Creative artwork featuring colourised 3D prints of influenza virus (surface glycoprotein hemagglutinin is blue and neuraminidase is orange; the viral membrane is a darker orange). Note: Not to scale. Credit: NIAID
Researchers at Vanderbilt University Medical Center have isolated human monoclonal antibodies against influenza B, a significant public health threat that disproportionately affects children, the elderly and other immunocompromised individuals, as they report in the journal Immunity.
Seasonal flu vaccines cover influenza B and the more common influenza A but do not stimulate the broadest possible range of immune responses against both viruses.
In addition, people whose immune systems have been weakened by age or illness may not respond effectively to the flu shot.
Small-molecule drugs that block neuraminidase, a major surface glycoprotein of the influenza virus, can help treat early infection, but they provide limited benefit when the infection is more severe, and they are generally less effective in treating influenza B infections. Thus, another way to combat this virus is needed.
The VUMC researchers describe how, from the bone marrow of an individual previously vaccinated against influenza, they isolated two groups of monoclonal antibodies that bound to distinct parts of the neuraminidase glycoprotein on the surface of influenza B.
One of the antibodies, FluB-400, broadly inhibited virus replication in laboratory cultures of human respiratory epithelial cells. It also protected against influenza B in animal models when given by injection or through the nostrils.
Intranasal antibody administration may be more effective and have fewer systemic side effects than more typical routes – intravenous infusion or intramuscular injection – partly because intranasal antibodies may “trap” the virus in the nasal mucus, thereby preventing infection of the underlying epithelial surface, the researchers suggested.
These findings support the development of FluB-400 for the prevention and treatment of influenza B and will help guide efforts to develop a universal influenza vaccine, they said.
“Antibodies increasingly have become an interesting medical tool to prevent or treat viral infections,” said the paper’s corresponding author, James Crowe Jr, MD. “We set out to find antibodies for the type B influenza virus, which continues to be a medical problem, and we were happy to find such especially powerful molecules in our search.”
For centuries, civilizations have used naturally occurring, inorganic materials for their perceived healing properties. Egyptians thought green copper ore helped eye inflammation, the Chinese used cinnabar for heartburn, and Native Americans used clay to reduce soreness and inflammation.
Today, researchers at Texas A&M University are still discovering ways that inorganic materials can be used for healing.
In two recently published articles, Dr Akhilesh Gaharwar, a Tim and Amy Leach Endowed Professor in the Department of Biomedical Engineering, and Dr Irtisha Singh, assistant professor in the Department of Cell Biology and Genetics, uncovered new ways that inorganic materials can aid tissue repair and regeneration.
The first article, published in Acta Biomaterialia, explains that cellular pathways for bone and cartilage formation can be activated in stem cells using inorganic ions. The second article, published in Advanced Science, explores the usage of mineral-based nanomaterials, specifically 2D nanosilicates, to aid musculoskeletal regeneration.
“These investigations apply cutting-edge, high-throughput molecular methods to clarify how inorganic biomaterials affect stem cell behavior and tissue regenerative processes,” Singh said.
The ability to induce natural bone formation holds promise for improvements in treatment outcomes, patient recovery times and the reduced need for invasive procedures and long-term medication.
“Enhancing bone density and formation in patients with osteoporosis, for example, can help mitigate the risks of fractures, lead to stronger bones, improve quality of life and reduce healthcare costs,” Gaharwar said. “These insights open up exciting prospects for developing next-generation biomaterials that could provide a more natural and sustainable approach to healing.”
Gaharwar said the newfound approach differs from current regeneration methods that rely on organic or biologically derived molecules and provides tailored solutions for complex medical issues.
“One of the most significant findings from our research is the ability of these nanosilicates to stabilise stem cells in a state conducive to skeletal tissue regeneration,” he said. “This is crucial for promoting bone growth in a controlled and sustained manner, which is a major challenge in current regenerative therapies.”
Gaharwar recently received a grant for his work in using inorganic biomaterials in conjunction with 3D bioprinting techniques to design custom bone implants for reconstructive injuries.
