Curiosity Issue 11 by Curiosity

ISSUE 11

Research . Rethink . Relearn

CONTENTS 4 Editorial 5

Featured Researchers

6 How national identity affects infection outcome 8 FEATURE Ctrl-alt-delete: Re-setting the post-pandemic South Africa

12 How vaccines save lives 14 Second wave severity: What semi-saved South Africa? 16 The long haul to partial recovery 18 Making sense of the numbers 20 Pandemic history foretells a dismal future 22 When the US sneezes â&#x20AC;Ś 24 Virus wages war on women 26 Understanding the infodemic 28 Valour and the virus: Professor Glenda Gray 2

CONTENTS

32 A fleeting green moment in time

46 PROFILE Xolani Radebe: Keeping an eye on the virus from the sky

34 The blame game: putting a pandemic on the pangolin

48 Beating the pandemic through innovative thinking

36 FEATURE What we caught online

50 Finding security in the unseen

40 Privacy and the dollars in your data

54 COLUMN Along came a virus â&#x20AC;Ś: Professor Lynn Morris

30 Teaching in a Covid global village

41 Infection online 42 TikTok/WeChat: Us and them 44 COLUMN Big data: A sword to wield or a knife in the back?

52 Dimming the lights on malaria

56 COLUMN In the company of criminals 58 HISTORY How the Wayside Inn became the Chris Hani Baragwanath Hospital

EDITORIAL

The Covid-19 pandemic has gone viral and has severely impacted on how we interact, conduct our business, teach and learn. Some disruption has been positive as we realise the importance of human connectedness, scientific research, and the changing nature of work. But it has also demonstrated the digital divides experienced worldwide and the dangerous reality of misinformation through social media and some public figures.

his eleventh issue of Curios.ty is themed #VIRAL. We examine how the virus that stopped the world enabled an opportunity for a reset of sorts, both in South Africa and globally (pages 8 to 11). As we gathered en masse online on Teams, Zoom, and Whatsapp platforms, our ways of social and professional interaction shifted completely. The feature on page 36 suggests that we need new rules of engagement on social media, while the stories on pages 40 to 45 reveal uncomfortable insights about who owns our data and its use. Living online for so long revealed opinions and attitudes that both shocked and surprised. Could a country’s collective psychology determine the outcomes of a pandemic? Wits scientists and their international peers have begun fascinating preliminary research on how national identity affects infection outcome (page 6). We see how different countries’ responses to the pandemic offer cautionary tales about the choices societies make (page 22). Right now at least three Covid-19 vaccine candidates show promise. We explain how vaccines save lives and share the significant, global contributions that Wits scientists have made to vaccinology in general (page 12). We investigate why the Covid19 infections in South Africa defied modelling predictions (page 18), but are cognisant of those for whom Covid-19 infection was a lethal reality (page 16). We consider what pandemics of the past can tell us about outbreaks in the future (page 20). The elephant in the room is the pangolin unwittingly suspected of causing the pandemic (page 34), but Homo sapiens have always played a part. The persistence of pandemics since the

Curios.ty is a print and digital magazine that aims to make the research at Wits University accessible to multiple publics. It tells Wits' research stories through the voices of talented academics and students. First published in April 2017, Curios.ty is published three times per year. Each issue is thematic and explores research across faculties that relate to the theme. Issue 11 of Curios.ty is themed VIRAL. Inspired by the SARS-CoV-2 global pandemic, content relates to both the virus that causes Covid-19, as well as the socio-economic, political, and environmental ramifications. Feature stories explore how this both presented an opportunity for a global reset, while demanding that we relook how we connect through social media. We ask uncomfortable questions about ‘infection’ online, who owns our data, and how the viral transmission of (mis)information caused an infodemic. We reveal the role of people in pandemics past and imminent, and our connection to the animals and environment we implicate. Research innovations in drone, nano, quantum and light technology offer enlightening solutions to challenging Covid-19.

middle ages reveals our role – with concomitant impact on the environment (page 32). And despite the lockdown not really delivering frolicking dolphins to a suddenly crystal clear Venice (read how to spot fake news and how to understand the infodemic on page 26), both people and planet remain under threat from future pandemics. Humankind must change this trajectory. As much as the pandemic has devastated public health, economies and people (and women in particular – see page 24) globally, it has also galvanised incredible innovations. Read on pages 46 to 49 how Wits student research in drone technology, waste water analyses, nanotechnology ‘super masks’, and behavioural linguistics could challenge Covid-19 from various angles. Similarly, innovations with light bulbs to help reduce malaria, and how messages carried in structured light could secure quantum communications in future (pages 50 to 53) suggest light at the end of the Covid tunnel. In early November, the World Health Organization DirectorGeneral, Tedros Adhanom Ghebreyesus said, “We might be tired of Covid-19. But it is not tired of us.” As December descends on an exhausted South Africa, now is not the time for complacency. By taking personal responsibility for our health and through the tireless and committed research by Wits scientists featured here, as well as those unseen and unsung, we’re in good hands. Stay safe. Professor Zeblon Vilakazi, Vice-Chancellor and Principal

Shirona Patel Head: Communications

CREATIVE DIRECTOR Lauren Mulligan

Dr Robin Drennan Director: Research Development

LAYOUT AND DESIGN Nadette Voogd

Refilwe Mabula Communications Officer

COVER Lauren Mulligan

Deborah Minors Senior Communications Officer and Curios.ty Sub-Editor

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Fifth Floor, Solomon Mahlangu House, Jorissen Street, Braamfontein Campus East TEL: +27 (0) 11 717 1025 EMAIL: curiosity@wits.ac.za WEB: www.wits.ac.za/curiosity/ All material in this publication is copyright and all rights are reserved. Reproduction of any part of the publication is permitted only with the express written permission of the Head of Communications of the University of the Witwatersrand, Johannesburg. The views expressed in this publication are not necessarily the views of the University or its management or governance structures. ©2020

FEATURED

RESEARCHERS UFUOMA AKPOJIVI

Ufuoma Akpojivi is an Associate Professor and Head of the Media Studies Department at Wits. He holds a PhD in Communications Studies from the University of Leeds, UK. His research interests are in the areas of media policy, democratisation, citizenship, new media and activism. He has authored many academic articles in these fields. He is the recipient of multiple research grants from the National Research Foundation Competitive Research Programme, the Andrew W. Mellon Foundation, and the American Council of Learned Societies, as well as numerous teaching awards.

BERNARD COETZEE

Dr Bernard Coetzee is a conservation scientist at the Global Change Institute at Wits who lectures in conservation with the Organisation for Tropical Studies, based in the Kruger National Park. He researches humanity’s impact, from climate change to light pollution, on biodiversity, mainly through studying birds and conservation evidence to determine the effectiveness of our strategies to alleviate such impact. He is active in global conservation science and policy initiatives and conducted a postdoctoral fellowship on Antarctic conservation planning at Monash University, Australia.

CLARE CUTLAND

Dr Clare Cutland is the scientific coordinator of the African Leadership in Vaccinology Expertise (ALIVE) consortium. She oversees the coordination, training and regulatory approval aspects of the Covid-19 vaccine trials that Wits leads, and she is a subinvestigator at one of the sites. Cutland has been an investigator on numerous phase I, II and III paediatric and maternal vaccine trials and is the clinical lead for neonatal sepsis prevention studies and immunisation trials. She was previously Deputy Director of the Vaccines and Infectious Diseases Analytics Research Unit (VIDA).

LAWRENCE HAMILTON

Lawrence Hamilton holds the South African Research Chairs Initiative Newton Bilateral Research Chair in Political Theory, Wits and Cambridge. He teaches and researches in political theory from and for the global South. He is the author of many articles and books including How to Read Amartya Sen (2020), Amartya Sen (2019), Freedom is Power: Liberty Through Political Representation (2014), and Are South

A number of Wits experts are featured in this edition of Curios.ty. View the profiles of all the researchers and contributors at: www.wits.ac.za/curiosity/

Africans Free? (2014). His current work is a book on the future of democracy. He is the only political scientist to hold a National Research Foundation A-rating.

SHABIR MADHI

Professor Shabir Madhi is Executive Director of the Vaccines and Infectious Diseases Analytics Research Unit (VIDA) and Dean of the Faculty of Health Sciences at Wits. A National Research Foundation (NRF) A-rated scientist, he is the NRF/ Department of Science and Innovation South African Research Chair in Vaccine Preventable Diseases and Co-Director of African Leadership in Vaccinology Expertise (ALIVE). A paediatrician, Madhi’s research focuses on vaccines against pneumonia and diarrhoeal diseases, which have informed World Health Organization recommendations on vaccinations in children and pregnant women. Madhi leads the Oxford and Novavax Covid-19 vaccine trials in SA.

UFUOMA AKPOJIVI

BERNARD COETZEE

CLARE CUTLAND

LAWRENCE HAMILTON

SHABIR MADHI

AVIVA TUGENDHAFT

Aviva Tugendhaft is a Senior Researcher at the South African Medical Research Council’s Centre for Health Economics and Decision Science – PRICELESS SA, in the Wits School of Public Health. Her research interests are in the development, implementation and evaluation of tools and methods to meaningfully engage the public in priority setting for health. She is committed to connecting science and society through the dissemination of research findings. Her doctoral research focuses on the modification and implementation of a public engagement tool (CHAT) for priority setting for health in a South African rural community.

JENNIFER WATERMEYER

Jennifer Watermeyer is an Associate Professor in the Department of Speech Pathology and Director of the Health Communication Research Unit (HCRU) in the School of Human and Community Development. The HCRU uses interdisciplinary approaches from the social sciences to address cultural and linguistic complexities of health, illness and disability. Watermeyer’s research focuses on interactional analysis of cross-cultural healthcare encounters, cultural understandings of illness, and healthcare interpreting practices, amongst other topics. She is a National Research Foundation-rated researcher and has published widely locally and internationally.

JENNIFER WATERMEYER

BOB WEKESA

Bob Wekesa, PhD, is Partnerships, Research and Communications Director at the African Centre for the Study of the United States, based at Wits. He is an Adjunct Lecturer in the Wits Journalism and Media Studies Department. He holds master’s and doctoral degrees from the Communication University of China, Beijing. His area of expertise is the multiple intersections of journalism, media and communications on the one hand, and international relations, geopolitics, diplomacy, and foreign policy on the other.

HOW NATIONAL IDENTITY AFFECTS INFECTION OUTCOME Could a country’s collective psychology determine the outcomes of a pandemic? A global cohort of researchers believes so. LEM CHETTY

LAUREN MULLIGAN

t is surreal to think how a microscopic virus has disrupted life as we know it, globally, and forever. During early lockdowns worldwide, we watched a science-fiction movie we never thought could materialise come to life, from Wuhan to Rome, Sydney to Johannesburg. No one was untouched. It was mindboggling and even virologists were astounded at times. By October 2020, more than 20 million people globally had been infected with the new coronavirus and over one million have died.1 The Covid-19 pandemic represents one of the greatest health crises of the past 100 years. A pertinent question to ask is what helped us as a global society to minimise the pandemic’s effects and reduce the rate of death? Face masks and young populations, some might argue. But a global team of nearly 230 experts found another unlikely answer in a group paper, International Collaboration on the social & moral psychology of COVID-19. The answer is national identity.

POSITIVE NATIONAL IDENTITY MATTERS

The research brought together scholars from around the world to examine “psychological factors underlying the attitudes and behavioural intentions related to Covid-19,” explains Dr Sahba Besharati, Senior Lecturer in cognitive neuroscience at Wits. The international team, led by Professor Jay van Bavel from New York University, focused on a wide range of factors such as beliefs in conspiracy theories, cooperation, risk perception, social belonging, intellectual humility, national identification, collective

narcissism, moral identity, political ideology, self-esteem and cognitive reflection. The lofty goal was to generate a massive multi-national sample that could serve as a public database for the scientific community. “It is a huge dataset which will be used for years to come. The sample currently includes 44 000 citizens in 67 countries,” Besharati says. The international team investigated why people adopted public health behaviours (such as wearing masks and screening) and endorsed public policy interventions (like closing bars and restaurants) during the early stages of the pandemic, among other research questions. “The results showed that those who identified more strongly with their nation showed greater support for public health policies and adopted these public health behaviours,” says Besharati. The paper defines “national identification” as the personal significance that being part of a nation holds for an individual. This national identity has been found to play an important role in motivating people to make costly contributions that benefit other members of their country – taxes, for example. The researchers found that harnessing this national identity could help promote “collective efforts to combat the pandemic within one’s country”. Van Bavel found that Covid-19 revealed that during a pandemic there may be “healthy” elements of national identity (which can also have negative connotations such as xenophobia). “Citizens who identified more strongly with their nation reported greater

support for critical public health measures. Our results provide robust evidence that national identification is a reliable predictor of all three forms of public health support measured in our survey: self-reported spatial distancing, physical hygiene and policy support,” he wrote. Besharati says the results showed, at an international level at least, that people felt as if they were working together for a global good. “If there’s anything that this pandemic has done, it has reminded us of our interconnectedness. We can’t just look at anything from our small point on the planet any longer.” Allowing ourselves to complain but comply with rules like border closures, travel bans, alcohol prohibition and more, showed how much we valued the health of our country’s citizens. Managing the pandemic gave politicians a mechanism to foster togetherness, as the study found that “political leaders and public health officials often foster a sense that ‘we are in this together’ and [that we] can manage the crisis through collective action”. The research also revealed that in the US, for instance, threats to strong national identity can lead to lower support for public health initiatives.

“Those who identified more strongly with their nation showed greater support for public health policies and adopted these public health behaviours.” are not too sure what the long-term impact will be, but we know it was a collective experience, even though it was not easy. We had an early lockdown, the peak was much later, kids were not at school, and the social restrictions all became exhausting,” says Besharati. “South Africans do generally have a negativity bias when it comes to our nation and nation-building, from my personal perspective at least. We tend to be jaded. But the pandemic showed us that so many of our problems exist in many other countries. Despite these problems, when we do need to come together, we can do it.” C

I AM AN AFRICAN?

The insights into South Africans, who remain a fractured society still recovering from past trauma and having varying levels of gees (spirit, enthusiasm), will be interesting. While the Wits research team in the School of Human and Community Development contributed to the findings, these are yet to be analysed at a local level. “We have the unique problem now of an overload of data,” says Besharati. Anecdotally though, despite the perception of South Africa’s difficult national identification problems, we did come together. “We

MORE ON THIS RESEARCH: South African researchers from Wits University who contributed to the 67-country study on social and moral psychology include: data lead, Dr Michael Pitman, Senior Lecturer in Psychology; ethics leads, Jennifer Watermeyer, Associate Professor Speech Pathology and Audiology and Director of the Wits Health Communication Research Unit; Kate Cockcroft, Professor of Psychology; Enid Schutte, Lecturer in Psychology; and Dr Shona Fraser in Psychology and at Tara Hospital.

FEATURE

CTRL-ALT-DELETE: RE-SETTING THE POST-PANDEMIC SOUTH AFRICA The Covid-19 lockdown has had a massive impact on South Africa’s economy, exposing profound weaknesses such as the country’s huge inequality. However, the pandemic also presents a chance to pause and reflect, and, possibly, launch South Africa on a much more equitable path. Charlotte Mathews asked how we can take this moment in time, and create a better South Africa for all.

ll indications at this point in time are that South Africa’s economic recovery from the Covid-19 pandemic and lockdown is likely to be slow and painful. An estimated two million people lost their jobs in the short term and domestic business confidence and consumer spending is expected to remain subdued for a long time. In the aftermath of the national lockdown, forced onto the country by the Covid-19 pandemic, hundreds of neighbourhood restaurants, shops and coffee shops have closed, putting thousands of cooks, waiters and cleaners out of work. Some wellknown and established companies such as Comair and Phumelela Gaming and Leisure have filed for business rescue, compounding the massive hit on the economy. In the media industry – a gauge of consumer spending – various media houses have closed their doors, including Associated Media (publishers of Cosmopolitan and House & Leisure), while Media24 has shut down several titles. SA’s strict lockdown has once again starkly exposed the country’s massive challenge with economic inequality. According to figures (see infobox) cited by Professor Imraan Valodia, Dean of the Faculty of Commerce, Law and Management, about 18 million households with an average of five people per household are living on just R2 600 per month, while at the other end of the scale, about seven million households of just two people on average are living on R38 000 per month. Those worst affected by the economic consequences of the lockdown are, once again, those working in the informal sector, foreign workers and women. The country’s healthcare system looks no better. Dr Adeola Oyenubi, Senior Lecturer in the School of Economics and Finance, recently showed how the health of the poor suffered substantially more than that of the rich during Covid-19. Black Africans were more likely to be poor and hungry, and report ill health, than white people. Oyenubi says a large percentage of the SA population is serviced by the public health sector, with few resources, and a small percentage of the population by the private health sector, with more resources. “It would be advisable to address this inequity, which is not sustainable. But it is not as simple as that. There are fears that a national health programme would become another Eskom quite quickly, and if that happens, everyone would be worse off. It would only work if the national health programme – such as the proposed National Health Insurance system (NHI) – was efficient.” Professor Martin Veller, Dean of the Faculty of Health Sciences, agrees. “I’m strongly in favour of a well-functioning NHI, although I’m critical of some of the current NHI plans,” he says. “If we had had a well-functioning NHI, we would not have seen the level of corruption that became evident, and got worse, in the health system.”

EXECUTING EFFECTIVELY

While South Africa has enormous capacity to execute effectively, the government’s initial Covid-19 response and subsequent events showed that the country is “two worlds in one: a world of leadership, enterprise and world-class response, while at the same time a world of incompetence and corruption”, says Professor Adam Habib, Wits’ former Vice-Chancellor and Principal. The problem is that execution capacity lies in the private

“Covid-19 is a health, financial, social and economic crisis in one, and we need similarly integrated solutions. We have to solve these problems collaboratively.” sector while we have ‘idiocy’ in the public sector, says Habib. SA Breweries can distribute alcohol every week to every tavern in SA; Imperial Logistics has massive capacity to deliver; the country’s banking system ranks in the top three or four in the world; and there is significant private sector capacity for testing and tracing for Covid-19 infections. Adjunct Professor Alex van den Heever in the Wits School of Governance says although the government used private sector capabilities to some extent in dealing with the virus, it did not create joint platforms, and government held on to operational decision making. Professor William Gumede, Associate Professor in the School of Governance, says: “Covid-19 is a health, financial, social and economic crisis in one, and we need similarly integrated solutions. We have to solve these problems collaboratively.” Habib agrees: “What is needed is trust in the private sector, but ideological positions stand in the way. Overcoming that is the first challenge.”

