She was tall, wrapped in a green patterned dress that clung to her legs and ended just above dusty flip-flops. In the bustling, sweltering market, Grace Mathanga looked at me appraisingly, as if to say: “What have we here?” And I knew she was the one.
It was the end of 2002. I had flown to Lilongwe, the capital of Malawi, with excitement in my heart and fear of failure eating at my gut. I’d been the Guardian’s health correspondent for a couple of years, and had written some big stories: about the Bristol babies inquiry into the deaths of small children during operations carried out by inadequate surgeons; about suicides on antidepressants, and fake cures for cancer. And I had harried the pharmaceutical industry over their prices and compromising payments to doctors. But now I had been dispatched to Africa in pursuit of an idea dreamed up by the then Guardian editor, Alan Rusbridger, a story with the potential to help save thousands of lives – if I could pull it off.
I hoped to find a woman who could embody the peril of a continent, could engage busy readers back home, and who was brave enough to talk to me. The threat was HIV, spreading Aids in Africa with appalling lethality, when it was no longer killing people in the UK. In 2003, 26.6 million people in sub-Saharan Africa had HIV, which meant possible ostracisation from their family and community, and was a death sentence. Women were being infected more often than men; young women more than old. The face of Aids in Africa was a young woman’s face. It was Grace’s face.
Grace had already lost her husband and child to Aids; her only chance of staying healthy and carrying on with her life as a shoe-seller depended on drugs to suppress the HIV in her bloodstream; drugs Africa could not afford to provide. She became the pivotal figure in a series of eight interviews I carried out, exploring the critical need for these drugs, and the reasons why women like Grace could not have them.
I interviewed a hospital doctor who wanted to give his patients Aids drugs but had none; Malawi’s vice-president, who said his country needed them but could not afford them; and Jean-Pierre Garnier, chief executive at the time of GlaxoSmithKline, the British pharmaceutical giant that made them. He said that drug prices should come down, but not if it meant his company making a loss. If Grace needed his drugs, donors should buy them for her. The real hero of the tale was Yusuf Hamied, boss of the Indian generics company Cipla, who was able to make a cheap three-drug combination pill because big pharma patents did not apply in India – but donor governments would not buy it because of their close ties to the companies headquartered in the west.
We were planning a special supplement. Martin Godwin, the photographer, was given a huge plate camera on a tripod for the trip. I won’t forget him in the market dirt, ducking out from under the heavy canvas that allowed him to load the plates in the dark, face running with sweat, fending off crowds of fascinated, squealing children. Rusbridger had named the project The Chain. Once I’d found the courageous shoe-seller in Lilongwe market, it had to be called Saving Grace.
Our supplement was published in February 2003. The response from readers to Grace’s plight was huge, and I think the reporting contributed to the eventually overwhelming pressure to get Aids drugs to Africa. It did save Grace. And it made me understand the reality of lives like hers and the power of journalism to do something about it.
Global health is about more than infectious diseases. It’s about cancer and obesity and heart disease, about genetic predisposition and stem cells and the hunt for treatments and vaccines, about the waning powers of antibiotics and shortages of doctors and nurses. It’s about our chances of having a healthy life or an early death.
But Aids, and then Ebola, brought home to me that we were living on a knife-edge, including those of us in wealthier countries. It wasn’t safe or morally right to assume such diseases were easily conquered, or would never reach our shores. That conviction kept me writing about infectious diseases even when the stories were out of fashion. And then, at the beginning of 2020, something else came along, something extraordinary that would teach us that any complacency we might have slipped into was totally misplaced.
I joined the Guardian in 1984 as the most junior of news reporters; one of only three women among a host of what appeared to my young and impressionable eyes to be very brilliant and intellectual men, several of whom sat at their desks in clouds of pipe and cigarette smoke. I had an English degree from a good university, but had trained with the hard-drinking, often hilarious journalists of the tabloids, having joined the Mirror Group training scheme in the West Country, and then spent two years freelancing for anyone who would have me, which was mostly the Daily Mail. The quiet, committed intensity and sheer brain wattage of the Guardian newsroom was a revelation, and I crept about, trying not to be noticed.
