Aligning knowledge, skills and capabilities across South Africa's health-innovation system to combat COVID-19

Never before has the importance of alignment between key actors in the national system of innovation around shared development goals been more important than in the current global battle against COVID-19. By Dr Glenda Kruss

K-Way Clothing Manufacturers in the Western Cape is making cloth masks to stop the spread of COVID-19. Photo: Western Cape Government

Over the past weeks, one of the strengths in South Africa’s approach to contain COVID-19 has been the rapid - and integrated - response of key actors in our health-innovation system.

South African scientists were very quickly able to contribute to the global effort to find a cure for the virus, by sequencing the genome of a local sample of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), the virus that causes COVID-19. A key public research institute, the Centre for Scientific and Industrial Research, established a national COVID-19 information centre to monitor and track the disease, to provide vital data to the government. South African teams have been included in global innovation challenges designed to rapidly identify innovative solutions to the most critical problems emerging during the pandemic, including socioeconomic challenges.

Universities began to use their research resources such as 3D printers to produce protective face masks for health workers, and their IT expertise to create vital data dashboards and interactive apps with real-time data that support public information.

The South African Radio Astronomy Observatory, which had built up expertise to develop complex systems on the Square Kilometre Array project, was tasked to lead the national effort to design, produce and procure vital ventilators. To support this effort, businesses are unearthing blueprints for ventilators to resume production, or designing low-technology solutions with available resources, while Denel is converting its arms production capability. Textile companies in the once vibrant clothing sector in Cape Town are contributing their skills by manufacturing cloth face masks.

Medical practitioners in academic hospitals have designed equipment that protects health workers from contamination during life-saving procedures. Most significantly, there are indications that the resources and networks built over decades of experience in treating and managing HIV/AIDs and TB infections are informing the management and treatment protocols for COVID-19, not least in the design of a proactive mass community-based testing programme.

Health as an island of excellence in the national system of innovation
Such responses are only possible because of past efforts to build an effective health-innovation system, of which the key actors are described in The state of the South African research enterprise, a review released in 2019 by the DST-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP) at Stellenbosch University.

Indeed, South Africa was one of the first countries to foreground in its science and technology policy the idea that, to support economic growth and inclusive socioeconomic development, we need to build a strong national system of innovation. This includes actors in higher education, public and private research institutes, government, business and other intermediary organisations, each with different purposes and operating at different levels – but oriented to achieve shared national development goals. Success lies in the flows of knowledge, technologies and innovation between users and producers, which requires effective interaction, linkages and collaboration.

Unfortunately, over the past decade, the national system of innovation has not always functioned as effectively as it should have, with less collaboration and transfer of ideas and technology than desired. Such an assessment is reflected in attempts to redesign the science, technology and innovation (STI) landscape, and in the recent articulation of a new vision for STI, aligned with the national development plan and Sustainable Development Goals, set out in the White Paper on STI 2019.

Fortunately, there are ‘islands of excellence’ in the innovation system – and one of these is the health sector.

Excellence in health is focused on fields that support the current interventions against COVID-19, shaped by decades of responding to the burden of diseases in a highly unequal society with high levels of poverty and unemployment. The SciSTIP review analysed academic publications in health fields, finding that just over 70% focused on infectious diseases: 46,1% on HIV/AIDS and 25,8% on other infectious diseases (identified using key words like virus, infection outbreak, surveillance, and fever, for example).

A distinctive feature of the health-innovation systems is a number of ‘mega-research’ institutions, such as the Centre for the Aids Programme of Research in South Africa, and mothers2mothers, which rely greatly on international donor support. According to the SciSTIP review, these institutes and centres combine significant human resources and multiple lines of research, and they have operating budgets that are much larger than research institutions anywhere else in the South African research system.

Weaknesses identified in the health-innovation system are equally significant to the success of present efforts — that health monitoring, data and surveillance systems were not sufficiently developed nor integrated effectively, nor was there sufficient capacity in the field of medical devices, particularly in terms of collaboration between health researchers, practitioners and industry, stated the SciSTIP review.

Expenditure on health R&D growing steadily
The mega-research institutions funded by foreign donors are critical to the health-innovation system, but for the health-innovation system to flourish and overcome weaknesses in a sustainable manner, it is critical to consider whether there is sufficient domestic expenditure to support health research and development.

The latest available data reported by the HSRC’s Centre for Science, Technology and Innovation Indicators reflect that in South Africa in 2017/18, 0.83% of the Gross Domestic Product (GDP) was spent on research and development (R&D), below the national target of 1.5%. Health R&D applies to research fields that include Engineering Sciences, Biological Sciences, Medical and Health Sciences and Social Sciences. Figure 1 shows that over the past five years, a relatively high and steadily growing proportion of gross expenditure on R&D (GERD) was allocated to health R&D, reaching 22% in 2017/18 — a positive indicator.

Figure 1. Percentage of GERD spent on Health R&D 2012/13 to 2017/18

Source: Centre for Science, Technology and Innovation Indicators

However, the question is whether these levels of expenditure are sustainable, given that the public sector is increasingly responsible for the majority of domestic health R&D expenditure. Figure 2 illustrates the growing share of the public sector in contrast to private expenditure, which includes the substantial health-oriented expenditure in the not-for-profit (NPO) sector. Historically, NPOs played a critical role in supporting HIV/AIDS research in the health-innovation system. Clearly, private-sector expenditure on health R&D could be substantially higher, to grow the system as a whole to the levels required to face the current challenges.

Figure 2. Public and private expenditure on health R&D 2012/14 to 2017/18

Source: Centre for Science, Technology and Innovation Indicators

Aligning efforts across the health-innovation system
That the health-innovation system is an ‘island of excellence’, and that health R&D is oriented to the scourge of infectious diseases, is reflected in the ability of many actors to respond rapidly to the challenges of COVID-19.

However, for these initiatives to be effective over the long term, the data presented here suggest we need two kinds of policy intervention.
First, despite signs that the current levels of R&D expenditure are increasingly focused on health, South Africa should be spending far more on R&D in general, and on health specifically. There is, particularly, room for the private sector to contribute. Existing weaknesses in health data systems and design of medical devices require urgent increases in funding and effort.

Second, the COVID-19 pandemic presents an opportunity to strengthen the health-innovation system, which was more difficult to achieve in the past. That is, the strongly shared goal of different actors in the higher education, research, business and government systems — to control the impact of COVID-19 on lives and livelihoods — makes possible a high degree of coordination of effort. It is critical that as part of government efforts, a strategy should be devised to align the knowledge, skills and capabilities of medical practitioners, academic researchers, government agencies and firms across the health-innovation system.

Author: Dr Glenda Kruss, head of the HSRC’s Centre for Science, Technology and Innovation Indicators

Acknowledgements: R&D data used in this article were prepared by Mario Clayford and Sibusiso Ziqubu; information on current initiatives was sourced by Gerard Ralphs.