HITTING THE RESET BUTTON

Valodia believes South Africa’s economy can evolve and innovate to generate new opportunities for the most vulnerable sectors. However, this would require the right set of policies accompanied by effective combined decision making and actions by government, business and labour. In the short term, informal sector businesses, even more than formal ones, would benefit from cash transfers, while in the medium to long term, South Africa needs to embrace the informal sector as part of the economy. “Policies should promote informal business activity, rather than restrict it, as they do currently,” he says. Valodia says it is possible to get wealthier South Africans to sacrifice some of their short-term interests to help tackle unsustainable levels of inequality. For example, existing laws should be enforced, such as paying domestic workers the legislated minimum wage. “Another solution is to have rational, rather than emotional, discussion about issues like a wealth tax. A third would be to address the fact that South African CEOs earn disproportionately high salaries, so some wage restraint at that level, either voluntary or legislated, could be considered.” More systematically, policies that would democratise ownership need to be considered. For example, giving workers a share in the company, or representation on company boards.

“South Africa needs to embrace the informal sector as part of the economy.”

OVERHAUL GOVERNANCE AT THE TOP

Van den Heever says the root of the mishandling of the Covid pandemic is that SA’s governing model is based on patronage networks, with political appointees in service, administration and procurement. He thinks the only way to fix this is to change government. “Putting stable leadership in place is a priority,” says Van den Heever. “SA is more vulnerable when the political system is dysfunctional. Countries with strong political leadership, such as France and Germany, fared better in dealing with the pandemic than those with weaker systems and fractured governments, such as Italy, the UK and the US.” Politically, we have to change our governance system for Parliament and state institutions to one that is, among other things, based on merit, common sense, accountability and partnerships, says Gumede. “Covid-19 could be the catalyst for fundamental political change,” he says.

Some of the country’s middle class has slipped back into poverty and that will make them more critical of government, and more willing to engage politically. They are likely to demand more transparency in the granting of government jobs and tenders, and this is already evident in the outcry over the Personal Protective Equipment tenders. There are probably going to be more public protests. People may start to vote more discerningly, instead of voting for parties out of long-held loyalty or for race-based reasons. The recent Constitutional Court judgment giving Parliament two years to reform to allow independent candidates to contest elections is a narrow change, but it will give South Africans more voting options in future and may be the start of bigger changes. “Under SA’s current closed-list system, politicians cannot be held accountable, and lack of trust in the legislature helps to explain the rise of public protests and youth inertia towards voting,” says Gumede. “Whatever new electoral system SA moves towards must be simple to understand, easy to administer and must allow voters to

elect candidates directly.” Habib says strong leadership is crucial for SA’s recovery. “Our president has demonstrated flashes of leadership brilliance, and then he disappears. He has shown management, but not leadership. What we expect from the president is to take the various interventions and weave them into a narrative that inspires and galvanises the nation to act.” Habib believes the president and Cabinet should be openly challenging the more populist interpretations of social justice that seem to prevail in both the opposition and ruling parties. “The executive leadership and stewardship of this pandemic must involve a politically educative and consciousness-raising element as much as it would entail management and execution of decisions.” He says that while the president has talked about a social compact, it does not need to happen in a convention centre. “Social pacts can evolve in the actual practise of small day-to-day multisectoral partnerships in the heat of a crisis.”

But whatever happens to the country politically, socially and economically in the future, Veller believes SA should be focusing its combined attention on being prepared for any new health crisis. “Another pandemic may strike, and South Africa should have plans to manage it. This needs political and bureaucratic management.” C

MORE ON THIS RESEARCH: Dr Adeola Oyenubi’s research showing how the health of the poor suffered substantially more than that of the rich during Covid-19: - (https://cramsurvey.org/wp-content/uploads/2020/07/ Nwosu-Estimating-income-related-health-inequalitiesassociated-with-COVID-19.pdf) - Figures of inequality cited by Professor Imraan Valodia: (https://www.news24.com/news24/analysis/ imraan-valodia-a-new-fairer-economy-is-possible-butthat-would-mean-sacrifice-2020)

HOW VACCINES SAVE LIVES BETH AMATO

SHIVAN PARUSNATH

While scientists around the world race to produce the most viable, safe and cost-effective Covid-19 vaccine, the story of how vaccines save lives is important to tell – now more than ever.

nly clean drinking water rivals vaccination in its ability to save lives1, according to the World Health Organization (WHO). And, although vaccine safety gets more public attention than vaccination effectiveness, independent experts and the WHO have shown that vaccines are far safer than therapeutic medicines.  Vaccines have virtually eliminated devastating and cruel illnesses like polio and pertussis (whooping cough), and serious lower respiratory tract diseases. Wits University scientists are leaders in paediatric immunisation research, with their studies informing global public health programmes. Wits teams are also leading two crucial Covid-19 vaccine trials in South Africa and Africa. Dr Michelle Groome, Senior Researcher at the Vaccines and Infectious Diseases Analytics Research Unit (VIDA) at Wits, says that since the introduction of the rotavirus vaccine in Africa, for example, an estimated 135 000 rotavirus hospitalisations and 21 000 deaths have been prevented annually. Rotavirus causes serious diarrheal symptoms in children. South Africa was the first African country to introduce the rotavirus vaccine into its national immunisation programme in 2009, and since then, diarrhoeal hospitalisation has decreased by 34-57% for children under the age of five. “Vaccination is the best way to prevent many childhood diseases, increase life expectancy and improve a person’s quality of life. In a low-to-middle income country, like South Africa, the robust immunisation programme is a major achievement. We have seen a decline in deaths from infectious diseases and now rely on high vaccine coverage to prevent outbreaks and disease,” says Groome.

VACCINES BETTER PROTECT BABIES OF MOTHERS FROM POORER COUNTRIES A vaccination against the respiratory syncytial virus (RSV) has been found to better protect infants born to women from low-to-middle income countries, such as South Africa, than those in wealthier countries. Dr Clare Cutland, the Scientific Coordinator at the African Leadership in Vaccinology Expertise (ALIVE) consortium, and Professor Shabir Madhi, Executive Director of VIDA and the Dean of the Faculty of Health Sciences at Wits, co-authored a seminal global study on RSV. The paper, published in the New England Journal of Medicine in July 2020, provides evidence that immunising pregnant women could protect their infants from severe RSV, which is a leading cause of lower respiratory tract infection. While the RSV vaccine will not be administered to pregnant women yet, the global study is pegged to inform WHO policy on the use of this initiative in public immunisation programmes.

VACCINE REINVENTION FOR COVID-19

The Wits Reproductive Health and HIV Institute (Wits RHI) is part of a global network of researchers, known as the Crown Collaborative, conducting the ‘Crown Coronation’ trial, which aims to determine whether the measles, mumps and rubella (MMR) vaccine given to healthcare workers reduces Covid-19 symptoms. Dr Sinéad Delany-Moretlwe and Professor Bruce Biccard from the Wits RHI are the national principal investigators. “In places where the MMR vaccine uptake is high, there seems to be lower incidences of severe Covid-19. This is really exciting for us, because it means we can use an already tested vaccine and safely repurpose it, at a low cost,” said Delany-Moretlwe.

WITS-LED COVID-19 VACCINE TRIALS

Wits University is currently involved in two Covid-19 vaccine trials, both led by Madhi (pictured right). (See https://www.wits.ac.za/ covid19vaccine/). The Oxford Covid-19 vaccine trial, announced in June 2020, is the first clinical trial for the Covid-19 vaccine in South Africa and Africa. The ChAdOx1 nCov-19 vaccine has been described by the WHO as amongst the world’s leading candidates. Moreover, a vaccine developed in Africa is a huge achievement for promoting context-specific treatment, and to generate evidence about how a Covid-19 vaccine will work in low-to-middle income countries. The Novavax Covid-19 vaccine trial is a partnership between VIDA and Maryland-based bio-technology company, Novavax. The Novavax Covid-19 vaccine, known as NVX-CoV2373 contains a nanoparticle S-protein. The trial will determine whether it protects against the disease in adults aged older than 18 years.

“Vaccination is the best way to prevent many childhood diseases, increase life expectancy and improve a person’s quality of life.”

VACCINES AND HERD IMMUNITY

South Africa bucked global Covid-19 trends, with significantly fewer deaths in relation to the number of people likely to have been infected with the virus. Scientists could not have predicted that about one-third of the population would be infected with the virus nor that the country would have a declining transmission rate. One reason may be herd immunity – which is a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through previous infections or vaccination. Non-pharmaceutical interventions like wearing face masks, social distancing and avoiding crowds played a major role. “We don’t know, however, if immunity is long lasting. We can’t just say that because one-third of South Africans may have contracted the virus that we have sustainable ‘herd immunity’,” says Madhi. “Our unique situation [lower deaths despite greater numbers of infections] could be explained by many factors. We will always need a vaccine to protect us against a serious illness like Covid-19.” C

VACCINE HESITANCY Courtney Ward, an anti-vaxxer, says: Our internal microbial world is vital to our immune system’s effectiveness regarding our health. I have never been an advocate for vaccines, especially this fast-tracked Covid vaccine that is suggesting all nations now have it. This ‘pandemic’ has a 99% recovery rate so it makes no sense to me that we need all be vaccinated. The ingredients found in most vaccines – mercury, human and animal cell tissue – is another reason I do not condone having this poison injected into my body.

VACCINE ADVOCACY Pablo Berra, a Covid-19 vaccine volunteer, says: I am the first, and so far the only Hispanic American to receive the Oxford Covid-19 vaccine. From the very first day at the Wits Shandukani Laboratory, I felt welcome and safe. After each of the two doses I had mild discomfort that lasted three or four days: headache, fever, and muscle aches, especially in my legs. I wanted to help save lives by being a vaccine volunteer. It has been the best decision I have made in service of others.

WHAT IS A VACCINE?

A vaccine is a biological product that elicits an immune response against a specific bacteria or virus. The immune response stimulates lymphocytes (white blood cells) in the body to produce antibodies and other inflammatory responses to kill off, inactivate or neutralise the germ when a person is exposed or infected. The antibody response is generally specific to individual germs, hence the need for different types of vaccines. Immunisation is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.

HOW IS A VACCINE MADE?

One way is by using either a weakened or attenuated (reduced) version of the germ, for example oral polio virus, that has limited ability to replicate or cause illness. Another approach is to use an inactivated version of the targeted vaccine, for example, the pertussis (whooping cough) vaccine. More common approaches include using only a specific target (antigen) of the germ, which can also target the immune response to neutralise the germ. These antigens are sometimes coupled with another chemical compound, an ‘adjuvant’, to enable a more robust immune response. Newer technologies include using weakened viruses that cause mild or no illness, and that are engineered, or technology that involves directly injecting the genetic material (messenger RNA or DNA) that codes for the antigen.

SECOND WAVE SEVERITY: WHAT SEMI-SAVED SOUTH AFRICA?

As Covid-19 cases surged in the northern hemisphere during October 2020, cases were declining in South Africa, suggesting that, despite relaxed lockdown measures, we might avoid a so-called “second wave” of infections, or at least experience a spike less severe than the original. BETH AMATO

outh Africa has surprised itself and the world with fewer Covid-19 deaths despite an infection rate that has been significantly higher than what was originally predicted. We may have indeed reached a critical stage of herd immunity thereby thwarting a second spike. The million-dollar question, of course, is why? “No-one could have predicted what happened in South Africa,” says Professor Shabir Madhi, the Executive Director of the South African Medical Research Council Vaccines and Infectious Diseases Analytics (VIDA) research unit at Wits University. “What the official figures show are not a true reflection of the actual number of people who have been infected. We believe that as many as 40% of people in densely populated areas have been infected with the virus. Antibody testing has shown this, and so about 20 million people have had Covid-19 in South Africa – which is more than the 25% we initially modelled.”

EARLIER EXPOSURE TO OTHER CORONAVIRUSES

Curiously, the high infection rates did not translate into a high rate of hospitalisation and death. (This is despite the South African Medical Research Council reporting, at the end of August, that there had been 43 000 “excess deaths” over and above the documented Covid-19 related deaths). Many of those infected were asymptomatic or mildly symptomatic. “I think that our low death rate, despite high infections, is a result of cross-protective immunity, probably because we’ve built up immunity from exposure to other coronaviruses,” suggests Madhi. But, he adds, this still does not explain everything. Professor Martin Veller, Dean of the Faculty of Health Sciences at Wits, agrees that all the reasons for South Africa’s lower number of deaths and hospitalisations are not known, and are multifactorial.

AGE MATTERS

“There’s no doubt, for example, that our youthful population meant we’d have different outcomes. The median age in South Africa is 27, which is young. Age matters it seems, despite our high burden of other diseases,” says Veller. In other words, while those with co-occurring diseases like diabetes, hypertension and obesity were more susceptible to developing complications when contracting Covid-19, younger people with these illnesses were better off than their older counterparts with the same illnesses. The excess deaths reported at the end of August were mostly people over the age of 60. “We don’t know why age matters, but it does,” says Veller. He notes that there is also some evidence that temperate climates play a role in flattening the curve of the virus. “In colder climates, like New York and Washington D.C., there was a rapid spike in cases at the beginning of the outbreak. While there is now another infection wave in the US and weather is warmer in September, [the second wave] is ‘flatter’ in warmer places like Arizona and Texas.”

HERD IMMUNITY – HOW LONG DOES IT LAST?

Herd immunity refers to a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection – whether through previous infections or vaccination – thereby reducing the likelihood

of infection for individuals who lack immunity. Cheryl Cohen, Professor of Epidemiology in the Wits School of Public Health and Head of the Centre for Respiratory Diseases and Meningitis at the National Institute for Communicable Diseases, says the high proportion of people who have been infected with the novel coronavirus have developed antibodies to protect them against further infection – at least for a while. This immunity is certainly one of the factors reducing transmission. “On a population level it is helpful to understand that the proportion of people who have evidence of previous infection may be assumed to have some level of protection against another infection. But we have no idea how long this immunity lasts,” says Cohen. But a new study, led by Cohen and known as the PHIRST-C study, may shed some light on the question of immunity. The study aims to find out how many people in individual households in rural and urban South Africa become infected with the novel coronavirus, how asymptomatic people transmit this virus, and how this virus interacts with other pathogens.

INSIGHTS INTO VIRAL RE-INFECTION

In the PHIRST-C study: SARS-CoV-2 community burden and transmission in two South African communities, participants will be tested twice weekly until the end of 2020 to determine whether they become infected with SARS-CoV-2, the coronavirus that causes Covid-19 disease. Sero-surveys will be used to investigate the presence of antibodies, which are evidence of an immune response to the infection. “The serology results from this study may help answer some outstanding questions related to Covid-19 immunity, for example, the level of antibodies needed to provide protection against re-infection, as well as the rate of asymptomatic infection in South Africa,” says Cohen. Until we have a better understanding of how herd immunity works with the novel coronavirus, however, measures like mask wearing, hand washing, avoiding large gatherings and social distancing must be adhered to, says Madhi. “There may be a resurgence of infections if we throw caution to the wind, but this resurgence, thankfully, may be less severe.” In the meantime, Wits scientists are working hard to produce a vaccine. “We’re way up there in terms of being able to produce something viable,” says Madhi. SARS-CoV-2, like many respiratory viruses, is here to stay. “Let’s hope it becomes a seasonal virus with sporadic outbreaks,” he says. C

UPDATE: “As of 17 December, SA is engulfed in clearly experiencing a major resurgence. The scale of it is unclear as yet, but preliminary data worryingly suggests it may even be more serious than the first. The pattern is also similar to the first wave, with the Western Cape and Eastern Cape affected, and signs of Gauteng and KZN being affected. This is of huge concern, as everyone is going on holiday to many of the worst affected areas. Remember that forming a ‘pod’, doing anything with other people outdoors, physical distancing, masks and handwashing are your chief defence.” Professor Francois Venter, Ezintsha.

THE LONG HAUL TO PARTIAL RECOVERY

So-called Covid long-haulers afflicted with 'Long Covid' are showing how long and frustrating the journey to recovery can be. UFRIEDA HO

RAWPIXEL

bit of make-up, sunshine and the laughter of her grandchildren are gifts of a happy life for Faye Khan. After being hospitalised with Covid-19 and surviving, she says she never takes small joys for granted. Walking a long road to full recovery makes Khan a so-called “long-hauler” of chronic Covid. For doctors, long-haulers signal a necessary shift to focus on the long-term impacts of the virus. Workplaces too will have to adapt as employees may feel unwell for weeks – even months – after getting back to work. For Khan, Covid-19 came to her as terror and doom and at one of the lowest points of her life. Khan, who works in Marketing and Communications at Wits, received shattering news of her twin sister’s death at the beginning of July. “There was a lot of traffic in and out of the house in Koster [in the North West] and I think that’s where I got infected,” she says.

MANAGING COMORBIDITIES

SUSPICIOUS SYMPTOMS

DOCTOR AS PATIENT

Back in her Johannesburg home a week later, she started feeling tired then suffered severe diarrhoea and vomiting. Her family doctor thought it might be food poisoning but recommended a Covid-19 test if her symptoms did not improve. Khan says these symptoms felt different and when she lost her sense of taste and smell, she was convinced it was Covid-19. Covid-19 symptoms at the stage of infection can be as varied as dizziness, coughing and shortness of breath, to confusion, leg pains and rashes, including chilblain like lesions on the toes and fingers, known as ‘Covid toe’. The subsequent Covid-19 positive result sent Khan to hospital. As a diabetic with hypertension, she was “terrified”. “My husband had to drop me at the entrance and they took me to the Covid ward where all the nurses and doctors were in full PPE, you couldn’t see their faces. All around me were very sick people on oxygen. I was convinced I was not going to get out of there. I never slept because I was so scared I wasn’t going to wake up again, and not being able to see my family was the worst,” she says.

With a shortage of beds Khan was discharged after five days when she was considered to be out of immediate danger. She was given an after-care booklet and instructions to self-isolate. And so began her long convalescence. Only after six weeks did Khan feel like leaving her home. She says even video chats made her feel low as her self-esteem plummeted and depression set in. “You just feel tired and sick. Even now I have sores in my mouth from being so dehydrated. I lost so much weight so fast. My doctor said all my organs were affected and my immune system was completely run down so he’s had to change my medication.” She had to have counselling for the grief of losing her sister and the impact of Covid-19 and was prescribed a temporary course of anti-depressants and sleeping tablets. Mounting medical and dental bills are also a worry.

