PROF Salim Abdool Karim, the newly appointed president of the Medical Research Council (MRC), sweeps into his office exuding energy and beaming from ear to ear, hardly the disposition you’d expect from someone who had less than four hours sleep the night before. His ability to thrive under pressure will stand him in good stead as he seeks to turn around an institute in the doldrums: the MRC’s international reputation has slid, its staff are demotivated, and it is chronically underfunded.
Hand-picked for the job by Health Minister Aaron Motsoaledi, Karim is used to difficult challenges. He was a political activist and medical student at the height of apartheid and went on to become one of the world’s leading HIV researchers, investigating vaginal gels to protect women from infection. His background left him unafraid to talk truth to power.
He was a member of former president ’s scientific AIDS advisory panel, established in 2000 to answer Mbeki’s controversial questions about the disease long after the scientific community had accepted that HIV caused AIDS. He was openly critical of the dissidents who disputed this link and of the very idea that a panel could vote on matters of scientific fact. He was also on the organising committee of the Durban Declaration, a petition signed by leading scientists affirming that HIV causes AIDS to try to counter the damage done by the dissidents.
Three years ago, he co-authored a warts-and-all analysis of the many problems that beset SA’s health landscape, which was published to much acclaim in the prestigious medical journal, the Lancet. The series of papers offered a snapshot of the dismal state of healthcare in SA at the end of former health minister ’s tenure, and is often quoted from by Motsoaledi.
Karim briefed the minister about The Lancet series before it was published, warning him it would not be good news.
"He said: ‘Is it factual?’ I said ‘Yes, everything we say we can back up.’ And he said: ‘That’s what I expect you to write.’ We are just so fortunate to have him as minister, he’s a rare politician who readily acknowledges we have problems and is really prepared to go out there and fix things," Karim says.
There is a long history behind the mutual respect the two men publicly proclaim. They were in the same class at medical school at the University of Natal, along with State Security Minister and Joe Phaahla, CEO of the South African Sports Commission. Motsoaledi twice rejected short-listed candidates for the MRC presidency, eventually asking its board to consider head-hunting Karim.
Karim landed on his career path more by force of circumstance than by choice. His first love was engineering, but although he was accepted at several universities, he couldn’t secure a bursary.
"I come from a very poor family. My father was a clerk in a factory, so I couldn’t afford to go to university. However, I got accepted to go to medical school and I got paid to do it. I had no choice. I spent most of my time as an activist. I went to medical school straight after the 1976 Soweto uprising. You couldn’t be there and ignore the fact that we needed to be part of the process of change. Medicine was a good way to express a social conscience."
Despite the heavy workload and his political activities, he still had time to get a BSc in computer science, which he studied by correspondence through Unisa.
Today, Karim is the director of the Centre for the AIDS Programme of Research in SA (Caprisa) at the University of KwaZulu-Natal, has an editorial hand in several peer review journals, and is a member of advisory bodies to influential institutions such as the Bill and Melinda Gates Foundation and the World Health Organisation. He also holds positions at Columbia University, Cornell University, and the Ragon Institute of Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard.
With so many strings to his bow, how will he find time to lead the troubled MRC?
"I like to multitask. I’ll have the newspaper here, I’ll be working on my computer, and I’ll be watching the TV there. Especially cricket, how I love cricket!" But more to the point, his working day typically starts at 5.30am and ends at 2am the next day. While most South Africans are winding down for the day, he’s just getting going with his US colleagues.
Karim plans to spend half of his time at the MRC’s main campus in Tygerberg, Cape Town, and the balance at Caprisa. He’s characteristically frank about the challenge ahead of him: "My mandate is very simple: to re-establish the MRC as a premier research organisation that can attract top-class candidates when it next advertises my position."
The MRC was without a president for more than two years after Anthony MBewu resigned in October 2009 to take up a position at the Global Forum for Health Research in Geneva. MBewu’s cosy relationship with Tshabalala-Msimang and his dissident views on HIV/AIDS did lasting damage to the MRC’s international reputation, say insiders. The MRC’s Ali Dhansay was appointed acting president after MBewu’s departure, an arrangement that put big decisions on hold, says Karim. His initial assessment of the institution is disheartening: morale is low; facilities are not being maintained properly; the effect of its scientific publications has diminished; and staff seem unaware of each other’s achievements.
"I’ve been asking people: ‘What was the biggest scientific discovery the MRC has made recently?’ And they don’t know. There’s no communication. At Caprisa, if someone publishes in The Lancet or the New England Journal of Medicine, we celebrate, we laud them. The MRC is losing profile. It can’t afford to do this. The taxpayers should be told what we are doing with their money."
The MRC’s budget for 2010-11 ran to R553m, just more than half of it in the form of grants from overseas health research organisations. Ever politically astute, Karim won’t be drawn on the details of a review of the MRC conducted two years ago, which concluded the institution was chronically underfunded, spent too much money on support services for in-house research, and should be answerable to the minister of science and technology rather than health.
The MRC’s board, rather than the executive, needs to respond to the review, he says. He is, however, determined to lift the MRC’s profile and ensure it is at the forefront of the implementation of the National Health Insurance (NHI) plan the government intends to roll out over the next 14 years.
"We should have a dedicated research unit that feeds into the debate — the knowledge-generating engine for the NHI."