“In reconstructive surgery, particularly for craniofacial defects, induced bone growth is crucial for restoring both function and appearance, vital for essential functions like chewing, breathing and speaking,” he said. “Inducing bone formation has several critical applications in orthopaedics and dentistry.”
“This approach not only bridges ancient practices with modern scientific methods but also minimises the use of protein therapeutics, which carry risks of inducing abnormal tissue growth and cancerous formations,” Gaharwar said. “Collectively, these findings elucidate the potential of inorganic biomaterials to act as powerful mediators in tissue engineering and regenerative strategies, marking a significant step forward in the field.”
ANC President Cyril Ramaphosa, with Minister of Health, Dr Joe Phaahla and his deputy Dr Sibongiseni Dhlomo, during the signing into law of the National Health Insurance Bill. (Photo: @MYANC/Twitter)
After the ANC received less than 41% of the votes in last week’s national elections, negotiations are now underway that will determine how and by who South Africa is governed. Ministerial posts, including the country’s top health job, might be on the negotiating table. Spotlight considers the candidates for the post of South Africa’s Minister of Health.
For most of the last 30 years, it went almost without saying that the country’s Minister of Health would be drawn from the ranks of the ANC. But given the dramatic decline in the party’s electoral fortunes and the consequent pressure to enter into coalitions or other deals, the pool of realistic candidates for the post of health minister might this year be larger than before.
The President has the prerogative to appoint any members of the National Assembly as ministers, whether or not they are of the same party as the President. The President can also at his or her discretion appoint two ministers who are not members of parliament. It is also relatively trivial for a party to ask a Member of Parliament (MP) to stand down and to have another sworn in, as happened with Minister of Electricity Kgosientsho Ramokgopa. This means that candidates who were not high enough on party lists to get seats in parliament could still be substituted in.
Although technically the pool of possible health ministers is thus quite large, political realities narrow the choices down considerably.
Let’s start with candidates from the ANC, given that odds are still that our next health minister will be from the party.
First in line is South Africa’s current Minister of Health Dr Joe Phaahla. He is not on the ANC’s national candidates list, but he is high up on the party’s regional list for Limpopo and thus set to become a member of the National Assembly. Though some might describe his time as health minister over the last three years as uninspiring, he also hasn’t been implicated in any scandals or made any obvious blunders.
It might well be that President Cyril Ramaphosa, presuming he stays in the job, sees Phaahla as a safe pair of hands and considers him the right person to drive the ANC’s stated goal of preparing for and starting the implementation of National Health Insurance. Phaahla previously served for some years as Deputy Minister of Health.
Second in line is the current Deputy Minister of Health Dr Sibongiseni Dhlomo. He is also not on the ANC’s national list, but he is high up on the ANC’s KwaZulu-Natal regional list and thus also set to join the National Assembly. He is a former MEC of health for KwaZulu-Natal and former chair of parliament’s portfolio committee for health. If Phaahla is not to return, Dhlomo would be the most natural replacement.
After those first two candidates, things get much harder to predict.
Former health ministers Dr Aaron Motsoaledi and Mmamoloko Kubayi are on the ANC’s national list and Dr Zweli Mkhize is on the ANC’s KwaZulu-Natal regional list. Given that Motsoaledi’s time at Home Affairs has been something of a disaster, it is not impossible that Ramaphosa might feel he can get more out of him back in the health portfolio where his record was somewhat better.
A return of Mkhize to the health portfolio seems extremely unlikely given the grubby circumstances under which he left. Kubayi’s role for a few months as acting health minister was really just that of a care-taker, and a return is unlikely.
One interesting trend is that the ANC has largely chosen medical doctors as health ministers and deputy ministers – Phaahla, Dhlomo, Motsoaledi, and Mkhize are all medical doctors.
Current Eastern Cape MEC for Health Nomakhosazana Meth is high on the ANC’s national list, though the poor performance of the Eastern Cape Department of Health in recent years should mean her chances of getting the top health job are slim.
