Koleka Mlisana’s career in microbiology started with something small. More than three decades in the field later, the decision she downplays as a small sacrifice led to her being one of the scientists at the forefront of South Africa’s stand against the HIV and Aids epidemic, and now the Covid-19 pandemic.
Born in Mthatha 59 years ago, the new co-chair of the ministerial advisory committee (MAC), the brains trust advising the government on the country’s response to Covid-19, got into medicine because “there were very few options to choose from” at the time. “If you were doing well in maths and science or biology, then it was, ‘Oh, you must go to Wentworth,’ which was the medical school back then.”
Mlisana did just that, enrolling at the then University of Natal’s medical school in 1980. “I met my husband [Zolile Mlisana] at medical school and we got married while I was still training,” she said.
“When I was doing my final year, we had our first son [Lukholo, in 1986] and shortly thereafter we had the other two. My husband was specialising in paediatrics, which meant he was busy. Night calls and all of that. It was very clear to us early on and I felt that one of us needed to have better working hours. Because he was already specialising in paediatrics, and he loved it, I then decided that I should rather look for a speciality that’s going to give me reasonable hours. It didn’t really matter to me what that was going to be. Lo and behold, there was an opening in microbiology. It’s not like I always wanted to be a microbiologist.
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“There was an opening in the medical micro registrar training programme at UKZN [the University of KwaZulu-Natal]. It was still University of Natal then. When I went to see the head of department, he said, ‘Oh ja, sure. Why not? I wouldn’t mind training the first Black microbiologist.’ And I was like, ‘Oh okay. So, there is no Black person who has done this?’ So, I joined the programme, and I must say I really developed love for the subject during the training.
“The benefit for me was that you would finish work, go home and you know that if you needed to be on call you could do so from home. I say this all the time to my husband, I don’t have to worry about microorganisms. If I leave them incubated in the incubator, I will find them there in the morning. It’s much easier. Little did I know the opportunities it would open for me.”
‘We could have done better’
Mlisana wanted a mornings-only job after she graduated, which the university couldn’t offer her. She entered the private sector instead, so she could work and spend time with her growing family following the birth of Andiswa in 1988 and Lufefe in 1991.
It was the HIV and Aids epidemic that brought her back into the public health sector and academia, when she mentored scientists and was one of the researchers of the virus that had claimed the lives of millions.
Through her work as one of the country’s renowned HIV researchers, Mlisana ended up at the Centre for the Aids Programme of Research in South Africa. Here, she worked with former MAC co-chair Salim Abdool Karim. She is also a member of the board of trustees of the South African National Aids Council.
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South Africa’s response to the Aids epidemic showed the good and the bad of the country’s health system. The Aids denialism by former president Thabo Mbeki was disastrous, leading to the death of thousands whose lives could have turned out differently had antiretrovirals (ARVs) been supplied sooner. But once political rhetoric was set aside and science allowed to guide its decisions, the country did well and now it has the largest ARV programme in the world, one that has prolonged the lives of many people.
Lessons from that period were important to how South Africa dealt with Covid-19. Unlike Mbeki and then health minister Manto Tshabalala-Msimang, President Cyril Ramaphosa and Minister of Health Zweli Mkhize made science the focal point of the country’s response to the pandemic.
“There are pockets where there were really great decisions and then there is somewhere where we did fail – expectedly so, we were trying to understand something new,” said Mlisana. “As Slim [Karim] would always say, ‘We are building this boat as we are sailing in it.’ We are bound to make errors, looking back is always much easier.
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“By appointing the MAC, that was another positive. The health minister managed to take the nation with him in understanding the disease and explaining difficult terms. Right now people know about variants, nobody calls it a strain anymore. We are calling it the correct thing and we also know about the replications. There were also conspiracy theories to deal with, which had its challenges.
