Medical Research Council annual report: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
12 April 2005
MEDICAL RESEARCH COUNCIL ANNUAL REPORT: BRIEFING

Chairperson: Mr L Ngculu (ANC)

Documents handed out:
MRC PowerPoint introductory overview
MRC introductory overview document
MRC PowerPoint presentation on HIV prevalence
MRC PowerPoint presentation on evaluating HIV/AIDS prevention programmes
MRC PowerPoint presentation SA AIDS Vaccine Initiative
MRC briefing on cardiovascular disease research
MRC PowerPoint presentation on strenthening research capacity
MRC HIV/AIDS research lead programme
MRC PowerPoint presentation on Indigenous Knowledge Systems

MRC website

SUMMARY
The Medical Research Council resented the different areas of focus and practice of the institution, as well as their challenges, successes and failures. They also gave input on key goals in the new financial year and the financial constraints. The MRC emphasised that their research had to inform healthcare practices, beliefs and behaviours of communities, individuals and service providers. The presentation included how the Council was involved with the South African Vaccine Initiative (SAAVI), Indigenous Knowledge Systems, training of staff, and the focus on cardiovascular disease. Members raised questions about MRC funding; leading causes of death in SA; an HIV / AIDS vaccine, traditional medicine and clinical trials.

MINUTES

Medical Research Council Overview
Professor Anthony Mbewu (Interim President) outlined the activities of the Medical Research Council (MRC). The overview included information about funding, cardiovascular research activities, HIV/AIDS research, the South African AIDS Vaccine Initiative and indigenous knowledge systems. He explained that the MRC worked from the premise that their research informed healthcare policy in South Africa. See presentation.

Discussion
Mr I Cachalia (ANC) asked from where the MRC got its funding, and if the government was likely to increase its contribution.

Professor Mbewu said that the government gave the MRC 50% of its budget. This grew at five percent per year. Twenty percent went to malaria and R120 million was spent on HIV/AIDS. The funding was not enough for the health research that was being done. The problem with external funding and being donor driven meant that the MRC would have to follow the donors’ interests. The United States spent 25% of their science and technology budget on healthcare where South Africa only spent 9%. Between 1999 and 2002, the government had doubled MRC funding. The government had consistently increased their budget.

Mr Cachalia asked about malaria. He asked about the mosquitos’ resistance to chloroquine. He asked about the drug being taken with traditional medicine and if that helped with resistance.

Dr M Matsabisa (Director: Information Knowledge Systems (IKS)) explained that the combination of traditional medicines and orthodox medicines could either make the combination too toxic because of the synergy or make the drug useless or make the drug addictive. Plant extracts being used with chloroquine had to be studied further because they had to understand the impact of the plant extracts as carriers.

Dr R Rabinowitz (ANC) asked if the medicine discussed for malaria was the new drug for malaria. Dr Matsabisa said it was.

Mr S Njikelana (ANC) said that the MRC had presented many broad programmes. Which ones were the MRC’s flagship programmes? He also asked the MRC to give highlights and the impact of their research work.

Professor S Reddy (Director: Health Promotion) mentioned the research done on tobacco as a highlight. The work of the MRC on tobacco was what underpinned the policy on tobacco. She said that the President mentioned the issue of tobacco in the State of the Nation Address.

Professor N Padayachee (Executive Director: Research) stated that alongside tobacco and South Africa having the most comprehensive policy changes on tobacco in the world (based on MRC work) other highlights included research on vaccines for children, particularly black children. South Africa was the first country in the developing world that provided hepatitis vaccines. South Africa was the only country in Africa that provided this. Highlights also included research on primary healthcare and the refocusing of energy on primary healthcare, the change of strategy of the implementation and transfer of research into policy and death certificates and notification. The MRC was doing a study to improve death certificates. Nowhere in the world were death certificates a true reflection of the cause of death. In hospitals the most junior person could fill out a death certificate. Notifications even in the best systems were only ten percent accurate. The study was looking at this.

Professor Mbewu added that the MRC had led research on children and on asbestos and were involved in South Africa’s most famous case involving asbestos poisoning.

Dr Matsabisa also added SAAVI, work with malaria across the continent, HIV prevention in work such as mircrobocides, cancer research, tuberculosis (a new drug) and military programmes as highlights for the MRC.

Professor Reddy said that they were doing research on people who were HIV negative. They were recruiting negative people and monitoring them over eighteen months. The study was to see if they could be kept negative.

