Dr. Mantombazana ‘Manto’ Tshabalala-Msimang

Manto Tshabalala-Msimang was born in Durban, KwaZulu-Natal on 9 October 1940. She attended Inanda Seminary Secondary School, a boarding school for black South African girls located 25 kilometers from Durban. She matriculated in 1959, at the age of 19.

Tshabalala-Msimang went on to receive her Bachelor of Arts degree in 1961 from the University of Fort Hare, located in the Eastern Cape. During her studies, she became involved with the African National Congress (ANC). A year after her graduation she was one of 27 young ANC members to go into exile after the apartheid government banned the organisation in 1960. She did not return to South Africa for the next 28 years.

While in exile, Tshabalala-Msimang studied medicine at the First Leningrad Institute in St. Petersburg of the USSR. She graduated in 1969, and learned to speak fluent Russian during her studies.

She then enrolled at the University of Dar es Salaam in Tanzania, and in 1972 received a degree in obestrics and gynaecology. It was there that she initiated the establishment of the Health Department of the ANC in Exile. The purpose of this body was to look at health issues specific to the exile community, including mental illness and malaria. In the 1980s, the department would address the issue of HIV/AIDS among ANC exiles as well. The department was designed to work together with the Tanzanian government, as well as 33 ANC missions located around the globe in countries such as Lusaka and Zambia.

In 1976, Tshabalala-Msimang accepted a job as head of the Health Training Programme for National Liberation Movements of the Organisation of African Unity. She was based in Morogoro, Tanzania for three years. Then, in 1979, she began to serve as Deputy Secretary in charge of human resource development and deployment for the ANC in Tanzania and Zambia. She held this position until her return to South Africa in 1990.

Tshabalala-Msimang convened the first International Conference on Health and Apartheid. It was hosted by the World Health Organisation in 1980. In the same year, she received a Master’s degree in Public Health from the University of Antwerp in Belgium. Over the next ten years, she conducted several studies as part of her position with the ANC. This included a 1981 survey on the nutritional well-being of ANC children in Tanzania, and a 1983 study on Malarial strands in ANC communities in Angola, Mozambique and Tanzania. Moreover, in 1986 she conducted a mental health survey within the ANC communities of Angola, Mozambique, Tanzania and Zambia.

In 1990, Tshabalala-Msimang returned to South Africa after almost three decades in exile. She served as co-ordinator of the ANC’s health plan for 1991-1994, which focused heavily on gender and primary health care issues.

On 29 April 1994 Tshabalala-Msimang was elected to parliament in the first democratic elections of South Africa’s history. She was appointed as Deputy Justice Minister in the cabinet of President Nelson Mandela on 1 July 1996. As Deputy Justice Minister, she issued comprehensive national policy guidelines for victims of sexual offences in 1998. This was the first time cohesive, multi-sectoral protocol for dealing with rape and sexual offences were ever issued in South Africa.

On 17 June 1999 Tshabalala-Msimang was appointed Minister of Health in the cabinet of President Thabo Mbeki. This marked the start of her extremely controversial nine-year tenure of the position. When President Mbeki entered into office, the number of HIV positive people in the country had reached nearly five million. Early in his presidency, however, Mbeki did not accept that HIV caused AIDS. Although official South African government policy said otherwise, few members of his cabinet publicly contested him. As Minister of Health, Tshabalala-Msimang perpetuated the views of the President.

Despite his unusual stance on the cause of AIDS, upon taking office President Mbeki called for all sectors of society to become involved in addressing the epidemic. Tshabalala-Msimang responded to this challenge by initiating the development of a five-year National Strategic Plan for HIV/AIDS.

In the autumn of 1999, Tshabalala-Msimang opposed the provision of an antiretroviral drug (ARV) called Zidovudine (AZT) to HIV-positive pregnant women. The drug has been shown to dramatically reduce transmission of the illness from mothers to their unborn children. Proponents of civil society pressured the government to have the drug distributed on a large scale, but Tshabalala-Msimang refused to promote any such policy. She stated in several public forums that the drug was toxic, though there was little scientific evidence to back her claims. Non-government organisations for HIV/AIDS awareness such as the Treatment Action Campaign (TAC) - formed by HIV positive activists in December 1998- reacted in outrage to her position. Her public statements in November 1999 regarding the drug includes the following:

‘AZT was never meant to treat HIV. It was meant to treat cancer and, when it was discovered to be toxic, the drug companies stopped clinic trials of the drug because it was so toxic. Is this drug really one we want to use?’

‘The fact is that some of the mice [tested on with AZT] have contracted cancer. It attacks bone marrow. It is very toxic.’

‘There is not substantial data that AZT stops the transmission of HIV from mother to child. There is too much conflicting data to make concrete policy.’

