The initial Africa Day observance at the University of Cape Town (UCT) held on May 19th went beyond being merely ceremonial—it acted as a strong impetus for contemplation, cohesion, and immediate steps forward.
Organized by the Faculty of Health Sciences’ (FHS) Pan African Health Sciences Forum with the theme “Africa at a Junction: Claiming Control Over Clinical Research and Healthcare for Future Generations,” this gathering was held at the Neuroscience Institute. The conference assembled medical professionals and learners to evaluate the advancements achieved during thirty years of democracy in South Africa, review the present condition of healthcare services, and contemplate future directions.
The conversation was notably relevant due to increasing worries over the viability of healthcare delivery and research, especially with funding reductions for associated initiatives in South Africa by the US government under President Donald Trump’s administration.
During her welcoming speech, Associate Professor Tracey Naledi from the Faculty of Health Sciences emphasized the significance of Africa Day through the lens of Pan-African ideals—unity, fairness, autonomy, and African empowerment. She passionately conveyed that the day isn’t just an occasion to honor achievements; rather, it’s crucial for taking control of our stories, assets, and destinies. “We must celebrate not merely success,” she stated emphatically, “but also regain authority over how we define ourselves, manage our wealth, and shape what lies ahead.”
Professor Naledi emphasized the significant part the faculty plays in strengthening African capability, noting that the Pan African Health Sciences Forum was established to assist this varied community.
In times of pestilence, we chose not to run away. We refused to stay hidden. We decided against isolating ourselves.
Although the present state of healthcare faces significant challenges, numerous achievements can still be acknowledged and celebrated, with ample cause for optimism regarding what lies ahead.
Presenting a keynote address covering the timeline, current state, and looming challenges of HIV and TB initiatives in South Africa, renowned clinician-scientist and global health equality champion Professor Linda-Gail Bekker highlighted the critical importance of these efforts. She emphasized the significant number of lives preserved thus far as well as the tenuous infrastructure supporting such progress.
She stated that when the chronicles of AIDS and the worldwide reaction are documented, our greatest legacy might very likely be that during the pandemic, we chose not to run away, conceal ourselves, or isolate from one another.
An individual and shared expedition
Since 2000, Professor Bekker has been fullysoft-funded, and she has led the UCT Clinical Trials Unit as the principal investigator from 2005 onwards. Her professional life has centered around HIV and TB research. Currently, her team comprises more than 400 specialists such as clinicians, behavioral scientists, lab technicians, pharmacists, data analysts, andcommunityresearchers.
When reflecting on history, Bekker recognized the shortcomings and distressing consequences of political denialism, especially during the initial stages of the HIV crisis in South Africa. She pointed out how the disease—which was initially seen as an issue exclusive to the West—rapidly turned into a widespread epidemic in the 1990s, resulting in countless deaths and highlighting significant societal disparities.
In her address, she recalled Chris Hani’s 1992 prediction of an “epidemic disaster,” which proved sadly accurate. Despite these dire circumstances, forward-thinking South African researchers started mapping out the course of the epidemic. They uncovered how significantly it affected women and noted its increasing prevalence among them. “All around us, people were dying, and our only response was to keep track of the numbers,” she recounted.
Breaking barriers, building solutions
Even within the somber backdrop, the last thirty years have also narrated a tale of scientific perseverance and communal advocacy. By showing that people from Africa were capable of following antiretroviral therapy (ART), along with illustrating how nurses and non-professional advisors could effectively administer healthcare without compromising safety, South Africa’s approach contributed significantly to transforming international standards for treating such conditions.
We witnessed instances of people coming back from the dead, much like Lazarus.
An image shared by Bekker depicted a formerly critically ill staff member who received treatment through ART at a specialized clinic in Gugulethu and managed to survive. She recounted, “There were instances like those seen with Lazarus; people returned from the brink of death.”
She highlighted the interconnected nature of HIV and TB, which have historically been addressed as distinct health issues. She explained that HIV-induced immunosuppression led to a significant surge in TB cases, increasing them sixfold throughout South Africa. Currently, Cape Town alone experiences more TB infections than all of the UK, the US, and Europe collectively.