Dr Rabinowitz asked if the MRC were doing research on the impact of cellphones on health. Professor Mbewu said that there was no work in that field. He agreed that it was an area that they should be doing work in.

The Chairperson asked if they had been involved with the MRC Bill that was being worked on. Professor Mbewu said the Board had given input.

Cardiovascular disease research briefing
Professor Mbewu presented the leading causes of deaths due to cardiovascular disease. He shared how tobacco was the leading cause of death in this area yet it was avoidable death. Obesity was the second highest killer. He said that heart disease was much cheaper to prevent than to treat. See presentation.

Discussion
Ms C Dudley (ACDP) asked about what she saw as discrepancies in the figures of the leading causes of deaths. HIV/AIDS was at the bottom of the top causes. She asked about the links between HIV/AIDS and tuberculosis, which was at the top of the list. She asked what the illnesses were that were killing HIV-positive people.

Professor Mbewu said that death from tuberculosis was linked to HIV/AIDS. This was misleading. He gave the example of KwaZulu-Natal where two-thirds of deaths by tuberculosis were linked to HIV. He said that it differed from province to province. He said many deaths listed as tuberculosis, pneumonia and meningitis were HIV related.

Dr Rabinowitz asked about the representation of causes of deaths in South Africa. She asked if the problem did not lie with the issuing of the death certificate as there were only three lines to write the causes. She asked if bad databases and records added to poor statistics.

Professor Mbewu said that getting the correct statistics for HIV/AIDS was a problem all over the world. One of the problems was that HIV/AIDS was not a reportable notifiable disease by law. Legislating notification would be the most accurate way to ensure the correct numbers. Even the United States, which had the most popular model of public health, had to use different methods to come up with their figures. Antenatal figures could not be accurate and this spoke to trends rather than numbers. The MRC had conducted surveys in different households in an area. Only 70% participated and 40% refused to give blood samples. Most South Africans did not know their status and were not part of ongoing care, which made it difficult. With new systems, they would hope to get better figures.

Professor Reddy said that traditional models of health were also the problem. A focus had to be on death and there now was a focus that placed future funding on death funding. She said by looking at behaviour it was cheaper to prevent the disease.

Ms Manana said that tuberculosis was still plagued by beliefs of the old order. The public should be educated more about the disease.

Professor Mbewu agreed that there were strong links between tuberculosis and HIV/AIDS but the link between tuberculosis and poverty were not absolute. He gave the example of the Western Cape being the second richest province but it had the highest rate of tuberculosis. The Northern Cape was the poorest province yet it had the lowest rate of tuberculosis. He agreed that society had to be careful not to be absolute. He said that people must remember that tuberculosis was curable yet HIV/AIDS was not.

Ms Makishe (ANC) asked about the figures of cancer. She asked why cervical and breast cancer was missing as a leading killer.

Professor Mbewu explained that cervical and breast cancers were the most common cancers amongst South African women. There was a vaccine on the market but it was expensive.[A VACCINE AGAINST CANCER???] It was a particularly South African problem. The MRC was trying to make cancer more profiled.

The Chairperson asked why there was a decline in sexually transmitted diseases such as syphilis. This question was not answered.

Health Promotion Research and Development Unit
Ms S James (MRC: Health Promotion) described the ‘Evaluation of a Life Skills HIV/AIDS Prevention Program’. Learners participated in a fact based interactive curriculum regarding the disease. The MRC felt that education was a vaccine that was an effective method of prevention. See presentation.

Discussion
Ms P Tshwete (ANC) asked about education as a vaccine. She also asked if there had been any collaboration with other departments around the design of the curriculum. She wanted to know why it had been based in KwaZulu-Natal (KZN). This project had been launched in 2001 and she did not get a sense that the MRC had worked with other nongovernmental organisations (NGO) such as Love Life. She wanted to know why the design was solely for the Department of Education. HIV/AIDS was affecting all other departments so why was the training not for everyone? Why was it limited to schools?

Professor Reddy said that according to the legislation all schools were required to run HIV/AIDS programmes and prevention programmes. This had to be multisectoral. The programme worked with the Departments of Health and Social Development particularly for the life skills component. The MRC had been approached as outside evaluators for the project. KZN was the focus province because it had the highest figures. She agreed that an evaluation had to be done in other provinces. The biggest lesson that had been learnt from the programme was that if the programme were not completely applied there would be limited results. If the programme was implemented correctly there would be major behaviour change. Other provinces needed the programme but this would have to be a joint venture with other departments.

