What is advice? … in the context of COVID-19

The challenges faced by countries and their governments to deal with the COVID-19 pandemic are formidable and in many countries there has been conflict and disagreement between the government of the day i.e. politicians and the experts i.e scientists and researchers. The United States is a glaring example of this scenario at its worst. There has even been conflict between public health experts and epidemiologists on the validity of various strategies to contain the spread of the virus with probably the most well documented example being that between the expert advice given to governments in the United Kingdom and Sweden. As in most things in life the final verdict on who was right and who was wrong will rest with historians at some future time.

In South Africa it was reassuring initially that government appeared to be following a course advised by a committee of eminent experts brought together in what was termed the Ministerial Advisory Committee (MAC). The Chairperson, Professor Salim Abdool Karim, an eminent South African scientist and researcher with an avuncular friendly appearance and style explained on national TV why the initial “hard lockdown” was necessary to “flatten the curve” by slowing the rate that infections increased to enable the health system to prepare for the inevitable increase in patients who would require hospitalisation. Other restrictions followed such as the need for social distancing, the wearing of masks and hand hygiene which again were justified on the advice of expert virologists and other medical specialists. It appeared that the advice of the experts was driving the policy decisions made initially by the political structure created after the institution of the National State of Disaster, the Coronavirus Command Council.

However, as the days went by and the lockdown restrictions persisted, these restrictions appeared to be less related to the advice of experts scientists but more driven by a desire to adhere to administrative and bureaucratic requirements. It also appeared that faceless bureaucrats developed the regulations which then were announced by various cabinet ministers in at time rambling press conferences. I will not outline some of the more outrageous restrictions such as what clothing could be purchased and what could not at at a particular “Alert level” but I find it difficult to believe that these came from the team of experts assembled in the MAC. More controversial were the bans on the sale of tobacco products and alcohol. the latter lifted and now reinstated. In the case of tobacco and alcohol I wish to believe that the MAC did indeed provide advice based on science, which should have informed government decisions.

It is, however, deeply concerning when the National Health Minister is reported in the Business Day of 13th July 2020 as stating that while the MAC has provided more than 70 advisories covering various topics not one of these advisories have been officially released by the Minister into the public domain. The Minister indicated that MAC members had sought to release and implement advisories but that “they failed to appreciate the government’s policy-making processes!” It is worrying that he indicated that advisories to become health policies have to be approved by the National Health Council (NHC) and that input, often wider than the NHC, was not restricted to scientific advisors. I had the privilege to be a member of the NHC and its predecessor the Health MINMEC from 1994 until my retirement in 2015 under several health ministers and in my experience this body while constituted in terms of the National Health Act cannot under any circumstances be regarded as a body of experts, constituted as it is primarily by career politicians and bureaucrats, particularly related to a subject so complex as the COVID-19 pandemic. It is noteworthy that it is the same NHC that approved government health policy during the period of AIDS denialism and while I am not suggesting that the current situation approximates in any way that sad period in the history of South Africa, it emphasises the fact that South Africans should have access to the advisories provided to the NHC by the experts within the MAC to determine the basis on which government policy is formulated and adopted.

Advice is what is provided in an advisory and it is accepted that this may for good and valid reasons not be adopted as government policy. But the question remains why should the citizenry not be able to assess the advice and process adopted to finally formulate the policy that once implemented affects all our lives. South Africa is a democratic society with a democratic Constitution lauded by many across the world and I agree with Professor Alex van der Heever from Wits with an impeccable academic background, that the advice provided to government in a democracy should be made public unless there is a compelling reason not to do so. In the current circumstances, with the country experiencing an epidemic threatening the lives and livelihood of every South African I struggle to find the justification not to do so.