In previous years, current Limpopo MEC for Health Dr Phophi Ramathuba was considered a possibility by some, but her name is only on the ANC’s candidates list for the Limpopo legislature and a few ill-judged incidents, such as a video in which she berated a pregnant woman, would make her a controversial choice. She’s also often been at loggerheads with unions in Limpopo. A lack of standing with healthcare workers may also hold back the prospects of one or two others with health backgrounds who did make it onto the ANC’s national list.
Candidates from other parties
The DA remains South Africa’s official opposition. Should they become part of a ruling coalition or government of national unity, the current Western Cape MEC for Health would be the party’s most obvious candidate for the role of health minister. Mbombo is however only on the DA’s list for the Western Cape legislature and is thus likely to again be the province’s MEC for health.
Jack Bloom, the party’s leading health MPL in Gauteng over the last two decades would be a long shot for the post of health minister, as would Dr Karl le Roux, an award-winning rural doctor who has joined the party. Bloom is on the DA’s list for the provincial legislature and not on the lists for the national assembly. It is thus not entirely out of the question that he could become MEC for health in Gauteng.
The EFF received the fourth most votes nationally, having been third in the previous national elections. In the previous parliament they were represented on the portfolio committee for health by Dr Sophie Thembekwayo (not a medical doctor) and Naledi Chirwa. Chirwa is last on the EFF’s national candidates list and is thus very unlikely to return to the National Assembly. Thembekwayo is 36th on the EFF’s national candidates list.
It is also possible that other parties such as MK or the IFP could end up as part of a governing coalition or government of national unity and that candidates from these parties would thus also be in with an outside chance for the top health job. There will be many new, and to us unknown, faces in parliament – no doubt we’ve missed some people with solid health backgrounds in our analysis.
As mentioned earlier, the President can appoint two ministers to his or her Cabinet from outside the National Assembly. It is thus possible that someone with health management expertise could be roped in from outside the usual political circles.
Though very long shots, outsiders like Dr Fareed Abdullah – former CEO of the South African National AIDS Council and an important player in the early days of HIV treatment – or Professor Glenda Gray – outgoing President of the South African Medical Research Council – might well, and arguably should, be considered. Though we’d be surprised if strong outsider candidates like these two are interested in the job given how politically fraught the role is likely to be. That said, we suspect the right outsider candidate would be a hit in healthcare circles.
Ultimately, whichever way the current negotiations pan out, the ball remains in the ANC’s court when it comes to determining who will be our next Minister of Health. That means the decision is likely to remain subject to the ANC’s internal politics, with all the complexities that entails.
Despite all the intriguing possibilities, chances are thus that it will be Phaahla or Dhlomo who get the nod – and in terms of South Africa’s healthcare trajectory things will probably remain roughly as they are now.
In a significant development for the South African healthcare sector, the Supreme Court of Appeal (SCA), has dismissed the Council for Medical Schemes (CMS) and the Registrar for Medical Schemes’ reconsideration application against the Board of Healthcare Funders (BHF) with costs.
At the signing of the National Health Insurance (NHI) Bill into law, the President asserted that medical schemes were elitist and excluded the majority of the population. However, it is important to note that for many years, medical schemes have actively sought exemptions to provide low-cost benefit options (LCBOs) that would enable more citizens to access medical aid coverage. Despite these efforts, medical schemes face significant regulatory hurdles that prevent them from offering these more inclusive options.
The court’s decision follows the raising of significant concerns by BHF in a letter to the CMS and the registrar, which highlighted key conflicts related to hostility towards medical schemes; unnecessary litigation; delays in developing legal frameworks for low-cost benefit options (LCBOs); ineffective appeal processes; the legality of CMS’s regulatory actions; the influence of the National Health Insurance (NHI) Bill on CMS policies; and the lack of review of Prescribed Minimum Benefits (PMBs) for 24 years.
Mr Charlton Murove, Head of Research at BHF, said that while the organisation respects the court’s decision, it is unfortunate that a personal cost order against the registrar was not awarded, and that the regulator continues to delay the matter.
“These delays divert valuable resources, and hinder progress on an issue that is critical to both the South African healthcare industry, and the health of citizens in need of essential services,” added Murove.