Fatigue and exhaustion after exertion were also the persistent symptoms that affected Professor Emeritus Guy Richards, a Critical Care specialist at Charlotte Maxeke Johannesburg Academic Hospital and Wits, who contracted Covid-19. He calls it a hazard of the job, but Richards says his biggest fear materialised when his wife and son were infected. “My second biggest concern was not knowing the degree of severity that the virus would have on each one of us,” he says, adding that up to 20% of people require hospitalisation and 5% of people will need to be in ICU. He monitored himself and his family by testing levels of oxygen in their blood and levels of inflammation. His son got better quickly but he and his wife had to start on treatments of dexamethasone, a corticosteroid used for its anti-inflammatory and immunosuppressant effects. Richards says: “It is difficult to document long-term symptoms and effects directly linked to Covid-19 because there isn’t something like a blood test you can do.”

“There are many case reports from people who do not regain their previous health … and risk factors for persistence of symptoms include high blood pressure, obesity and mental health conditions.”

LINGERING MALAISE

Long-haulers have reported everything from persistent cough and fatigue to gastro-intestinal problems, racing heartbeats to brain fog and ringing in the ears. When doctors can’t pin-point or treat people effectively, they can feel unsupported and their anxiety worsens. Post-traumatic stress and depression also takes root. Richards says doctors have to listen more to patients’ individual, and wide-ranging complaints. “Once you’ve ruled out respiratory complications, blood clotting issues and heart complications, then it’s about helping patients adapt and accept that there are some things that they will not be able to do as well as they did before they got ill and this can be for weeks or months even.” Richards flags that Covid-19 has helped to bring renewed awareness of Post-Intensive Care Syndrome (PICS), which can occur when any patient who has needed treatment in ICU does not return to their former level of physical, mental or cognitive function for months, even years, after being discharged. Online support groups for Covid long-haulers have sprung up. The South African Facebook group had 13.8K members as at October. It calls itself a platform to “give each other emotional support and any other useful information while in the fight of Covid-19 quarantine”. A World Health Organization report released in September confirms growing data on lingering symptoms. “There are many case reports from people who do not regain their previous health … and risk factors for persistence of symptoms include high blood pressure, obesity and mental health conditions.” The report highlighted data from the 2003 SARS (also a coronavirus) outbreak, stating that patients reported “persistent and significant impairment of exercise capacity and health status over 24 months. Health workers who had SARS experienced even more marked adverse impact and 40% of people recovering from SARS felt chronic fatigue symptoms 3.5 years after being diagnosed”. Richards says it means not dropping the ball on prevention. And the message hasn’t changed: wear your mask, wash and sanitise your hands and keep to social distancing guidelines and well ventilated spaces.” C

MAKING SENSE OF THE NUMBERS Modelling pandemics might be an imperfect science, but it is the best that we have. UFRIEDA HO

mperfect-important may be the apt hybrid adjective for mathematical modelling that has taken a dominant role in how the world is trying to make sense of the unknowns of the novel coronavirus, SARS-COV-2, which causes Covid-19. The strength of mathematical modelling is in tracking and projecting likely scenarios for the progression of the disease. Strong forecasting can help guide policy and decision-making to improve planning and ensure that limited resources are allocated efficiently. The downside, though, is that any modelling by equations is only as strong as the data and numbers that get crunched. Extrapolation and analysis from projections can vary widely and be misaligned to realities. Covid-19 response is high stakes territory, not just in saving lives and limiting damage to economies and livelihoods, but also in how precedents and policies are justified. It deserves deeper scrutiny.

AN ECOSYSTEM FOR INFERENCE

South Africa’s official modelling has largely been undertaken by the South African Covid-19 Modelling Consortium made up of researchers from the National Institute for Communicable Diseases (NICD) and Wits, Cape Town and Stellenbosch universities. According to the official South African coronavirus portal, in May the country relied on ‘primarily two models’: the National Covid19 Epi Model and the National Covid-19 Cost Model. “The Epi Model seeks to capture the transmission dynamics of Covid-19 at a population level over time. This takes into account the disease

severity and the treatment pathway that patients may encounter. This feeds into the Cost Model which represents the type, number and price of ingredients to cost responses.” In May 2020, the consortium forecasted 40 000 deaths and a million infections nationwide by the end of November. By midOctober, the death toll stood at 17 863 and 693 359 recorded positive cases. The May modelling was used by the government to decide on hard lockdowns, including the still contentious bans on alcohol and cigarettes, as well as budgets for the procurement of personal protective equipment, building field hospitals and even importing the services of 217 Cuban doctors at a cost of a reported nearly half a billion rand to shore up the local emergency response. Widespread corruption has already resulted in ongoing Special Investigation Unit inquiries and the axing of Gauteng Health Minister Bandile Masuku. On a provincial level, Professor Bruce Mellado, a physicist from the Wits School of Physics and iThemba Labs, has been part of the Gauteng Advisory Council that has informed the provincial response strategy. Mellado says no model is ‘100% perfect’. He says modelling is set by parameters and is most efficient when there is accurate data and context within a strong ecosystem of epidemiologists, healthcare workers, clinicians, policymakers, data scientists and mathematicians. “Any data is good, even if it is flawed, so long as you know where the flaws are and this comes from having the input of hundreds of people from different work streams,” says Mellado.

D1 “Our job as modellers is to look at realities objectively and to try to understand the weakness and strength of data and to understand that the on-the-ground realities are complex. We correct, recalibrate, adapt and re-adapt the parameters of the model as we go along.” Currently Mellado’s model is updated on a monthly basis and he has a core team of 50 people who work on the province’s Covid-19 dashboard.

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DATA DEFICIENCY INHIBIT PROJECTIONS

For Professor Alex van den Heever, modelling a pandemic with its unknowns and variables has inherent shortcomings – too many to convey much useful information. He believes that projection models in particular are problematic. “They don’t reflect enough on localised ‘hotspot’ mapping, or contributing factors including dispersion rates, residual susceptible population numbers, herd immunity, glitches in testing, access to testing and delays and errors in testing results,” he says. Van den Heever, who holds the Chair of Social Security Systems Administration and Management Studies in the Wits School of Governance, says lack of transparency and ‘fiefdom-like’ control over the data and flow of information should be red flags. “There just isn’t enough information for coherent projection – assumptions drive the results and there’s not enough evidence to show how interventions impact on a projection itself. “Because of a failure to present granular information and the fact that information and data are hidden – or only accessible [to] those who sign non-disclosure agreements with government – means there’s limited access to information for empirical analysis.” Van den Heever warns that when data and information flow is controlled it cannot be tested or challenged, and can be misused to give false legitimacy to government decisions, policies and precedents.

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DEMILITARISING DATA

Graeme Götz, Director of Research Strategy at the Gauteng City-Region Observatory (GCRO) says making data more accessible and more specific is key to being able to geo-code (use data to pinpoint locations) or to tease out spatial patterns of how coronavirus spreads. A key lesson for a democracy is that information and data “cannot be militarised and removed from the public domain under the guise of protecting privacy – not under these circumstances”, he says. Götz has been part of the data analytics research work stream in the Office of the Premier. Since March the Observatory has been mapping the pandemic with drilled-down framing that zooms in on specific risks and vulnerabilities. This includes understanding the impact on the elderly and on women, and evaluations of the households most affected by lockdown restrictions. Much of the data has been ward-level information. Götz says it is specific but anonymous, meaning privacy is protected but allows for targeted and localised responses that could replace blanket hard lockdowns.

REDEFINING ECOSYSTEM RESPONSES

“Modelling is fine, but one really has to mine the data to better understand the patterns and draw conclusions from that,” he says.

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“There just isn’t enough information for coherent projection – assumptions drive the results.” Modelling and the flow of data has become an area of contestation in the coronavirus response. It can be a distraction from focusing on better strategies and resource allocation, says Professor François Venter, Divisional Director of Ezintsha. Venter believes modelling in the main has been considered and consistent, although the timing of projections was inaccurate. “We can’t cherry-pick the parts of data or a model to suit our own narratives. The models aren’t the problem, as much as our reactions to them are,” he says as a caveat. Venter’s added warning is for greater vigilance. We should not allow the Covid-19 fight to be reduced to pitting sides against each other – including arguments of lives versus livelihoods; to the development of personality cults; or allowing state moralism and hypocrisy to expand off the back of controlled data. Keeping more eyes on the ball is what will matter most because the virus is not yet done with the world. C

PANDEMIC HISTORY FORETELLS A DISMAL FUTURE If history has taught the world anything, it’s to ignore the warning signs and carry on catching diseases. TAMSIN OXFORD

SHIVAN PARUSNATH

he word “pandemic” is heard just about in every radio and TV advertisement, seen on every news site and heard around dinner tables all over the world. While it has suddenly cropped up as a hot topic among our generation, the history of pandemics is as old as the human species itself – if not older. Pandemics come from the intermingling of different creatures and animals under different conditions. They are on the move from epidemic to endemic to pandemic – the Greek words of ‘pan’ meaning ‘people’ and ‘demos’ meaning ‘widespread’. And they are not done with the human race.

PAST PANDEMICS

“There have been a number of recognised pandemics in recorded history with the oldest recorded just over 7,000 years ago,” says Catherine Burns, Associate Professor of Medical History, Adler Museum of Medicine at Wits. “We have physical, narrative and medically recorded evidence of pandemics that have moved through thousands of years, and the most virulent was smallpox, only eradicated in the 1970s.” Smallpox has been found in the remains of mummified humans buried in the third century BCE. The disease has cropped up throughout recorded history and its emergence has been directly linked to the movement of human beings. The disease killed 200 million people throughout its lifetime. The first ever vaccine was created to defeat this disease.

The Black Death, one of the most fatal diseases for which there are records going back at least 3 000 years, was known as The Plague, The Pestilence or The Great Mortality. More than 250 million people died from the disease in Eurasia and it wiped out around 30-50% of Europe’s population. The Plague of Justinian 500 CE, which killed perhaps a tenth of the world’s population, was matched in ferocity by the widely shared view of experts that 500 million people – over 30 percent of the world’s population at the time – became infected with the 1918-19 influenza pandemic known as the Spanish Flu, with at least 50 million global deaths. Since then, the world has faced the consequences of other influenza strains, waves of cholera and yellow fever, tuberculosis, polio, and then HIV/Aids, SARS [Severe Acute Respiratory Syndrome], Swine flu, Ebola, MERS [Middle East Respiratory Syndrome] and Covid-19 [Corornavirus Disease 2019].

MIGRATION MOVES VIRUSES

Pandemics come from human-animal mingling and from human expansion across previously hidden recesses of the globe. Population movement contributes to the spread of infectious diseases. This is further complicated by travel hubs, increased population density, personal hygiene, and comorbidities. From wars to planes to cars to trains – disease moves from the epidemic to the pandemic thanks to the movement of human beings. An epidemic refers to a disease that is actively spreading: whereas

endemic is the constant presence of a disease in a specific location. Pandemics, however, have ‘passports’ – they cross borders. “It is important for us to keep in mind that we have already witnessed several pandemics prior to that caused by SARS-CoV-2. We’re currently in the seventh pandemic of cholera and the third pandemic of plague,” says Professor Adriano G. Duse, Chief Specialist, Chair and Academic Head: Clinical Microbiology and Infectious Diseases at Wits. “Pandemics are not new. We were warned. The International Health Regulations, introduced in 1969 and modified in 2005, are aimed at preventing the spread of infectious diseases between countries and continents.”

“The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency.” Then, in 2011, the World Health Organization (WHO) issued a warning: “The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency.” Its warning was echoed by experts and leaders from around the world – Joshua Lederberg, then president of Rockefeller University, Bill Gates, and leading epidemiologists and virologists who all raised the red pandemic flag long before Covid-19 dominated world headlines. The virus has exposed exactly how unprepared humanity was for its impact and begs the question: how do we prepare for what happens next?

POST-PANDEMIC DYSTOPIA

“We’ve a lot of evidence that pressure on resources and the plant and animal kingdoms have made us more vulnerable,” says Burns. “We have closed the spaces, and while we’ve made advances in keeping older people and children alive for longer, we’re doing huge damage to animal and plant ecosystems. We need to find ways of sharing the insights learned by experts across multiple silos and with leaders who can ignite global action on a scale that will impact all our lifestyles.” To avoid a potentially dystopian future – a society characterised by human misery, disease, and overcrowding – the world has to slow down its voracious devouring of resources and land. It has to find better ways of putting expertise and insight into action so as to resolve the pressure on systems, to reduce protectionism and rather share resources and knowledge. There is no reliable vaccine for tuberculosis, HIV/Aids is not cured, and the Covid-19 vaccine is not immediately available. So, not only does the world need to pool its knowledge, but it needs to pay attention when a virus emerges to prevent it from becoming a pandemic. Unlike what happened in 2020. “We cannot take the line that there will be an effective vaccine soon,” says Lenore Manderson, Distinguished Professor of Public Health and Medical Anthropology at Wits University. “House arrest is also not a continued way to live. Covid-19, like HIV, tracks the social fault lines of both race and class and underscores unequal care in society. It is a real dilemma.” A dilemma further complicated by another question raised by experts and, once again, ignored: Are antibiotics the new pandemic? Quite possibly. Antibiotic resistance is a pandemic waiting to happen. Humanity has misused antibiotics so badly that many are now useless. As Covid-19 continues its march across society and economy, now is the time to pay attention to what might come next. C

When the US

SNEEZES...

Different nations’ responses to the pandemic should serve as a warning to exercise extreme caution in choosing leaders. DELIA DU TOIT

“I see the disinfectant that knocks it out in a minute ... is there a way we can do something like that? By injection?”

people "When put ey zol, th the on saliva and paper, ey h then t t tha share zol."

“We are all going to die one day.”

s Covid-19 took hold in Wuhan, China, in December 2019 and the city was quarantined and locked down, experts the world over fiercely debated the ethics and effectiveness of such measures. And, as the virus rapidly spread across the world in the following months, different nations and their leaders’ responses ran the gamut – some enforced strict lockdowns, others seemingly ignored the threat, and headlines of dubious decisions ran almost daily. In Colombia, the days that residents could leave the house depended on their ID number; President Alexander Lukashenko of Belarus recommended vodka and saunas as protective measures; while Sweden only began instituting lockdown restrictions in December. US President Donald Trump, at one point, speculated publicly on whether injecting

bu “I d be t re on’t pe en s cen dri a t o n on ple s ying ly I’ k ve ha ly w ho nd a uld that s b s th ut a wit h th not e v ls h v eir iru o p od s w ois ka ith on it. ”

disinfectants could kill the virus, leading some disinfectant manufacturers to promptly issue statements warning against ingesting their products. South Africa was lauded for its early response to the pandemic and later criticised for some bizarre decisions, such as banning tobacco and alcohol, and widespread corruption that dampened relief efforts.

NARCISSISM TRUMPS SCIENCE

It soon became clear that some leaders and countries fared better than others, though the issue is much more complex than mere governance. In broad strokes, those leaders who are egotistical and right-wing, including Trump and Brazil’s President Jair Bolsonaro, tended to favour denialism and put the economy before lives – and lead in infections and deaths, says Professor Lawrence Hamilton, National Research Foundation/British Academy Bilateral Research Chair in Political Theory at Wits and Cambridge University. “Countries and leaders that were organised and empathetic in their approach and followed scientific guidance, such as South Korea, New Zealand and Finland, were able to control the spread of the virus and fake news from the outset,” says Hamilton. John Stremlau, Honorary Professor of International Relations at Wits, says these dynamics were at play long before the pandemic. “Covid simply accelerated their effects. Trump is out of sync with the traditions of science and serious inquiry, attempting to discredit the Centers for Disease Control and World Health Organization, and is only interested in himself. Such narcissistic leadership styles were disastrous for managing Covid. These nations became outliers in a time when collective action is the only way to deal intelligently with the problem.” Indeed, several countries started banning travellers from nations that fared poorly in managing the pandemic. After decades of having one of the most powerful passports in the world, US citizens found themselves barred from much of the world, including the European Union nations, the UK, China, Japan and Australia.

SQUABBLES DISMANTLE BRICS

At the other end of the spectrum, more open-minded leaders and those that approached the problem with science rather than politics – interestingly, most African countries – were able to solicit support from beyond their borders, says Dr Bob Wekesa, Coordinator of partnerships, research and communications at the African Centre for the Study of the US at Wits. This, however, did not apply to all the BRICS nations (the emerging economies of Brazil, Russia, India, China and South Africa), he adds. “While the BRICS did well through support for member states through the New Development Bank, Brazil’s denialism is perhaps the worst case of pandemic mismanagement in the BRICS and, at the same time, tensions escalated between India and China on their common border. What a time for the two emerging powers to go into a fight!”