Ms M Manana (ANC) asked about the obesity results from the Youth Risk Survey. What were the recommendations?

Professor Reddy said that the youth risk survey looked at school going children between fourteen and seventeen. Seventeen percent were overweight and four percent were obese. This was very high for a developing country. She said that alongside this was ten percent that were underweight. Education systems were irresponsible because some form of exercise had to be provided. 40% of the children were inactive with twenty percent sitting more than three hours a day in front of the television. The intervention would be to do research as to what would really work to reduce figures. A coordinated approach that made interventions at information giving, community and legislation would be beneficial. They had to also look at what the food industry was doing and physical activity in schools. 29% of schools had no physical education.

Ms Manana asked if the MRC was involved in the work being done about high blood pressure. Was the MRC involved with the legislation being looked at to curb the adding of salt on food?

Professor Mbewu said that hypertension was also a serious problem in South Africa along with obesity and was due to high levels of alcohol and salt intake. He said that the diet of this country was a major risk factor for stokes or heart attacks. This could be controlled. 80% of the western diet consisted of processed foods which had high levels of salt. A possible reduction of the problem could be through legislation and programmes.

Ms N Nkabinde (ANC) asked if the project in KZN addressed stigmatisation and looked at the cultural factors of HIV/AIDS. Professor Reddy said that in the survey they did not do enough on culture but there were questions regarding culture included.

Ms Makishe (ANC) asked for clarity about the lower figures of behaviour change. Professor Reddy said that on figure six the partial education started off higher but became less positive. She said that skills based part had to me looked at in more detail.

The Chairperson asked if the results were printed in all vernacular languages. Professor Reddy said that all research was done in all the languages of the community.

South African Aids Vaccine Initiative (SAAVI)
Ms E Levendal (Co-director) outlined the origin of SAAVE and the different components it was made up of. She explained that SAAVI was part of a global exercise to find a vaccine. The first trials would be held at the end of this year. The vaccine would not be 100% effective; thus education and the vaccine would have to work hand in hand. See presentation.

Discussion
Dr Rabinowitz asked what was the best the MRC hoped to achieve from the vaccine? Since the virus changed all the time how would that factor be catered for in the vaccine?

Professor Mbewu said that it was mistake going after the virus because of the changing nature of the virus. The virus was always changing because it wanted to survive. That was the reason why it had taken so many years to produce a vaccine. Traditional medicine did not go after the virus, rather the work that it did was on the immune system. Thus traditional medicines allowed the body to live a normal lifespan.

Dr Matsabisa added that there was some evidence that some traditional medicine products did seem to work on the immune system. He said that this medicine had restored the immune system, which allowed the individual to live happily with the virus. The virus could not infect less than two percent of people. Less than three percent did get the virus but it did not progress to the AIDS stage. 97% of people who did get the virus, progressed to death. He said that if traditional medicines could push the 97% into the 2% that would be good. More studies were needed because it was difficult to target a virus that wanted to survive.

Ms M Madumise (ANC) asked for more clarity on the two percent that were HIV-positive but the disease never progressed. She wanted to know if they were carriers.

Dr Rabinowitz asked what work was being done on genotypes to ensure that people would be able to resist the virus.

Professor Mbewu explained that there was scientific evidence to prove that Africans were more susceptible to HIV/AIDS because the receptor that Africans had was faulty. He emphasised that the hypothesis was not totally proven. The MRC was currently looking at it.

Ms Madumise asked for clarity about which drugs existed as a vaccine against HIV/AIDS.

Professor Mbewu said that education was an effective tool in prevention. He said that a lot of research had been done to develop drugs to prevent HIV/AIDS and prevent the progression of the virus. He said that a solution would be found.

Professor Reddy added that the secret vaccine was education. She said that a strong lesson from their programme was that education would have to be strongly defined. Education had to move beyond pamphlets and move towards skills based community education. Skills negotiated behaviour more effectively.

Ms Dudley asked what the deadline was for the completion of the vaccine. She asked about the comment about the vaccine not being 100%. She said that if one received a polio vaccine one would expect not to get it. She asked for clarity.

Professor Mbewu said that they did know when they would have a successful vaccine. Many tests were happening all over the world, but they were looking at roughly five to ten years. The body did mount a response to the virus but the antibodies did not eradicate the virus. He said that the tests indicated suggested that the virus would not be 100% effective. Behaviour change and prevention were the best methods to stop the virus.

