Anti-apartheid activism

Gray entered the University of the Witwatersrand in 1980 where she studied at the medical school for six years followed by seven years of specialization in pediatrics.^[9] Her siblings were already at the university and one of her brothers was involved with a radical student union that was opposed to apartheid. Gray joined the Health Workers Association, a group intent on desegregating South Africa's hospitals. In 1983 the first HIV/AIDS cases and deaths were confirmed in South Africa and Gray committed to educating South African communities about how to prevent HIV.^[8]

HIV research and activism

By the time that Gray completed her training as a pediatrician in 1993, HIV was prevalent among many children admitted to Chris Hani Baragwanath Hospital, the largest hospital in Africa,^[10] situated on the outskirts of South Africa's largest black township, Soweto. In 1993 Gray, along with colleague James McIntyre, co-founded a perinatal HIV clinic.

Glenda Gray (right) at the Fogarty NIH 50th symposium, 1 May 2018

In 1996, Gray started the UNAIDS PETRA study, in five urban settings in South Africa, Tanzania and Uganda, to determine the effectiveness of a shorter anti-retroviral regimen.^[11][12] In 1999 she was awarded an International Fogarty Fellowship to study Clinical Epidemiology.^[12]

She was the executive director of the Perinatal HIV Research Unit (PHRU),^[13][14] part of the Medical School of the University of the Witwatersrand, based at Chris Hani Baragwanath Hospital prior to her appointment as president of the medical research council in 2014.^[2] HIV was generally not recorded as a cause of death during the 1990s and 2000s but its effects could be seen in the infant and child mortality rates.^[15]

In early 2020, an efficacy study for an HIV vaccine led by Gray was stopped early. The study, involving 5407 HIV-uninfected participants, was started in 2016 and should have continued until 2022. However, preliminary data viewed in January 2020 to evaluate safety and efficacy showed 129 HIV infections in the vaccinated group and 123 in the placebo control group. Many HIV scientists did not believe the study would succeed, as a previous efficacy study in Thailand had shown an efficacy of only 31%. Gray believed that owing to the severity of the HIV epidemic in South Africa a new trial was worthwhile pursuing. The independent monitoring board that evaluated the interim results concluded that it was futile to continue with the study.^[16]

Infant formula

Gray has not been a stranger to controversy. At her first research presentation in 1996 at an international AIDS conference, she championed the position that HIV positive women in developing countries should feed their babies infant formula rather than breast milk to avoid the transmission of HIV from mother to child. The prevailing opinion at that time was that the risk of infant death by diarrheal diseases, caused by mixing contaminated water with the infant formula, outweighed the chance of contracting HIV.^[28] Gray's research in the Soweto communities indicated that infant formula could be safely used, but this put her in direct conflict with the activists who had led boycotts against Nestle, because of their infant formula, since the 1970s.^[29] Subsequent research on the topic demonstrated high deaths in formula fed compared to breastfed children of HIV-infected mothers.^[30][31]

AZT

The drug Zidovudine (also known as azidothymidine (AZT)) is an anti-retroviral drug that can be used to prevent the transmission of HIV from mother to child during childbirth. The course of the treatment was 14 weeks, and women in developing countries could not afford this. Despite criticism from an editorial of The New England Journal of Medicine, Gray conducted a trial (replicating a study from Thailand) using a shorter course of treatment against a placebo which proved that the shorter couse was effective.^[8][32][33] However, the South African government, under president Thabo Mbeki and health minister Nkosazana Dlamini-Zuma, refused permission for the drug to be used, as it was considered too expensive. Gray was involved in the clandestine procurement of the drug and treatment of patients, in opposition to the government.^[8]

Gray was involved in starting the Treatment Action Campaign (TAC), along with Zackie Achmat and others, as an HIV/AIDS activist organisation.^[8] Only after Gray received the 2002 Mandela Award for Health and Human Rights and the legal battles in 2003 involving the TAC, were nevirapine, a drug more effective than AZT in preventing mother to child transmission of HIV,^[34] and other anti-retrovirals officially sanctioned by the government for use in South Africa.^[35] By then, Nkosazana Dlamini-Zuma had been replaced as Minister of Health by Manto Tshabalala-Msimang and the argument against anti-retrovirals had changed from one of affordability to the endorsement of traditional African medicine over conventional treatment.^[36]

COVID-19

In 2020, Gray was appointed to the South African government's Medical Advisory Committee owing to the COVID-19 pandemic in South Africa. On 26 March 2020, the South African government imposed an almost total lockdown on all inhabitants. From 1 May 2020, the lockdown was gradually lifted under a five-stage plan. On 15 May 2020, Gray said, "Initially, there was good reason to implement the lockdown to slow down the spread of the virus and buy time to ready the health system, and this was largely achieved". She now felt that "the lockdown should be eradicated completely, and that non-pharmaceutical interventions (NPI), such as handwashing, wearing masks, social distancing and prohibitions on gatherings, should be put in place."^[37] In addition she noted that:

• An increasing number of malnutrition cases were being seen in hospitals, including at Chris Hani Baragwanath Hospital. "We have not seen malnutrition for decades and so we are seeing it for the first time in the hospital", she said.^[37]
• The phasing out of the lockdown in a "month-to-month" fashion had no basis in science. Many lockdown regulations seemed to be "thumb-sucks", made up on the spot with little rationale behind them.

She told the media:^[37]

Health minister Zweli Mkhize stated that Gray had "made factually incorrect and unfounded statements".^[38] He pointed out that the government had appointed a research subcommittee to which Gray belongs to advise them. He said that the thumb-suck comment "undermines the joint work and effort that the National Coronavirus Command Council, Cabinet and government as a whole have been engaged in."^[38] With regard to the comment on schooling he said: "The Department of Basic Education has been engaged in various consultations with its stakeholders on the correct approach to take in the process of opening schools."^[38]

Subsequent to Mkhize's comments, the acting director general of the Department of Health, Anban Pillay, said that an investigation into Gray's conduct was needed.^[39] On 25 May 2020, the South African Medical Research Council apologized for Gray's statements and barred its staff from speaking to the media^[40] while more than 250 academics issued statements of support for her.^[41][42][43]

On the following day, 26 May 2020, Mkhize said that he "considers the Professor Glenda Gray matter closed", and he mentioned that "there is no basis to suggest any interference with academic freedom".^[44]