KNIVES OUT FOR NATIONALISM

Though these varying reactions will have potentially serious implications for politics and international relations, the ramifications won’t necessarily be due to Covid, says Hamilton. “If and when normality returns, there’s a greater chance of nations

“Those leaders who have responded worst to this crisis have also been the main sources of countless conspiracy theories and misinformation.” returning to the ‘normal’ dictated by their institutional makeup, rather than being completely different. Those with narcissistic leaders with trust deficits will still face those issues. Right-wing leaders like Trump, Bolsonaro and Russia’s president Vladimir Putin are simply not interested in international institutions and have taken the opportunity of Covid to strengthen their nationalistic approach.” The pandemic did cause image problems for some nations, says Wekesa. “Trump’s behaviour rendered the US elections a referendum on whether the US should maintain its global leadership or sink further into its America-first isolationism. “China, where the pandemic originated, will struggle to regain its global soft power even though it managed to control the pandemic earlier than most, suggesting that it will be ahead of the curve in terms of economic recovery. This has great implications for the current geopolitical set-up and so-called decline of the West. “On home soil, corruption will remain a major economic challenge to South Africa.” Covid has shown how serious the scourge of corruption is, says Hamilton. “If President Cyril Ramaphosa has any chance of getting the ANC and country behind him, he has to find a means of opening the economy and cracking down on corruption.” One thing is sure, agree the experts: the world needs to start working together to prepare for the next pandemic. In an online lecture at the Wits School of Governance in September, Minister of International Relations and Cooperation Dr Naledi Pandor reiterated that a nationalist approach is outrageous. “We’re one people,” says Stremlau. “The pandemic was and is a defining moment globally, a reminder that real threats require collective action. It will change the global system. In the case of Trump, who came to the job as a reality TV star and failed casino boss, and did not grow into the job and probably cannot do so, and similar leaders, we have to hope that the change of administration brings leaders who can make use of the talent and expertise surrounding them and understand their obligation.” There are indeed two important lessons here, agrees Hamilton. “First, we must use it to find a roadmap for how we can properly make the health and wellbeing of a state’s population the raison d’être of its government. Second, given that it is no accident that those leaders who have responded worst to this crisis have also been the main sources of countless conspiracy theories and misinformation, we must learn to keep oligarchs away from political power.” C

Almost everyone has suffered in some way from the effects of the Covid pandemic – but women have suffered far more, threatening some of the gains made in gender equality in a democratic South Africa. ERNA VAN WYK

VIRUS

WAGES WAR ON WOMEN 24

NECHIRWAN-KAVIAN

uring pandemics, women are hit hardest and are disproportionately affected in the health, socio-political and economic arenas. The Covid-19 outbreak is no exception. In Gauteng, more women (56%) than men have tested positive for the virus, according to the August 2020 Map of the Month of the Gauteng City-Region Observatory (GCRO). The gender bias during pandemics is also visible in other studies, such as the National Income Dynamics Study (NIDS) Coronavirus Rapid Mobile Survey (CRAM). This five-wave-study, looking at five time frames between February 2020 and April next year, is the largest nonmedical Covid-19 research project in South Africa. “Data from wave 1 show women in South Africa were especially hard hit by the crisis during February. Though women accounted for less than half (47%) of those employed in February, they accounted for two million, or twothirds (67%), of the three million net job losses that were recorded between February and April,” says Daniela Casale, Associate Professor in the School of Economics and Finance. This unequal economic toll on women is frequently referred to as the ‘she-cession’, in reference to recessions. The survey shows that while women accounted for two-thirds of job losses,

men received two-thirds of the Covid-19 grants (65%). One of the main reasons for this disparity in job losses is because of the continued concentration of women and men in different parts of the economy, and many of the hardest hit sectors were those that typically employ large numbers of women – tourism and hospitality, retail trade, personal care, and domestic and childcare services. In addition, women were found to have taken on more of the extra childcare work in April. Women also lost their jobs across the spectrum in low-, semiand high-skilled employment. “What has been so devastating about this crisis is that everyone has suffered, but they have not suffered equally. Those who have been the biggest job losers have been at the bottom end of the skills distribution, so we know that most of the jobs lost were by women at the bottom end; women who in February were earning less than R1 500 per month,” says Casale. Wave 2 of the survey, conducted since June and released in September, provided an opportunity to track how women have fared since the economy started to reopen, and shows women remain well behind men in reaching their pre-Covid employment levels. Women’s employment levels were still down 20% in June against February, while men’s were down 13%. “A worrying finding is that even though women were overrepresented among the job losses, they were under-represented in the income support received in June. Only 41% of the beneficiaries of the Unemployment Insurance Fund [UIF] or the UIF temporary employer/employee relief scheme, and 34% of those who had been paid the new Covid-19 social relief of distress grant, were women,” says Casale. It is likely that fewer women received the social relief of distress grant because it cannot be disbursed concurrently with another social grant, such as the child support grant. This means unemployed women are in effect penalised if they are also the main caregivers in families and communities, raising questions about the fairness of SA’s social protection system.

DOUBLE BURDEN

“The Covid-19 pandemic has forced us to take a fresh look at the burden placed on women to manage responsibilities on a daily basis,” says Odile Mackett, Lecturer in the Wits School of Governance. Women in paid jobs often still perform unpaid reproductive duties, such as housework and rearing children, in addition to their wage labour, and are estimated to spend up to five more hours a day on unpaid reproductive labour than men. To help women cope, these tasks have increasingly become ‘outsourced’ to people who live outside the household – domestic workers, nannies, and food delivery and take-away services rather than cooking at home. However, women may then still be left to pay for or ‘manage’ the employees who perform these tasks, according to Mackett. Women’s extended working days have thus become normalised, despite the adverse effects that this has on their progression within the labour market and their general wellbeing. This is amplified by the findings of the Wave 2 NIDS-CRAM survey, in which twice as many women as men said childcare has negatively affected their ability to work, to work the same hours as before lockdown or to search for work. “From the evidence we have so far, the pandemic and ongoing lockdown are having a much more severe effect on women and

“A worrying finding is that even though women were over-represented among the job losses, they were underrepresented in the income support received in June. their prospects in the labour market. This threatens to reverse some of the slow gains towards gender equality over the past 25 years in SA,” says Casale.

TRACKING THE SHADOW PANDEMIC

The Covid-19 pandemic has highlighted the “shadow pandemic” of gender-based harm (GBH). Its extent during Covid-19 and the lockdown will only truly be understood in the years to come from data collected now and when pre- and post-pandemic trends and statistics can be compared. Wits Journalism Lecturer Dr Nechama Brodie, author of the book Femicide in South Africa, which is based on her doctoral research, conceptualised the Homicide Media Tracker, now in development. The Tracker’s aim is to study violence in South Africa as reported in the media over the past 40 years. The idea is to build a tool that collects and keeps all media reports of homicide that can act as a baseline, including GBH. “If we want to say that GBH during this pandemic is different, then different to what? Data and information gathered now, during the pandemic, will definitely come into play in future analysis,” says Brodie. She cautions, however, that the trend has been to view everything, including GBH, through the lens of the pandemic and that to suddenly ignore and discard life before and after the pandemic is problematic – because while the pandemic will change many things, many things will not have changed, such as human nature. “Violence against women is a societal problem and we cannot study violence without studying the society within which it takes place. As a society we have become good at performative acts of opposition to GBH; we sign petitions, post hashtags, change our social media profile pictures, but we do not actually perform acts that are useful. “Information and data have value. With the Homicide Media Tracker, I want to build a baseline, because it can eventually become one tool that can be used by others who are studying violence, including femicide and gender-based violence. “What South Africa did with this lockdown is the most bizarre and unexpected controlled experiment in terms of interpersonal violence, where we removed alcohol for three months. Only in the years to come are we going to see very interesting and probably very scary information about the levers that drive or amplify or minimise interpersonal violence and also violence against women. But at this stage we do not know the true extent of GBH during Covid-19,” says Brodie. C

UNDERSTANDING THE INFODEMIC Misinformation, mythology, and fake news have collided to produce staggering quantities of Covid-19-related information, the misrepresentation of which has implications for public health. DEBORAH MINORS

id you hear the one about injecting bleach to stave off Covid-19? Perhaps you forwarded that WhatsApp message your uncle shared about drinking ethanol for immunity? No doubt you’ve encountered ‘viral infection by 5G’, ‘dolphins frolicking in Venetian canals’, or know someone who believes the virus was made in a lab. Along with a lethal virus, the Covid-19 pandemic has unleashed a tsunami of information, misinformation, myths and fake news that the World Health Organization (WHO) calls an “infodemic” – this is an over-abundance of information including deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas. So serious is the infodemic that the first WHO Infodemiology Conference took place in 2020.

‘MYTHINFORMATION’ AND FOLKLORE

In Africa, our own infodemic emerged. “Myths doing their rounds in Africa were the belief that SARS CoV-2 does not affect Africans, which was fuelled when a Cameroonian student who contracted the virus in China responded well to treatment,” says Dr Neelaveni Padayachee, Head of Clinical Pharmacy, who researches pharmaco-vigilance and rational drug use and who delivered a podcast on coronavirus conspiracies and myths. “Another popular myth was that the virus will not survive in the warm African climate – this has been shown to be untrue – and the myth that spraying alcohol and chlorine all over your body will protect you from the virus.” These myths emerged from an explosive collision in SA’s sociopolitical and cultural milieu at the heart of which is the question: who do you trust? Professor of Sociology David Dickinson says that sometimes misinformation happens simply because people misunderstand something.

“People make a mistake, and it’s common in a complex situation such as the Covid-19 pandemic. For example, references to ‘the Covid-19 bacteria’, when in fact it’s a virus,” he says. In this case there is no malice or intent to misinform, but the public health implications are profound. Early in SA’s Covid-19 pandemic, Dickinson assembled an impromptu focus group in the townships he frequents for his research, to test the myths that erupted almost immediately. “In my conversations in the townships I’ve been struck by how early on in the pandemic these beliefs emerged, and how fluid the alternative theories were. Myths are the way that people try to make sense of things – myths like ‘the virus was made in a lab’,” – which, Dickinson points out – is also a myth that emerged during the HIV pandemic. “Folk theories and lay theories about HIV, which are linked to bodies of knowledge about traditional healing and ‘global control by Bill Gates’ are genuinely held by people. They have constructed it as ‘the truth’ and it’s not a mistake,” he says. In his book, Myths or theories? Alternative beliefs about HIV and AIDS in South African working class communities (2013), Dickinson writes that folk and lay theories [of HIV/AIDS] are also often highly palatable in that they provide hope and comfort in terms of prevention, cure, and the allocation of blame “Covid beats HIV hands down in the area of folk theories operating. However, this happens because science doesn’t have an answer to Covid-19, so then you have license to make up your own.” “We need to ask: What’s the underlying concern? The 5G beliefs stem from concerns about technology and its perceived threat to job losses or personal freedom, for example”.

FAKE NEWS AND KERNELS OF TRUTH

Much maligned but fundamental to taking pandemic parlance to the people, the role of the media cannot be under-estimated.

Glenda Daniels, Associate Professor in Media Studies at Wits, says: “Lies travel faster than facts, research has shown. People should find credible news sources where news has been checked,” – although she concedes that within the media sector, fact-checking functions are not at the same level that they used to be, a fact borne out in Wits Journalism’s State of the Newsroom report (2018). Daniels says, “It’s hard for everyone to work out what is fake news and credible sources, but there are huge initiatives in the country and around the world to help the public.” Lee Mwiti, Chief Editor at Africa Check, a fact checking non-profit in Wits Journalism, says: “Misinformation with the broadest reach is that which has a kernel of truth embedded, rather than that which is fabricated. It is worth remembering that myths are consequential, they have a real impact on people's health, relationships and safety.” Ina Skosana is the Health and Medicine Editor at The Conversation Africa through which university academics share factual and accurate research with the public. She says myths and misinformation are common in a crisis – as seen during the Ebola outbreak. “Science communication experts identified fear and the speed of social media as contributing factors,” she says.

THE POST-TRUTH ERA

“Communication is complex and contextual,” says Leigh Crymble, a doctoral student in Behavioural Economics at Wits Business School, who is researching language, ideology and behaviour in relation to broader social, psychological, and economic structures of society. “We are now living in what many call the ‘posttruth era’, where critical, active consumption of information is so important. The tricky thing is that we’re used to trusting people close to us, but research is increasingly showing that these are often the people sending us misinformation. Because our immediate behavioural reaction is to trust the sender, we often get caught up in misinformation.” Crymble says that the key to diffusing fake news is to repeat the facts continually and consistently across platforms in ways that don’t allow for conflicting messages. C FACT CHECKING TOOLS AND

SOURCES • Africa Check: How to Fact Check: https://africacheck.org/ how-to-fact-check/ • https://sacoronavirus.co.za • The Conversation Africa WhatsApp service to help stem misinformation around the virus: - South Africa: +27 76 771 2387 - Kenya: +254 741 976111 - Ghana: +233 541 946552

BUILDING TRUST DURING A PANDEMIC

How do we communicate to save lives during a pandemic? Professor Jennifer Watermeyer is Director of the Health Communication Research Unit at Wits. In her book, Communicating Across Cultures and Languages in the Health Care Setting: Voices of Care (2018), Watermeyer writes that metaphors can be essential and empowering in healthcare communication. They can be tools of cultural brokerage for the “discourse of the unsayable”. “In the case of the Covid-19 pandemic, metaphors have emerged to explain concepts such as contagion – coronavirus is like ‘glitter’ or a ‘forest fire’. If used correctly and chosen appropriately, metaphors can be useful for explaining difficult concepts,” says Watermeyer. Metaphors can go wrong, however. “We have seen the dark side of this in the case of HIV/Aids, where there may be confusion around terms such as positive/ negative. With Covid-19, battle or violence metaphors have the potential to legitimise authoritarian response and lockdown measures.” Watermeyer says that simple, time-sensitive, proactive communication that focuses on what is known and not known during a pandemic engenders trust. Trust comes from what Aviva Tugendhaft calls “deliberative engagement”. Tugendhaft is a Senior Researcher in the SAMRC Centre for Health Economics & Decision Science - PRICELESS SA. She and colleagues published research on the modification of a public engagement tool, a board game called CHAT (Choosing All Together). “When the legitimacy of the decision-making process is questioned, it results in low levels of public trust, even if many measures to address the pandemic are evidence-based,” says Tugendhaft. “Meaningful engagement goes deeper. Tools like CHAT are ‘deliberative’ – they start with a shared knowledge base and empower people to make informed decisions as a group.” Flattening the infodemic curve requires us to understand the origins of information and extract the kernels of truth. Public health communications must be consistent and accurate. It is only through engaging deliberately with each other and with the facts that we can learn to trust and share the information that keeps us alive.

Let's flatten the infodemic curve This person didn't send a rumour to the group chat.

This person double checked their facts.

This person got their news from trusted sources.

This person asked 'how do you know that's true?

DIGITAL HYGIENE

With fake news proving to be a real threat to our health, it’s important for us all to keep our news reliable by practising digital hygiene in the same way we do physical hygiene. Dr Leigh Crymble provides some tips for digital hygiene: • Source: Check to see if the news is also being reported on mainstream sites. If the source is “a friend of a friend”, treat it as a rumour and discard it. • Content quality: Credible news sites are less likely to have typos, spell things incorrectly or use poor grammar. Text in colour, capital letters and the overuse of exclamation marks should also make you suspicious. • Encouraging you to share: Fake news thrives when it’s shared. If the message asks you to forward it to your network, be wary. Remember, fake news can only spread if we spread it. • Report fake news: Fake news about Covid-19 is now a criminal offence in South Africa. If you receive information that you suspect to be fake news, take a screenshot or copy the link and report it to fakenewsalert@dtps.gov.za or WhatsApp 067 966 4015.

VALOUR AND THE VIRUS

Throughout her career, Professor Glenda Gray has focussed on one thing only â&#x20AC;&#x201C; saving lives. This focus has brought her into conflict with government and the science establishment. But using hard data as evidence, she made a massive contribution to overturning disastrous national health policy on HIV. Delia du Toit asked her to reflect on HIV, denialism and the gray in between. SHIVAN PARUSNATH

“I

hate working from home,” declares Professor Glenda Gray against a neutral palette of grey and cremé in her Cape Town home. “Hate it, hate it.” It makes sense, as she is used to commanding health conferences, steering teams of researchers, and chairing some of the most respected and effective medical committees in the world. She’s used to getting her hands dirty, working like a “bat out of hell”. Gray’s impatience in saving lives and finding a vaccine for HIV – and lately Covid-19 – turns her into her own worst critic. As CEO and president of the South African Medical Research Council (SAMRC), chair of the research sub-committee on Health Minister Zweli Mkhize’s team of 50 expert Covid-19 advisors, and Co-Principal Investigator of the National Institutes of Health’s HIV Vaccine Trials Network, which conducts over 80% of candidate HIV vaccine clinical trials globally, Gray has built up an international reputation as one of the best in the world in her field. She was awarded the national Order of Mapungubwe in 2013, and earned a spot on TIME’s list of the 100 most influential people in the world in 2017. In 2018, she earned her A-rating as a researcher. But none of this comes without sacrifice. She admits that she has barely slept this past year. “I’m just always behind, there’s so much to do. In the beginning of the Covid-19 pandemic, I would wake up in the middle of the night, worrying about our country.”

THAT OTHER PANDEMIC

It’s not the first time she’s felt this way. In the 1990s, at the height of the HIV/Aids pandemic, Gray worked around the clock to help the sick and dying around her. “HIV started emerging in the 80s, while I was doing my clinical training at the Chris Hani Baragwanath Academic Hospital in Soweto. It exploded in the wards, there was just tremendous death all around us. I spent my weekends with comrades in Soweto organising HIV workshops.” Her first study was on whether HIV-positive women in developing countries could safely feed their infants formula to avoid transmitting the virus through breast milk, and she presented the paper at an international AIDS meeting. “I had no idea of the controversy it would cause. After I finished my presentation, the first question from an audience member was whether I was on Nestlé’s payroll. “At the time, health leaders recommended that women in developing countries shouldn’t feed formula, arguing that the risk of death from contaminated water outweighed that of contracting HIV. But I didn’t think white men from the northern hemisphere should make decisions for black, African women. I wanted to give the women the information and let them choose for themselves.” Later, it turned out that women in Soweto were indeed able to use formula safely and reduce HIV transmission rates. That incident would set the stage for much of her career – a drive to save lives while fighting convention. “Controversy has dogged me all my life,” she smiles wryly. She established the Wits Perinatal HIV Research Unit at Bara in 1996, with Professor James McIntyre, and would soon fight a battle on two fronts as Aids denialism reared its ugly head at the highest level. Former President Thabo Mbeki began courting denialists who said that poverty – not HIV – caused Aids and that antiretroviral drugs (ARVs) were toxic. “It was a public health disaster. The government kept saying it wasn’t Aids but selenium deficiency, while people were dying in the wards. I was angry and frustrated. I wasn’t just a researcher; I was also looking after these people. We knew for a fact that HIV transmission could be averted with drugs, and the government refused to supply them. We had evidence! So many deaths could have been avoided.” She recalls a “screaming fight” with Manto Tshabalala-Msimang,

then Minister of Health, who at the time advocated beetroot, lemon and garlic for curing Aids. Some estimates have put the death toll of government Aids denialism at 330 000. But Gray kept fighting the only way she could – through hard data and advocacy, clashing with those in power at every turn. “I never saw myself as a scientist, really. I wanted to alleviate suffering and science was just the vehicle.” In 2001, Gray assisted the Treatment Action Campaign in taking on the government in court, demanding the distribution of treatment to HIV-positive pregnant women. Soon after, in 2002, Gray and McIntyre received the Nelson Mandela Health and Human Rights Award for their efforts to prevent mother-to-child transmission of HIV. At the award ceremony, Mandela said that it was “beyond doubt and argument” that giving drugs to pregnant women is necessary. This award, and Madiba’s support, was critical in the fight against HIV, she says. It made it clear that the government was wrong. Later that year, the court ruled in favour of providing the drugs and finally, her real work could begin. Gray was involved in rolling out ARVs across the country, developing dosing regimens, and studying the effects.