“Anyone can say that we could have done better. Right now, the main focus is vaccination. Could it have been done better? Definitely … There was an issue about payments into the Covax group and how that was delayed. That could have been avoided. I am not a politician, and I don’t want to get into political decisions, but the fact that we ended up with a variant in December, that wasn’t good for us as a country.
“But at the same time, because of the working together and the surveillance system that had been put in place, we were able to pick it up early and we were able to analyse and understand what this variant was doing. What we unfortunately had not anticipated as scientists was that that variant wasn’t going to respond well to the currently existing vaccines as we would have hoped. That was another delay as far as vaccines getting into the country.
“Going forward, we need to see how we can strengthen the areas where we feel we may have failed as a country.”
Not enough testing
Mkhize announced on the evening of 13 April, the day of this interview, that the country had volunteered to temporarily suspend the rollout of the Johnson & Johnson vaccine. The decision was made following the advice of the Food and Drug Administration in the United States, which had picked up that six of the 6.6 million people inoculated with this vaccine had developed “unusual” blood clots. So far, only health workers have been inoculated in South Africa, while citizens who are 60 years or older can now register online to receive the vaccine. The sluggish pace of the rollout has been heavily criticised.
Another challenge has been the slow rate of testing. It is a serious challenge as countries that have managed the coronavirus infection rate well are those that have tested for it vigorously. South Africa had conducted slightly more than 10.4 million tests by 21 April, in a country of around 50 million people. Mlisana is the perfect person to ask about this as she chaired the subcommittee that dealt with testing and is the executive manager of academic affairs, research and quality assurance at the National Health Laboratory Service (NHLS).
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“Whatever testing that comes into the lab [NHLS] is directed and driven by the public health facilities. This is what we have been saying to the Department of Health, that it’s really the hospitals, clinics or whatever processes that are driving the number of tests, including screening and community testing,” said Mlisana.
“We cannot, as a lab, go out there and get people tested. That has been a challenge, in that we are dependent on what gets submitted to us for testing. The question has been, if you are looking at all the provinces, there has been an outcry that Limpopo has just not been testing enough. I don’t fully understand why that is so. We have tried our best because we know that one of the key legs of managing the epidemic is in testing. But now if the hospitals are not testing enough, it really becomes a challenge.
“There was a phase where NHLS could not cope with the volumes, but now there are enough resources and technologies to be able to do a lot more testing. Unfortunately, it is beyond the control of the NHLS. In terms of the government’s control, the national government can say, ‘Guys, we need to do more testing,’ but then it depends on the provincial heads and what their stance is on testing. That’s one of the areas where we can definitely improve.”
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Mlisana’s wish, to help her cope with her new role in addition to her other commitments, is an extra 12 hours a day, she said jokingly. Her role differs from Karim’s and is based on where South Africa stands at any given time. Karim had to inform and calm an anxious country that was negotiating uncharted territory. Mlisana has to assure and help regain some of the trust, with the waters now steady but South Africa not out of danger just yet. Understanding of the coronavirus and the habits developed to limit its spread has changed, so the aim is to ensure that people still adhere to those measures and that the vaccination rollout is a success.
Her tone when she speaks is assuring, making complicated scientific processes accessible to laypeople. She is, however, reluctant to be the “face” of the response to this pandemic. “I said to a group that I was introducing myself to, ‘My name is Koleka Mlisana, I am not Professor Abdool Karim Salim. That must be very clear.’ I know Slim very well, I am friends with him and have known him for a very long time. I know what he is capable of and he has done a sterling job. That’s him. This is me.
“I am different, and how we are going to manage this is going to be different. I am not a person who wants to always be out there, doing interviews and whatever. I need to see how we are going to change that. I don’t know whether it’s going to be doable or not because for me, the ministerial advisory committee is a group of very able people and experts in their fields. My take is, let’s see who is an expert in what area and how do we make sure that those individuals come out and speak on behalf of the committee. It’s big shoes that I am getting into, but the nation must understand that we are different and they mustn’t expect me to be an Abdool Karim, because I am not.”