Director’s report
On the 14th November 1953, the laboratories of the Poliomyelitis Research Foundation (PRF) were opened by the then Minister of Health, Mr A.J.A.R van Rhijn. The Poliomyelitis Research Foundation then evolved into the National Institute for Virology (NIV) in April 1976 and subsequently the National Institute for Communicable Diseases (NICD) in January 2002 To commemorate this 50th anniversary a special academic day was held on 12 November 2003. In addition to presentations of the contemporary research activities of the Institute and guest presentations by Dr James W LeDuc, Director: Division of Viral and Rickettsial Diseases at the Centers for Disease Control and Prevention (CDC), USA and Dr David Heymann, formerly Executive Director: Communicable Diseases, WHO and recently appointed to head the WHO Global Polio Eradication program, a historical look-back at the early origins of the Institute and its subsequent evolution to the present NICD was presented. With the global polio eradication programme drawing close to its goal of certification of a world free of the virus by 2005, it is as well on the 50th anniversary of the NICD, to reflect on the early beginnings of the Institute which was born as a direct result of poliomyelitis.
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The story of the NICD began in 1948 and its early beginnings are chronicled in the book “The History of the Poliomyelitis Research Foundation” by Prof James Gear, published by the Poliomyelitis Research Foundation. South Africa, in common with a number of countries throughout the world, including the United States, suffered from particularly severe outbreaks of poliomyelitis which swept through the entire country with several thousand cases and several hundred deaths. Poliomyelitis was in those days indeed a dreaded disease against which the population had little protection. Following the 1948 epidemic the Poliomyelitis Research Appeal was launched by the then Mayoress of Johannesburg, Mrs Evelyn Gordon. The appeal not only embraced South Africa, but was also supported by communities as far as Kenya. However, the appeal for funds and the drive to develop a polio vaccine was not without its controversies. From the start there was strenuous opposition from highly placed sources. The Secretary of Health of Union Health Department, Dr George Gale, opposed the Poliomyelitis Research Appeal and no support was forthcoming from the Government of the day. Sir Basil Schonland, president of the CSIR enlisted the help of Sir Edward Mellanby, Secretary of the British MRC to evaluate the appeal. Sir Edward, in consultation with British virologists, called the appeal for funds to develop a vaccine “intellectual dishonesty”. In their opinion there was no possibility of developing a vaccine against poliomyelitis in the foreseeable future.
Nevertheless, over half a million pounds were collected which enabled the laboratories to be built and commissioned in 1953 under its first director, Professor James Gear. The first batches of vaccine made in these laboratories were ready for use in 1955 – amongst the first used for human immunization in the world.
They were initially tested in twelve children of members of staff of the Institute, including Prof James Gear’s sons. Vaccination was not without controversy. The South African Medical Journal in September 1955 published the following letter from the Border Branch of the Medical Association of South Africa which was subsequently reprinted in the lay press and received widespread publicity:- “Sir, the East London division of the Border Branch of the MASA, at a recent meeting unanimously decided to ask you to make the following facts public re the present position of polio in this country. The Institute of Polio Research – to which the public of the Union of SA has donated £600,000 – has produced a vaccine which the Union Health Dept., - without any trial on humans and without any knowledge at all of long term effects or the length of immunity conferred – has decided to use in mass vaccination. Without any consultation with, or information to, the medical profession, the department is almost stampeding the public into having their children vaccinated with a vaccine the effects of which – and this is admitted – may even be harmful and dangerous”.
“The gross mishandling of the whole situation and the deliberate withholding of information to the medical profession has created a set of circumstances which have thrown grave doubts on the vaccine and has decided the local body of medical men to advise their patients not to submit to vaccination with a vaccine the effects of which are questionable.”
An acrimonious exchange of correspondence took place between Prof Gear and Dr Morris Shapiro, later Director of the South African Blood Transfusion Service and Dr Hillel Shapiro, Editor of the South African Medical Journal and Medical Proceedings, who both vehemently opposed the administration of polio vaccine to children. Nevertheless by 1958 the PRF was able to vaccinate 750,000 individuals with formalin inactivated polio vaccine and in the following year the incidence of polio dropped sharply. At the same time, work in the PRF laboratories commenced on developing an attenuated live strain of polio virus to be administered orally. In 1958 the PRF received three strains of live virus which had been attenuated by passage through cotton rats, from Dr Albert Sabin.