“We knew for a fact that HIV transmission could be averted with drugs, and the government refused to supply them. We had evidence! So many deaths could have been avoided.” IN THE SPOTLIGHT AGAIN

But Gray would knock heads with government again. Earlier this year, she criticised aspects of government’s restrictions during the national lockdown to prevent the spread of Covid-19, saying that parts of the approach were “unscientific”. “Politics and science are like oil and water,” she says. “But it must be that way, or one of us is doing something wrong. Scientists have an obligation to society and should never have to kowtow or explain government decisions. A healthy, robust scientific community is able to express itself.” This time, however, Gray and the Minister of Health are fighting the same battle. “What I can say about Mkhize is that he’s chosen lives over livelihoods. Lockdown has had other ramifications, but I can’t fault government’s caring for the people.” While Gray has earned recognition for her work from across the world, she feels her proudest moments were where she could translate science into practice. “I’m grateful we could finally give ARVs to pregnant women in Soweto, after we’d promised them for so long that it would work.” She is still in contact with some of the infants she helped save, who have since gone on to graduate and find jobs. “Reducing human suffering is what it’s all about.” But she’s determined to help end at least one of the two pandemics, if not both. “I can’t say I’ve had a career highlight yet, because we haven’t developed an HIV or a Covid-19 vaccine yet. But every failure brings us closer to success.” “For now, I’m sorry for being the poster child for failure,” she says, in all earnestness. C

TEACHING IN A COVID GLOBAL VILLAGE

t takes a village to raise a child. This African proverb illustrates the community’s collective responsibility for bringing up children, regardless of bloodline or future benefits. The pandemic has brought to the fore the value of African value systems in education. *Karabo, a visually impaired student, had just started university when South Africa went into lockdown and Wits closed on 17 March 2020. The first-year student was beginning to get to grips with the transition from high school to university, when she found out that her classes would move online. This raised her anxiety levels as she had last worked on a computer in Grade 9 and had low levels of computer literacy. Fortunately, at Wits help came from all sides as Karabo, her neighbours and family worked collaboratively with the Wits Disability Rights Unit (DRU) to ensure that she could navigate the abrupt change to an online learning environment, which was doubly challenging for someone visually impaired.

ENVISIONING SPECIAL NEEDS ONLINE

Andrew Sam, an Adaptive Technologist at the DRU, was responsible for walking this journey with Karabo through a ‘village’ that offered support. “We pretty much got through it, but there were many long

It takes a village to raise a child but the global village is shrinking. The fourth industrial revolution and the global pandemic demand a rethink on how we teach online for those most compromised and the risks associated with this ‘redistributed university’. BUHLE ZUMA

hours of work, sometimes frustration, as students had to get used to the new system,” says Sam. It helped that the DRU started thinking about how Covid-19 would affect students with special needs long before President Cyril Ramaphosa announced the national lockdown. “We had seen what was happening in other countries and needed to be ready for this eventuality,” says Sam. By the end of February, the DRU had started moving resources online to enable staff to work remotely. The team had identified guides and free software similar to that in the DRU computer labs that would enable students to work from home.

LOCKDOWN LEARNING LIBERATES THE PHYSICALLY IMPAIRED Particular attention was given to ‘print impaired’ students – an inclusive term which includes the visually impaired and those with learning disabilities, such as dyslexia or reading difficulties. Consideration also had to be given to the hard of hearing and Deaf students who under normal circumstances have access to a Sign Language interpreter or real-time caption transcriber in the classroom. As online learning is mostly delivered through audio and without an interpreter, hearing impaired students risked exclusion

Wits' Targeting Talent programme primes learners in grades 10, 11 and 12 from disadvantaged backgrounds for success at university

from learning. To overcome this, the DRU overlays lectures with Sign language interpretation using Loom software (a video messaging tool) and various voice-to-text software programmes to provide captions for audio. The pandemic seems to have been more forgiving for students with mobility issues and other physiological impairments. These students could work from the comfort of their homes and access recorded lessons long after the lecturer had left the virtual classroom.

NURTURING TALENT FOR A POST-PANDEMIC WORLD

Technology has enabled Wits University to continue with its flagship programme for high school learners. The Targeting Talent Programme (TTP), launched in 2007, primes Grade 10-12 learners from disadvantaged backgrounds for success at university. A major component of the programme is the June/July curriculum, which sees hundreds of academically-talented learners immersed in contact learning on the University’s premises. Rather than suspend the programme due to Covid-19, TTP moved online, with an extended timetable that ran from June to October for the 2020 cohort of 500 learners. Zena Richards, Director of the Student Equity and Talent Management Unit at Wits which runs the TTP, says learners were given tablets and data so that they could be taught using typical online teaching pedagogy. “The design took cognisance of the learners’ realities with regard to time available outside of normal school work, living conditions, house chores and care of siblings [and] poor connectivity, etc. The majority of the activities involved asynchronous [flexible] offline learning,” says Richards. Counsellors and Wits senior student mentors offered psychosocial support.

THE THREAT OF THE ‘REDISTRIBUTED UNIVERSITY’ While technology has sustained the academic programme online, there are fears that the pandemic is leading to the redistribution of the power of universities. The concept of the ‘redistributed university’ was central to discussions between academics in Mexico and South Africa in October. It brought to the fore some of the seemingly overlooked threats to universities during this time. The discussions highlighted that universities do more than teach; they contribute to political and civic culture and promote social justice – a role familiar to many South African institutions. The discussion was jointly hosted by the Mexican Studies Centre at Wits, the Wits Institute for Social and Economic Research (WiSER) and the National Autonomous University of Mexico.

Dr Sizwe Mpofu-Walsh, a Postdoctoral Fellow at WiSER, says: “One of the things lost, and which I lament, is that universities in South Africa, historically, have been sites of political contestation and dissent. What we have lost at this moment is the university being a locus of dissent and contestation, and that loss has been important. Political dissent has been redistributed out of the university and that is a threat that we should be cognisant of.” Participants also raised concerns about the paradox of a technology-driven university: “The university has opened itself and redistributed itself by allowing more voices through digital technologies. At the broader level we may be seeing the redistribution of power towards big tech where the mediation of the university happens now via big tech. “The university’s power to control its own internal borders is coming under pressure from a far greater source of power and we may be seeing the university retreating in terms of the power it is able to wield in society,” warns Mpofu-Walsh.

“While technology has sustained the academic programme online, there are fears that the pandemic is leading to the redistribution of the power of universities.” Technology might have been seen as an equaliser, but the nature of capital and the desire for profits can possibly undermine this vision and marginalise those with limited financial resources, says Professor Garth Stevens, Dean of the Faculty of Humanities. By 2025, online learning platforms are projected to yield US$350 billion per annum, he adds. Professor Sarah Nuttall, Director of WiSER, asks of the changing role of the university: “What do the university and the knowledge project become without the communal and spirited life provided by the university corridor? What happens to the stakes of the argument, the terms of disagreement, and the capacity to read nuance when exchanges move to the online terrain?” The technology-infused corridors in the university village may be shrinking under the new normal. C

Watch the video of the Mexico-SA discussion at: https://bit.ly/36kxotz

A FLEETING

GREEN MOMENT IN TIME The full effects – both positive and negative – of the Covid-19 pandemic on the environment are yet to be realised, but scientists predict that an Age of Pandemics is imminent unless human beings change their ways. SHAUN SMILLIE

FRED RIVETT

idden in a 78-metre long ice core recovered from a glacier in the Swiss/Italian Alps is the story of how humankind’s worst-ever pandemic improved air quality across medieval Europe. From this core, a team of scientists were able to reconstruct air quality in Europe over the past 2 000 years. They did this by measuring the concentration of lead in the air. They found that during the period 1347-1353, when the Black Death (a global epidemic of bubonic plague) killed possibly as many as a third of Europe’s population, lead concentration levels fell drastically. The mass die-off meant the demand for lead fell. Lead dust that ended up in the air, from medieval smelters, dropped too. Six-and-a-half centuries later, the SARS-CoV-2 pandemic has left its mark on the world’s air quality, after it shut down global industrial production and left most of the planet’s population under lockdown. In the future scientists may use contemporary ice cores, and an array of other tools, to assess the impact that this modern pandemic had on the environment and the human race. The Covid-19 pandemic is yet to leave us, and there is still so much to be learnt from its global impact. But what we do know so far, is that the virus has had a massive influence on the global climate.

KEEP COOL TO CARRY ON

To prevent an irreversible change in the climate system, according to the International Panel on Climate Change, we have to limit a global temperature increase to 1.5°C. “For us to prevent a 1.5°C overshoot, we have to cut emissions by about 8% of 2020 levels, and we have to do so for every year for the next decade,” says Associate Professor Vishwas Satgar of the Department of International Relations at Wits University. “Some people are suggesting that Covid-19 impacts have brought emissions down to between five and eight percent.” What Covid-19 has also done, however, is provide us with a peek into a bleak imminent epoch, which is being called the Age of the Pandemics. “We should be looking at these climate sensitive pandemics

as something that could happen more frequently in decades to come,” says Associate Professor Jennifer Fitchett in Physical Geography at Wits.

AVERTING THE AGE OF PANDEMICS

The Age of Pandemics is likely to be driven by climate change, deforestation and a growing human population that will in the future come into more and more contact with deadly, still unknown pathogens. Scientists have already proposed a way for stopping future pandemics. In a paper in the journal Science, scientists called for the introduction of a number of measures to prevent viruses from emerging from tropical forests and jumping species. These measures include arresting deforestation through improving the lives of people who live in forested areas, introducing better legislation to preserve forests, and curtailing the wildlife trade in bushmeat through better patrolling, to bring an end to wet markets. The authors suggest that measures should be put in place to prevent people from going into forests to prevent human contact with deadly pathogens. While protecting us from new potential emerging viruses, these measures will in the long term provide better protection for the globe’s fauna and flora. These efforts are estimated to cost between R363 billion-R495 billion a year to implement. However, this is a drop in the ocean compared to the tens of trillions of dollars that the Covid-19 pandemic is believed to have cost globally.

GREEN ECONOMY OPPORTUNITY

Satgar believes that we need to use the Covid-19 pandemic and its convergence with multiple crises to develop a paradigm that transforms societies to deal with the systemic drivers of these crises. For instance, many countries in their efforts to rebuild in the aftermath of the pandemic have committed to green deals, where nations will invest in renewable energy sources and commit to reversing climate change. But while South Africa has introduced stimulus packages to fire up the economy, little or nothing has been said about investing in a green economy. In the short term, the government wants to

IS THE ENVIRONMENT RIGHT FOR A SECOND SPIKE?

While Covid-19 has had an effect on the environment, the inverse is also true. Natural cycles have an impact on the virus and South Africans might see this effect in autumn 2021. Researchers from Wits’ GCI and the School of Geography, Archaeology and Environmental Studies have been assessing whether there are any environmental or seasonal components to the Covid-19 outbreak. They believe there most likely are. The team found that the SARSCoV-2 virus, which causes Covid-19 disease, might start following a seasonal cycle, where there will be a rise in infections in the winter months. This might mean that South Africa could see the arrival of a second wave of Covid-19 in autumn.

use tourism to stimulate the economy. However, Satgar points out global tourism is responsible for massive spikes in emissions because of the airline industry. “It is a difficult one, because tourism certainly has been a very important economic sector for us, and so it is very much the way to kick-start an economy. However, there is also a large concern about the role of tourism and travel in the spread of Covid-19,” says Fitchett, who has studied the effects of tourism and climate change in South Africa. Professor Bob Scholes of the Wits Global Change Institute says the Covid crisis should be used as an opportunity to change the direction of the economy. “I do see an alternative narrative, where we have massive injections of stimulus and we can use this stimulus to take us on a track to transform the economy into a green economy.” While critics may complain that it would take too much to place

the economy on such a footing, the pandemic has shown what humankind can do when in a crisis. “You know when we really get together and finally grasp the nettle, we actually can achieve remarkable things,” says Scholes. However, the problem with pandemics is that their positive effects on the environment are often fleeting. This is seen in that same Alpine ice core that revealed how the Black Death cleaned up those medieval skies, 650 years ago. Just a couple of years after the plague swept through Europe, the concentrations of lead were increasing and returning to the levels that they were before the Black Death appeared. Today, pollution levels are once again on the rise and the gains made are soon to be wiped out. “If we stay on this trajectory of business as usual, we are going to see the full-blown social and ecological collapse of systems,” warns Satgar. C

THE BLAME GAME: PUTTING A PANDEMIC ON THE PANGOLIN Is blaming a threatened species for a global pandemic not an indictment of our environmental conscience? SHIVAN PARUSNATH

THILO BECK

hen the SARS-CoV-2 virus first emerged in the media in late December 2019, warnings of the highly transmissible virus were accompanied by photos and videos of Chinese wet markets, from which the virus was rumoured to have originated. The wet markets showed graphic imagery of animals and animal body parts strewn across unwashed counters, and was immediately met with outrage and widespread condemnation. In many cases, the videos being shared were not even of Chinese markets, but markets in Indonesia. As research on the issue began in earnest, it emerged that the virus may not even have originated from a wet market. This was just the beginning of the spread of Covid-19 related misinformation and fake news in the media.

MUDDLED ORIGINS

Zoonotic diseases (those passed from animals to humans) have had a long history of impact on human populations. From vectorborne diseases such as West Nile virus and bubonic plague, to diseases that stem from direct contact or the consumption of

animals and their by-products, such as Ebola and brucellosis, our purposeful or accidental interactions with animals have caused the loss of millions of human lives. The largest global pandemic to have ravaged our species in recorded history is the Spanish Flu, which according to the Center for Disease Control and Prevention, claimed the lives of approximately 50 million people. The origins of this virus when it spread around the world in 1918 was a mystery, and only later did it emerge that the H1N1 virus that was behind the Spanish Flu had an avian [bird] origin, and most likely reached humans through interactions with, or consumption of pigs. “Most emerging diseases today have animal origins. As many as 75-80% of new diseases come from animals,” says John Frean, Associate Professor in the Wits Institute for Malaria Research and a pathologist in the Centre for Emerging Zoonotic and Parasitic Diseases in the National Institute for Communicable Diseases. “With genetic technology as advanced as it is today, it is possible to compare the genome of a virus found within humans, to viruses sequenced in other organisms to determine where the likeliest origin might be,” explains Professor Lucille Blumberg, Wits

potential impact for these species? “Being identified as a reservoir species for a highly communicable virus can afford an animal some protection, but can also result in the unnecessary culling and destruction of animals,” says Blumberg.

ANIMAL ANTICS

“Most emerging diseases today have animal origins. As many as 75-80% of new diseases come from animals”

Professor Mary Scholes, from the School of Animal, Plant and Environmental Sciences at Wits, recalls an experience that she had in the early 2000s. “When we were doing research in Zimbabwe, there was a call from President Robert Mugabe for pangolins to be brought to the presidential house in Harare.” These offerings were given as a sign of loyalty and respect for the former president, since in Zimbabwean Shona culture, presenting a leader with a gift of a pangolin is a highly honourable act. “This resulted in a widespread pangolin hunt, with people commonly walking around the veld looking for pangolins. This likely affected wild populations significantly over that period, perhaps even causing localised extinctions,” she says. Knowing the effects that this kind of targeting can have on animal populations, Scholes is wary of the associations that have been made between pangolins and the Covid-19 pandemic, and how this affects them going forward. “This call from the president likely affected wild populations significantly over that period, perhaps even causing localised extinctions,” she says.

THE SOUTH AFRICAN PERSPECTIVE

Medical School alumna, 2020 honorary Wits honorary doctorate recipient, and Deputy Director at the NICD. It was a simple matter then, to sequence the genome of the novel SARS-CoV-2 virus and to find out the likeliest source of the disease. However, despite the technology available to us, there is still room for error and confusion.

APPORTIONING BLAME

The first inklings of research identified bats as likely intermediate hosts for the SARS-CoV-2 virus, and research papers from previous years that warned of the possibility of coronaviruses spilling over from bats to humans became widely shared across social media. A few months later, new research purported to pinpoint the SARS-CoV-2 virus as having a potential pangolin origin. Quickly, however, this research was realised to be flawed, and acknowledged as an “embarrassing miscommunication” by the scientists involved. But as with most forms of ‘news’ in the digital age, once it has been put out on the internet, it is very difficult, nigh impossible, to retract. As the blame shifted from animal to animal, what were the

The consumption of wild animal meat in South Africa does not come close to rivalling the bushmeat trade in other African or Asian countries. However, “it is an economic reality in South Africa that some people do rely on wild animals for food,” says Frean. “Based on our current socioeconomic system, farm-produced food is not readily available everywhere.” Animals and animal body parts are also commonly consumed in traditional medicine practices in South Africa, although these tend to be far more benign. “There is much less risk from consuming dried-out body parts than fresh animal flesh, simply because pathogens do not typically survive as well on dried out material,” says Frean. Professor Mbulaheni Simon Nemutandani, Head of the School of Oral Health Sciences at Wits has worked with indigenous traditional healers for over 20 years. “Registered traditional healers take necessary precautions to ensure the safety of the material with which they work. Of course, just as in Western medicine, there are quacks that are not registered and do not follow guidelines. This is where risks might come in,” he says.

THE ONUS IS ON US

Blumberg cautions against thinking that we have to look to traditional medicine markets or bushmeat for the next zoonotic disease. “Through modern agriculture, we consume animals all the time and contract zoonotic diseases all the time. Antibiotics are widely utilised to try to keep animals disease free, but they aren’t always 100% effective. There are still new diseases emerging all the time from cows, pigs and chickens.” So as much as humans like to point the blame towards others in the food chain, the onus really is on us to be more cautious and thoughtful about how we interact with the species with whom we share our world. “The less we encroach on wild habitats and interfere with wild animals, the less chance we have of experiencing these spill overs in the future,” says Blumberg. “A healthy environment means healthy animals, and healthy humans.” C

FEATURE

WHAT WE CAUGHT ONLINE We need new rules of engagement on social media – even if we don’t know it yet. UFRIEDA HO

LAUREN MULLIGAN

t may be the superpower of our time: finding the courage to disable notifications on your social media apps. Recognising the need to claw back some of the attention we squander on the internet and social media is the first step in being able to navigate with greater success – and less stress – our world of information overload, disinformation, fake news and what some even call an “infopocalyse” and “infodemic”. “Infopocalyse” may be hyperbole, as the rise of the machine (and code) is far from a write-off for humanity. Someone like Yuval Harari, historian, philosopher and author, would argue anyway that humans are a “post-truth species”, we are by no means freshly arrived to a world where fictions are propped up for power, or propaganda is sharpened until it is a weapon.

A TOOL, NOT AN AGENT

Doctor Helen Robertson, who teaches an ethics course to master’s students in the School of Computer Science and Applied Mathematics, says there is no turning back the viral impact of social media – “the genie is out of the bottle”. She cautions against sensationalism that social media is in and of itself the problem. “We need to think about social media as a tool, not necessarily an agent that is value laden. The value, or lack thereof, comes from what humans want do with the technology,” she says. Robertson says the platforms are designed to be fine-grained. This subtlety – which is also complex – gives technology the scope, scale and speed to spread and entrench certain agendas and values with devastating success. There are reasons to be concerned, or at least be more vigilant, says Doctor Benjamin Rosman of the School of Computer Science and Applied Mathematics. Rosman says the “noble” intentions that may have informed the early days of the internet – ideas like universal access, connectivity and an unfiltered free-flow of information – have morphed, and morphed fast and ugly.