The CMS has since filed the Rule 30A affidavit and the supplementary record. The BHF legal team is currently studying these documents for purposes of moving forward with the main review application, where its members will be updated.
To this end, BHF remains committed to ensuring a fair and effective regulatory environment for the South African healthcare sector.
“We, as the BHF, will continue to advocate for the interests of our members and the millions of beneficiaries they serve, striving to create a healthcare system that is equitable, transparent, and capable of meeting the needs of all South Africans.
“This court case is crucial in the context of the National Health Insurance (NHI) as it highlights the necessity of reducing the burden on the state while it prepares for the implementation of NHI, ensuring access to quality healthcare for everyone is essential,” concluded Murove.
A new study to be presented at the SLEEP 2024 annual meeting found a distinct relationship between sleep duration, social media usage, and brain activation across brain regions that are key for executive control and reward processing.
Results show a correlation between shorter sleep duration and greater social media usage in teens. The analysis points to involvement of areas within the frontolimbic brain regions, such as the inferior and middle frontal gyri, in these relationships. The inferior frontal gyrus, key in inhibitory control, may play a crucial role in how adolescents regulate their engagement with rewarding stimuli such as social media. The middle frontal gyrus, involved in executive functions and critical in assessing and responding to rewards, is essential in managing decisions related to the balancing of immediate rewards from social media with other priorities like sleep. These results suggest a nuanced interaction between specific brain regions during adolescence and their influence on behaviour and sleep in the context of digital media usage.
“As these young brains undergo significant changes, our findings suggest that poor sleep and high social media engagement could potentially alter neural reward sensitivity,” said Orsolya Kiss, who has a doctorate in cognitive psychology and is a research scientist at SRI International. “This intricate interplay shows that both digital engagement and sleep quality significantly influence brain activity, with clear implications for adolescent brain development.”
This study involved data from 6516 adolescents, aged 10–14 years, from the Adolescent Brain Cognitive Development Study. Participants answered questionnaires about sleep duration and recreational social media use. Brain activities were analysed from functional MRI scans during the monetary incentive delay task, targeting regions associated with reward processing. The study used three different sets of models and switched predictors and outcomes each time. Results were adjusted for age, COVID-19 pandemic timing, and socio-demographic characteristics.
Kiss noted that these results provide new insights into how two significant aspects of modern adolescent life, social media usage and sleep duration, interact and impact brain development.
“Understanding the specific brain regions involved in these interactions helps us identify potential risks and benefits associated with digital engagement and sleep habits,” Kiss said. “This knowledge is especially important as it could guide the development of more precise, evidence-based interventions aimed at promoting healthier habits.”
The American Academy of Sleep Medicine recommends that teenagers 13 to 18 years of age should sleep 8 to 10 hours on a regular basis. The AASM also encourages adolescents to disconnect from all electronic devices at least 30 minutes to an hour before bedtime.
Novel enEbCas12a protein shows potential promise as gene-editing tool to one day treat disease
Researchers have developed a novel version of a key CRISPR gene-editing protein that shows efficient editing activity and is small enough to be packaged within a non-pathogenic virus that can deliver it to target cells. Hongjian Wang and colleagues at Wuhan University, China, present these findings May 30th in the open-access journal PLOS Biology.
Recent years have seen an explosion of research attempting to harness CRISPR gene-editing systems – which are found naturally in many bacteria as a defence against viruses – so they can be used as potential treatments for human disease. These systems rely on so-called CRISPR-associated (Cas) proteins, with Cas9 and Cas12a being the two most widely used types, each with their own quirks and strengths.
One promising idea is to package CRISPR proteins within a non-pathogenic virus, which could then deliver the proteins to target cells; there, they would modify specifically targeted DNA sequences to treat disease. However, the commonly used adeno-associated virus is small, and while some Cas9 proteins can fit inside, Cas12a proteins are typically too large.
Now, Wang and colleagues have identified a relatively small version of Cas12a, termed EbCas12a, that occurs naturally in a species of the Erysipelotrichia class of bacteria. By deliberately switching out one of the amino acid building blocks of the protein for another, they boosted its gene-editing efficiency. When applied to mammalian cells in a dish in the lab, this modified protein—dubbed enEbCas12a—shows gene-editing efficiency comparable to that of two other Cas12a proteins known for highly accurate gene editing.