A triumph at risk
Thanks to both international and national efforts, such as the World Health Organization’s 3×5 campaign (aiming to provide antiretroviral therapy to three million individuals affected by HIV/AIDS in low- and middle-income nations by the close of 2005), along with initiatives like PEPFAR and The Global Fund, South Africa currently supports almost six million people undergoing treatment. On a worldwide scale, thirty million people receive antiretroviral therapy, resulting in twenty-one million lives being saved and restoring longevity across numerous regions on the African continent.
However, these successes are currently at risk.
On January 20, 2025, the freshly sworn-in U.S. administration froze all funds allocated to PEPFAR. By February 27th, numerous USAID cooperative agreements had been canceled. The management of PEPFAR shifted to the State Department, resulting in an unexpected reduction of its $460 million yearly budget specifically designated for South Africa.
The repercussions were swift. This led to staff layoffs, program cancellations, and the suspension of numerous active HIV and TB clinical studies, encompassing several focused on preventive measures and therapeutic advancements.
An endangered legacy
In the last three decades, South Africa has developed one of the globe’s most robust clinical research frameworks for HIV and TB, covering everything from initial human tests to extensive community-based application studies. The country’s organizations stand toe-to-toe with leading worldwide entities in terms of research productivity, and their findings have significantly influenced international approaches to treatment and prevention.
According to an analysis conducted in 2019, South Africa placed third worldwide for peer-reviewed publications on HIV/TB, following the United States and the United Kingdom, but topped the charts when considering citation count per article. The University of Cape Town (UCT) was at the forefront of this achievement.
However, that ecosystem, as Bekker points out, is currently unstable. “We have grown reliant on federal U.S. funds, and support has been withdrawn,” he says.
She stated that without a substitute for PEPFAR, South Africa might witness more than 500,000 additional HIV infections along with an equivalent number of fatalities in the upcoming years, resulting in substantial losses both economically and in terms of human life.
A call to action
Bekker asserted that the future should be characterized by innovation, strong political dedication, and an enhanced focus on prevention. “Relying solely on treatment is not enough; prevention needs to take center stage. We possess the necessary means,” he stated firmly.
From injectable PrEP to tailored service distribution and community-led care approaches, she feels that solutions are attainable. However, the most significant hurdle continues to be reaching the “hardest to reach” individuals—those marginalized due to stigma, legal persecution, and systemic disparities.
The panelists, who stepped onto the stage following her presentation, concurred.
Professor Digby Warner, who leads the Institute of Infectious Disease and Molecular Medicine (IDM), pointed out that crises often bring opportunities, emphasizing the need to avoid reverting to obsolete systems. He stated, “We acknowledge…the dependencies and inequalities we criticized half a year ago are not always elements we wish to restart.”
He advocated for adopting more thoughtful and strategic methods moving ahead: “There’s room for improvement in how we facilitate research within this framework. The true strength lies in the convergence of communicable and non-communicable diseases along with various societal elements. It’s crucial that we seize this opportunity to alter our community’s encounter with these health issues.”
By coming together…if we genuinely focus on fostering South-South collaborations…we have the potential to achieve greater success.
In reflecting on local capabilities, Professor Mashiko Setshedi, who leads the Department of Medicine at UCT, remarked: “The pandemic had a similar effect; surprisingly, we managed to conduct research aimed at developing vaccines—a first—but we accomplished this.” Emphasizing collaborative strength, she noted: “When we unite… when we focus on South-South partnerships… our potential increases significantly. We have much to anticipate as we aim higher than what was previously considered achievable.”
The CEO of the South African Medical Research Council, Professor Ntobeko Ntusi, shared similar views and characterized the present funding crisis as a dual-edged situation: “This is a time when our viewpoint truly counts for something. Financial support has been pulled back, research operations have faced disruptions, people are losing jobs, and postgraduate students are missing out on valuable learning experiences. As a result, we can anticipate increased suffering and higher death rates among numerous patients.”
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