ALGORITHMS EXPLOIT OUTRAGE

“It seemed reasonable in the beginning that platforms like Facebook and Twitter were free in exchange for users having to see a few adverts displayed. But that turned to developers targeting advertising using autonomous algorithms learning from users’ data – things like your Google searches, what we engage with most and how long we remain engaged with content,” says Rosman. Even that was relatively benign. But, as platforms like Twitter, Facebook and Google have vied for users’ attention and engagement to make profits, Rosman says algorithms have been used to not just tailor and target advertising but also to hold attention and encourage engagement. Achieving this comes down to exploiting emotions, in particular outrage, Rosman says. The algorithms have learnt that people respond most to content when they are outraged. So the algorithm pushes more incendiary content to an outraged person and lights the fire of a vicious cycle. “The algorithms are designed to keep you on sites for longer, ensuring more engagement and effectively keeping you more addicted and making your attention the commodity,” he says.

DESTABILISING CIVILISATIONS

Rosman says as people froth with outrage in their echo chambers and bubbles, the algorithms also starve them of exposure to content that presents rational, opposing views. It is a dangerous blindsiding that deepens polarisation and can ‘destabilise civilisations’. Destabilisation could be skewing voting and political outcomes, creating rifts, breaching privacy rules, introducing harassment in the form of trolling, offering fake news that stands in for decision-making and deepening the erosion of critical thinking. For Phumlani Nhlanganiso Khoza, founder of Scilinx Research, which is part of the WitsNeuRL Neuroscience Research Laboratory, the social media platforms are not likely to change much, which

“We need to think about social media as a tool, not necessarily an agent that is value laden.” means users need to get savvier. “The technology is not going away and it can be a wonderful classroom. The problem is how people react to metrics,” says Khoza. He adds that there’s a growing mental health burden as people seek the dopamine hit from social media interaction. Dopamine is the chemical transmitter released when we are rewarded or motivated. It is also linked to attention and memory. “For some people they feel terrible when they don’t get attention on social media and their perceived competing influencer does,” he says.

SAVING SOCIETY

Khoza says people should remember that social media is a cocoon – just one reflection of the world. The majority of people in the world are not engaged on any of these platforms. He points out that social media is filled with bots; software applications capable of creating fake accounts, fake followers and troll armies. A way to break free from the feedback loops is to improve foundational learning in society. This would entail teaching that supports deep thinking and problem solving, not methods that are fixed to metrics, memorising or rigid timeframes. Added to this, Khoza says, there needs to be investment in technology and innovation as well as adaptive, proactive regulation. “Some regulations mean very little. They are not very effective. When even I, as a techie, am not going to read or understand everything that goes into something like a cookies policy that come up on a website, then it’s clear companies are just trying to cover themselves,” he says. But innovation could help. It could be an app that summarises content on an issue to win back time and be a buffer against triggering content. It could be removing “like” buttons, retweeting and sharing options, follower counters and even possibly a default option that scrubs users’ data and histories from platforms. Khoza says, ultimately: “Social media is a diet of the mind – choose what you want to consume and accept that sometimes you just have to leave the platform or exit the group.” It makes for thinking about rules and regulation for new media, says Professor Ufuoma Akpojivi, Head of Media Studies. “We should fact check before we share or respond to something – or at least read the article and comments first. And just like old media

has rules and policies about how people are allowed to comment or engage, new media should have the same,” he says. “The beauty of democracy is that we don’t all need to agree, but some users on platforms like Twitter are not looking for engagement, they are there to shout at others or to police people and they haven’t learnt to agree to disagree.” Professor Glenda Daniels, a Media Studies lecturer whose latest book Power and Loss in South African Journalism (Wits University Press) has just been launched, says the real damage from social media’s current dominance is deepening divides in society. Only an estimated eight million South Africans, out of a population of 58 million, have Facebook accounts. That leaves the majority shut out, even if it is from the “binary opposition debates” that Daniels says marks social media interaction.

UNREGULATED FANGS BITE

“In less than 10 years, we’ve gone from about 575 community newspapers to fewer than 200 today – all the advertising, including the communities’ news itself, has gone to Facebook and it’s outrageous that Facebook has gained all of this for free. The FANGS [Facebook, Amazon, Netflix and Google] make the profits these days. Many are not paying tax and governments, civil society, NGOs and everyone lets it pass – all unregulated – because we are told it’s the way right now, there’s nothing you can do,” says Daniels. Widening digital divides pushes people further into their corners, says Professor Imraan Valodia, Dean of the Faculty of Commerce, Law and Management. At the most fundamental, he says, are the divides noted by the Future of Work(ers) project at Wits University’s Southern Centre for Inequality Studies. They point out “the exorbitant cost of mobile phones and data, inadequate network coverage and access to electricity, users’ limited literacy, and gender norms that discourage women from using cellphones”. Along with this, the world is seeing a rise of far-right leaders and populism. “People feel increasingly excluded, so they resort to things like petty nationalism or they target migrants.” Valodia points out that data has become virtual gold, and the monetisation of social media companies has meant a concentration of massive wealth in the hands of a few, adding to imbalance and divisions in society. There are no silver bullets for changing social media into something that does more good than bad, but there is pushback in the form of smarter regulation and a louder call for transparency, he says. Valodia has most recently been involved in shaping competition regulation policy. It entails building frameworks to ensure that large tech companies are prohibited from mergers and acquisitions that essentially allow them to buy out start-up companies that may become potential competitors. Change and safeguards must also come with old-fashioned social action, he says. “If we find something unacceptable as a society – like the massive concentration of wealth held by a few – we have to fight to change it. We have to design the rules that make our world more sustainable and equitable.” We may not be at the point of deleting all our social media apps just yet, but the time has come for new rules of engagement, even if most people don’t realise it yet. C

PRIVACY AND THE DOLLARS IN YOUR DATA TAMSIN OXFORD

The balance between sharing personal data online and how it’s used and by whom is difficult to define and complex to regulate. The best defence for your data lies in the decisions that you make.

‘I

f you’re not paying for the product, you are the product’ – a quote attributed to many but that has its origins in the early 1970s in reference to television. Data has always been a commodity, but today it is far more valuable. Yet we continue to give it away for free. “The data that people share on platforms and with companies is worth a lot of money to those companies,” explains Benjamin Rosman, Associate Professor in the School of Computer Science and Applied Mathematics at the Wits. “Data is powerful and valuable and can be used by organisations to target you with adverts and messaging.” When Google logs what you’re doing, it learns a lot about you. It can deliver targeted adverts, immediately benefiting companies paying for those adverts. If Amazon uses your data to share tailored recommendations u, Amazon benefits – but who rightfully owns this data? “Data is supposed to be owned by the individual who creates it, but when you sign up for any platform-as-a-service [PaaS], you agree to certain terms and transfer certain rights and responsibilities,” says Professor Turgay Celik in the School of Electrical and Information Engineering at Wits. “You’re shown about 200 pages of terms and conditions and you just agree to it.”

DATA PROTECTION 101

There are regulations around the control, ownership and protection of personal information. In South Africa, these are defined by the Protection of Personal Information Act (POPIA. The act regulates the companies and individuals using the data but, despite these rules and protections, complexity persists. For example, how do you protect your data if you don’t know it’s being used?

“Data is powerful and valuable and can be used by organisations to target you with adverts and messaging.” “You need a good understanding of how the data is collected from you and how the data is exchanged,” says Celik. “You then need to establish what protections are in place for that data and these will vary dependent on how the data is being used. If these protections are breached and you’re informed, then you can take steps to protect it, and yourself.” There are alternatives to regulation that focus on data security at the granular level, for example, digital signatures that ensure data shared with a platform remain there. Individuals should ensure they are better informed, and consider changing small details, like birth year, to obscure identities. “You need to understand your rights and be vigilant in terms of whether people who have access to the data are adhering to the agreements you have with them. If data are abused, organisations can be prosecuted, but so few people really understand what their rights are and how their data is protected,” says Emeritus Professor Barry Dwolatzky at the Joburg Centre for Software Engineering, Wits. “If you’re benefitting from the arrangement with the company that has your data, then perhaps you should be happy with handing over your data. There’s a balance between civil liberties, and saying ‘what the heck, let them use my data as I get value from this arrangement’.” C

INFECTION ONLINE Online attacks and phishing surged during Covid-19. Is there a permanent solution to cybercrime? DELIA DU TOIT

“S

orry, but your password must contain an uppercase letter, a number, a haiku, a gang sign, a hieroglyph, and the blood of a virgin,” states a meme in circulation for some time. Indeed, few online efforts are as frustrating as setting up and remembering a password. In the internet age, the average person has more passwords than they can remember – 70 to 80, according to password manager NordPass. It’s no wonder then that instead of picking a complex password, many people opt for something that is easily guessed. Last year, the UK's National Cyber Security Centre (NCSC) analysed passwords belonging to accounts worldwide that had been breached – the most popular passwords included gems like “password”, “111111” and “abc123”. The top hacked password, though, was “123456”, which was supposed to protect over 23 million of the accounts, followed by “123456789” on over seven million accounts. Band names, first names and sports teams were also popular passwords.

DODGY DIGITAL DEFENCES

Just as housebreakers look for weak spots in fences to enter a home, online criminals hunt for weak online security to exploit. When they do so, human error is most often to blame. “Most online users are naïve and hardly have time for their security despite the warnings and awareness creation. Simple security hygiene is not observed,” says Doctor Uche Mbanaso, visiting scholar at the Wits Learning Information Networking Knowledge (LINK) Centre and executive director of the Centre for Cyberspace Studies (CCS) at Nasarawa State University, Nigeria. The pandemic created the perfect storm for cyber criminals to take advantage, with Interpol reporting an increase in cyberattacks targeting small businesses, corporations and governments, says Doctor Kiru Pillay, LINK visiting researcher and convenor of the Wits Cybersecurity Professional Practice and Leadership Certificate Programme. “Data breaches impact both individuals and organisations by releasing personally identifiable information [PII], which can be

“The pandemic created the perfect storm for cyber criminals to take advantage, with Interpol reporting an increase in cyber-attacks targeting small businesses.” used to identify an individual, into the public domain or selling it on the dark web. This data is often used for identity theft and making transactions online or, with some additional information, could be used to create new bank accounts or take out loans under a real person’s name.” For corporations, data breaches can be devastating. Besides the reputational damage, loss of income and costs incurred to contain the breach and increase security, regulators are increasingly seeking to impose fines on corporations after data breaches, says Pillay. Equifax, a US-based credit agency, was fined $700 million after a 2017 data breach.

COMBATTING CYBERCRIME

Hackers are always ahead of the game, says Mbanaso. “Beating hackers would require operating like them - thinking and acting indiscriminately.” Pillay says that, increasingly, the private sector is stepping up: “The South African Banking Risk Information Centre [SABRIC], for example, is a non-profit formed by the four major banks to assist in combatting organised bank-related crimes.” And policy is catching up – President Ramaphosa is considering the Cybercrimes Bill, which the National Assembly and the National Council of Provinces have already approved. “The Bill will codify numerous existing offences related to cybercrime and will create a variety of new offences,” says Pillay. But user vigilance, such as strong passwords, remain the best individual defence. C

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TIKTOK/WECHAT: US AND THEM Banning popular apps like TikTok and WeChat is about more than a spat between the US and China – it raises a number of serious and far-reaching questions.

CHARLOTTE MATHEWS

edicated users of Chinese-developed social media apps TikTok and WeChat may have been infuriated by US President Donald Trump’s threats to ban their use in the US. But for the rest of the world, it looks like just another US/China trade manoeuvre. It is not, though. It centres on a number of long-running, pertinent issues that are likely to stay unresolved even after the dust has settled on TikTok and WeChat. At issue are whether governments can access personal information for control purposes and corporates can do so for profit; how to control the spread of ‘fake news’; whether there needs to be a global internet oversight body; and whether trade protectionism is sweeping the world, post-Covid. Trump’s threats to ban TikTok (with about 100 million active users in the US) and WeChat (with about 20 million) apparently stem from warnings from the US security establishment that these apps could be used by the Chinese government to collect data on US citizens and launch disinformation campaigns. But the Chinese media believe there is a commercial agenda. John Stremlau, Honorary Professor in the Department of International Relations at Wits, says it is difficult to understand what Trump intended with this ban, but it was probably partly a pre-election move to put a gloss on his administration’s ‘tough on China’ foreign policy.

PROTECTION OF PERSONAL DATA

Stremlau says that the US ban is unlikely to be followed by a similar ban by South Africa, as SA currently has better relations with Beijing than with Washington. WeChat and TikTok are mining user data for profit, similar to platforms like Facebook, Twitter and Google mining data for disinformation – although the Chinese government may be more actively involved than the US. Professor Imraan Valodia, Dean of the Faculty of Commerce, Law and Management at Wits, says one of the main concerns about these developments relates to surveillance and the use of the data that is collected. “I understand TikTok’s algorithm generates data about users, so the question is who has access to that data and what will it be used for? This is a complex legal matter.”

TRADE CONSIDERATIONS

According to the Harvard Business Review, the implications of the US ban on TikTok are less to do with accessing US customer data (which is probably available elsewhere, anyway) and more that the threat to ban everyday technologies could spiral out of control and prompt retaliation. This would affect international trade. Mills Soko, Professor in International Business and Strategy at the Wits Business School, says that the battle for control of TikTok in the US goes beyond social media and spying concerns. “It is bigger than who owns the popular app. It is essentially about the future of US-China relations, as well as the volatile and unpredictable business environment which companies are forced to navigate as tensions between the two countries intensify.” He says that the TikTok saga is in some ways a replay of the Trump administration’s campaign against Huawei. Both are proxy fights about a wider battle for global technological supremacy between the world’s two largest economies. Both fights have aroused fears about the possible emergence of a world order characterised by the decoupling of the US and Chinese economies, the rise of economic nationalism and its attendant hostility to

“The fact is governments and private corporations are already collecting our data, for example Facebook and Apple, and it is not clear what they use it for.” foreign investment, and the disruption of global supply chains. These developments will have adverse consequences for the global economy and companies, Soko warns.

CONTROL OF THE INTERNET

Stremlau says credible information is essential in complex international relations. Social media’s torrent of mis- and disinformation can be especially harmful in conflict situations. “Social media is feeding illiberalism and privacy is being infringed. It is absurd for Twitter and Facebook to say that they cannot control what is collected and disseminated on their platforms,” says Stremlau. “Of course it is possible to exert oversight, but the question is how. Nations will have to devise credible, decent legislation because the alternatives are worse. We will not preserve democracy unless we tackle the issue.” Stremlau says that the impact of the US-China disputes over technology could be a bifurcation of the internet. This would be negative for the rest of the world, which is increasingly bound together. In the face of current threats such as climate change and Covid-19, the internet can play a vital role in conveying information. “What is needed is a global body or commission that will manage the internet,” he says. “We already have similar bodies for telecommunications, health (although the WHO needs to be reformed and strengthened) and air travel. It should be an independent, government-sanctioned body.” Valodia says that the dispute raises questions about the extent to which the state can determine who can operate and what digital applications its citizens are allowed to use. “The bigger issue here is about the control of different types of technology,” he says. “This ban centres on complex issues around the way different countries use, or do not use, data-gathering systems. “We can probably expect various reciprocal legal challenges and attempts to ban certain applications and systems,” says Valodia. “The fact is that governments and private corporations are already collecting our data, for example Facebook and Apple, and it is not clear what they use it for.” He agrees that there is a need for a global architecture of rules for the management of data. An institution like the World Trade Organization would be a good place for this kind of treaty, as it already enforces rules on trade systems. “However, there are some quite large national and individual rights issues at stake here,” says Valodia. “For example, everyone assumes Facebook is a free service, but our buying habits and our internet habits are being monetised. Do they have the right to do so and who gives them that right? It is a multi-faceted issue.” C

BIG DATA: A SWORD TO WIELD OR A KNIFE IN THE BACK? Big data can both enable life-saving advances and be exploited in socially and economically harmful ways. Competition policy will determine if big data is a tool for inclusion or exclusion. LIBERTY MNCUBE AND IMRAAN VALODIA 44

o you have a smart phone, wearable fitness device or retail loyalty card? Do you have presence on social media? Do you order food on an online platform? Are you a member of a medical aid scheme? If you have answered â&#x20AC;&#x153;yesâ&#x20AC;? to any of these questions, like most of us, you are generating data. With advances in computational and statistical methods (or algorithms), huge quantities of data can be examined to identify correlations, make predictions, draw inferences and bring together new insights. This is big data.

BIG DATA: A DOUBLE EDGED SWORD?

Big data has the ability to save lives. For example, doctors are using big data to determine when premature babies are likely to develop an infection. Big data promises to help solve important societal challenges such as improving education and enhancing government service delivery. In the economic sphere, big data is increasing marketplace efficiency and boosting economic productivity. Its promises do not stop in the present. In the near future, connected and driverless cars may make driving between Johannesburg and Pretoria much safer for all of us. But the same analytic power that makes it easier to predict the outbreak of a virus, or identify who is likely to have been exposed to Covid-19, also has the capacity to reinforce disadvantages faced by the poor and marginalised, increase the dominance of powerful

groups, increase prices and undermine innovation in the economy. For all of its potential, the complex and opaque algorithms that mine big data can also be used in ways that are socially and economically harmful. How, for example, search algorithms decide what to reveal, what to hide, and what to prioritise has huge implications.

