Linda-Gail Bekker: scientist vs virus

Prof Linda-Gail Bekker runs a hand impatiently through her silver pixie-cut hair and stands up to open the windows in a tiny corner office at the Groote Schuur Hospital campus of the University of Cape Town (UCT).

She marches to a large, wood-framed window and fiddles with the latches. "Everything we know about the benefits of ventilation to limit transmission of Covid-19 could easily have been applied to help prevent the spread of TB a long time ago," she says. "Covid has forced us to rethink everything, including how we design buildings."

Bekker’s ground-floor office overlooks the Chris Barnard heart centre and the hospital’s old mortuary.

"It’s not the greatest part of the medical campus," she says. "But in the early days, when people were coming to our centre for antiretroviral [ARV] treatment trials, we wanted to give study participants an easy way into the building without having to disclose their status, so they could just slip in [through] a side door."

Bekker pushes the old, heavy window open as far as she can, expels a heavy sigh and grins. "I’m a bit of a dramatist, as you can tell," she says. "I love being on stage."

The Zimbabwe-born doctor is the director of UCT’s Desmond Tutu HIV Centre and an internationally acclaimed HIV and TB researcher. But right now, she’s in the spotlight for being the co-lead investigator — along with Prof Glenda Gray, president and CEO of the SA Medical Research Council — of SA’s Sisonke Covid vaccine trial.

The study, which looks at how the Johnson & Johnson (J&J) shot performs when rolled out on a large scale, is the only way SA’s health workers are currently able to get Covid jabs. (The medicine regulator is concluding its approval processes for several Covid vaccines, including J&J’s.)

When the first health worker received a Covid jab just after 2pm on February 17, it was Bekker who carried that J&J dose — a vial in a neat aluminium holder — down the main corridor of Khayelitsha District Hospital to the vaccination room.

And when President Cyril Ramaphosa was vaccinated in the same room shortly afterwards, Bekker — along with Gray — watched quietly over his shoulder.

The events were broadcast live on television and Bekker enjoyed every bit of it — not just because she loves action, but also because she and her husband and son had all had Covid in December.

"It was scary as hell because of its unpredictability," she says. "At night I would lie next to my husband as he coughed, worrying he would crash, and wake him up to take his temperature. We, as doctors, knew the symptoms and course of the disease to the T, and still there was a huge, intimidating fear element to it."

Gold tinsel is draped across a bookshelf sagging under the weight of medical science books and research awards in Bekker’s office. On her desk, a stethoscope lies coiled next to a sheaf of paper, a gold plastic crown, magic wand and two smiling plastic penises in different shades of brown.

"I got the penises from a sexual health clinic for gay men in London that I visited for work," she explains. "I’m far more on the side of positive, affirming health education rather than ‘don’t do’ restrictive stuff."

The crown-tinsel-wand combo dates from Bekker’s days as the first African president of the International Aids Society, between 2016 and 2018. "I’m not shy, I’m forward — and a little controlling," Bekker admits. "So they decided I was the drama queen and gave me all the stuff that fitted with it as an inauguration present."

In 2020, Bekker co-published a whopping 69 peer-reviewed research papers, mostly on the use of oral pre-exposure prophylaxis (PrEP), in the form of a daily HIV prevention pill, for teenagers and young women. This research has resulted in practical programmes, such as the Desmond Tutu Health Foundation’s PrEP project, which has Tutu Teen Trucks distributing HIV prevention pills to women aged between 16 and 25 (the group most vulnerable to HIV infection in SA) in areas such as Khayelitsha, Nyanga and Philippi, in Cape Town.

Bekker established the foundation in 2004 with her husband, TB researcher Robin Woods.

"At the heart of it, I’m a researcher, that’s my essence," she says. "I’m fascinated by why things are the way they are, what makes them go the way they do, and how they could work better — and what I’ve chosen is the health system and infectious diseases as my black box to unpack."

Last year, this black box expanded from HIV and TB research to the largest pandemic the world has seen in more than a century. Bekker joined the SA arm of J&J’s Ensemble study, which showed that, 28 days after it is administered, the company’s Covid-19 vaccine is 64% efficacious in protecting against moderate to severe Covid in SA, 85% against severe disease and 100% against hospitalisation and death.

It was these results, released in late January, that led to SA’s current Sisonke implementation trial, which is providing health workers with early access to the J&J jab by using 500,000 doses of free research stock provided by the multinational.

The government had originally planned to use the AstraZeneca jab, but that fell through when the results of a small study showed the shot provided only 10% protection against mild to moderate Covid caused by 501Y.V2, a new variant of the SARS-CoV-2 virus that causes Covid-19.

The Ensemble study, however, was conducted at the same time that this more infectious variant emerged in SA. With 501Y.V2 responsible for more than 90% of the Covid cases recorded during the study, the research was able to establish how well the J&J jab works in protecting against the variant.

Though the government has procured 11-million J&J jabs, the shots (or at least some of them, depending on availability) can only be shipped once the vaccine has been approved for use by the SA Health Products Regulatory Authority (Sahpra) — a lengthy process that’s only likely to be concluded in April.

