A. ASSAf Consensus Study Reports
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In order for ASSAf to fulfil its science advisory role regarding key challenges facing the nation, a variety of consensus and assessment studies are undertaken. Activities are aligned closely with government’s strategic goals. The in-depth Consensus Study Reports are either commissioned by an external funder or generated by a Standing Committee on a specific topic. ASSAf has Standing Committees on Health; Scholarly Publishing in South Africa; Science, Technology, Engineering and Mathematics (STEM) Education; Biosafety and Biosecurity; Humanities; and Science for the Reduction of Poverty and Inequality.
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Item Scholarly Books: Their Production, Use and Evaluation in South Africa Today(Academy of Science of South Africa, 2009) Academy of Science of South Africa (ASSAf);This consensus study addresses the world of book publishing in and from South Africa. It explores the special scholarly virtues of these works and the contributions they make to ‘the literature’ and to the general advancement of scholarship and science. It sets out to do this in a form that will be useful to practitioners and policy-makers alike, answering the many questions that have arisen in relation to such issues as optimal research practice, training, planning and resourcing.Item HIV/AIDS, TB and Nutrition: Scientific Inquiry into the Nutritional Influences on Human Immunity with Special Reference to HIV Infection and Active TB in South Africa(Academy of Science of South Africa, 2007) Academy of Science of South Africa (ASSAf)The availability of highly effective drugs to control HIV/AIDS and cure tuberculosis has tended to downplay the potential benefits that may accompany appropriate supportive measures, designed to complement or precede pharmacotherapy, to arrest progression from infection to disease (TB), or to delay the rate of progression of the earlier phases of the illness, before specific medicinal interventions are indicated (HIV). Nutritional support is one such potentially valuable measure. Clearly the clinical efficacy of nutritional intervention is likely to be dependent on the extent to which individual infected subjects suffer from functionally significant nutritional deficiencies prior to nutritional intervention. The same argument is generally pertinent to interventions at population level – populations of infected subjects with a high prevalence of nutritional deficiency, such as those in developing countries, are more likely to benefit from health policies aimed at eradicating or diminishing nutritional deficiencies than are populations in developed countries, from where much of the reported research has emanated. It is important to bear in mind that the pre-antibiotic phase of dealing with TB was characterized by intense concentration on strengthening the immune defenses of infected subjects with diets, improved and altered environmental conditions and every other conceivably helpful measure. After the discovery of effective drugs, this aspect of TB therapy quickly became secondary and largely uncontroversial. Because HIV infection cannot be cured but only controlled, with drugs being applied at particular, serious stages of progressive disease (according to current guidelines, at least) the emphasis in the management of infected people during the phases prior to drug administration is still on general, non-pharmacological support, especially as for many reasons it is highly desirable to postpone the introduction of specific antiretroviral therapy for as long as possible. This background has motivated the current study, which has analyzed the relevant scientific literature, concentrating on regionally relevant studies, with a view to providing the best possible, evidence-based advice for South African policymakers. The over-arching conclusion from this analysis is that there is a lamentable paucity of relevant, solid data on which to base sound policies for this country. Recognizing the dire need to deal optimally, right now, with an existing health crisis, this study has evaluated the current nutritional guidelines from the World Health Organization, the national Department of Health, and the Southern African HIV/AIDS Clinicians Society, in the light of what scientific evidence is available. Broadly, these guidelines are endorsed in the current analysis as being generally close to the best possible in the prevailing circumstances. The study, having identified serious gaps in our knowledge, has compiled a set of critical research questions, guided by evolving understanding of the relevant basic science. The panel urges that the answering of these questions should be given high priority by research policy makers in the hope that the insights thereby gained will provide the kind of solid evidence on which refined policies for the practice of healthcare can safely and effectively be based in future.Item Report on a Strategic Approach to Research Publishing in South Africa(Academy of Science of South Africa, 2006) Academy of Science of South Africa (ASSAf)Two strands of influence have affected the publication of local scholarly journals in South Africa in the recent past. The first of these was the establishment of the Bureau of Scientific Publications that subsidized the publication of a number of journals that had been established during the 20th century. The ‘Bureau journals’ were an attempt to foster academic publication in South Africa and to make their products available to an international readership – quality of material was to be coupled to quality of production. In this respect the establishment of the Bureau was mimicking a similar development in Australia and could be seen as a mechanism for fostering home-grown talent. The second influence was a new mechanism of funding universities, which rewarded them directly for the academic publications that they produced. Both of these influences had a significant impact on the development of local journals, the behaviour of individuals, the financial sustainability of learned societies that produced the journals, and the institutions that received the ‘output’ subsidy. The Bureau was recently closed, with only one journal, The South