Schoub’s book reveals pandemic’s prize fighter: the NICD

Professor Barry Schoub, most recently at the forefront of South Africa’s fight against the COVID-19 pandemic, was behind the establishment of the National Institute for Communicable Diseases (NICD). He has now written a book titled, Fighting an Invisible Enemy: The Story of the National Institute for Communicable Diseases. The SA Jewish Report speaks to him.

What inspired you to write this book?

Three motivations. First, since time immemorial, the public has been frightened, overawed, and even bewitched by the great plagues of yesteryear. The recent devastating COVID-19 pandemic similarly brought back the fascination and fear. It was therefore now an appropriate time to talk about the country’s NICD.

Second, the colourful history of the NICD itself makes for a good read while also being a needed historical document.

Last and most importantly, there was an important public health motivation – communication with the public. Community buy-in and support are crucial for the control of outbreaks.

What’s your relationship with the NICD? What does it mean to you?

In November 1995, as director of its predecessor institute, the National Institute for Virology (NIV), I started urging the department of health to establish an NICD. This became a reality with the advent of the National Health Laboratory Service (NHLS), an important component of the new democratic government’s health plan.

Accordingly, Dr Nicholas Crisp, currently a deputy director-general of health, and I sat together for several months in the late 1990s planning and assembling the nuts and bolts of both the NHLS and the NICD. Both were born in early 2002, and I was appointed founding executive director of the NICD. I retired in 2011.

Having been the “father” of that worthy institute, I’ve watched with considerable pride how the NICD has grown into a major global player in the control of epidemics and pandemics.

Why is this institute so important to South Africa?

Pandemics and epidemics of infectious diseases still feature among the 10 biggest threats to the future of humanity, according to think tanks such as the World Economic Forum. In South Africa and on the African continent, infectious diseases are still the foremost cause of death and disability.

The NICD therefore has a special responsibility to be a sentinel for the early detection of impending outbreaks, to monitor the spread of infectious diseases, and to chart the effectiveness of control measures. Accordingly, NICD laboratories were appointed by the World Health Organization (WHO) to serve as collaborating and regional reference centres, spanning the full spectrum of infectious diseases.

What are its most important findings?

Suffice it to say that many hundreds of publications in prestigious highly cited international scientific publications attest to the quality of the research.

What would you say has been its most notable work over the past 10 years?

As one example of notable work, I could mention the Special Pathogens Unit. It operates the only maximum-security laboratory on the continent, and plays a key role in outbreaks of Viral Haemorrhagic Fever in Africa and further afield. In addition to laboratory diagnostic support, expeditionary teams assist in some of the most inhospitable places in the world.

These outbreaks have been fearsome in their virulence. For example, 82% mortality in the 1998 Marburg outbreak in Durba in the Democratic Republic of the Congo; and 88% in Uige in Angola in 2005.

What are you most proud of?

The major responsibility of the institute – the surveillance and monitoring of communicable diseases – developed from humble beginnings.

While the NICD commenced life with strong laboratory support from its two predecessor institutions, the NIV and the SAIMR (the South African Institute for Medical Research), the critical epidemiology and surveillance responsibility was created de novo (from the beginning). It started off as a simple viral watch programme with a retired general practitioner and two nursing sisters tracking influenza within a network of local collaborating doctors and clinics.

Today, the epidemiology of infectious diseases in the country and beyond is an extensive and highly complex operation employing, inter alia, sophisticated mathematical modelling tools for alerting, charting, and measuring outbreaks and epidemics.

Importantly, there’s regular communication with the profession; the authorities, locally and internationally; and the public.

What did the NICD do during the COVID-19 pandemic?

The years of the COVID-19 pandemic consumed much of the resources of public health institutions throughout the world, and the NICD was no exception.

Fortunately, the NICD had built up particularly strong molecular and immunological capabilities from AIDS research programmes. Within a few weeks of the first case landing in South Africa in March 2020, the institute had developed its own in-house molecular diagnostic test, which enabled the spread of the infection to be studied early on.

The outbreak was charted using surveillance tools such as clinical specimens and monitoring wastewater for virus load in the community and as an early warning signal of the emergence of new variants and subvariants. Thus, the NICD, as part of the Network for Genomic Surveillance consortium, alerted the world to the advent of two of the five variants of SARS-CoV-2 – the Beta variant in December 2020, and the current Omicron variant in November 2021.

While it seems so long ago, what was the NICD’s role in countering HIV-AIDS?

In early 1987, even before HIV had reached South African shores to any significant extent, the Medical Research Council of South Africa established the AIDS Virus Research Unit in the NICD. This unit grew into the largest research unit in the institute.

One of the most important surveillance programmes of the NICD is the annual study of the prevalence of HIV in pregnant persons. The study, involving more than 37 000 pregnant persons from more than 1 500 public health antenatal clinics in all 52 health districts, annually measures the extent of HIV in the South African population. About 30% of these women are found to be HIV positive, making South Africa the country with the largest population of people living with HIV in the world.

Looking back, who are you were most proud of and why?

As I wrote in my dedication to the book, it has been a privilege and a pleasure working with such a magnificent team as the NICD. I’m proud of the entire personnel of the institute, past and present.

What were the toughest issues the NICD faced?

Undoubtedly, the major constraint facing public health institutions like the NICD is financial. Though research programmes are largely funded by local and international sources, the more fundamental financial support takes the form of salaries. It remains a constant challenge to retain qualified scientific staff in a highly competitive environment.

Who have you have written this book for?

The book is primarily for a general audience. It’s not meant to be a scientific text. For that, there’s more than ample biomedical literature. Of course, I anticipate that there will be much interest from members of the medical and allied professions, many of whom have been taught by members of staff of the institute.

What do you want them to take home and why?

A major contribution to the control of outbreaks and pandemics is buy-in and support from the public. This has to be grounded in reliable, scientifically based evidence.

Unfortunately, the potentially malevolent influence of mass communication and a not-always responsible media, what the WHO has dubbed “the infodemic”, has been a serious potential threat to public health. The damage from public hostility is graphically illustrated by the resounding success of the earlier smallpox eradication campaign as against the current frustrating inability to reach the goal of polio eradication.

What are you doing now?

I keep abreast of the ever-expanding scientific/medical literature in my field as I continue to be consulted informally. I have also developed other non-medical interests, probing the fields of religion and philosophy of religion.