Differences of opinion vital 'to arriving at the best advice': Prof Abdool Karim
IN FULL: Professor Salim S. Abdool Karim's statement in response to Professor Glenda Gray’s comments on the Ministerial Advisory Committee (MAC) on Covid-19, which advises the government on its response to the pandemic:
The MAC comprises of 51 individuals from academic backgrounds, health services, and government institutions. The MAC receives questions and queries from the minister or the director-general, collects the necessary and available evidence, and puts forward a set of recommendations based on the evidence collected. More recently, the MAC has also been generating its own questions for advisories to the department of health.
The MAC is comprised of four committees: research (Prof Glenda Gray), public health (Prof Shabir Madhi), clinical (Prof Marc Mendelson), and laboratory (Prof Koleka Mlisana). The committees of the MAC meet as needed, usually a few times a week. The entire MAC of 51 members, meets about once a week. The minister, deputy minister and director-general are invited to attend MAC meetings regularly. At the meetings they attend, each of the four MAC committee chairs provides a report back with a set of slides. This provides the department of health leadership with an overview of all the advisories provided by the MAC. MAC members have the opportunity to share their views and interact with the minister, deputy minister and director-general at these meetings.
To date, the MAC has submitted about 50 advisories to the department of health ranging from clinical guidelines to advice on prevention strategies; note that some advisories are revisions or adjustments to past advisories based on new evidence or new questions.
To the best of my knowledge, none of the advisories submitted to date have been rejected by the department of health. In addition, the MAC has been working on advisories over the last several days related to 10 issues, including the easing of the lockdown and the alert level regulations. A full list detailing all advisories in various stages is attached.
With regards to MAC advice to the department of health relating to the ending of the lockdown, Prof Salim Abdool Karim publicly made a general comment on the need for a systematic phasing out of the lockdown.
In a public briefing on April 13, Prof Abdool Karim made a comment stating: “Abrupt return may increase spread — plan the systematic easing of the lockdown over several days: stepwise approach to reduce risk of rapid transmission taking economic imperatives and social disruption into consideration.” This presentation was also subsequently shared with the entire MAC membership and no MAC member commented in difference with this sentence in the presentation.
My recommendation on the phased easing of the lockdown was based at that time on his knowledge that countries were adopting a phased approach to ending the lockdown to avoid rebound in infections. Phased ending of lockdowns are now widely practised, though the manner and speed of the phasing out process varies substantially. Past that initial advice, the MAC was not asked to provide more specific recommendations on how the lockdown should be eased or ended.
On Tuesday May 12, the over-arching chair of the MAC Prof Abdool Karim convened a meeting with the committee chairs specifically to share his concerns about the regulations relating to the lockdown levels.
All the chairs concurred and expressed their concerns about the regulations at the meeting. Prof Glenda Gray, together with the assistance of Prof Marc Mendelson, were tasked with preparing an advisory on the MAC’s concerns about regulations, including the 3 regulations that were published that morning relating to clothing, purchasing of cars, and small businesses.
The draft of this regulations advisory was submitted by Prof Gray late on May 15 for tabling at next week’s MAC meeting for approval and then onward submission to the department of health.
Differences of opinion within the MAC are not only important, but are fundamental to arriving at the best advice. Many different views are encouraged in the MAC. These differences ensure that all points of view are considered and that a variety of opinions are presented.
All advisories are made as a result of the debate within the committee where the available scientific evidence is considered before a formal recommendation is made. It is then up to the department of health to determine if these advisories are adopted and implemented.
Further, members of the MAC are welcome to share their personal views, both in MAC meetings and publicly. However, the official views of the MAC are conveyed in its advisories and to the media through the chair.