Spotlight Editors
It has been a bruising year or so for medical researchers in South Africa with the US pausing, cancelling, and then resuming some grants. But as bad as things were, what played out wasn’t the worst case scenario, and momentum is now building toward recovery.
For decades, the United States government has been the world’s top funder of medical research. When it started cutting research funding last year, South Africa was caught in the firing line. This is because the US administration decided to specifically target South Africa, but also because South Africa was uniquely exposed due to the sheer volume of US-funded research here.
Over recent decades, South Africa built an impressive network of research groups and infrastructure to support high quality research – all underpinned by a strong regulatory environment, several good universities, and many productive partnerships with research groups from across the world. All this, plus the fact that we have large TB and HIV epidemics, means that South Africa was, and still is, one of the best places in the world to conduct research on these two diseases.
But a weakness of South Africa’s impressive research infrastructure was its overreliance on US funding.
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To be clear, this was not an overreliance on aid or charity. South African researchers won grants from the US by coming out on top in rigorous and highly competitive selection processes. Much of the research done here benefited people around the world, including in the US.
Instead, the thing that we overly relied upon was that the US would continue to make medical research grants in a way that is rational and in our common interest.
There was much chaos and uncertainty last year with the pausing, cancellation, and resuming of grants. One small positive is that bad as things were, what played out wasn’t the worst case scenario we seemed to be heading for. At least some projects got their funding flows restored. You can read more about that in this Spotlight article.
But there is no doubt that the situation remains very bleak. While some studies that were already underway will be completed, it seems very unlikely that the US will fund any new studies in South Africa in the coming years. Given the historic scale of US investment here, the total volume of clinical trials conducted in South Africa will almost certainly fall precipitously.
Charting a new course
One ray of light in all this has been the response from the South African Medical Research Council (SAMRC) – probably the best run of all the entities linked to the Department of Health.
To limit the damage from the US research cuts, the SAMRC mobilised a rescue fund of about R600 million. This includes major contributions from National Treasury, the Gates Foundation, the Wellcome Trust and the ELMA Foundation.
Some of this funding has already helped sustain dozens of research projects and protect vital expertise during a period of instability. The current funding supports work in HIV, TB, newborn and child health, as well as non-communicable and other infectious diseases.
One example is a cutting-edge HIV vaccine clinical trial that began in January at the Desmond Tutu Health Foundation’s clinical research site at Groote Schuur Hospital in Cape Town. While still in its early stages, the study aims to help piece together what an effective HIV vaccine might look like.
Beyond the SAMRC’s efforts, universities and research institutions have also stepped in, raising funds to safeguard projects and retain skilled staff whose jobs were at risk.
Even so, we are still facing a massive net loss to money for medical research in South Africa.
What to do?
Funding from international partners will remain vital in South Africa. For now, the US government still invests substantial funds in South Africa, as does several philanthropies and the European Union, through the European & Developing Countries Clinical Trials Partnership. There are also new partnerships such as one we recently reported on between South African and Korean researchers.
Such partnerships are not just about money – science thrives where there is collaboration across national borders. In fact, almost all of the most important TB and HIV clinical trials conducted in South Africa in the last two decades were collaborations between researchers from multiple countries. No matter how you slice it, collaboration with international partners will remain an essential foundation of the medical research landscape in South Africa.
The problem was never that South African researchers took too much money from the US or other donors, or worked too closely with researchers based in other countries. One might quibble on details here and there, but on the whole, US-South African research collaboration in recent decades has been a resounding success.
Rather, the problem was that we invested so little of our own funds that we became overly vulnerable to changes in external funding.
Professor Ntobeko Ntusi, president and CEO of the SAMRC, previously told Spotlight that the SAMRC receives in the region of R2 billion from government per year, including funds from both the Department of Health and the Department of Science and Innovation.
Unlike so many parts of our government, the SAMRC is a well-run entity that got clean audits in each of the last five years. This strongly suggests that money allocated to it won’t be wasted or looted. If we understand recent messaging from the Finance Minister and National Treasury, this is precisely the kind of clean government spending that should be rewarded in future budgets.
Relative to health budgets more generally and to what government has historically spent on entities such as South African Airways, the SAMRC’s budget is tiny. As far as we can tell, the current funding level is largely a product of history – apart from the still widespread atmosphere of austerity, there really isn’t any other reason why the budget shouldn’t be scaled up over the next three years to be double what it is now.
The SAMRC supports a sector in which South Africa has truly world-class capacity – capacity that as we speak remains under threat. More than just the research studies and the jobs for young scientists, what is at stake here is the idea of South Africa as a place where we can do world-class medical research. Allowing funding cuts to extinguish this bright spark, would feel like a victory for Afro-pessimism.
The reality is that if President Cyril Ramaphosa and National Treasury seizes the opportunity, the shock of the US funding cuts could be turned into a bright new beginning for medical research in South Africa – all at a price that in relative terms is very low. Let’s hope they have the vision and ambition to seize the day.
Disclosure: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
Republished from Spotlight under a Creative Commons licence.
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