The COVID-19 pandemic has posed major challenges to public health medicine specialists. For Extraordinary Professor Hassan Mahomed, who has been at the forefront of coordinating the response in the Western Cape, it has been an especially demanding period.
Mahomed, who holds a joint position with the provincial Department of Health and the Division of Health Systems and Public Health at Stellenbosch University's Department of Global Health, has been involved in combating the spread of the virus right from the start.
“In early 2020, we saw cases increasing around the world," he recalls. “Already by February – before we had our first cases – my colleagues and I began to set up information sessions for our staff, alerting them to the fact that there was this global threat and that we should be prepared for cases in the Western Cape.
“By March, we had our first diagnosed case of COVID-19 – someone who had returned from travelling abroad.
“By that time the national Department of Health and the National Institute of Communicable Diseases had developed guidelines and done some training in the provinces, which I was part of. From that time, I've been involved in coordinating the response to the COVID-19 pandemic as it played out in this province."
Mahomed chairs a monthly meeting of the COVIDCovid-19 outbreak response teams to coordinate responses and serves on a senior management technical committee which currently meets twice a week to provide technical support to the provincial leadership on how to respond.
His work included developing a COVID-19 vaccine strategy for the province “as an initial guide to start thinking through how we were going to implement the -19 vaccine programme".
Mahomed was then asked by the provincial government to set up an expert team in the province to provide advice on vaccination, now called the Western Cape COVID-19 Vaccine Expert Advisory Group.
This group includes vaccine experts, behavioural experts, ethical experts and representatives of the community. “It provides advice to the province depending on what the issue is," says Mahomed.
“A major success of the expert advisory group has been around equity – making sure that fairness of access to vaccines is put on the agenda of the Province. We made the Province acutely aware of the fact that we need to make sure that the poorest and the vulnerable get access to vaccines," says Mahomed.
“The Province has put in place a number of processes where they engage with community organisations and set up local teams to support registration for vaccination in deprived communities and to facilitate access."
He adds: “The second key area is about providing technical advice to the province when there are difficult issues around vaccine administration – about who qualifies for vaccination, and some of the ethical issues around how the vaccination programme should be implemented, so that those who are at high risk and those who are most vulnerable are prioritised.
“One of the big challenges of the vaccination programme is that there is a limited supply, so one of the big ethical issues has been: how do you prioritise? The committee has provided extensive advice, both from a technical and ethical point of view, on how best to approach this issue."
Mahomed notes that the spread of misinformation is another particular difficulty: “That's been a global challenge, both for Covid and Covid vaccines – how to ensure that the population is properly informed about vaccines and the vaccination process.
“Our main way of responding is not to engage with individuals who are the source of misinformation, but to engage with the general public – firstly, to discourage the spread of misinformation, but mainly to provide an alternative narrative, and that is to say: vaccines work, and vaccines are largely very safe."
Mahomed comments on the third wave of the COVID-19 pandemic with a mixture of fortitude and hopefulness: “The science around COVID has evolved. Initially we had to make difficult decisions without enough information on how the virus behaves and how it spreads. We've learnt a lot over the past year."
Mahomed is certainly well-placed to play a leading role in addressing this challenge. He worked at various local hospitals after completing an MBChB at the University of Cape Town (UCT) in 1985. He subsequently did a Master's degree in community health at UCT in 1996 before joining the City of Cape Town in 1998 as an epidemiologist – the first such position at the municipality.
In December 2012, he joined the Western Cape Health Department, a position affiliated to Stellenbosch University's Faculty of Medicine and Health Sciences. In addition to responding to the health needs of the province, Mahomed – who completed a PhD in public health at UCT in 2013 – teaches undergraduate and postgraduate students at Stellenbosch University.
Mahomed draws many lessons from the scientific community's rapid response to Covid-19. “We need to learn from the speed of development of COVID-19 vaccines and look at how we can apply this to other conditions," he says.
“We've had tuberculosis, HIV and diarrhoea epidemics for a long time. Many of these diseases are preventable. Let's look at what we can learn from our response to the COVID-19 pandemic to overcome some of these conditions."
But, for now, perhaps the most urgent challenge remains limiting the spread of COVID-19. “There is always the risk of COVID-19 virus variants in the background," says Mahomed. “The sooner we are vaccinated, the better. Our main message is: continue to follow all the normal infection control measures such as physical distancing, mask wearing and handwashing; avoid gatherings; support the vaccination programme.
“One key issue is that we need everyone to take responsibility and for us to build solidarity – to see ourselves as a community, where we help each other. If everybody follows the prevention and control measures, we will have a way of limiting the spread of the disease."
