Page 88 - A Widening Idea of Health and Health Research - The South African Medical Research Council from Creation to COVID

Positively into the New South Africa: The MRC, 1995–2012

into their own malaria control programmes.
In contrast to the unified nature of malaria research, in the case of TB a research
unit, a research group, a centre and a programme coexisted, unwilling to combine
their particular foci as they were rooted in different disciplines like microbiology,
molecular genetics, immunology and therapeutics and were, in addition, located at
different universities. Thus, even as the HIV/AIDS epidemic and the emergence of
drug-resistant TB were driving TB’s incidence higher and higher in the last years of
the 20th century, research on TB by MRC-backed units was chequered. It ranged
from devising ways to implement the new Directly Observed Treatment Short Course
Strategy (DOTS) more effectively to developing techniques for shortening the time
needed to diagnose TB, from setting up a reference centre for anti-TB drugs to
helping to sequence the fourth TB genome. Warning against such over-ubiquity in TB
research without a commensurate publication output, an MRC committee noted that,
although ‘there is a lot of money available for TB research from overseas … the MRC
needs to take action or it may end up embarrassing itself’. 127
Two other pre-1995 research units continued to put their specialist skills in the
field of health statistics to significant effect in the new century too. The Biostatistics
Unit’s statistical evaluation of the efficacy of upskilling public health nurses to be
able to administer antiretroviral therapy was accepted nationwide with important
consequences for the practical rollout of this therapy in the country, while the unit’s
detailed geographical analysis of the prevalence of HIV enabled provincial health
authorities to target high-risk areas for HIV prevention and treatment programmes.
More tightly targeted were the efforts of the Burden of Disease Research Unit
(BODRU) after 1994 to capture a demographic picture of the newly democratic
South Africa. From early on BODRU therefore sought to identify the large lacunae
(or ‘black holes’ as they dubbed them ) in South Africa’s vital statistics through
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demographic surveys, mortality surveillance and burden of disease studies which drew
methodologically on its pioneering investigation of vital registration and statistics in
Cape Town. Most glaringly revealed was the gross inadequacy of the country’s official
mortality statistics – it was estimated that they captured only 56 per cent of all deaths
in 1994 – even though these statistics were central to any demographic portrait, for
they were what an expert report to the Department of Arts, Culture, Science and
Technology called ‘the cornerstone of health status data’. With this in mind, not
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only did BODRU press the state to improve its registration procedures and facilities
appreciably, but it also sought to have the questions on death certificates augmented
and clarified, and even how to fill in the certificate added to medical curricula so as
to secure more informative and comprehensive outcomes. The upshot of the former

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