(Retrieved from: www.southafrica.to)

Tshabalala-Msimang was also criticised in her first year as Minister of Health for supporting trials of the South African produced drug Virodene on HIV-positive soldiers in Tanzania. The main active ingredient of the drug was a lethal industrial solvent, and trials in South Africa had been disallowed since 1997 due to concerns regarding its safety.

Tshabalala-Msimang continued to spearhead the Health Department’s response to the HIV/AIDS epidemic in spite of these mounting criticisms, and in January 2000 she successfully coordinated the creation of the South African AIDS Council (SANAC). This was a committee that sought to consolidate political leadership and increase civil society’s involvement in the fight against HIV/AIDS.

In February the Department of Health launched the HIV/AIDS/STD National Strategic Plan for South Africa 2000-2005 (NSP). The two primary goals of the plan were to reduce new infections, and to alleviate the impact of HIV/AIDS on individuals, families and communities. The NSP’s five key focus areas were prevention, treatment, care and support, legal and human rights, and monitoring, research and evaluation.

Despite the launch of this relatively comprehensive plan, Tshabalala-Msimang continued to make public statements about HIV/AIDS that many activists viewed as unclear and misleading. For instance, in a September 2000 interview conducted by talk show host John Robbie (and aired South African radio station 702 Talk Radio), the Health Minister refused to give a direct answer to the question of whether HIV causes AIDS. Tshabalala-Msimang retorted:

“Umpteen times I have answered that question. My whole track record of having worked at the area of HIV and Aids for the last 20 years is testimony. Why should you ask me that question today?”

“You are not going to put words into my mouth.”

“You will not force me into a corner into saying yes or no.”

(BBC News, 2000)

Tshabalala-Msimang continued to oppose the administration of ARVs among HIV-positive South Africans during this period as well. Her controversial public statements regarding this issue in November 2000 include the following:

‘Today I want to dispel this myth, because it is absolutely not true [ that ARV's work ]. The pharmaceutical industry and those who have a vested interest in the drug industry fuels this propaganda.’

‘We (the ANC government) have no plans to introduce the wholesale administration of these drugs in the public sector. ARVs are not a cure for Aids.’

(Retrieved from: www.southafrica.to)

In 2002, South Africa’s High Court ordered that the Health Department make the ARV drug Nepravine available to pregnant women as a means of preventing the transmission of HIV from mothers to their unborn children. Moreover, the South African cabinet affirmed the official policy that ‘HIV causes AIDS’ to end any further speculation of this fact by either Mbeki or Tshabalala-Msimang. Nonetheless, government provision of ARVs remained remarkably low. Upon being questioned in December 2002 as to why money was being spent that year on new German submarines for the South African army rather than on a mass proliferation of ARV treatment, Tshabalala-Msimang notoriously responded by saying ‘Look at what Bush is doing. He could invade”’ (Retrieved from: www.southafrica.to)

In February 2003, the Treatment Action Campaign (TAC) organized a march of thousands on parliament to protest the failure of the government to provide universal access to ARV treatment. Then, in March the TAC launched a civil disobedience campaign to heighten pressure on the Health Department to issue an ARV treatment plan.

Partly due to the growing pressure from both domestic and international civil society, Tshabalala-Msimang coordinated a new plan to respond to the epidemic called ‘The Operational Plan for Comprehensive HIV and AIDS Management, Care and Support.’ This plan was implemented in November 2003, and set preliminary targets for making ARVs available to the general public by 2005.The ANC government accordingly implemented an ARV treatment programme in several provinces in March 2004.

However, Tshabalala-Msimang continued to make statements that ran counter to official South African policy. Her advocacy of good nutrition through staple African foods such as garlic, lemon and root vegetables as a viable alternative to ARVs in combatting HIV was deemed irresponsible by HIV/AIDS activists. This stance earned her the derisive nicknames ‘Dr. Garlic’ and ‘Dr. Beetroot’ from critics. Some of her infamous statements endorsing nutrition as treatment for HIV include the following:

‘I think garlic is absolutely critical” Lemon is absolutely critical to boost the immune system. Olive oil is absolutely critical”¦ just one teaspoon, it will last the whole month.’ – 9 February 2005

‘Nutrition is the basis of good health and it can stop the progression of HIV to full-blown AIDS, and eating garlic, olive oil, beetroot and the African potato boosts the immune system to ensure the body is able to defend itself against the virus and live with it.’ – 30 June 2005

(Retrieved from: www.southafrica.to)

While promoting nutrition as treatment for HIV/AIDS, Tshabalala-Msimang also continued to make controversial statements questioning the safety of ARVs. Such statements include: ‘Antiretrovirals are not paracetamol or aspirins. Antiretrovirals are medicines that not much is known about.’(Kapp, 2005).

