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30 March 2021 | Story Prof Francis Petersen | Photo Sonia Small (Kaleidoscope Studios)
Prof Francis Petersen.

Systems, processes, and policies are not exactly things that grab the headlines or are popular topics for dinner conversations. But they become vital in times of crisis. 
And if there is one thing that we have learnt from the COVID-19 pandemic, it is that no amount of time, effort or resources should be spared to get them in place before disaster strikes, says Prof Francis Petersen.

During my own education and training in the field of engineering, I was constantly reminded of the value of systems: a set of components working together as parts of a mechanism or an interconnecting network; a complex whole. In subsequent years, I also realised time and time again how system principles can be applied equally successfully in management. In any organisation, systems ensure unified and stable operation. And in times of crisis, they prevent hysteria, uncertainty, and unnecessary waste of time.

Lessons learned in reaction to the pandemic

At the University of the Free State (UFS), we quickly learned the value of acting proactively when it comes to the COVID-19 pandemic, as well as getting sustainable systems in place that operated in unity. Amid all the uncertainty and change, we found that it was vital not to re-act in a knee-jerk manner and steered away from implementing random measures that did not consider the entire institution, its history (how it grew and developed up to this point in time), and its future (the altered, post-COVID-19 landscape).

Early reaction and a sustained focus on the period after the pandemic, characterised our response action. A UFS COVID-19 Task Team was already formed at the end of February 2020, as news of the first infections trickled in from Wuhan, China.

When the first South African COVID-19 infection was reported on 5 March 2020, a Special Executive Group moved into action. It had several focus areas: Teaching and Learning, Staff, Operations, Re-integration of Staff and Students on Campus, Finance, Risk and Legal, COVID-19 Science, and Future Thinking. We immediately began the migration to remote teaching and learning, which involved the training of staff, getting the material online, briefing students, procuring laptops, and zero rating the learning portals.

In mid-March 2020, staff who were able to, were asked to work from home. Events were postponed, staff and students were trained to work in a remote setting, and a moratorium was placed on international travel – even before a national lockdown was put in place by government.

In retrospect, this timely, holistic, systematic approach proved to be invaluable.

Learning from a global system

The pandemic also reinforced the lesson that no country is an island. We should learn from others, not repeat their mistakes, and not ignore their successes.

A successful system never operates in isolation, but is affected by, and has an influence on the systems around it.

As we are entering the vaccine phase of the pandemic, it is more vital than ever to maintain a ‘systems’ approach.  Now is not the time for shortcuts, untested remedies, and vague claims of efficiency. Now is the time for systematic implementation of tried and tested processes, developed over time and underscored by good science.

Our part in the vaccine production system

At the UFS, we are privileged to play a role on two important fronts: 

The South African National Control Laboratory for Biological Products (NCLBP) located on our Bloemfontein Campus, is performing the all-important task of vaccine-lot release. As the sole provider of this service in the country and one of only twelve World Health Organisation (WHO)-contracted laboratories worldwide for vaccine quality-control testing, it forms part of a carefully crafted regulatory system, which has been established, fine-tuned, and tested over many years to serve the interests of the global community.

Vaccines are biological medicines and some of the most complex pharmaceuticals available today. It is vital that their regulation be governed by scientific and not commercial or political principles. It is a role that should under no circumstances simply be given to the ‘lowest bidder’ or the one who promises ‘speedy delivery’.

The NCLBP did not get to play this regulatory role overnight. It was already established in 1997 after an extremely stringent audit by the National Regulatory Authority (NRA) and subsequent recommendations by the WHO.

This means that all its operations – from the way documents are compiled and stored, to the maintenance of equipment and infrastructure, as well as staff competency – are performed according to strict international guidelines and are continuously and closely monitored.

It forms part of an involved system with checks and balances in place to ensure that no mistakes are made. 

Similarly, FARMOVS – a wholly owned clinical research company of the UFS, together with several medical and scientific experts at the university –  has submitted a clinical trial protocol for approval to the South African Health Products Regulatory Authority (SAHPRA) to determine the efficacy of Ivermectin for COVID-19.
FARMOVS was systematically prepared and shaped for this role, having been involved in countless pharmaceutical trials, proving its own efficacy consistently over a protracted period.
Not only is it the only onsite ISO- (International Organisation for Standardisation) and GLP- (Good Laboratory Practice) certified bioanalytical laboratory on the African continent – it has continuously proven itself to adhere to the most rigorous international requirements over the past 47 years.   

It is extremely satisfying – and reassuring – to see how institutions like these two, rooted in sound science, and having proven their consistency, efficiency, and accuracy over many years, are now stepping up to the plate and performing the all-important functions for which they were painstakingly and systematically designed. 

‘Vaccine nationalism’

This pandemic has shown that, through the interconnectedness of our world, one country or region has an impact (in this particular case a health-impact) on other countries and regions. In this context, it is up to rich countries to ensure fair and equitable access to vaccines for poorer countries, and that the WHO proposal to request pharmaceutical companies to waive their intellectual property rights in this regard, should be supported. 

‘Good science’ more important than ever

Another thing the pandemic has highlighted, is the importance of good, sound science amid all the hype, speculation, and false news that unfortunately also characterise the COVID-19 era. 

The co-incidental meteoric rise in the popularity of social media has fuelled the fire of unverified and unscientific claims that are so often just lapped up by information consumers in the public sphere. Unfortunately, since we have entered the vaccine phase, this has become increasingly rife. 

Here, the role of universities as education and research facilities is becoming more important than ever. Not only do we need to provide and communicate the ‘good science’ that everyone craves. But instead of simply advising from the side-line, we should also be playing a vital practical role, actively applying our knowledge, resources, and expertise within the broader society we serve, as has been aptly demonstrated in our important role of vaccine regulating.

Role of universities in the post-pandemic era

Without a doubt, the pandemic has highlighted the importance of online learning, the huge need that exists to be properly equipped for this and has given us a powerful shove in a direction we were already advancing to.

But it has also shown us that, in the midst of increasing digitisation, our need for social and physical interaction remains. The isolation brought about by COVID-19 has taught us that we cannot only function as a digital society. This will probably lead to higher-education institutions presenting a blended mode of learning and teaching in the future; a combination of online learning and face-to-face interactions, ensuring that students still get to experience campus life and the valuable interactions that go with it. 

The pandemic has also helped to crystalise the way in which we as ‘generators of knowledge’ should interact with society. The recent rhetoric of anti-scientific world leaders has caused communities to become distrustful of universities and science. 

We need to actively work on building trust within communities again. And we can only do this by working closely with other sectors of society, gauging real needs, and working together as parts of a bigger system in order to find real, practical solutions that can be seen by everyone to make a positive change in different spheres of society. 

Every organisation, business, government, and institution benefit from having both visionaries and pragmatists.  The visionaries help us to imagine a future we want to live in. The pragmatists work out practical, doable, and sustainable steps to get there. 

Sometimes it becomes necessary for the activists and orators to step aside and create space for the scientists and administrators to systematically get on with what needs to be done.
While we are all eager to move beyond this period in our collective history, back to a world that resembles more of the ‘old normal’ we long for, we should not make hasty, ill-considered moves and take shortcuts to get there.

We should also see this period as our opportunity to push our boundaries, embrace the ‘new normal’, and be innovative in our thinking on how to stay there. 


(Prof Francis Petersen is a registered professional engineer and has served on the executive managements of higher-education institutions, science councils, and industry organisations.)

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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