Health Minister Zweli Mkhize should make the details of more than 70 advisories drafted for the government by the Ministerial Advisory Committee (MAC) on Covid-19 public because there is no reason not to do so.
This should be done so the public could see for themselves what scientific advice was offered to the government, senior members of the MAC said this week.
The Department of Health steadfastly refuses to release the advisories, with Mkhize arguing it might mistakenly be taken as official policy.
Some advisories have been publicized, such as the MAC’s recommendations on the use of a cheap steroid to treat Covid-19 patients, and an advisory related to the wearing of masks.
Frustration seems to be building among some MAC members who feel the lack of transparency is complicating the fight against the virus because the public is increasingly questioning the rationale behind regulations.
The head of the Ezintsha Health Unit at the University of the Witwatersrand, Professor Francois Venter, said he believed due to “micromanagement and gross inconsistencies and even hypocrisy” seen in regulations, the social contract to prevent the spread of the virus had been broken.
“This is because the public may stop participating in key measures – like social distancing, mask-wearing and hand-washing – to prevent the spread of the virus if they do not understand the reasons behind decisions.
“You can attend church but not your family dinner.
“You can get in a crowded taxi at 6am but not drive at 10pm. Public health is about trust, transparency and consistency, we are not seeing this,” Venter said.
At least one member of the MAC said he agreed with Mkhize’s refusal to issue the advisories to the public.
“The MAC advises the minister, not the public. That is the purpose of the MAC. I am of the opinion that MAC advisories flow to the minister who then decides if he accepts the advice or not,” said retired colonel Theo Ligthelm, a former officer in the SA National Defence Force’s Medical Health Services (SAMHS) as well as former head of military health operations and consultant in disaster medicine planning.
Pros and cons
Dr Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand, said that while it was the prerogative of the government to make its advisories public, he felt they should be.
He said this would allow the public a chance to inform themselves on how the government formulates its policy.
Madhi added the advisories were based on science, which was already out in the public, so there should be no reason they could not be released to the public.
However, he also explained the pros and cons to releasing the advisories, saying: “The pros would be that you are much more transparent in terms of decision-making and the public knows what scientists have actually advised.
Dr Shabir Madhi said:
“The cons of it is that if the government decides to go a different route other than what is being advised then they would need to basically justify it. So, it can create some level of confusion for the public as to why the scientists are advising one thing and the government is doing another thing.”
The head of infectious diseases at Helen Joseph Hospital, Dr Jeremy Nel, also believed the advisories should be available to the public, saying it “would transform the MAC to something closer to an independent scientific advisory body, which would be a welcome change”.
“Naturally, the government would be free to apply or reject the advice, there may well be other non-medical factors that they would apply to their decision-making process, and that is to be expected.
“But, making the advisories public would subject both the advisories and the government’s decision-making process to greater public scrutiny as well as to constructive criticism. This is healthy both from a scientific and democratic standpoint,” Nel said.
“In addition, it would help facilitate key health messaging by being able to communicate advice directly to the public,” he added.
Another scientist, who also advises government and who wished to anonymous for fear of reprisal, said many MAC members would like to see this information (the advisories) in the public domain so people could see what was being debated.
While MAC advisors spend hours and weekends drafting the advisories, the source said they were doubtful as to whether these were taken forward for consideration.
Some advisories have been issued, but only when “it suited” the government, the individual added.
The source believed one reason the government had not made advisories public was because South Africa’s politicians were “not used to being transparent” or being held accountable, the source said.
Legal battle looming?
Meanwhile, News24 has filed two Promotion of Access to Information Act (PAIA) requests, seeking access to the advisories and more detailed data collected by the government on Covid-19.
On Friday, department spokesperson Popo Maja said the reason for the non-response was “either that we did not have the requested data or the release of such would compromise patients’ personal information”.
There is clear evidence in presentations to the media by the Gauteng health department, reports by the National Institute for Communicable Diseases and elsewhere the data requested is being collected and analysed.
In requesting comment, News24 referred to at least four requests since May and the letter to Buthelezi, which set out the data requested as follows:
Testing data (sample collection dates, sample delivery dates, location/facility where a sample was collected and processed).Data around deaths (comorbidities, facilities where death was reported, location of deaths outside a healthcare setting).Spatial data around contact tracing and case investigation.Hospitalisation data (date of admission, whether an ICU/ventilation was required/data on outcomes).News24 has not requested the personal information of Covid-19 patients, and the PAIA application makes clear the data requested should be depersonalised.
This data would allow for detailed mapping, to a suburb or ward level, of Covid-19 hotspots and enable citizens to be aware of outbreaks near their homes, schools or workplaces almost as they happen – allowing them to be aware of outbreaks near their homes or workplaces in near real-time.
This data is being stored in a central repository by the CSIR information hub on Covid-19 in Tshwane to which access is severely limited.
“The department is not aware of the value of such detailed location data to citizens. Citizens are informed daily about the infection rates in their provinces. Admittedly, some provinces are more pro-active in releasing district and sub-district data than others,” Maja said on Friday.
Only Gauteng and the Western Cape make daily data available on the number of cases per sub-districts and districts.