The research team then demonstrated that enEbCas12a is small enough to be used for adeno-associated virus-based gene therapy. They modified enEbCas12a to target a specific cholesterol-associated gene, packaged it within the virus, and administered the virus to mice with high cholesterol. One month later, they found a significant reduction of blood cholesterol levels in the treated mice, compared to mice that did not receive the virus.
More research will be needed to determine if enEbCas12a could one day be used to address human disease. Nonetheless, these findings suggest it could be possible to use adeno-associated virus to deliver Cas12a proteins for gene therapy.
The authors add, “The novel compact enEbCas12a, along with its crRNA, can be packaged into an all-in-one AAV system for convenient gene editing in vitro and in vivo with high-fidelity, which can be very beneficial for future clinical applications and more tool developments including all-in-one AAV- based multi-gene editing, base editing, primer editing, etc.”
Negating an adjective by placing ‘not’ in front of it affects the way our brains interpret its meaning, mitigating but not entirely inverting our interpretation of its definition. In a study published May 30th in the open-access journal PLOS Biology, Arianna Zuanazzi at New York University, US, and colleagues offer insight into how the brain represents changes of meaning over time and offer new methods for further linguistic research.
The way the brain processes negated adjectives – ‘not bad’ or ‘not good’ – is not understood. Previous studies suggest that negated phrases are processed more slowly and with more errors than their affirmative counterparts. Cutting-edge artificial neural networks appear to be largely insensitive to the contextual impacts of negation, leading many researchers to wonder how negation operates.
In lab-based experiments, 78 participants were asked to read affirmative or negated adjective phrases, good/bad, not good/not bad, happy/sad, not happy/not sad etc. on a screen and rate their meaning on a scale of one (really really bad/really really sad) to ten (really really good/really really happy). Answers took longer for negated adjectives and interpreted meaning was more varied. Cursor tracking showed that people are slower to interpret them, first understanding them to be affirmative before modifying towards their opposite meaning.
In a second experiment, participants rated affirmative or negated phrases on a scale. Meanwhile, magnetic fields generated by the electrical activity of their brains were captured by magnetoencephalography (MEG). Zuanazzi and colleagues again saw slower reaction times for negated adjectives. The brain activity shows that initial interpretations and early neural representations of negated adjectives are similar to that of affirmative adjectives, but are weakened, backing up the previous suggestion of a mitigated effect.
The analysis contributes to the debate as to how negation operates. The ability to characterize the subtle changes of linguistic meaning through negation in the brain using imaging methods could help to tease apart understanding of other linguistic processes beyond the sum of the processing of individual word meanings.
The authors add, “The study of negation offers a compelling linguistic framework to understand how the human brain builds meaning through combinatoric processes. Our time-resolved behavioural and neurophysiological data show that, in a sentence like ‘your coffee is not hot’, negation (‘not’) mitigates rather than inverts the representations of a scalar adjective (‘hot’). In other words, negation reduces the temperature of your coffee, though it does not make it cold.”
Our willingness to help others is governed by a specific brain region pinpointed by researchers in a study of patients with brain damage to that region.
Learning about where in the brain ‘helping’ decisions are made is important for understanding how people might be motivated to tackle large global challenges, such as climate change, infectious disease and international conflict. It is also essential for finding new approaches to treating disorders of social interactions.
The study, published in Nature Human Behaviour, was carried out by researchers at the University of Birmingham and the University of Oxford, and shows for the first time how a region called the ventromedial prefrontal cortex (vmPFC) has a critical role in helping, or ‘prosocial’ behaviours.
Lead author Professor Patricia Lockwood said: “Prosocial behaviours are essential for addressing global challenges. Yet helping others is often effortful and humans are averse to effort. Understanding how effortful helping decisions are processed in the brain is extremely important.”
