Africa-Press – South-Africa. Access to information in a pandemic should be automatic, not a prolonged fight for disclosure, write
Marlise Richter and Yanga Nokhepheyi.
South Africa has been subjected to some eccentric government decision-making during this time. At various times during the period of disaster or ‘lockdowns’, regulations under the Disaster Management Act prohibited a wide spectrum of activities: the selling of open-toe shoes, alcohol and cigarettes, for example; and restrictions and requirements on funerals, gatherings and travel – at times, with no real public health rationale – mostly all drafted without public consultation. The state’s often violent enforcement of these restrictions is unforgettable and indefensible.
While acknowledging that not a lot was known about Covid-19 then and that the science changes rapidly, in our analysis, some of these decisions were not based on the public health evidence available at that time or the advice of the Ministers Advisers, many of whom serve or served on the Ministerial Advisory Committees (MACs) appointed by the Minister of Health, though some seemingly fall outside of the MACs too.
Regrettably, even the latest Regulations – open for public comment – do not always closely follow the advice given by the Ministers Advisers.
Available in public domain
Yes, some of the MAC Advisories are now available in the public domain, but in 2020 this was not even the case. Then, the former Minister of Health said that he would not release the advice provided to him as it ‘did not represent the government’s final position on the issues under discussion and that it was necessary to appreciate government’s complex policy formation process’. Following a formal access to information request by News24 coupled with a public outcry, the Department of Health sporadically published some of the expert MAC advisories.
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This was often done with long delays between submission to the minister and the public release -our research shows that it was as much as a three-month delay at times. MAC members also have to sign confidentiality agreements – this also precludes them from sharing their advice or recommendations. The current co-chair of the MAC, Professor Koleka Mlisana noted that MAC members had even urged the Department of Health to publish all of its advisories timeously, then.
In 2021 onwards, the Health Justice Initiative engaged the Department of Health on multiple access to information matters to advocate for greater transparency and accountability in a pandemic.
We also submitted a formal request for information in July 2021 on all the MAC Advisories among other things – this led to a flurry of several older MAC advisories being published within days of the request being filed. Subsequent MAC advisories were also uploaded, but still with a worrying lag time. For example, the MAC’s ‘Omicron’ Advisory’ was submitted to the Minister of Health on 3 December 2021 (the variant was first reported on 24 November 2021) and only published on 21 January 2022, when South Africa’s fourth wave due to the Omicron variant was already considered over.
We do know not if the published MAC Advisories are indeed all the expert advice and Advisories submitted to the Minister, and where any other expert advice of all the Ministers Advisers for 2020 – 2022 is located. Either way, they should be public and confirmed on oath.
Court order
Our request for the disclosure of the names of all of the Ministers Advisers (there are other advisors who do not sit on the MACs, this much has been admitted by the V-MAC Chairperson, Professor Barry Schoub in a media interview) and copies of all expert advisories and recommendations related to specific topics remain unanswered – including on:
Contrary to recent claims by the Deputy-Director General, Dr Nicolas Crisp, the Health Justice Initiative did not request his ‘entire computer, the minister’s and the director-general’s’ or ‘a “Wikileaks” on everything in the entire government’.
We approached the Gauteng High Court in early April 2022 to seek an order for the Department of Health to disclose all expert advice, for future publication, even outside of a state of disaster, to be without delay, and within 72 hours of submission.
Health Justice Initiative heads to court to have Covid-19 MAC decisions made public
Along with the Department of Health, from mid-2021 we requested the Department of Sports, Arts and Culture and the South African Medical Research Council and SAHPRA to disclose all related requests, waivers and approvals that enabled, in our view, an unfair system where South Africa prioritised certain ‘special groups’ to get a vaccine ahead of their respective age cohorts, while everyone else waited their turn for the age group. Only SAHPRA provided the information, and the documents they disclose is worth reading.
Info is in public interest
We believe these ‘special groups’ include certain sports teams, sports administrators, and government officials, but so far no one wants to really confirm who exactly benefited. This was at a time when South Africa was prevented by global manufacturers from accessing sufficient and timely vaccine supplies, and we did not have enough supplies for an immediate mass vaccination programme – while our health system was under severe strain due to multiple Covid-19 waves.
In the next pandemic, and the one after, where scarcity exists, this inequitable approach and ‘precedent’ cannot be the norm – if it is then the rationale and all the interests behind it must be opened for scrutiny. Also, we have argued that for scarce and valuable vaccines to go to fit, young and healthy sports players and sports or government officials, ahead of elderly or immunocompromised people, irrespective of how important a sports game is for ‘national pride’, at a time of a global vaccine supply crisis, does not make public health or ethical sense.
We want to ensure that the decision-making and rationale for proceeding, are open to public scrutiny, to ensure that vested commercial, or business interests do not take precedence over public health considerations – and for sound eligibility and allocation principles to inform a framework that we need for future pandemics too. This is why we want to know did the MAC endorse or suggest such an approach, and if not, who did?
The information we seek is in the public interest. The management of the current pandemic and future pandemics require ethical, and evidence-based decision-making, that is rooted in accepted public health principles and research in the context of scarce resources. ‘Pandemic readiness’ requires that clear and transparent processes are put in place to ethically and fairly allocate scarce public goods to those who most urgently require it. This necessitates more transparency, more public vigilance and open decision-making. There can be no secrecy in a pandemic.
– Marlise Richter is a senior researcher and Yanga Nokhepheyi is a researcher at the Health Justice Initiative.
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