The Health Minister’s claims of ARV toxicity and simultaneous promotion of alternative, ‘African’ remedies for HIV garnered increasing scrutiny from the public. For instance, Dr. Jerry Coovadia, a professor at the Nelson Mandela School of Medicine, made the following impassioned statement in May 2005:

‘I am surprised by the manner she draws up her amazing beliefs”¦ to speak of side effects [of ARVs] is contrary to what the scientific evidence suggests. When she talks about raw garlic, onion, lemon and beetroot, what scientific evidence does she produce? Her actions could have severe implications for people and the image of the nation. Some form of censure should emerge.’

(Retrieved from: www.southafrica.to)

By March 2005, the number of people receiving ARV treatment remained far below the targets set in 2003 by Tshabalala-Msimang’s operational plan. In December 2004, the Treatment Action Campaign estimated that 500,000 people who needed ARVs at that time were not receiving them. Regardless of these highly concerning statistics, in 2005 Tshabalala-Msimang was honoured by the National AIDS Trust Fund for her work in prevention, care and treatment of the illness.

In 2006, Tshabalala-Msimang coordinated a review of SANAC as well as a review of the National Strategic Plan 2000-2005. She called for a restructuring of SANAC and the drafting of a new five-year plan to flow from the previous one.

The Health Minister’s controversial stance on HIV/AIDS treatment was brought to the forefront of the international scene later that year during the XVI International AIDS Conference in Toronto that took place from 13-18 August. Tshabalala-Msimang attended, and promoted her view that traditional medicines and nutritious African foods were sufficient in preventing AIDS. Her booth at the conference was decorated with a garlic, beetroot and lemon exhibit that was intensely scrutinized by the international community. This criticism was captured in the closing speech of the United Nations special envoy for AIDS in Africa Dr. Stephen Lewis, in which he stated that the South African government had a ‘lunatic fringe’ (BBC News, 2006) attitude toward the epidemic, and that it had been ‘obtuse, dilatory, and negligent about rolling out treatment.’ (Ibid.)

On 5 September 2006, 65 of the world’s leading scientists in the field of HIV/AIDS sent a written request to President Mbeki for Health Minister Tshabalala-Msimang to be dismissed immediately. Ten of the signatories were South African, and the rest were British, Australian and American. Most of the letter’s signatories had attended the XVI International HIV/AIDS Conference in Toronto. The letter stated that Tshabalala-Msimang was an ‘embarrassment,’ (News 24, 2006) and insisted on an end to the ‘catastrophic, pseudo-scientific policy that [portrayed] the South African reaction to HIV/AIDS.’ (Ibid.) In another line of the letter, the scientists stated that they were ‘deeply affected by the way that science [was] being undermined by the South African Minister of Health.’ (Ibid). Despite her many vocal and distinguished critics, President Mbeki did not dismiss the Health Minister nor insist she make any changes to her policies.

Six months later, on 20 February 2007, Tshabalala-Msimang was admitted to the Johannesburg Hospital due to having accumulated an excess of fluid in her lungs. On 26 February, Jeff Radebe was appointed as acting Health Minister while she was hospitalized. On 14 March, Tshabalala-Msimang underwent a liver transplant. Rumours circulated that her liver failure had been caused by heavy alcohol consumption, however an official statement cited autoimmune hepatitis as the cause. Shortly after her recovery, Tshabalala-Msimang reclaimed her position as Health Minister.

In March 2007, the Health Department launched a new National Strategic Plan for HIV/AIDS and STDs for 2007-2011. This plan was coordinated by Tshabalala-Msimang and represented a further evolution in her policy prescriptions towards more internationally accepted biomedical interventions of the pandemic.

On 25 September 2008, President Mbeki formally resigned from office after having lost the support of the ANC. Kgalema Motlanthe was appointed as interim President, and upon taking office immediately dismissed Tshabalala-Msimang as Minister of Health, replacing her with Barbara Hogan. During the nine years that Tshabalala-Msimang served as Health Minister, South Africa was one of only 12 countries in the world that regressed in terms of reaching the 2015 millennium development goals.

Her tenure did see a number of notable achievements, including increasing access to primary health care, improving general maternal health, reducing malaria, counteracting the exodus from South Africa of skilled doctors and nurses, and dramatically strengthening tobacco controls. However, from 1999-2003 there was a 57% increase in deaths in South Africa, invariably due to inadequate intervention by the government of the HIV/AIDS epidemic. It has been estimated that without Tshabalala-Msimang’s obstruction of ARV treatment, at least 330,000 unnecessary deaths could have been prevented.

On 16 December 2009, Tshabalala-Msimang passed away due to complications from her liver transplant. At her funeral President Jacob Zuma paid tribute to her service as Health Minister by noting the 1500 clinics that were built during her tenure. Her prominence and authority in the ANC remained strong in the years immediately before and after her death due to her long-standing allegiance to the party, despite its members having dismissed her from office in 2008. She is survived today by her second husband Mendi Msimang, and her daughters Zuki and Pulane from her first marriage.