In the study, the researchers focused on the vmPFC, a region located right at the front of the brain, which is known to be important for decision-making and other executive functions. Previous studies using magnetic resonance imaging (MRI scanning) have linked the vmPFC to choices that involve a trade-off between the rewards available and the effort required to obtain rewards. However, these techniques cannot show whether a part of the brain is essential for these functions.
Three groups of participants were recruited for the study. 25 patients had vmPFC damage, 15 patients had damage elsewhere in the brain, and 40 people were healthy age and gender-matched control participants. These groups allowed the researchers to test the impact of damage to vmPFC specifically.
Each participant attended an experiment where they met another person anonymously. They then completed a decision-making task that measured how willing they were to exert physical effort (squeezing a grip force device) to earn rewards (bonus money) for themselves and for the other person.
By enabling participants to meet – but not see – the person they were ‘working’ for in advance, researchers were able to convey the sense that participants’ efforts would have real consequences, but hide any information about the other person that could affect decision-making.
Each choice the participants made varied in how much bonus money for them or the other person was available, and how much force they would have to exert to obtain the reward. This allowed the researchers to measure the impact of reward and effort separately, and to use advanced mathematical modelling to precisely quantify people’s motivation.
The results of the study clearly showed that the vmPFC was necessary for motivation to help others. Patients with vmPFC damage were less willing to choose to help others, exerted less force on even after they did decide to help, and earned less money to help others compared to the control groups.
In a further step, the researchers used a technique called lesion symptom mapping which enabled them to identify even more specific subregions of the vmPFC where damage made people particularly antisocial and unwilling to exert effort for the other person. Surprisingly, damage to a nearby but different subregion made people relatively more willing to help.
Co-lead author Dr Jo Cutler said: “As well as better understanding prosocial motivation, this study could also help us to develop new treatments for clinical disorders such as psychopathy, where understanding the underlying neural mechanisms can give us new insights into how to treat these conditions.”
“This region of the brain is particularly interesting because we know that it undergoes late development in teenagers, and also changes as we get older,” added Professor Lockwood. “It will be really interesting to see whether this area of the brain can also be influenced by education – can we learn to be better at helping others?”
Several political parties have pledged to plug shortages of healthcare staff at government hospitals and clinics by training more health workers. They’re right to be concerned with understaffing, but are they putting the right solutions on the table? Jesse Copelyn investigates.
As the election approaches, one message seems ubiquitous among opposition parties: there is a severe shortage of health workers at government hospitals and clinics. Manifestoes of the DA, EFF, MK, IFP, ActionSA, UDM, Rise Mzansi and the ACDP all make some reference to the issue or simply state they would increase the number of health workers in the system if they were in power.
But why are so many parties from across the political spectrum pointing to this particular problem, and are they proposing realistic solutions?
Government health facilities are shedding staff
Various sources of data show that public health facilities are indeed heavily understaffed, giving weight to parties’ concerns. For instance, in March, the National Health Department revealed that appointments for a number of key clinical posts across the country have not been made. In some of the worst-performing provinces – the Free State, North West and Limpopo – more than 20% of posts for medical officers (i.e. non-specialised doctors) were unfilled.
Additionally, in the North West, almost 2 out of 5 nursing posts were vacant, while half of all positions for psychiatrists were unstaffed. Meanwhile in the Free State, a mere 3 out of 5 posts were filled for physiotherapists and occupational therapists.
These health worker shortages appear to be getting worse. The 2030 Human Resources for Health strategy document, which was published by the National Department of Health, estimated that in 2019, we required about 186 000 primary healthcare workers in the public sector. This would ensure that every person that relies on government services had access to a basket of primary healthcare services that matches the country’s needs. Yet at the time, we only had about 115 000, meaning that we were short by about 71 000 workers. And by 2025, that gap was projected to widen to over 87 000. This is because it was assumed that the number of clinical staff would remain the same over time, while the overall population (and thus the number of patients) would increase.
In reality, this actually understates the problem, Dr Donnella Besada, a health economist who was involved in that research, tells Spotlight. Rather than remaining the same, the number of health personnel in the public sector probably will have declined by 2025.
“The workforce is likely to go down over time as a result of the freezing of posts, retirement, illness and death,” she explains.