I went to Greenham Common to talk to the protesters against American missiles; I covered the Dunblane and Hungerford shootings; and I was sent to Iraq when Saddam Hussein’s regime invited reporters in to prove they had not massacred Kurds in a village in the north. I was in the Mall for the funeral of Diana, Princess of Wales.
At the beginning of 1998, I became the Guardian’s health correspondent. I had to be persuaded. Why were women always given the soft options, I thought. Education and health, not crime or defence? But as I was mulling over whether I had done the right thing, a story broke that made me understand how much health coverage mattered.
In February 1998, the Royal Free hospital in London held a press conference about a scientific paper written by Andrew Wakefield, a consultant gastroenterologist. Wakefield and colleagues theorised that the measles virus in children was linked to gut disorders and autism. Other co-authors of the Lancet paper spoke, but it was the previously unknown Wakefield – relaxed, charismatic; a Boris Johnson figure in his easy confidence – who electrified the small audience of journalists. We knew immediately this was a big story. Wakefield was the antihero journalists love, somebody with absolute conviction who takes on the mighty establishment.
But he turned out to be wrong. The scientific paper was a collection of eight case studies of children with autism who had gut disorders. The link to the measles virus was only a hypothesis. But Wakefield, who was never a vaccine specialist, called for children to be given the measles vaccine containing weakened live virus separately from the other components of the MMR jab, which protect against mumps and rubella. And the damage was done.
“Alert over child jabs” was our story, the first front page I’d had as health correspondent. Every newspaper splashed on it. It was arguably one of the most momentous stories in global health ever, though I had no idea at the time. It reverberates to this day. The bitter fight over Wakefield’s MMR hypothesis took scepticism to a whole new level. I admit I delayed my daughter’s second MMR dose, writing a personal piece later when I changed my mind. The idea of a link between vaccine, gut disorders and autism was enough to panic any young parent. I was afraid Wakefield might have stumbled on some terrible truth. But nobody has ever been able to replicate his team’s research. Wakefield’s paper was retracted by the Lancet. He was struck off the medical register for dishonesty and subjecting children to unnecessary procedures in pursuit of his theory in 2010. By 2018, Europe was in the grip of a major measles outbreak, and children died. It should not be blamed on one man, but the climate of opinion generated by his ideas – and anger at the way he had been treated – had much to do with it. Vaccines became political, and have stayed that way.
There have been anti-vaxxers throughout history, but the tidal wave of anxiety triggered by Wakefield is still breaking on shores around the world. Early on, I and others who doubted him had to wrestle with pseudo-science and cherrypicked studies that were thrown at us as “proof” that the jab caused autism. Of course, they did nothing of the sort. Journalists are trained to be sceptical, but another skill I needed, I discovered, was countering scepticism.
I wrote about the harm caused by passive smoking; about transplanting pig hearts into humans; the chances of a cure for cancer; the ethics of fertility treatment; and drug companies hiking their prices to unaffordable levels.
And then, in 2000, I came across the same strand of denialism and refusal to believe in established science that I had encountered in Wakefield’s supporters during the MMR crisis.
I wrote a piece about South African president Thabo Mbeki’s doubts that Aids was caused by a virus. He believed the disease wiping out thousands of his people was a result of poverty, and embraced dissidents like Peter Duesberg in the US. Because of the interest the story generated, I was dispatched to the International Aids Conference in Durban, which made headlines around the world. At its heart was the frankly immoral disregard of the world’s poor for whom Aids drugs were too expensive. Doctors and scientists, whom I had only known as cool and dispassionate beings, spoke out with passion and raw emotion.
It was a cause that became the Guardian’s and mine, and in 2003 led to Saving Grace. Readers felt the same way. Many people wanted to give money. All we could do was suggest they donate to organisations in Malawi. But I felt we had a responsibility to Grace, whose name and face we had appropriated. A year later, in 2004, I flew back to Malawi to find out what had happened to her.
