Face to Face: Prof Helen Rees on SAHPRA, women’s rights, and her appetite for justice

Face to Face: Prof Helen Rees on SAHPRA, women’s rights, and her appetite for justiceProf Helen Rees is a renowned scientist and chair of South Africa’s medicines regulator, SAHPRA. PHOTO: Supplied
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As a rebellious teenager growing up in the British town of Harpenden, Helen Rees would sneak out to attend anti-apartheid talks. “That was the stop-the-Boks tour,” she recalls. “[British politician] Peter Hain was an activist trying to stop the Springboks from touring the United Kingdom. In those days, the isolation of sport in response to apartheid was starting to really gain traction.”

Rees went on to study medicine at Cambridge University, where she also obtained a Masters degree in political and social sciences. Starting her career as a clinical doctor in paediatrics, women’s reproductive health would always remain her enduring passion.

It was while working as an intern at a London hospital that she fell in love with a loud-laughing South African doctor, Fazel Randera. Together they became health activists, bringing medical care first to post-independence Zimbabwe, then to apartheid South Africa – defying the Group Areas Act by living together as a mixed race couple in Randera’s sister’s garage in Lenasia, Johannesburg.

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In 1986, a heavily pregnant Rees who then was a member of NAMDA (the National Medical and Dental Association), hid youth inside Johannesburg’s Alexandra clinic as the township around them burned. At the time, Rees and Randera were part of a group of activist doctors who were channelling international funding to the clinic where Rees headed the paediatric section and Randera obstetrics.

“We were able to provide health services in Alex, which didn’t have any,” she recalls. “I remember being there in 1986 when Alex was on fire. I was about 37 weeks pregnant, I think, trying to hide youth who’d been shot, trying to keep them away from the SANDF (South African National Defence Force), trying to resuscitate them. I just remember that day, the whole clinic was surrounded by Caspirrs and people with guns aimed at us. I was standing in the doorway of the clinic, saying, ‘You can’t come in here!’ In the end, of course, they did.”

A global shift

In 1994 – as the HIV crisis started to loom over South Africa – the nation’s first democratically elected health minister Dr Nkosazana Dlamini-Zuma tasked Rees with setting up a research unit for women’s reproductive health. Initially, with a staff of five, this unit grew into what is today the Reproductive Health and HIV Institute at the University of the Witwatersrand (Wits RHI), with a staff contingent of over 2 500. “About 70% of that is women. We have a very strong female leadership,” says Rees.

How did it come about?

Rees says that when she founded Wits RHI, a need for a women’s health policy in South Africa overlapped with a global shift in sentiment and language around women’s reproductive rights and sexuality.

“Working with NAMDA, we had a meeting in Maputo in 1991, which was the first time that health activists from inside South Africa met with ANC members [specialising in health] in exile. And the idea was to start formulating what a health policy for the country would look like and I was asked to write the women’s health policy. In 1994, we set up a research unit focusing on women’s reproductive health – issues like HIV, sexually transmitted diseases, contraception, choice on termination, maternal health, cancer of the cervix, and so on.”

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Prof Helen Rees started the research unit for reproductive health at Wits. PHOTO: Supplied

At the same time, women’s sexual and reproductive rights became an issue on the global agenda.

“It really hadn’t been an issue before,” says Rees. “So every 10 years the United Nations has a conference on what they call ‘population and development’. And prior to that, the focus had always been on demography, on birth control, that kind of language. But in 1994, that conference also changed. The focus was on reproductive health and women’s rights – not control of women and women’s bodies.”

Today Professor Rees is a top international public health scholar who chairs and sits on several World Health Organization (WHO) and other scientific committees relating to vaccines and immunisation, medicines access, polio eradication, COVID-19 and pandemic preparedness, and medicines regulation. She singles out a position near to her heart – that of chair of the board of MedAccess, a London-based social financing company, which brings medicine to patients in low- and middle-income countries.

The list of accolades behind her name is impressive.

In 2012, Rees received the South African Order of the Baobab for her contribution to the South African health sector. This year, she received the Batho Pele Platinum award for her contribution to South Africa’s COVID-19 response. Earlier this year, she was awarded the French National Order of Merit for her “outstanding medical career and commitment to improving global health, with a focus on public health in Africa”. A letter from French ambassador in South Africa, Aurélien Lechevallier, notes her “regular communication on the COVID-19 situation and immunisation strategy in South Africa”.

When you start mixing politics with regulation, then you lose that independence. – Prof Helen Rees

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Earlier this year, Prof Helen Rees received the Batho Pele Platinum award for her contribution to South Africa’s COVID-19 response. PHOTO: Wits RHI

In the firing line at SAHPRA

Rees has chaired SAHPRA (the South African Health Products Regulatory Authority), since its inception in 2017 – a position that saw her in the line of fire as COVID-19 vaccines were contested. In June last year, leader of the Economic Freedom Fighters (EFF), Julius Malema called for Rees’ resignation during a march to the regulatory body’s headquarters in Tshwane. Malema described Rees as “a stumbling block” to the approval of vaccines from Russia and China, threatening that the EFF would do a “sit-in” at her house.

Commenting on such political pressure on her personally, Rees says, “One of the things we’ve recognised is that it’s not intuitive to understand what a drug regulator does. A drug regulator does not do the research, it does not determine the price, it does not determine national policy on what drugs come in, or what drugs don’t. The drug regulator says, give us the evidence and we will look at your product – whether it’s a therapeutic, a vaccine, or complimentary medicine or a medical device. We will look at your product and we will say, is it safe? Is it of good quality? And does it work for what it claims to work for?

“Every citizen in this country, no matter who they are, will want to know that when their child is ill and crying with an ear infection, that the antibiotic they give that child is of a good quality – that it’s safe, that it’s going to work. When you start mixing politics with regulation, then you lose that independence.”

Rees explains that SAHPRA was created as an independent entity that reports to the health minister through its board, unlike its predecessor the MCC (Medicines Control Council) – which she also chaired – and which was housed inside the National Department of Health.

With excitement in her voice, she adds that a 16 000 product backlog stemming from the MCC era has now been cleared up. This will be officially marked at an event hosted by SAHPRA on December 2.

“The MCC had this old way of doing business, which was paper-based and while very rigorous on any one product, it wasn’t embracing new technology,” she says. “So we inherited this huge backlog from the MCC of about 16 000 products. So that was a big focus, clearing the backlog because you can’t function as a regulator like that.

“We had to move to electronic, we had to be smarter in the way we evaluate information, and partner and share data with other regulatory authorities. So, not only did we clear the backlog, but we’ve taken best practices into the business going forward and it’s been beneficial in many ways.”

She adds how the height of COVID saw SAHPRA teams working around the clock. “Like many other teams, we were really working day and night. We had a lot of technical experts on the board who would roll up their sleeves and work with the staff. I mean, normally you have a divide between staff and the board. But for the pandemic, we all rolled up our sleeves and worked together…”

Appetite for justice

Maybe one of the most striking things about Rees is how her commitment to justice has manifested in her work in health and medicines regulation.

She credits her own politically and socially minded parents for honing this appetite for justice. “I think one of the primary influences was my father. He was this very strong Welsh socialist, from the day he was born to the day he died. He came from a family of mine workers and trade unionists and had this strong belief in what was right and what was wrong. And my mother, on the other side, was a Methodist and a liberal who had this sort of compassion. She taught cookery and was a good seamstress but always wanted to be a doctor. Then the war came, and she was young, and there was no money in the family. Well, it was a nice balance and framed my worldview…”