9. The attack on science

Antiretroviral medicines have saved the lives of millions of South Africans. Over 5-million people in this country take these pills daily. It is quite probably the largest public sector chronic medicine programme in the world. It is a testimony to the success of modern medicine and public health care. It has reversed the catastrophic effects of the HIV pandemic, which caused life-expectancy to drop from about 63 in 1991 to a low of 54 in 2004.

It almost wasn’t so. From the late 1990s until he lost power, South Africa’s former president Thabo Mbeki dithered and denied while people died. An incurable sceptic of scientific medicine, he and his health minister cast aspersions on antiretrovirals and promoted pseudoscientific alternatives.

The Treatment Action Campaign (TAC), an activist movement, successfully campaigned to change the government’s policy. It used court action, protests, mass education programmes and savvy media tactics to win over public opinion and ultimately force the Mbeki administration to commit to a treatment plan. In 2004 the public sector antiretroviral treatment programme began. While Mbeki remained in power, he and his health minister continued to hamper the rollout but by 2008, after Mbeki had lost power, the number of people on treatment crossed one-million.

The conflict between the TAC and Mbeki’s government, the latter supported by an array of pseudoscience promoters, was one of science vs antiscience. The TAC invested huge effort into teaching journalists and the public the basics of HIV science. It paid off; the mainstream media was preponderantly on the side of the TAC and this played a major part in the Mbeki administration relenting. The mainstream media also regularly published useful information explaining the science of the prevention and treatment of HIV. (Read a detailed account of the TAC.)

The internet was in its heyday in the 2000s. One of us, Nathan Geffen, has previously described how the TAC made use of technology to create a moral consensus across South African society that a state-funded antiretroviral treatment programme in the public health system was the right thing to do. Geffen stated:

“There is a lot of excellent information on the web. But let’s not forget that Thabo Mbeki cited his reading activities on the Internet for his scepticism of HIV science that resulted in several hundred thousand avoidable AIDS deaths in South Africa. Alas, with the good there is also bad and the Internet is awash with junk. Countering the most harmful nonsense is an exhausting task.”

The TAC harnessed the technology of the day successfully. But its primary means of organising was face-to-face meetings, not the Internet. This quote is from Geffen’s article written in 2012:

“Social media is not a replacement for human engagement, the community meeting or a protest. Social media helped organise the protests in Tahrir Square but social media was not the protest itself. Sending a tweet or posting on Facebook is not the same thing as a hunger strike or an act of civil disobedience. People often forget this: the virtual world is there to assist the non-virtual one, not vice-versa.”

Whether the last sentence of this quote is still true is the burning question.

With the rise of Twitter and then TikTok and Instagram, would the techniques of the TAC have been as successful in recent times? Well, we’ve arguably had our answer to that question with the Covid pandemic. The anti-vaccination movement was a fringe one until the pandemic, when it undermined public trust in scientists and led to high levels of vaccine hesitancy across Europe and North America. Genuine scientists battled to keep up with the professional full-time purveyors of misinformation. The growth of the antiscience movement has now resulted in the appointment of RFK Junior, a vaccine sceptic, as the US Secretary of Health, and upheaval at the National Institutes of Health and Centres for Disease Control, two of the leading science research institutes in the world.

The capacity to run a mass misinformation campaign has dramatically increased since the days of the TAC. The cost of running misinformation campaigns is much smaller too. Flat earthers were rare a decade ago; now Flat Earth is a world-wide movement. The insanity of it is hard to fathom.

Science, despite its obvious achievements over the past 500 years, is under attack. In the US, which has contributed more than any other country to scientific research in our lifetimes, antiscience proponents have taken over the government; they are now the establishment. It is a dark time indeed. Scientific research will not cease and innovation will continue, but the quality of and quantity of research, especially in medicine, is likely to decline while the current madness is in the ascendancy in the US.

The problems go beyond the current US administration. The Global Investigative Journalism Network reports: “Over the past decade, furtive commercial entities around the world have industrialized the production, sale, and dissemination of bogus scholarly research. These paper mills are profiting by undermining the literature that everyone from doctors to engineers rely on to make decisions about human lives.”

The report explains:

“It is exceedingly difficult to get a handle on exactly how big the problem is. About 55,000 scholarly papers have been retracted to date, for a variety of reasons, but scientists and companies who screen the scientific literature for telltale signs of fraud estimate that there are many more fake papers circulating — possibly as many as several hundred thousand. This fake research can confound legitimate researchers who must wade through dense equations, evidence, images, and methodologies, only to find that they were made up.”

Countering this are a myriad of volunteers around the globe scouring the scientific literature for fraud and nonsense. Deserving special mention is Retraction Watch, which has been tracking retractions and exposing bogus research. This is the right to be informed in action.

Communication about science can benefit from a right to be informed. Such a right can be used to hold the digital platforms, such as Facebook, Instagram, TikTok and Twitter (X), to account for failing to stem the flow of pseudoscience. Perhaps it can also be used to hold governments or ministers to account when they peddle unscientific nonsense. It can be used to take action against systemic purveyors of scientific fraud.