GOOGLE GOES SHOPPING

A few years ago, the European Commission investigated a complaint in which an algorithm in a search engine made it harder to find rival firms’ products. This conduct denied rivals the chance to compete, and reinforced the power and economic interests of the company that owned the search engine. As a result, consumers faced higher prices and less choice. This was the famous Google Shopping case. We think of Google’s search engine as a no-cost resource that generates independent and unbiased results. The European Commission was concerned that Google’s algorithms may have given its own comparison-shopping service more prominent treatment than it gave to competitors. In other words, when an individual searched for a particular consumer product using Google’s search engine, the results gave higher priority to Google’s Shopping service and ranked rivals’ products low down in the search results. Since no one looks beyond the first few pages of a search result, rivals were excluded. The European Commission fined Google €2.42 billion for abusing its dominant position as a search engine by giving anti-competitive advantage to Google Shopping, and excluding rivals. There are a number of similar cases being investigated by competition authorities globally. From a competition point of view, what matters is how algorithms are actually used. One important issue is algorithms that determine prices. Pricing algorithms raise two important issues. First, they may increase the effectiveness of cartel conduct. Second, they may enable price discrimination strategies that lead to higher prices for certain groups of customers. Cartels – where firms collude to fix prices – are a particular concern for competition authorities. Traditionally, such cartels operated through formal and informal meetings where cartel agreements were reached. In the digital age, it is now possible to design algorithms to fix prices without meetings ever occurring. Algorithms that charge different consumers different prices for the same goods, or raise prices without limit, provoke important competition and moral questions. Is it acceptable and procompetitive, for example, for an online shopping platform to use your search history to steer you toward purchasing products that have higher prices rather than lower prices? If competition authorities, policymakers and the public are alert to the risks presented by algorithms and big data, they will be able to take steps to guard against them. This will help ensure that big data can be a tool for economic inclusion, and not exclusion. There are several reasons to be cautious against assuming that the possession of big data automatically gives firms the ability to exercise market power. First, many types of big data are readily available and replicable. Second, multiple firms can often collect and use the same set of data without creating barriers or strengthening entry barriers and market foreclosure concerns. Third, big data can quickly become obsolete. In general, competition authorities must determine whether big data creates a competitive concern on a case-by-case basis. On 4 April 2020, the Economist noted, in relation to the Covid-19 crisis, that “the pandemic will have many losers, but it already has one clear winner: big tech”. Online platforms have been largely unaffected by (or have benefited from) lockdown

“If competition authorities, policymakers and the public are alert to the risks presented by algorithms and big data, they will be able to take steps to guard against them.” restrictions. In the long term too, it is plausible that the Covid-19 crisis will accelerate the trend toward online shopping. Without regulation, big data will either be immensely beneficial to individuals and society or profoundly detrimental – or will undoubtedly be a mixture of the two. As we navigate the gamechanging terrain of big data, it is vital that competition authorities work to ensure that big data benefits all citizens, whatever their backgrounds. C

Liberty Macebo Mncube (left) is an Associate Professor of Economics at the School of Economics and Finance at Wits University and he is also a Managing Director at FTI Consulting. His teaching and research focus on industrial organisation, competition economics and competition policy. Mncube is a Member of President Cyril Ramaphosa's Presidential Economic Advisory Council – appointed 1 October 2019 for 3 years. He is a former Chief Economist of the Competition Commission of South Africa, serving as Chief Economist from January 2014 to February 2019. Professor Imraan Valodia (Right) is Dean of the Faculty of Commerce, Law and Management. He holds a doctorate in economics and his research interests include inequality, employment, and competition policy. He led the establishment of the Southern Centre for Inequality Studies at Wits and he is a part-time member of the Competition Tribunal. He advised the Minister of Economic Development on amendments to the Competition Act, legislated in 2019. In 2016, President Cyril Ramaphosa appointed Valodia to chair the Advisory Panel on the National Minimum Wage, introduced in 2019.

PROFILE

KEEPING AN EYE ON THE VIRUS FROM THE SKY

When Covid-19 hit South Africa, 21-year-old Wits engineering student, Xolani Radebe, knew that he wanted to be part of the solution, so he designed a temperature-reading drone to screen for the virus.

REFILWE MABULA

SHIVAN PARUSNATH

he third-year mechanical engineering student says that the drone, with a built-in thermal camera, can detect the body temperature of large groups of people in vast areas such as malls or other busy places. “High fever has been said to be one of the symptoms of Covid19. The drone is able to detect if anyone in a large gathering has an above-average temperature and can alert the drone operator,” says Radebe. “The drone can also save time for those who are screening large groups of people in busy areas. Instead of screening each and every person, the drone can be flown to read the temperature of everyone in that area.”

The drone is a modification of an existing prototype designed by Radebe and his business partner, Tino Kurimwi, with whom he co-founded an aviation company in 2019. Radebe’s love for aviation and his aspiration to build airplane engines sparked his interest in drone development. Designing something that could fly was a step closer to his aviation career, he says.

ELEVATING EXPECTATIONS

Radebe has not always been a big dreamer. Growing up in a community where most young people are unemployed and were never afforded opportunities to study further, Radebe never imagined pursuing a career as an aircraft engineer.

“Drones are solution based. Initially, we wanted to use the drone for crime detection purposes but we decided not to, for our own safety,” says Radebe. “Drones are able to serve multiple purposes. They can be used to search for missing people and to reduce the costs of using airplanes.” He is proud that his innovation can make a positive impact, despite the costs that come with designing a screening drone. The drone’s thermal camera costs around R5 000 and the components to make the actual drone cost about R16 000 to R18 000, says Radebe. Although costly, he says the drone was not designed to generate revenue but to contribute to the fight against Covid-19. As someone who has benefited from development programmes, he has a great affinity towards them. He hopes to use his drones for a community development programme to help high school learners who are interested in aviation and engineering. “Uplifting people in my community is important to me. I want to give others the same opportunities that I have been afforded in life. I would not be pursuing engineering had it not been for the exposure from the youth development programme,” says Radebe, who currently works out of the Transnet Matlafatso Centre at Wits, where he is mentored and nurtured.

“It is difficult to have a dream when people around you are not working or even studying further. There is no source of inspiration and this can be discouraging. You look at them and see yourself and wonder if you will turn out like them.” Fortunately, a high school teacher ignited a flame of hope after Radebe nearly gave up on himself. Radebe says that Mr Ngwenya, his teacher from Letare Secondary School in Soweto, helped unearth his latent potential. A conversation with Ngwenya on the topic of purpose changed Radebe’s negative outlook. “My high school teachers gave me a sense of purpose and gave meaning to my life. I had lost focus until Mr Ngwenya called me to order in Grade 11. Then I realised that I needed to change my ways and focus,” says Radebe. Empowered with a vision and purpose, the drone designer began making an effort to achieve academic success. His interest in aviation was piqued after he found out about the field at a career expo. “I developed a keen interest in aviation when I attended the Africa Aerospace and Defence (AAD) show. I had the opportunity to meet with the chief of staff of the South African Air Force at this show and at the 100 defence countdown.” After receiving advice from a lecturer at Wits on whether to pursue mechanical or aeronautical engineering, he opted for the latter.

ENGINEERING FOR SOCIETAL GOOD

Radebe believes in advancing societal good and finds solving problems using his engineering skills gratifying. His motive in designing the drone was to provide solutions that could aid with some of South Africa’s social ills.

“The drone can also save time for those who are screening large groups of people in busy areas. Instead of screening each and every person, the drone can be flown to read the temperature of everyone in that area.” SURVIVING HARDSHIPS

The charismatic youngster has encountered hurdles that threatened his ambitions and led to a mental breakdown. In his second year at Wits, Radebe failed and had to repeat his modules, which made realising his dreams seem almost impossible. “It was very hard for me when I failed – to the extent that I suffered a mental breakdown. But knowing that this degree was a stepping stone for me to achieve my ambitions, I had to try again. I was fortunate to receive a lot of support from Mr Kholisile Khumalo, Chairperson of the Youth Development Programme at AAD. He encouraged me not to give up,” says Radebe, who is grateful that he is able to continue his studies thanks to his sponsor, Pioneer Foods. Radebe, who refers to himself as ‘Gogo’s (granny’s) boy’ says that he endured the pain of failure and repeating his modules because he wanted to make his grandmother proud – she raised him from the age of 11 after his mother passed away. Radebe’s company, Rita Sibanyoni (RS) Aviation honours his grandmother. He hopes that RS Aviation will be the biggest drone company in Africa in future. For Radebe, the sky’s the limit. C

BEATING THE PANDEMIC THROUGH INNOVATIVE THINKING Three Wits postgraduate students demonstrate how their research and innovative ideas can make a positive contribution to addressing challenges caused by a pandemic. BETH AMATO

Tamlyn Naidu

Zakhele Ndala

cientific breakthroughs are often synonymous with the toughest times in human history. Now, when public mistrust of science abounds thanks to fake news and misinformation, the widespread adoption of new scientific innovations requires something more. Scientists need to make their discovery meaningful, trustworthy and engaging to a wide variety of people. The Wits PHD Seminar in September 2020 aimed to attract postgraduate students who wanted their research to “speak to as many publics as possible”. The Senate Graduate Studies Committee chose the word pandemic for the competition, with the winners selected not only for their accessible presentations, but for their scholarly ingenuity, disciplinary flexibility and responsiveness in the face of global challenges. “The most important requirement was that students should demonstrate how they could tweak their research for the benefit of literate publics,” says Professor Robert Muponde, Head of Postgraduate Affairs. Eleven students entered the competition. Here are the top three:

Leigh Crymble

COVID EARLY-WARNING IN WASTE WATER

Competition winner, Tamlyn Naidu, a PhD student in the School of Chemical and Metallurgical Engineering, looked at how early detection techniques in sewage systems could curb Covid-19 infection rates. Pathogen-based illnesses are mysterious and cunning: transmission can occur between people who experience no symptoms. The likelihood of these people getting tested or visiting a doctor is small, meaning accurate measures of infection cannot be obtained. Even so, direct testing is time-consuming, cumbersome and expensive, and a widely available Covid-19 vaccine a long way off. An interesting solution to early detection and control of transmission is the testing of faecal matter in wastewater treatment plants in South Africa. Naidu says that infected people shed billions of viral particles in their faecal matter, even while asymptomatic. Her ‘biosensor’ has two parts: one for isolating the genetic material, and the other for identifying this genetic material. Using the biosensor to detect the presence, concentration, type and strain of a biological organism,

especially highly contagious pathogens, allows for accuracy of infection statistics and the identification of community hotspots. Waste water testing has been used to detect both viral and genetic illnesses in the past – the polio virus is the most commonly tracked in sewage plants and, where cholera has been found in hospitals, scientists have tested the broader area’s waste water to see the disease’s spread. Anthrax, botulism, plague, smallpox, and others are also commonly tested for, and narcotics, hormone and prescription drugs can also be identified. “The importance of waste-water testing can’t be underestimated. If viral and indeed, genetic diseases are detected, future generations’ health could be saved,” says Naidu. While the testing of faecal matter in waste water treatment plants has not been implemented on a large scale, the Netherlands analysed sewage to determine the number of people in a particular area who had been infected, with a reported accuracy of every one in 100 000 people. If implemented properly, Naidu’s biosensor could potentially track a number of different pathogens. However, little research has gone into large-scale production of the equipment, making it an expensive endeavour. “But, in the case of an epidemic or even a global pandemic, these costs would be off-set almost entirely,” she says, adding that the biosensor is also versatile in that it can be used in any size facility. In the case of SARS-CoV-2, for example, countries could have started tracking waste water in airports to determine when the virus entered the country. Indeed, biosensors could be placed in homes and at private facilities.

COVID FACE MASKS ON ‘NANO’ STEROIDS

Zakhele Ndala in the School of Chemistry took second place for redesigning the face mask to deactivate airborne viruses, using nanomaterials. With mounting evidence indicating that SARS-CoV-2 is airborne, measures such as wearing a face mask to prevent transmission are effective. But Ndala goes a step further: he introduces nanomaterials in face masks to increase their efficacy. Any virus, he notes, would not make it past the mask matrix and would become inactive. The three components used would perform three functions: Polydopamine nanofibres will act to trap aerosol particles; silver and copper nanoparticles will inactivate the virus; and nanoflowers from the inorganic compound (MoSe2) would be used to immobilise the silver or copper nanoparticles and prevent them from clustering and becoming ineffective. “Our nanomaterials fabrication lab in the Wits School of Chemistry is fitted with an electrospinning machine. This machine allows us to fabricate nanofibres of different sizes from various polymers,” says Ndala. The World Health Organization has flagged the risk of self -contamination with the wearing of normal fabric masks. While these masks are better than nothing at all, Ndala’s antimicrobial mask would be able to inactivate a virus or bacteria that it comes into contact with, which is a feature that normal masks do not have. The antimicrobial masks would ideally be piloted in healthcare facilities where frontline workers are at a higher risk. “Currently, there is a higher cost of production for these special masks compared to the surgical masks worn now, but with several new innovations being developed to make antimicrobial masks cheaper, we’re confident that it could be piloted soon,” says Ndala.

CHANGING BEHAVIOUR BY SHARPENER COMMUNICATION

Leigh Crymble, a PhD student in Wits Business School, took third place for her research into how language, values and decisionmaking shape a person’s adoption of behaviours to avoid contracting Covid-19. While non-pharmaceutical interventions, like mask wearing, handwashing and social distancing, are proven to mitigate the spread of SARS-CoV-2, there are many people who do not adopt these behaviours. But science can explain this too: “It is as a result of inherent behavioural biases, coupled with generic, passive communication methods,” says Crymble. This is where “nudge” theory comes in, and where Crymble’s submission is unique: she wants to enact behavioural change using a framework called Behavioural Linguistics. “This approach proposes the development of personalised communications tailored to multiple language profiles to reduce behavioural friction and encourage increased compliance,” she says. To delve deeper, a behavioural linguistics model, known as SHARPENER, is highly likely to “nudge” or convince people to do something different. Indeed, SHARPENER was first used for a series of handwashing posters that Crymble developed for the Department of Health. Crymble’s handwashing posters worked in that there was simple accessible language, the benefits were highlighted, the message was action based, and they called upon community spirit (Ubuntu). The posters used striking visual language, in blue to signify trust, and blue ticks to show that the information was verifiable. “Making a decision is very intricate, and so our messaging must tap into the various motivations and beliefs guiding decisionmaking,” she says. C

WHAT IS SHARPENER? Subliminal: Subconscious cues used such as visual language (colour, imagery) Herding: Make recipient aware that other people are following the desired action for social proofing Aversion to loss: Highlight the possibility of losing out on something if the recipient does not act Reciprocity: Offer the recipient mutual benefit through something tangible (gift, appreciation) Positive self: Encourage recipient to picture themselves in a favourable way through their action Expertise: The message-sender should be trustworthy and in some position of authority or credibility Novelty: Message needs to catch attention with positioning that is new or unusual and relevant Existing state: The status quo or the default is the easiest option for recipients, reducing need for a decision Rarity: Include scarcity (time, special offer, limited availability) to drive urgency.

FINDING SECURITY IN THE UNSEEN Messages carried in structured light can secure quantum communications in the future. SHAUN SMILLIE

ust over the horizon, a scary world awaits. Superfast quantum computers are on the rise and soon they will be able to crack what were once considered unbreakable man-made encryption algorithms. In this world, banks won’t be safe as hackers armed with quantum computers will be able to break security codes and clear out bank accounts. Money hidden under mattresses might once again become a preferred way of saving.  “If you had spoken to me five years ago, I would have said well, quantum computers are a little bit of a dream. But that’s not the case anymore,” says Professor Andrew Forbes in the School of Physics at Wits University. “Late last year, they demonstrated what they call quantum supremacy. That means that the quantum computer solved a problem that would have taken an age on a normal computer.” In this experiment, Google, using its Sycamore quantum processor, performed a calculation in 200 seconds that would have taken the world’s top supercomputer 10 000 years. Quantum computers might not be that powerful yet, but they are becoming more accessible. Wits students have access to the IBM quantum computing network. “At the moment, students can run very small versions of Shor’s algorithm and break very small encryption procedures, but nothing that people need to worry about,” says Jonathan Pinnell. In 1994, US mathematician Peter Shor came up with an algorithm for quantum computers that could be a breakthrough in factoring large integers (a number that can be written

without a fractional component), which is tricky even for powerful computers. Quantum computers hold much hope for the world. Their computing power is already helping in understanding chemical simulations and they are being used to improve the software on self-drive cars.  Keeping information safe in this future is going to require quantum technology and that is what Forbes, Pinnell and the rest of the team at Wits are trying to do. They are working at using structured light to provide communication that is impossible to intercept. Data are transmitted through the use of patterns of light.   To explain how it works, Forbes uses the analogy of how navies once used the raising of flags to communicate between war ships. “So you can think of these different patterns of light as a very sophisticated form of flag waving. When I send one spiral, it means something specific, when you send two spirals, it means something completely different. Now I can use that light – broken down to the level of structured photons, the most elementary particle of light – to encode a lot of information,” says Forbes. In July, the team achieved a world first when they shared secure information with 10 participants over a network and used 11 dimensional patterns to pack loads of information into each photon. Previously, this could only be done through oneon-one or peer-to-peer communication. The network is not limited to 10 participants; many more

users can be added. But the beauty of this is that any attempt to eavesdrop or intercept the message will destroy it. This means messages can go viral to a trusted group of individuals, without the fear of someone eavesdropping. “It is impossible to crack, because as soon as you intercept these lights in the quantum world, the message gets destroyed,” says Forbes. The Wits team is in a global race to roll out a secure quantum network. In just over a month, they plan to test their network in the field, by sending data over a 300m link. If that is successful, the next plan is to communicate between the Telkom and Sentech communications towers in Johannesburg. The idea is to one day use 5G towers to build a secure quantum communications network. These cellphone towers, according to Forbes, are all within a 10km radius of each other, which means that they are within line of sight and will be ideal to carry the quantum network. Beyond that, satellites could be used as a medium to transport the network. “First, it is 300m, modest baby steps,” says Forbes. “Then it is five kilometres with tower-to-tower.” One challenge the team is likely to face one day is that, unlike other communication media like radio, the light cannot be amplified. Attempts to amplify the medium would alter the light,

“They are working at using structured light to provide communication that is impossible to intercept. Data are transmitted through the use of patterns of light.” causing the message to be destroyed.  Forbes says that once quantum networks have become established, we will not even know they are there if they work well. “If everything works perfectly, then you won’t see it. It will be as if life carries on like normal, But if it wasn’t there, and these threats were realised then cases of fraud and banking irregularities would sky rocket. So it is one of those things where we hope nobody notices.” C

DIMMING THE LIGHTS ON MALARIA The fight against the disease that kills hundreds of thousands of people in Africa each year could be as simple as changing a light bulb. SHAUN SMILLIE

RODION-KUTSAEV

osquitoes might just be the most annoying little creatures on earth – always buzzing around your head, while you are trying to sleep. But as we all know, these little creatures are still some of the most prolific killers on Earth. Every year, a quarter of a billion people are infected with malaria and of these 405 000 die from the disease. Although a vaccine exists and malaria is for the most part very treatable, these measures are expensive. While there are many high-tech and low-tech ways to target the malaria parasite, such as drugs, attempts to sterilise male mosquitoes and the use of mosquito nets to stop mosquitoes from biting people as they sleep, another way to manage the disease could be aided by changing a light bulb.

in Africa may increase vector disease transmission. “Light pollution is gaining a foothold in Africa and one of humankind’s oldest known killers might be using this to its advantage,” says Coetzee. Scientists know mosquitoes use a number of senses, from sniffing out odour, to detecting the carbon dioxide in a person’s breath and possibly light to find their prey. “Light is probably one of the cues that tells the female mosquito that she can or cannot feed,” explains Professor Lizette Koekemoer, of the Wits Research Institute for Malaria. “But the light by itself is not good enough, because if there is no (human) odour she will go somewhere else.” Koekemoer is a primary collaborator in Coetzee’s research.