Ms Makishe (ANC) asked how the project worked with communities. Ms Levendaal said that although the Initiative was based at the MRC it was reaching communities. There were three community vaccine officers that worked in identified sectors. They worked with political, secular, local and provincial government because they had strong community programmes. They also worked with traditional healers and leaders. People had many posters but they used workshops because talking to people made more of an impact. They also worked with organisations such as Soul City, Love Life and Planned Parenthood South Africa.

Professor Padayachee added that the involvement of people in clinical trials was being abused in the private sector. The private sector was paying a lot of money, which made it difficult for government initiatives, which would be cheaper in the long run. The MRC had restricted money to pay trialists. He said that institutions and academics should only carry out clinical trials.

The Chairperson asked for more information about the sex workers in Kenya who could not contract HIV/AIDS. Again, this question was not answered.

Health Promotion Research and Development Unit: Training
Professor Reddy outlined the training initiatives at MRC. They had the mandate to develop future scientists. The MRC focused on research capacity strengthening.

Discussion
Mr Cachalia asked if the MRC collaborated with tertiary institutions.

Professor Reddy said that the MRC did. She gave the example of the youth risk study, which was done with tertiary institutions. Workshops were organised in the nine provinces, which had invited civil society. She said that the approach was not to wait to develop institutions. In thirteen months each province would have statistics of their figures in relation to national figures.

Indigenous Knowledge Research
Dr Matsabisa explained that this unit researched traditional health. The areas of focus were research and development, knowledge management and the utilisation of research findings. See presentation.

Discussion
Dr Rabinowitz used the example of the trial with CSIR, Pfizer and traditional healers to question the strength of the system. Pfizer dropped out of the out trial; thus the benefits did not go to the KhoiSan community. Was the system strong enough to ensure that the benefits went to the community? Was it developing systems to allow for the easy patenting of traditional medicines? If this was not being done then should the Department not be doing something to make traditional medicines more viable? What steps had to be taken to ensure this?

Dr Matsabisa said that the appetite suppressant study that was collaborated on isolated a chemical called P54. He said that he could only speculate on the reasons for Pfizer pulling out. Either Pfizer was disinterested in benefit sharing with the KhoiSan people or they had been able to synthesise the molecule in the lab and no longer needed the plant. They were currently looking at hosting a workshop with the Department of Trade and Industry around the protection of patents and the current patent laws. He said that regarding traditional plants one could not ‘invent’ the plant, one could only ‘discover’ the plant. The laws were not adequate for traditional medicine and new discoveries. South Africa had to develop their own models to protect traditional medicine.

Ms Madumise asked how far the scientific trials were? She asked if there were any results from the 2003 trails and how many people were involved.

Dr Matsabisa said that the clinical trials had looked at the claims presented. Then they had done safety studies and completed seven products. Toxicology studies had to be done for three months on each product, which basically increased the doses of the medicine. He said that they had tested one product last year with a feasibility test done in the Eastern Cape. They had not found anything worrying although feedback indicated that people felt more beautiful and energetic. An efficacy study would have to be done to prove that the product worked.

Ms Madumise mentioned that she had a tree in her garden, which people used for healing in her area. She invited Dr Matsabisa to come and investigate the potential of the tree.

Dr Matsabisa said that a process had to be followed. He welcomed the invite and said that they would have to enter into confidentiality agreements before any action could be taken.

Dr Rabinowitz asked where the unit thought they were going to get the funding for the next phase. Who were they looking to?

Dr Matsabisa said that funding for the IKS unit was a problem because pharmaceutical companies would not fund competition that could put them out of business. He said that they had sent a plea to government. They had received some funding from the Department of Health of R4 million. It cost the Department two to three million to run one trial. Funding had to be sought to ensure that the vast knowledge and wealth of medicinal plants was not lost.

Mr Njikelana commented that previously traditional medicine was not there to make a profit. He raised the ethics of profits versus health. How far had this issue been taken on board?

Dr Matsabisa explained that ethics were changing and traditional healers were working for a profit. The MRC worked on the principle that they would share equally. The material transfer and the confidentiality clauses all pushed benefit sharing. It was made clear that the knowledge researched would no longer be private and would now be public. The community as a whole had to be rewarded.

Mr Njikelana wanted to know to what extent civil society was part of the beneficiaries.

Dr Matsabisa said that this was no longer the case. Part of the Bill on Traditional Leaders had included a section where healers said that they wanted to do benefit sharing with communities. They were currently setting up registration systems.

The meeting was adjourned.