Reach, a multilateral funding mechanism, South Africans are testing innovative approaches to detect TB and HIV/TB coinfection as early as possible in high-risk areas, such as communities living near mines.
These programmes didn’t launch overnight, and they didn’t happen by accident. Today’s innovation landscape is a product of years of civil society advocacy, high-level political commitment, major investments and strong international partnerships.
Since the early 2000s, the South African government has launched major programmes to support innovation for HIV and TB. In 2005, the human capital programme of the Square Kilometre Array radio telescope project kicked off. It works to develop a new generation of young South African researchers and engineers. The Global Health Innovation Accelerator was launched in 2014 and aims to advance evidence-based technologies and accelerate research to improve the health of women and children in South Africa.
These investments are paying off. More than three million South Africans now have access to HIV treatment and National Health Laboratory Services data shows that mother-to-child transmission rates of HIV have dropped nationally from an estimated 30% in 2004 to about 1.5% in 2015.
But we also know that our fight against HIV and TB is far from over.
We face the largest HIV epidemic in the world, with about seven million South Africans living with HIV, according to the Joint United Nations Programme on HIV and Aids. And health department data shows that half a million South Africans contract TB every year, about half of whom already have HIV.
These challenges are daunting, and the stakes are high. Although we’ve made remarkable progress, current advances are not yet enough to end these epidemics. Without new tools, particularly for prevention, we may even see our hard-fought progress reversed. If we want to write the last chapters of HIV and TB in South Africa, we must invest in innovation.
South Africa must strengthen its role as a leader in science and research. This will require increasing resources for research and development. We are confident this will deliver long-term returns.
Current studies have the potential to evolve into high-impact solutions, and future investments can help us to find other potential game-changers.
As we continue to develop new tools, we need to be prepared to get them to people who need them — as quickly and efficiently as possible.
The innovations we develop here at home will inevitably benefit people across the globe. Even now, while South Africa is the epicentre of both the HIV epidemic and the most exciting HIV research, other countries, including our neighbours, are benefiting from the same tools and strategies that have been core to our own progress.
Investing in innovation for HIV and TB will support South Africa beyond these epidemics as well. By building strong scientific and research capacity, we’ll have the opportunity to establish ourselves as a global leader in health and development.
Ultimately, the next generation of South Africans will be ready to develop and deliver solutions to the biggest scientific problems we don’t yet know about.
The next phase of the global response against HIV and TB is unfolding, and the world needs leadership committed to innovation for positive impact. We know South Africa is up for the challenge.
Naledi Pandor is South Africa’s minister of science and technology. Dr Trevor Mundel is the president of the global health division at the Bill and Melinda Gates Foundation. He was born in South Africa and received his medical degree from the University of the Witwatersrand
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Bhekisisa means "to scrutinise" in Zulu
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