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Scientific Evidence Matters: South Africa Must Lead the Continent in Harm Reduction
For the past nine years, I had the privilege of being the Science Advisor to three New Zealand Prime Ministers. This involved addressing domestic and international challenges around how science feeds-in to policy-making that impacts the daily lives of every man, woman and child. Examples include vaccination and immunisations, tackling youth obesity and advising on legal and illicit drug use. These 'life and death' issues have resonance for countries worldwide. Yet, my day-to-day interactions with Pacific Island and ASEAN countries, in particular, were flanked by critical relations with the South African science system. As Africa's leader in policy innovation, an undercurrent of 'doing the right thing' with empathy for people stands out. This must continue. The evidence shows that a draconian, criminalisation approach to public health does more harm than good.
I have shared multiple closed and public platforms with South African leaders and intellectuals. One of my career highlights was receiving the inaugural American Association for the Advancement of Science (AAAS) Science Diplomacy Award in 2015, to be followed by then Minister for Science, Naledi Pandor in 2016. We have all been impressed by the carrier-wave effect her creation of 'Science Forum South Africa' has had in igniting conversations about science, society, education, youth, innovation and diplomacy across Africa. I again saw the green shoots of this outward-looking vision last week when meeting with the Academy of Science, the National Advisory Council on Innovation; and the Diplomatic Training and International School of the Department of International Relations and Cooperation.
South African scientists are in demand too. In June, Dr Albert S. van Jaarsveld was appointed Director General and CEO of the Vienna-based International Institute for Applied Systems Analysis. In July, Prof. Daya Reddy was elected as first President of the Paris-based International Science Council. In July also, Cape Town was announced as host of the World Science Forum 2021. These and other international recognitions showcase how South Africa's scientific reputation is on the rise.
I am a firm believer in the value of independent science advice in complex decision making. These are issues where scientific evidence and public or political values do not align. With circa fifty ministers, eleven official languages and a dizying array of public, private and civil society influencers, its easy to see how South Africa's elected representatives have particularly challenging roles. Policy-making is ultimately about choices between options that involve different tradeoffs affecting different stakeholders in different ways. It is entirely proper that in choosing between possbile options, policy-makers weigh up societal and political values – fiscal, diplomatic, ideological and religious, to name but a few – and they will always have an imminent electoral risk in mind.
People's worldviews are reinforced by the information bubbles they now live in, which means that many only listen to people and media whose views align with their own inherent biases and ideologies. People want categorical answers. Science can rarely provide them. There is always a danger that even the best available science can be ignored. When that happens, it is more likely that policy outcomes will not serve the citizen well.
But, as expectations on policy processes grow, science and robust evidence have increasingly essential roles to play. Science has multiple disciplines defined by a set of processes designed to find as-reliable-as-possible knowledge about the world within and beyond us. And social media and other non-neutral media can be effectively used to manipulate opinion, often by claiming 'facts' and 'truths' even when they are neither facts nor truths. Such manipulation not only undermines democracy, but also undermines society's ability to use knowledge to make progress.
When used to inform the policy-maker and the citizen, science can identify what options really exist and what are the likley consequences of each. Of course, science is always provisional, but that should not be an excuse for ignoring it. Nor should it be dismissed simply because it does not fit with prior biases or fixed views. But science can reduce the heat in a debate that can otherwise be drowned in polemical rhetoric and allow decision-makers to work through complex and seemingly irresolvable issues.
One of the most difficult areas of public policy is harm reduction science aimed at reducing the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs. What we often see is that the science will be cherry-picked or intepretted to advance opposing arguments. Civil society and industry actors are well drilled in this. In turn, this can reinforce firm convictions about the validity or otherwise of the science. If a government wants it, it is called an input. If they do not, it is called lobbying.
All countries recognise the importance of vaccination and immunisations. Yet the 'anti-vax' movement seems impossible to eradicate – it is supported by false science, rejected by every robust health authority and scientific academy, and yet is promoted by celebrities and other non-experts. There are side effects to vaccination but the societal sense of precaution and risk assessment has balanced those risks as small in relation to the consequences of pandemic illnesses vaccination is designed to eradicate. (As a young paediatrician, I remember well dealing with young children with irreversible brain damage or pneumonias from measles. Diptheria and polio are not diseases we want to face again).
The harm from smoking tobacco is well understood. 75% of smokers may die from related diseases. South Africa is losing circa 1000 citizens a week. It is universally accepted that smoking kills. Vaping we are not yet sure about, hence the intense debates worldwide. Vaping clearly reduces exposure to cancer-causing chemicals. And any reduction in carcinogen exposure is clearly beneficial to the individual. Some argue that it may create a gateway to smoking. The long term safety of some of the chemcials used in vaping systems is unclear and requires urgent regulation. It is concerning that tobacco and alcohol companies are targetting Africa and Asia as their market opportunities decline elsewhere. A further confounder is that vaping manufacturers are often the very tobacco companies creating the problem in the first place. A policy dilemma is apparent.
On balance, the arguments for vaping have been accepted by many reputable scientific authorities and governments are better informed. New Zealand, for example, reversed its outright ban while Public Health England advocates that vaping technologies be given out for free to smokers. Yet, there remain too many unknowns that only independent science can resolve. Africa too must invest in and share this research in global partnerships.
Countries are debating whether to address drug addiction through a criminal or a health lens. Needle exchange, while it may facilitate intravenous drug use, reduces the rates of HIV-AIDS and hepatitis in user communities. Some countries deal with individual drug use as a health and addiction issue, moving to legalise marijuana either broadly or for apparent medical reasons and restricting criminal approaches to dealers and importers. Others see drug use as a zero tolerance criminal matter clogging their justice systems, while not addressing root issues. But there are layers of complexity here. Opiates, metamphetmaine and cannabinoids all have different market dynamics and biological effects. We know all too well the side effects of marijuana use on the adolescent brain, yet advocates for decrimilaisation provide 'evidence' minimising this. The dangers of synthetics, very high potency leafs, contaminations, and the social costs of criminalisation are all powerful arguments. What is clear is that it is time to challenge the way societies view drugs and those who use them with greater emphasis on justice, dignity and human rights.
My fundamental belief is that science alone cannot decide. 'Evidence' is one among many types of advice that inform the decision-making process. Above all, the meaning of risk varies. Risk to a politican is very different to that of a citizen. Key determinants such as information selection, confirmation bias, pluralistic ignorance, extremism, polarisation etc. require greater understanding and attention. Others include language, race, ethical values, cultures, politics and the impact any decision can have on other areas of policy. How to balance risk and precaution is a recurrent theme for politicans and the leaders of their national science systems. That said, the scientific community must stand behind its evidence and shout up when policy-makers cleary get it wrong and lives matter. And while I have used examples of harm reduction, the interaction betwen science, societal values, concepts of risk and precaution and politics pervade every aspect of a democratic society. Whether it is dealing with climate change, artifical intelligence or tackling obesity, in every case both the natural and social sciences working together have an importent role to play.
Better decisons are more likely when science is properly used. In recent years, South Africa has understood and embraced this. It cannot drop the ball now. The parallel reputation-rise of South African science has been impressive to see.
Sir Peter Gluckman
Chair, International Network for Government Science Advice
Former Chief Science Adviser to the Prime Minister of New Zealand