Africa Journal of Science, continuing to receive support through the Academy of Science of South Africa on the basis of its international impact. The funding for ‘outputs’ of the tertiary institutions has continued, although in a modified form that includes a reward for completed masters and doctoral degrees. These developments raised two related questions. The first was whether it was appropriate for the state to support the publication of (some) learned journals in the interest of fostering intellectual exchange. The second question was whether all of the articles, published in journals recognized for the output subsidy of universities, deserved to receive recognition, in view of the wide variation in quality of the material produced. The Academy was commissioned in 2001 in this context by the Department of Arts, Culture, Science and Technology (now the Department of Science and Technology) to undertake a study to address these two questions, with a view to making recommendations for the optimal development of policy in the future. The effect of globalization on knowledge exchange, which is mediated very largely through scientific journals being published in English, and having their origins in Europe and North America, has resulted in the neglect of regional journals. It has also led to the development of benchmarks based on bibliometric analysis of publication patterns that has resulted in global ranking of tertiary institutions. These trends are being countered in the African context, with its relatively neglected tertiary sector, by a need that is expressed by the African Academies of Science that are members of the Network of African Scientific Academies (NASAC), to consider the publication of high-quality journals that report work of significance to African scientists. The degree to which such a project is feasible, and whether it could be successfully implemented both in South Africa and elsewhere on the continent, needs to be explored after the release of this report. Although the report was prepared at the request of, and with funding from the Department of Science and Technology, in order amongst other matters to address specific questions that had been raised about the subsidy for scholarly outputs, its potential impact both in understanding international trends in scholarly knowledge production and in giving guidance to those who would like to foster the publication of indigenous journals, will be great if careful attention is given to the recommendations that are contained in this study. The report was developed and has been guided to a successful conclusion by Prof Wieland Gevers who initiated it during his tenure as President of the Academy and has now brought it to fruition as the Academy’s Executive Officer, with the invaluable assistance of Dr Xola Mati as study director. He and the authors of the various chapters are thanked for the care and attention with which they have produced a seminal analysis of South African publication patterns. They will receive their reward in full measure through the impact that this report will have on the further development of the National System of Innovation.Item Revitalising Clinical Research in South Africa(Academy of Science of South Africa, 2009) Academy of Science of South Africa (ASSAf)Clinical research in a developing country like South Africa contributes to health care at all levels by identifying the causes of problems, facilitating diagnosis, improving the efficiency and effectiveness of care, and promoting good policy-making. It also supports the training of competent health professionals of all kinds, and contributes to global knowledge about locally, as well as generally, prevalent diseases in terms of prevention and treatment. The key narrative of clinical research in South Africa over the last two decades has been that of a largely unplanned, but cumulative, disinvestment in publicly funded programmes, resulting from the withdrawal of the health departments of provincial governments from this sector (academic hospitals are now funded for service functions only), the absence of discounts for research tests from the business model of the National Health Laboratory Service (NHLS), chronic underfunding of the Medical Research Council (MRC) despite its obviously important mandate for maintaining and developing medical/ clinical research capacity in the country, and the lack of funding streams to universities that might in principle have been applied to meet the overall shortfall in support. These intersecting developments are a kind of ’elephant in the room’, well known to all participants, but very poorly documented. Tertiary service units struggle to remain active in research, and to translate their expertise into improved health service. As a result, many clinical researchers have been left with no option but to turn to the pharmaceutical industry for the funding of those clinical trials in which the companies concerned have an interest, or to international donors who conduct large-scale, short-to medium-term, projects in South Africa, with local researchers drawn into international teams, often led by outsiders. The pharmaceutical investment is directed predominantly at the profitable areas of chronic diseases of lifestyle, mental illness and allergy, while most of the external donor funding is directed at the serious local HIV and TB pandemics. Local and international clinical conference activity has accordingly begun to reflect the agendas of donors and industry. There is little likelihood that continuation of the present situation is compatible with rebuilding and sustaining solid research capacity in the clinical domain, nor can the ideal of well-coordinated state support for a health system, built on the ‘intelligence’ of good clinical research, ever be realised. The serious decline in clinical research activity and capacity has prompted this study by ASSAf (http://www.assaf.org.za) in order to make recommendations on the overall revitalisation of clinical research in the country within the broad paradigm of essential national health research. An additional stimulus is the emphasis of government in its ten-year science and technology plan on the development of new medicines and other biologically useful agents (‘farmer to pharma’).