Indeed this was a trend that had already begun in the 2010s when total government spending on health began to stagnate in real terms, and irregular expenditure ballooned. Thus, government health facilities didn’t have the money to hire more staff, and between 2012 and 2016, the total number of people employed by provincial health departments actually declined.
The extent of the problem is perhaps most acutely seen in the area of specialist care, as the Human Resources for Health strategy document shows. Take anaesthesiologists – the doctors who put you to sleep before an operation and monitor your vital signs. Researchers estimated that given factors like the age of the population and the types of diseases that are prevalent, South Africa should have about 50 anaesthesiologists for every million people. In the private sector, we’re well over the bar, with nearly double that targeted ratio. In government health facilities, however, we’re way under, at about 6 anaesthesiologists for every million patients.
Right problem, wrong solution?
Clearly, politicians are onto something when they talk about the need to increase the number of health workers in public hospitals and clinics. But how do parties propose that we do this?
While solutions vary, one of the most common proposals that has been put forward both in party manifestos, and in interview responses to questions by Spotlight, is that we should invest more in training of health workers. For instance, the EFF manifesto states that the party would establish “at least one health care training facility per province and [ensure] that there is no province without a health sciences campus, inclusive of nursing school and medical school [sic]”. Similarly, the newly established MK party states that it would “expand the capacity and intake of medical schools”.
Manifestoes by ActionSA and RiseMzansi also state that they would train more health workers, while the UDM and ACDP told Spotlight that they would invest more in nursing colleges, along with other measures.
What unites these approaches is the belief that a central reason for understaffing is that we aren’t training enough health workers, and we have to find ways of boosting this capacity. However, two senior managers in the public health system that spoke to Spotlight provide a very different take. They argue that the most fundamental reason for understaffing is budgetary – facilities simply cannot afford to appoint more health workers even though there are often qualified people available for hire.
For instance, a former CEO of a public hospital in the Western Cape, who would prefer to remain anonymous, explains to Spotlight that the reason their hospital was unable to plug shortages is simply due to “affordability in terms of the budget received from the national government”.
In this context, more campuses and colleges would do little to solve the problem. “[T]oo many training institutions mean that once they graduate there are too few posts for internships or community service”, the former CEO says, referring to the positions that medical students must take up at government hospitals and clinics after graduating. He elaborates: “Once [the internship and community service] is done, there are no posts for permanent positions”.
All the way on the other side of the country, a senior manager at a government hospital in KwaZulu-Natal, who also wanted to remain anonymous, says much the same. He tells Spotlight that “understaffing has been a problem for some time”, and that the shortage of nurses is currently the most significant obstacle. Asked about the causes, he says “financial reasons” are almost always to blame (though he did feel that we needed to train more specialists). He elaborates “this year the budget has been cut compared to last financial year, so [the shortages are] a bit severe now”.
Asked whether more training would solve the shortage of nurses and medical officers, he is doubtful. “[M]any of the already-qualified people were not able to be employed, so training more? I don’t think this is a solution… for now the focus should be on employing the unemployed people”, he says.
This sentiment is also largely echoed by the National Department of Health, which in April stated that there were over 2000 unfunded posts for medical doctors in the country. An additional R2.4 billion was needed to fill them, according to the department, which has also been battling accusations from the South African Medical Association that over 800 qualified doctors cannot find work. In response, the department claimed that the majority of them had only just finished their training.
Training capacity has already hit its ceiling
What one might not realise from reading party manifestos is that the country has already substantially boosted the training of doctors over the last decade. As I have previously written for Bhekisisa, it is partially because of this that the public health system is increasingly struggling to absorb new medical graduates entering the system.
Professor Shabir Madhi of Wits University. Photo: Wits University.
For instance, Professor Shabir Madhi, the dean of the health faculty at the University of Witwatersrand (WITS), tells Spotlight that universities began to increase the intake of medical students (ie, those training to be doctors) some time ago, partly due to state pressure. Over a similar time period, the government expanded the Nelson Mandela Fidel Castro programme, which educates medical students in Cuba. As a result, while there were fewer than 1500 medical graduates that were available to be placed for internships in 2017, there were over 2100 in 2024.
