Frightening disease outbreaks are nothing new for SA's pointsman in the coronavirus war

“Courage — not complacency — is our need today. Leadership — not salesmanship. And the only valid test of leadership is the ability to lead, and lead vigorously.” These words from the late US president John F Kennedy, spoken 60 years ago, still ring true now as SA and the rest of the world respond to the coronavirus pandemic.

SA has seen a sharp increase in the number of cases since members of a tourist group returning from Italy tested positive.

With President Cyril Ramaphosa at the helm of the national response, the minister of health, Zweli Mkhize, is the de facto chief of operations, co-ordinating efforts to address this pandemic.

Mkhize is a politician whose public profile (outside the ANC) has largely been limited to KwaZulu-Natal, where he was health MEC from 1994 to 2004, making him the longest-serving health MEC in SA.

He would later become finance MEC (2004-2009) and then premier. After the 2012 ANC national conference, he moved to the party's Johannesburg headquarters as treasurer- general — a relatively low-profile post within the party top six.

As SA scales up its response to Covid-19, the question is, can Mkhize co-ordinate and lead SA out of this major global crisis?

Past history, proven expertise and experience help us to gauge a person's ability to face the task ahead. So, what is Mkhize's track record in public health, and outbreak response in particular?

After the 1994 elections, Mkhize became one of only two ANC MECs in KwaZulu-Natal, where the IFP had won a majority. As a young reporter in the province with an interest in the transformation of public health in the 1990s (I later served an eight-year stint as a spokesperson for the national health department), I had a direct interest in observing Mkhize's public health career.

He drove a massive clinic-building programme, expanding health infrastructure across KwaZulu-Natal, to help accommodate the free health care announced by Nelson Mandela for pregnant women and children younger than six, and the primary health care delivery approach adopted by the ANC.

The first major disease outbreak Mkhize had to deal with was a surge in malaria, which peaked with 63,000 cases in the Lubombo region, bordering Mozambique and Eswatini, in 2000. About 67% of those cases were in KwaZulu-Natal.

In addition to environmental factors, the sharp increase in malaria was driven by the resistance that mosquitos had developed to the insecticide being used against them, and by the limitations of the treatment regime.

Mkhize led the conversation with epidemiologists and other health experts to find the solution. Ultimately, the drug policy was changed from monotherapy to artemisinin combination therapy, and permission was granted to spray DDT (dichloro-diphenyl-trichloroethane), the use of which had been restricted by the World Health Organisation (WHO) 30 years earlier.

Mkhize instructed provincial health teams to spray each and every building in the remote rural communities of northern KwaZulu-Natal, in a cross-border operation with Mozambique and Eswatini. The teams also distributed information about symptoms and the need to seek early medical attention.

Five years later, in the 2005 season, the number of cases dropped to 7,700. Deaths from malaria in KwaZulu-Natal plunged 98.5%, from 340 in 2000 to five in 2010.

Following the success of the anti-malaria campaign, the WHO said in 2006 it now believed DDT should be used for indoor residual spraying, “not only in epidemic areas but also in areas with constant and high malaria transmission, including throughout Africa”.

At about the same time that malaria erupted, KwaZulu-Natal was also hit by an outbreak of cholera in rural communities with limited access to water and sanitation.

The disease was peaking during the December holidays, when migrant workers return home and people share food and drink in traditional ceremonies. With limited media penetration to drive awareness and a stretched health infrastructure, it was feared that cholera would take a heavy toll.

A joint operations centre (JOC) was set up, locally led by Mkhize. The JOC's efforts included spreading the prevention and treatment message via the Ukhozi FM radio channel, deploying tankers to deliver potable water, streamlining laboratory services to deliver quick diagnoses, and setting up dedicated cholera wards to prevent further contamination.

In 2004, David Hemson, research director at the Human Sciences Research Council, wrote that 114,000 people contracted cholera over a 13-month period but just 260 of them died, “a fairly low level of mortality (at 0.31% of those infected)".

From the experience in Asia and Europe, it is clear that the number of coronavirus infections in SA is going to increase over the coming weeks. Mkhize acknowledges this in a Business Day article this week, saying SA can expect an “explosive” rise in cases.

It is going to require strong leadership across all sectors (including business) to turn the coronavirus situation around. This could be where Mkhize's ability to co-ordinate the work of multiple experts, government departments and non-governmental organisations is crucial in keeping everyone focused on a common goal.

The way he has stepped up to the challenge so far, his agile and open communication with the public and readiness to consult a range of stakeholders, demonstrate what we can expect from him going into this crisis.

As he said this week: “We need to move into higher gear. We are determined to take hard decisions if need be. We cannot rule out a need in the future to impose a state of emergency.”

Hard decisions lie ahead for all of us.

• Mngadi is a former Natal Witness reporter and health ministry spokesperson. He is currently a corporate affairs executive in the private sector