The Mail & Guardian March 31 2000

While no one disputes President Mbeki's good intentions, his investigation of dissident views on HIV/AIDS has plunged South Africa into a national health crisis.

Scientific knowledge is only ever provisional. Whatever the rigour applied in trying to establish it, it survives only for as long as it is not falsified or a better explanation for something is not put forward.

So there is something to be said for the person who sets out to falsify all or part of an accepted theory. He or she may well produce a significant improvement or a revolution in our understanding of something. Challenging the conventional wisdom can, indeed, be a heroic pastime in science.

There is nothing inherently wrong in trying to keep open the debate about HIV/AIDS -- if at all the virus and the syndrome exist and are linked -- provided the debate proceeds along the rules of scientific enquiry, and is not informed by moralising objections to gay lifestyles or Malthusean arguments about pharmaceutical companies inventing syndromes in order to create a market for their products.

But engaging in this kind of investigation can be highly problematic if you are Thabo Mbeki, president of South Africa. And so it has become.

We are faced with the greatest threat to public health in this part of Africa since smallpox and other imported European diseases decimated the indigenous black tribes in the early years of colonialism.

Faced with this crisis, we can legitimately expect of our president that he ensure that state policy on the issue is coherent, well-understood by the public at large, energetic and based on the best available scientific knowledge. He is, after all, a politician, elected to rule.

Instead, he has at times behaved like someone trying to be the Boy's Own basement lab hero of AIDS science. He has allowed his attention to be diverted into abstruse debates on immunology and related science. He seems to have become the international political patron of views on HIV/AIDS which seriously undermine the deployment in this country of best available methods based on the best available science for treating HIV/AIDS and related conditions. In the process, the nation's attempt to deal with this national health crisis have been plunged into confusion. And the four million-odd South Africans who have contracted the syndrome can be forgiven for feeling, if not exactly abused, certainly neglected. Worse, each attempt by Mbeki and his representative, Parks Mankahlana, over the past fortnight to dig themselves out of this hole has only plunged them and the rest of us deeper into it.

It is small wonder that scientists, diplomats and politicians, even in Mbeki's own party, are asking whether Mbeki's usually astute judgment has completely deserted him. His behaviour has also led to unhelpful speculation about why he is so strangely exercised by the issue. Even if the largely discredited dissident views to which he wishes to give so much air are eventually proved to have been right, this will not compensate for the ground that is being lost right now in our fight against what best science sees fit to call HIV/AIDS.

We have been told of late that the "president has never said HIV does not cause AIDS". But we know that Minister of Health Manto Tshabalala-Msimang's proposed international panel, very much at Mbeki's instigation, is to look into "everything about AIDS", including "whether there's this thing called AIDS, what it is, whether HIV leads to AIDS, whether there is something called HIV, for an example. All these questions."

Mankahlana has taken pains in the past fortnight to ensure that we all understand the true nature of free speech, and has accused voices like ours of attempting to stifle free thought and debate.

But this is nonsense. We and other critics of the president's approach to HIV/AIDS would deny no one -- not even crackpots -- the right to challenge conventional wisdom. The issue for us is that Mbeki is missing his vocation completely if he seeks to revise scientific knowledge instead of expediting policy in the way he was elected to do.

Tshabalala-Msimang's evident unease in interviews suggests she is rather less well-disposed to the dissident view on HIV/AIDS than she believes Mbeki would like her to be, or than her predecessor, Nkosazana Dlamini-Zuma, was. Deputy President Jacob Zuma has suggested, since the controversy erupted, that the presidency may hold back in future from declaiming on issues of science. But he seemed less than willing to rule it out completely.

Why has Mbeki embarked on this stubborn, silent crusade? There are no obvious reasons, no reports of African National Congress branches rising up and demanding that the president personally push the case for the earth being flat in the world of AIDS science. One might expect the Pan Africanist Congress to lead any arguments that South Africa is merely a playground for neo-colonialist pharmaceutical companies, but instead its fiery health spokesperson, Dr Costa Gazi, is suing the government over its denial of AZT to pregnant mothers.

The dismay over Mbeki's actions crosses the nation's traditional fracture lines, with Mamphela Ramphele and Malegapuru Makgoba, among the most prominent of the black scientists and doctors, as desperate for a government turnaround as any white health worker.

No one disputes Mbeki's good intentions. He clearly understands the extent of the AIDS epidemic, and the social and political problems it poses. If he were not deeply concerned by the AIDS problem, it is highly unlikely he would have become so deeply embroiled in it.

What is unclear is his judgment on this matter -- and his willingness to confine himself to the job he was elected to do and to restrict his forays into the intricacies of specialised subjects to the taking of best available advice.