The opposite trends have nonetheless taken place for some other health worker categories. For instance, in 2017, there were over 21 000 student nurses and midwives, and this dropped to below 15 000 in 2022. As Spotlight previously reported, this decline is at least in part due to disruptions related to how nurse training is accredited in South Africa.
According to Madhi, we’re still not training enough health workers to meet the needs of the country, but further expanding student intake wouldn’t address the current understaffing crisis, as the government is unable to employ the health workers that we’re already producing. Instead of training more health science students, he says, the health department needs to focus on “incorporating existing and newly graduating healthcare workers into the public sector”.
Additionally, even if we resolved our budgetary problems, there are hard limits on how many more students we can currently train, says Madhi, who laughs off campaign promises about building more medical campuses and scaling up student intake. “[M]ost of the training of health workers takes place outside of the classroom in our healthcare facilities,” he says, adding that “there are only so many healthcare facilities that have the right type of personnel to be involved in training, and their ability to absorb more trainee healthcare workers is fairly limited”.
While universities have increased the intake of medical students over the years, the ceiling has now been reached, argues Madhi, who notes that the number of trainee doctors that WITS is sending to its academic hospitals is “already exceeding the capacity that they can accommodate”. As a result, the university now sends students “to other hospitals which weren’t necessarily designed, and are not necessarily equipped or resourced, to undertake training”. He notes that these problems don’t just apply to trainee doctors, but also “occupational therapists, physiotherapists, oral hygienists and dentists”.
Madhi concludes: “Unfortunately, politicians are somewhat naive of what is required to establish training programmes in the health sciences”.
Toxic chemicals used to flame-proof plastic materials can be absorbed into the body through skin, via contact with microplastics, new research shows. The study offers the first experimental evidence that chemicals present as additives in microplastics can leach into human sweat, and then be absorbed through the skin, into the bloodstream.
Many chemicals used as flame retardants and plasticisers have already been banned, due to evidence of adverse health effects including damage to the liver or nervous system, cancer, and risks to reproductive health. However, these chemicals are still present in the environment in older electronics, furniture, carpets, and building materials.
While the harm caused by microplastics is not fully understood, there is increasing concern over their role as conduits of human exposure to toxic chemicals.
The research team demonstrated in a study published last year, that chemicals were leached from microplastics into human sweat. The current study now shows that those chemicals can also be absorbed from sweat across the skin barrier into the body.
In their experiments, the team used innovative 3D human skin models as alternatives to laboratory animals and excised human tissues. The models were exposed over a 24-hour period to two common forms of microplastics containing polybrominated diphenyl ethers (PBDEs), a chemical group commonly used to flame retard plastics.
The results, published in Environment International, showed that as much as 8% of the chemical exposed could be taken up by the skin, with more hydrated – or ‘sweatier’ – skin absorbing higher levels of chemical. The study provides the first experimental evidence into how this process contributes to levels of toxic chemicals found in the body.
Dr Ovokeroye Abafe, now at Brunel University, carried out the research while at the University of Birmingham. He said: “Microplastics are everywhere in the environment and yet we still know relatively little about the health problems that they can cause. Our research shows that they play a role as ‘carriers’ of harmful chemicals, which can get into our bloodstream through the skin. These chemicals are persistent, so with continuous or regular exposure to them, there will be a gradual accumulation to the point where they start to cause harm.”
Dr Mohamed Abdallah, Associate Professor of Environmental Sciences at the University of Birmingham, and principal investigator for the project, said: “These findings provide important evidence for regulators and policymakers to improve legislation around microplastics and safeguard public health against harmful exposure.”
Professor Stuart Harrad, co-author of the paper, added “the study provides an important step forward in understanding the risks of exposure to microplastics on our health. Building on our results, more research is required to fully understand the different pathways of human exposure to microplastics and how to mitigate the risk from such exposure.”
In future research, the team plan to investigate other routes through which microplastics could be responsible for toxic chemicals entering the body, including inhalation and ingestion.