LIGHTBULB MOMENT

MOZZIES IN THE SPOTLIGHT

According to Dr Bernard Coetzee of the Wits Global Change Institute, the malaria carrying Anopheles mosquito most likely uses artificial light as an additional cue when seeking out humans. And they are not alone, other mosquito species responsible for carrying such harmful viruses as the Zika and West Nile virus might be using light to lead them to humans too. Coetzee is on a mission to try to understand how artificial light

The problem is that little is known about mosquitoes and their relationship with artificial light. This is the knowledge gap that Coetzee, with the help of a prestigious research grant, wants to fill. Coetzee is the winner of the Jennifer Ward Oppenheimer Research Grant for his work on light pollution. The aim of the grant is to support African-led research that might solve

“If you can work out what spectrum of light is attracting mosquitoes, then you can make a recommendation for people not to use it.”

real-world problems on the continent. Coetzee was selected from 217 applications from 26 countries across Africa. “This research comes from a longstanding interest in light pollution,” says Coetzee. “And one of those extensions, of course, is how light pollution might alter a range of things, especially these disease vectors like mosquitoes.” Coetzee’s research will be partly based in the laboratory, where he will assess the effect that different kinds and spectra of light have on mosquitoes.

SHINING A LIGHT ON AFRICA

Some mosquitoes are diurnal, seeking out their prey during the day, while others are nocturnal, operating under completely different circumstances. “The team will also model and map artificial lights and exemplar areas so that we can work out what sort of lights

people are actually using, especially in the rural areas. I haven’t seen anybody in the developing world really quantify who is using what, and how this affects things biologically,” says Coetzee. As studies overseas have shown, artificial light use varies even from town to town. “There are some really cool photos from the US, where you can see two different towns. They look different at night, because the kind of light that people are using in those towns is different,” says Coetzee. If he is correct, and we can understand how artificial light influences mosquito behaviour, it could well become another weapon in the fight against one of the biggest killers in Africa. “If you can work out what spectrum of light is attracting mosquitoes, then you can make a recommendation for people not to use it,” he says. C

ALONG CAME A

VIRUS…

Lynn Morris reflects on a lifetime of virus hunting, from HIV, through Ebola, to SARS-COV-2.

have spent the past 25 years doing research towards an HIV vaccine and now we might have one for Covid-19 in less than a year! Of course, we don’t have one yet and vaccine development is notoriously difficult and full of surprises, so we will need to wait and see – but probably not for long. All indications suggest that a vaccine against SARS-CoV-2, the virus responsible for Covid-19, is going to be much more feasible compared to HIV. There are currently 11 Covid-19 vaccines in large scale efficacy trials with five already approved for limited use, compared to a pitiful six efficacy trials conducted for HIV – none of which have proven worthy enough for licensure.

FUNDING FICKLE AS A VIRUS

This warp speed Covid-19 vaccine development happened, in part, because we were able to take advantage of what we learned from HIV. Viruses are simple life forms that use similar mechanisms to hijack and exploit human and animal cells. I have watched with amazement how speedily many of my HIV colleagues have redirected their decades-long HIV vaccine programmes towards studying Covid-19. This speaks not only to the global urgency to find solutions, but also to the fickle nature of research funding and the underresourcing of health and science. We have also seen the resurrection of old research programmes on SARS-CoV-1 and MERS (Middle East Respiratory Syndrome); both are coronaviruses that caused earlier human epidemics but work was halted when the threats died down. We made the same mistake with Ebola vaccines that sat on the shelf for 10 years before rapid action saved the day. In the aftermath of Covid-19 we need to ask hard questions about how we prioritise funding for the things that pose real threats to our existence, such as new and emerging viral pandemics.

SUPER-SPREADING DATA

The rapid progress in the search for a Covid-19 vaccine has also been enabled by the immediate sharing of data and information. The sequence of the novel SARS-CoV-2 virus was published in less than a week of it being discovered and within a month after the first cases of severe pneumonia were described in Wuhan, China. Scientists around the world quickly used these sequences to slot into their vaccine platforms and to design their own diagnostic

tests. The GISAID (Global Initiative on Sharing All Influenza Data) database already has a staggering 100 000 SARS-CoV-2 sequences representing almost half of all viral sequences ever published, including HIV. There has been a deluge of scientific papers published on Covid-19 in the past eight months, many following a rushed review process or even before scientific peer review. Science is driving policy in real time with new discoveries acted on immediately. This willingness and eagerness to share information has serious downsides as many of the published papers are insubstantial or inconclusive – with some of them having been hastily retracted. There has been concern that this state of disaster will be exploited for political gain with vaccines being prematurely used – a scenario that was quickly dispelled by a pledge from major vaccine manufacturers that they will not seek licensure until all safety checks are passed.

VACCINES AGAINST VIRUSES

I am a volunteer in one of the Covid-19 vaccine trials that is being led by researchers at Wits. I did this not only because I believe in the power of vaccines, but also because I, like everyone else, am at risk of SARS-CoV-2 infection. But we now know that not everyone who is infected has the same outcome. SARS-CoV-2, like HIV, is an insidious virus (albeit in a different way) causing stealth infections in large numbers of people while having severe and sometimes fatal consequences in others. This state of asymptomatic infection poses significant management challenges for public health officials as it undermines the test and trace approach that is critical to halting transmission. Unlike SARS-CoV-1, SARS-CoV-2 is expected to become endemic – widespread within populations – and will thus continue to circulate for years to come. While we still don’t know the level and durability of immune responses needed for herd immunity, we do know that vaccines are the best way to control and eradicate viruses. Vaccines work by stimulating our natural immune defences. After my vaccinations (I received two doses), I imagined how this little bit of the SARS-CoV-2 virus (the spike protein) was being hunted down by the B cells that conduct surveillance to detect invaders in my body. Once engaged, these cells start the process

of making virus-fighting antibodies that take a few weeks to appear. During this time, I was keeping track of my body’s reaction to the injection by filling in a daily vaccine diary, documenting things such as tenderness, redness, swelling and temperature. But I had nothing more than the equivalent of a small insect bite that quickly resolved. These reactions differ between vaccines and between people. Although there have been a few reports of more significant reactions, none are as bad as the effects of infection with the real virus. Assuming the vaccine works as expected (and that I received the vaccine and not the placebo), the best reaction would be to have antibodies to SARS-CoV-2 that will protect me from Covid-19 infection.

“We need to ask hard questions about how we prioritise funding for the things that pose real threats to our existence, such as new and emerging viral pandemics.”

GLOBAL VIRAL VIGILANCE

But let us not forget that viruses are masters of disguise. Thankfully, SARS-CoV-2 seems so far to be less adept at changing its cloak than viruses such as HIV. This makes it an easier target for a vaccine. However, SARS-CoV-2 hasn’t faced any real opposition yet since most people are still susceptible. Once immunity builds up either through infection or vaccination, this could change as this virus, like all viruses, will try to get around any efforts to stop it from spreading – so we need to stay alert. The success of a Covid-19 vaccine will rely on the majority of those at highest risk agreeing to be vaccinated – an effort that is being undermined by those who use fake science and misinformation to cast doubt on vaccines. But most importantly what the Covid-19 pandemic has demonstrated is that if there is political will and a coordinated and well-funded global effort, vaccine development can proceed exceedingly fast. There is no doubt that new pathogenic viruses will continue to emerge. Let’s build on what we have learned from the Covid-19 pandemic so we can respond more rapidly and effectively to viral threats, including HIV, which still remains one of the world’s biggest health challenges. C

Lynn Morris is the incoming Deputy ViceChancellor: Research and Postgraduate Affairs at Wits (April 2021), Interim Executive Director of the National Institute for Communicable Diseases (NICD), Head of the HIV Virology Lab in the Centre for HIV & STIs at the National Health Laboratory Service and a Research Professor at Wits. As a National Research Foundation A-rated scientist, Morris is internationally recognised for her work in understanding the antibody response to HIV. She is one of a handful of the most highly cited scientists in the world. Among many other accolades, she received the Vice-Chancellor’s Research Award from Wits in 2014.

COLUMN

IN THE COMPANY OF CRIMINALS Using the National State of Disaster that was declared to deal with the Covid pandemic to try to govern booze and cigarettes, is the wrong approach. Dealing with this issue requires the same political will demonstrated against the pandemic. SCHALK MOUTON

SHIVAN PARUSNATH

was sitting with a bunch of criminals. Hidden safely, in a quiet, dark corner of a restaurant where neither the cops nor the Virus could find us. Sipping an illicit coffee. Those were dangerous days – shortly after the restaurant blockade had lifted. The restaurant was not yet allowed sit-down patrons. But there we were. Looking around the table, I carefully took in the faces behind the masks. Bankers, CEOs, lawyers, businessmen. Criminals all of them – and that, admittedly, included me. As one of the men looked down at the menu, his shoulders sagged. An involuntary sigh filtered through the puppy-dog face masking his mouth. “I hate choices!” he shouted. “It’s like when your spellcheck gives you 10 suggestions for the incorrect word you typed! How the COVID am I supposed to know which one to pick?” he cries – completely disconfoculated (don’t blame me – this word was suggested by my spellchecker). At the time, when two people met randomly in the shopping aisle, conversation turned to how the national lockdown had broken the country, and then, more importantly, how to get hold of booze or cigarettes, banned by the government. Everyone had a plan. Each of us had become an outlaw. Some started by simply ringing the emergency number listed on the front door of the liquor shop (something I hadn’t done since a morning, long before dawn in Parys, when I was a student more than 20 years ago). Others dipped into their community WhatsApp group, trading whatever commodity they had on hand – like a bag of compost in one case – for a bottle. But as the country’s combined desperation increased, the schemes became more sophisticated. “Now that my Uber driver doesn’t have any passengers, he delivers booze for the local liquor store,” said one of the men, distractedly reading a Whatsapp over his glasses. “My contact distributes gin packaged as hand sanitiser,” said

the owner of a large upmarket luxury store. “My neighbour started selling the bottles of alcohol he had in his house, just to make some cash while he was out of a job,” says one of the lawyers. “He became so good at it that large, wellknown distributors contacted him to distribute alcohol for them. Now he only sells alcohol by the pallet.” The elderly friend of the mother-in-law of one group member made a bag of cash by selling off her late husband’s wine collection at more than 10 times the price it would have normally cost per bottle. The guy with the puppy dog mask looks up – still undecided between the omelette and bacon or the haute cuisine boerie roll. “I brought a case of wine up from Cape Town the other day. I got stopped at the Vaal border, handed over three bottles to the cops, and went on my way – no problem.” The three bottles, it seems, was the going rate. My own infraction came on a weekend, after being invited to a last-minute braai. I was invited on condition that I brought some beers. I scoured the neighbourhood in vain. Eventually, I ended up at an establishment that was allowed to sell alcohol over weekends, but only to sit-down customers. “Can I have 12 beers, please?” I asked the barman, as confidently as possible. “To take away or drink here?” he asked, leaning over the counter – eyeballs burning deeply into my soul. “Take away,” I took a chance. Better to be honest, I figured. “Can’t do it,” he said in a voice that would make James Earl Jones cringe, as he turned away, wiping glasses with a white kerchief. Conversation closed. “Okay,” I said. Less confident. Legs shaking slightly. “I will drink them here.” Without a further word, the bartender bent down and picked up a cardboard box full of new glasses. One by one, he took the 12 glasses out of the box, polishing each one to a shine. He then

proceeded to take 12 of my chosen brand out of the fridge and packed them into the box. “I’m not allowed to do this …” he just let it hang, as he handed over the box, adding a 100% mark-up on the sale. While the national lockdown was in many ways initially the right thing to do, the decision to ban the sale of cigarettes still remains a mystery to me. The myth that smoking cigarettes could intensify a Covid infection was quickly dispelled, and while the ban on alcohol sales may have kept some hospital beds open during the lockdown, I am still not convinced about the motives behind it. The problem, as I see it, is that the government tried to use the powers bestowed by the state of disaster legislation to solve two social ills that the country is facing. The first is the pressure that cigarette smoking places on the health system and the second is the myriad problems that come with alcohol abuse. I am not a smoker and I drink barely more than one beer in six months. But while I am the first to complain when I sit in a restaurant and a person at the table next to me decides to light up, for the couple of months during lockdown when smoking was banned, I fully backed the dudes who raised their rasping voices to be allowed the right to buy a cigarette. Using the lockdown to clamp down on real, serious issues the government has been unable to solve for decades is just wrong. These issues – as well as all of South Africa’s other problems, like public health, pit toilets in schools and the high road accident death toll – should receive the same kind of political will to sort out as government demonstrated in dealing with the Covid pandemic. After becoming a ‘dry’ country and entering the prohibition era on 19 January, 1920, the US banned the sale of alcohol to its citizens. While the intention was to deal with the national problem of alcohol abuse, the unintended consequences are clear today. Restaurants closed down as they were no longer able to make

a profit without liquor sales, theatre revenues declined, legal breweries and distilleries closed down, cutting thousands of jobs, while thousands more truck drivers, waiters and other related workers lost their livelihoods. The state of New York lost 75% of its revenue, which was derived from liquor taxes. In the end, prohibition cost the US a total of $11 billion in lost tax revenue and over $300 million to enforce. While it’s still early days to judge South Africa’s mini prohibition during lockdown, the parallels are clear. The ban on cigarette sales didn’t stop cigarette trading: It merely drove the industry underground. A South African study published earlier this year showed that 93% of consumers were driven to buy cigarettes from illegal sellers. Many of them, I am sure, made use of the services of the cannabis shop in our neighbourhood. Ironically, this shop was allowed to stay open and actually posted a dodgy-looking guy in a trench coat on the side of the road, flashing packets of cigarettes to passers-by. An investigation by Carte Blanche exposed that during the 70 days of the cigarette ban, more than R2 billion had been put in the pockets of organised crime syndicates. With all their problems, alcohol and tobacco sales are large earners for the South African Treasury and banning them actually causes more problems than their ban would solve. Unlike my friend with his spellchecker, most South Africans quite like the right to make decisions for themselves. Prohibition laws always backfire and usually turn good citizens into criminals. When South Africans want a beer for a braai, chances are that they will be able to find one. And, if all else fails, they can always visit the local copshop, where they are sure to find any brand they like – albeit at a premium. C

HOW THE WAYSIDE INN BECAME THE CHRIS HANI

BARAGWANATH HOSPITAL Since Johannesburg’s days as a frontier town, Baragwanath has evolved from a refreshment post for gold miners, to a military and then civilian hospital, to a world-renowned Wits teaching hospital that today is a site for two of South Africa’s three Covid-19 vaccine trials. DEBORAH MINORS

WIKIPEDIA

ohn Albert Baragwanath was a Cornish immigrant who came to the Witwatersrand gold fields in the late 1900s. He bought land and set up a refreshment station in what is now Soweto. The location was one day’s journey by ox-wagon from Johannesburg, where the road to Kimberley joined the road from Vereeniging. John’s Wayside Inn became known simply as ‘Baragwanath’s Place’. The Welsh surname translates as ‘bread’ (‘bara’) and ‘wheat’ (‘gwenith’).

THE IMPERIAL MILITARY HOSPITAL, BARAGWANATH

During World War II, the British Empire needed healthcare services for military personnel. In September 1940, the Secretary of State in London asked the South African government to provide facilities for Imperial troops of the Middle East Command. The British government bought the land from the Corner House Mining Group, which then owned the land which previously housed Baragwanath’s Place. Construction at a cost of £328 000 for a hospital of 1 544 beds began in November 1941. The first patients were admitted in May 1942. Bara treated mostly tuberculosis patients from the Middle East and Far East Command. Field Marshall Jan Smuts (Wits’ first chancellor) officially opened the Imperial Military Hospital, Baragwanath in September.

ACADEMIC MEDICINE AND APARTHEID

Meanwhile, in 1941, the Wits medical school had opened its doors to black medical students (although they had to have completed a first degree at the South African Native College, Fort Hare). Still, by 1945, the medical school had enrolled

82 black medical students (46 Indians, 33 blacks, 3 coloureds) and, in 1947, Dr Mary Malahele was the first black female medical school graduate. In 1948, the National Party came in to power in South Africa. Apartheid became law. The Transvaal Provincial Administration bought the hospital for £1million. Bara was resurrected as a civilian hospital with 480 beds and links were immediately forged with the Wits medical school. Patients in the ‘Non-European’ wing of the ‘white’ Johannesburg Hospital were transferred to Baragwanath. Despite operating in a profoundly unequal society and Baragwanath Hospital being under-resourced and over-crowded, it enabled Wits medical students access to sophisticated technologies and exposed them to diverse pathologies. Professor Haroon Saloojee, who qualified in the 1970s and is now a Personal Professor of Paediatrics and Child Health at Bara, said in an earlier interview: “There is no doubt about it that if you exclude that link [with Wits University], that would make the Bara experience a less exciting and less enticing alternative”.

The academic affiliation meant “you had a calibre of clinicians and other people who represented excellence.”

CHRIS HANI AND DEMOCRACY

In 1985, black students no longer had to obtain ministerial approval to attend ‘white’ universities. The percentage of black medical students at Wits rose from 8.9% to 28.9%. A decade later, the New South Africa was imminent. Chris Hani, a prominent anti-apartheid activist, was murdered on 10 April 1993. His name was attached to Baragwanath Hospital in acknowledgement of his contribution to the struggle. Today, Bara is the third largest hospital in the world, occupying around 173 acres, providing some 3200 beds and employing 6760 staff. It is the site of Wits University’s Vaccines and Infectious Diseases Analytics Research Unit (VIDA), which leads two of the country’s three Covid-19 vaccine trials. C Image credit & sources: Baragwanath Hospital, Soweto A History of Medical Care 1941-1990, Simonne Horwitz, Wits University Press, 2013 www.chrishanibaragwanathhospital.co.za

Visit the Adler Museum of Medicine for the OUTBREAK exhibition brought to you by the Harvard Global Health Institute

Why and where do infectious diseases emerge? What makes them spread so quickly? Where is the next one coming from?

7 York Road, Parktown, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

11 January 12 February 2021

Further information: Sepeke.Sekgwele@ wits.ac.za 011 717 2081