Nature Editorial on AIDS in South Africa: response to President Mbeki

Following is an editorial in Nature 27 April 2000 on the the President of South Africa's opinions and actions recently regarding AIDS, and in response to the letter Mr Mbeki sent. This letter follows the editorial:

Dear Mr Mbeki ...

An open letter to the president of South Africa.

We are writing in response to your recent letter to world leaders, including US president Bill Clinton and United Nations secretary general Kofi Annan, expressing your concern about the horrific situation that your country faces over the spread of AIDS, and your desire to see the situation approached in the most rigorously scientific way possible (see below). We share this goal; AIDS will not be defeated or contained without access to the best treatment that modern science has to offer. But we are also concerned that, in your admirable enthusiasm to ensure that a wide spectrum of scientific views is heard, you appear tempted to give greater weight to some voices than the scientific process justifies.

No one who has been impressed by your success in what many claimed impossible ˇ the peaceful transition to democracy in South Africa following the long struggle against the iniquities of apartheid ˇ will reject the argument that there are times when the voice of those challenging the existing order must be heard. Your own colleagues have referred to the astronomer Galileo in this context. But this does not mean that all dissidents and 'heretics' can claim equal legitimacy merely on the basis of their persecution; democratically endorsed procedures exist through which their ideas can be put to the test, and viable heresies separated from those that, after close scrutiny, deserve to be placed aside.

Politics has developed one set of such procedures: the ballot box, parliamentary debate and constitutional law. Science has developed its own, very different, set. Contrary to the impression given by your letter, science thrives on the ideas of heretics. But heretical hypotheses only become widely accepted in science if they prove useful and effective in understanding and interacting with the natural world. The peer-review system is little more than a way of speeding up the process of sorting out those ideas which have a greater chance than others of surviving intellectual scrutiny and testing through experiment.

One hypothesis that has survived this process is that the idea that there is a direct, causal relationship between infection with the human immunodeficiency virus (HIV) and the onset of AIDS. We are well aware of the arguments of those who challenge such a direct relationship. Our columns have been ˇ and remain ˇ open to anyone offering evidence to the contrary, but on one simple condition: that their evidence passes the same rigorous tests of scientific robustness that are applied to any scientific paper that we receive. So far this has not happened. Those who have experienced rejection may choose to castigate this as 'censorship', but the vast majority of authors of the scientific papers that we reject on technical grounds accept the process as valid and necessary for the health of science.

You yourself admit in your letter to President Clinton and the other world leaders that your comments about the treatment being given to heretical ideas on the nature of AIDS may be "extravagant"; you justify this on the grounds that in the recent past you have had, in your own words, "to fix our eyes on the very face of tyranny". But as Koďchiro Matsuura, the new head of Unesco, said at a meeting in Nigeria this week: "Without a scientific capacity of its own, Africa will not be able to tackle and overcome its endemic diseases". 

Mr Mbeki, we ask you, in the spirit of Matsuura's comment, not to ignore the advice of your own leading scientific and medical experts, nor to reject those aspects of science that offer your country the greatest hope for the future. A respect for vigorous scientific debate is one of these aspects that we endorse. Giving excessive credence to populist hypotheses that fly in the face of established evidence and fail to survive rigorous peer review is not.

Letter fuels South Africa's AIDS furore

MICHAEL CHERRY

[CAPE TOWN] International controversy over the South African president Thabo Mbeki's views on the nature of AIDS deepened last week, when the text of an outspoken letter sent earlier this month to US President Bill Clinton, UN secretary-general  Kofi Annan and the heads of state of Germany, France and the United Kingdom became public.

In the letter, Mbeki gives the strongest evidence yet of his sympathies for those who argue that AIDS may not be caused by HIV.

Ironically, earlier in the week James Wolfensohn, president of the World Bank, had promised that there would be "no limit" to the funds available for combating AIDS in the developing world. In his statement, delivered during the annual World Bank meeting in Washington, Wolfensohn singled out sub-Saharan Africa as being in particular need.

The publication of the letter coincided with the release of South Africa's AIDS statistics for 1999, which confirm that nearly ten per cent of its population ˇ about 4.2 million people ˇ is infected with HIV.

Mbeki's letter was passed to The Washington Post by a senior US official, following a meeting in Atlanta the previous week between South Africa's health minister Manto Tshabalala-Msimang, its ambassador to the United States, Makate Sisulu, and Sandra Thurman, director of the White House office of national AIDS policy.

In the letter, Mbeki states that he is "convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of AIDS in the West."

Referring to 'dissident' AIDS researchers who believe that HIV does not cause AIDS, he continues: "The scientists we are supposed to put into scientific quarantine include Nobel prizewinners, members of academies of science and emeritus professors of various disciplines of medicine!"

In the South African parliament last Wednesday, Jacob Zuma, deputy president and chairman of the National AIDS Council, denied that Mbeki had at any stage said that he challenges the view that HIV causes AIDS ˇ or the contrary.

"During the last decade and a half and more, a heated debate amongst scientists and others relating to this question, has been going on," said Zuma. Rallying to the president's position, he continued: "We should not, and we will not, leave any stone unturned, even if this means including the views of the so-called 'dissidents'."

Zuma said that an international panel being set up by the South African government to advise on an appropriate national policy on AIDS included "all points of view in the debate and is constituted of the most eminent world scientists who can help to ensure that we understand HIV/AIDS correctly and therefore respond to it correctly".

But the decision to set up the panel, and the way it is being done, has itself come under criticism. Although the panel is due to meet for the first time in South Africa next week, its members have not yet been announced. Two medical researchers, both linked to the dissident movement, are the only people who have confirmed their participation.

One is Gordon Stewart, professor emeritus of public health at the University of Glasgow, who became well known in the 1970s for his opposition to whooping-cough vaccine. The other is Sam Mhlongo, professor of family health at the Medical University of South Africa, north of Pretoria.

In 1997, Stewart co-authored an article with Eleni Papadopulos-Eleopulos of the Royal Perth Hospital, Australia, and other 'dissidents' in the journal Current Medical Research and Opinion. A later article in the same journal by Papadopulos-Eleopulos and others on the pharmacology of AZT, which claimed that the drug was unacceptably toxic, appeared to be a major influence in Mbeki's refusal to sanction state provision of this drug to prevent mother-to-child transmission of HIV (see Nature 402, 3; 1999).

During the debate in parliament last week, Mike Ellis, a member of the Democratic Party, said that Mbeki seemed so defensive about AIDS that he was placing sound judgement and rational thinking at risk. Kobus Gous, health spokesman for the New National Party, accused the president, through his contact with the dissidents, of having "given a podium to discredited scientists, false hope to AIDS sufferers and created doubt in the public mind".

But support for Mbeki's stance came from an unusual quarter when the right-wing Boerestaat Party applauded the president's efforts to "investigate the biggest hoax in the twentieth century".