In an effort to get jabs into SA in the meantime, Bekker and Gray designed the Sisonke study, as Sahpra approval for the use of a vaccine in a research setting requires far fewer checks and is therefore much faster.

By Monday evening, about 148,000 of the country’s estimated 1.25-million health workers (everyone working in health settings, not just medical professionals) had been vaccinated; the Sisonke study’s investigators aim to have 500,000 vaccinated by the end of April.

"Covid research is HIV research on steroids — it happens at double the pace and you’ve got all the additional air transmission risks, which means most of the research is conducted remotely and contact with study participants is via apps or the phone," Bekker says.

"Because we’re also targeting older people, who are more likely to fall seriously ill from Covid, doing research remotely has been challenging," she explains, referring to the fact that older people are less likely to use apps, or have tablets or smartphones.

Bekker and the Sisonke team have been working day and night to get vaccines into SA, ensure they’re distributed equitably, procure syringes and train sufficient vaccinators.

"The pace and the pressure, given that all of this is moving incredibly fast, put a huge amount of pressure on our side," she says. "But we’re driven by the fact that each health worker who gets vaccinated via Sisonke is someone who wasn’t protected … before."

Even as a three-year-old on the Zimbabwean farm where she grew up, Bekker dreamt of being a doctor. "It was, like, hello, sorry, that’s me — I’m going to direct everything towards becoming a doctor, from the games I play, to the school subjects I choose in high school, to the type of topics I focused on during debating competitions."

By graduating with an MBChB from UCT in 1986, the former high school head girl realised that dream. "Not because I’m particularly bright," she says. "I’m just very industrious — when I’ve set my mind on something, I do it with full vigour and enthusiasm."

Bekker then specialised in infectious diseases, and also completed a PhD in which she compared how HIV-negative and -positive people responded to TB infection.

It was HIV and TB — as well as the physician’s love of drama and being "voor op die wa" [being forward] — that brought Bekker and her husband together. While she was working as a registrar at Groote Schuur Hospital — part of her infectious diseases specialisation — she moonlighted at the nearby Somerset Hospital, where Woods was running an HIV clinic.

The couple got acquainted, and once went to see a South Asian art film in which there was ballroom dancing. "Voor op die wa as I am, I looked in the newspaper and saw lessons [advertising] Latin American dancing, and called Robin to say I had booked us," Bekker says with a laugh.

She pauses and glances at one of the pictures of their son, Ollie, on her desk. "You can’t do ballroom dancing and not create chemistry, the tango is seductive."

Twenty-one years later, and with Ollie now 19 years old, Bekker and Woods are "still very much related through HIV and TB".

Bekker points to the pictures that a young Ollie drew to congratulate his parents on becoming professors, and says: "Ollie had an unusual childhood. He grew up in a household with constant chatter about CD4 counts [a measurement of the strength of someone’s immune system] and viral loads. [a measurement of how much virus of, for instance, HIV, there is in someone’s body]. But he turned out relatively normal."

There are six piles of papers and lever-arch files stacked, in no particular order, on the right of Bekker’s desk — next to a potted miniature rose, its cardboard wrapping still untouched.

"I have no focus," she laughs. "I’m all over the place, I’m interested in many things, in all aspects of the work I do."

With a tilt of her head, Bekker says she tells her students that the study of infectious diseases is like a colossal round of the murder mystery game Cluedo.

"Somebody in a room has been taken out by some weapon and you’ve got to figure out what it is — so there’s the pathogen, there’s health, there’s an organ system, you’ve got to find it and deal with it."

But the research that underpins the solutions, Bekker believes, should not only be understood by medical professionals. "I do think science is precious, but it’s not only for the [people holding] PhDs — a small fraction of humanity. It’s something we can make accessible to other people."

That’s why she has a Twitter account. "I pride myself that I am one of those lucky people who can take quite a tough concept and translate it," she says. "Robin gets furious because he’s smarter on a whole different plane to me. He’s incisive in his thinking, but I often can take his lecture and make it more accessible and people go: ‘Wow, I really enjoyed that.’ Then I go: ‘Well, that was actually exactly what he said.’"

On Twitter, however, Bekker doesn’t just stick to the hard science — she gives her opinion too, on subjects ranging from the US elections (she’s a supporter of Joe Biden) to chief justice Mogoeng Mogoeng linking Covid vaccines to the devil and the number 666 ("people in high office and public positions have a responsibility to care about their words and/or speak/not speak about topics they don’t have a clear understanding of"), to the pace of the government’s Covid vaccine rollout ("looking forward to seeing dates associated with this communication. Time = infections = deaths").

It’s not the first time Bekker has voiced her concerns about policy implementation publicly. During the HIV denialism of president Thabo Mbeki’s administration in the late 1990s and early 2000s, she and Woods sided with advocacy organisation the Treatment Action Campaign in its fight for access to ARV treatment for people with HIV.

"It’s like this is a déjà vu now with Covid vaccines," she says.

"I’m at that place now where I’m reminded that access [to Covid jabs] is not a given. It seems scientists will always have to be activists around access, putting pressure on the governments and international bodies to make sure life-saving interventions such as vaccines are provided timeously and equitably in a world that’s dominated by inequality."

*This article was produced by the  Bhekisisa Centre for Health Journalism.