Production of oral polio vaccine subsequently replaced that of formalin inactivated vaccine and the first mass vaccination campaign throughout South Africa began in late 1960 and was completed in 1961. Following on these campaigns there was an immediate dramatic fall in the incidence of polio. The steep fall in polio continued through the 1970’s. In the 1980’s two large epidemics of polio occurred in under-immunised populations in Gazankulu, now Limpopo province, in 1982 and in 1988 in KwaZulu-Natal and the last case of polio in South Africa was detected in 1989.
The founding mission of the PRF had been successfully achieved. The Institute now took on the broader responsibilities of laboratory support for all virus diseases while the discipline of medical virology greatly expanded during the 1970’s. A new threat now appeared on the horizon, the viral haemorrhagic fevers, and in 1975 the first of the viral haemorrhagic fevers hit South Africa, Marburg virus disease. In 1976 the Department of Health purchased from the PRF its laboratories and renamed the Institute the National Institute for Virology (NIV). In 1979 the only BSL-4 laboratory on the continent was opened with Prof Bob Swanepoel at its head. The following decade saw the emergence of a new virus disease, the most formidable of all infectious diseases, HIV/AIDS. An MRC HIV/AIDS research unit was established in 1987 under myself and assisted by Dr Des Martin and Dr Sue Lyons and this was subsequently developed into a world-class research unit by Prof Lynn Morris together with Dr Clive Gray and Dr Caroline Tiemessen.
During the late 1990’s it became abundantly clear that there was an urgent need nationally and regionally to develop a CDC-type Institute on the African continent to monitor communicable diseases, both existing infections as well as newly emerging infections. This need was fulfilled in January 2002 by the establishment of the National Institute for Communicable Diseases (NICD) which came about with the transformation of laboratory services and the advent of the National Health Laboratory Service (NHLS). The NICD was formed by adding to the NIV, the public health oriented microbiology laboratories from the former South African Institute for Medical Research (SAIMR) and creating a new third division, that of epidemiology and surveillance.
The newly formed NICD now faces different challenges to that of its predecessor, the PRF. One vaccine preventable disease, smallpox, has been completely eradicated from the planet. Poliomyelitis itself is circulating now only in seven countries in the world (compared to a 125 at the start of the global eradication campaign in 1988). Measles has dramatically decreased and diseases such as diphtheria, pertussis and tetanus are rarely seen.
These have now been replaced by HIV/AIDS, TB, malaria as major public health threats in addition to a new concern, the spectre of new and emerging infectious diseases both natural and deliberate. The inaugural academic day of November 2003, which will now become an annual event in November of each year, showcased the sterling achievements in research and communicable diseases surveillance by the virological and microbiological units of the Institute. The academic achievements of the Institute have been most impressive. During 2003 4 PhD and 2 MSc students of the NICD graduated through the University of the Witwatersrand. The laboratories have been accredited by SANAS (South African National Accreditation System) to ISO17025. Its BSL-4 laboratory serves as a WHO Collaborating Centre and its polio and measles laboratories as WHO Regional Reference Centres. One of the HIV/AIDS laboratories serves as the only non-American site for the HVTN (HIV Vaccines Trials Network).
Several WHO sponsored training courses were held at the NICD as detailed in this report. All this has been achieved with, by international standards, a very small team. Nevertheless, they proved to be a team of highly dedicated and professional personnel. It has indeed been a privilege to serve as their Director. The NICD now looks forward with confidence to meeting the highly challenging future of monitoring communicable diseases, both regionally in southern Africa and also wider afield in the African continent. The spirit of the early scientific pioneers of 50 years ago should serve as an inspiration to the future endeavours of this Institute.
BARRY D SCHOUB
EXECUTIVE DIRECTOR |