To my amazement, a Dutch GP, Hetty van Dijk, who was temporarily working in Malawi, had read a pirated copy of the supplement and tracked Grace down to her stall in Lilongwe market. Not only had she put Grace on antiretroviral medication, but she had started what she called the Saving Grace Foundation, raising money to supply HIV medication to other women.
I wrote about the foundation, and our readers immediately sent money to support it. Eventually it was taken over by an organisation called Theatre for a Change, which put on small dramas in villages to teach people about HIV and ways to protect themselves. Grace works with them to this day. And now she has a child, 12-year-old Chisomo – a girl who was born free of HIV, thanks to the antiretroviral drugs that her mother continued to be on during her pregnancy.
Saving Grace changed me. It was the moment I realised that health reporting could be a force for good. As I continued reporting on Aids in Africa, I was acutely aware that, for women, health is an issue of human rights, whether it’s their risk of HIV, their children’s risk of malaria, or their chances of dying in childbirth. Young women were being infected with HIV because they had no control over their lives, which were dictated first by a father and then a husband. Often it was worse: they were exploited by older men, obliged to have sex to get money to survive, left alone with children and a fatal virus. In the early years of covering this catastrophe, I heard their stories and was speechless at the injustice.
Back in the UK, I wrote about the obesity pandemic shortening lives and the sugar and fast-food manufacturers that had denied any responsibility. And I wrestled with the shifting guidelines on how much it was safe to drink. I was in danger of becoming a hypocrite, as someone who liked to unwind in the evening with a glass or two of something alcoholic. Teetotal journalists are usually ex-journalists, in my experience. (But I did cut down.)
And then, in December 2013, Ebola, a disease caused by a virus that came from animals emerged in a part of Africa where it had never been before, on the borders of Guinea, Sierra Leone and Liberia. By early 2014, it was rampaging across three African countries and causing worldwide terror. This was the stuff of grisly science fiction – a plague spread by body fluids. Some victims haemorrhaged blood from their eyes and noses. Most died. There was no vaccine, and no treatment.
Few saw the danger – not even the World Health Organization. On 8 April 2014, I listened to a WHO briefing on Ebola. It was still an Africa story, not a global health threat – until the end of July, when two American missionary medical workers in Liberia caught the disease and the world started to panic.
I found myself trying to calm everybody down. People catch Ebola from close physical contact, within families or in hospitals, not randomly, I said. Africa’s borders are permeable, so it may not help to close them, I wrote. If it came to the UK it would be quickly contained, like Mers. But the sheer horror of this virus scared everyone. I remember people thinking that the world was about to end. Someone asked me whether we should all shun taxis in London, in case they’d had somebody in the back with Ebola. People thought they could catch it by sitting next to someone on the tube. We journalists planning to go to Sierra Leone, where NHS nurses were heading, attended government briefings on how to stay safe. Media organisations including the Guardian wrote guidelines for their correspondents. I argued strongly that we should not impose two weeks’ quarantine on anyone coming back (Public Health England said it was not necessary for journalists because they were very unlikely to catch it) and won, in principle, but colleagues were so anxious that when I got back from Sierra Leone, it seemed kinder to work from home for a week or two.
As so often, the fear is greater the further away you are. In Sierra Leone, I learned to touch elbows, my temperature was taken every time I entered a building, and I all but washed my hands away, but everybody was calm. Those who had the disease were nursed behind protective walls, and even moats, by selfless nurses and doctors wearing suits that made them look like astronauts and risked heatstroke if they stayed with patients for more than an hour.
Then I woke up feeling hot and ill on the day I was supposed to fly home. It can’t be, I thought. I haven’t had physical contact with anybody with Ebola. But then I remembered Liberia.
I’d flown to the capital, Monrovia, for a few days, and had gone out at dawn with a convoy of Médecins Sans Frontières staff, to distribute malaria drugs in an impoverished community hard-hit by Ebola. “Don’t shake hands, don’t touch anything, and don’t sit down,” I’d been warned. But when I talked to people in the massive queue for drugs as the sun began to come up, I struggled with spelling a name – and its owner grabbed my notebook and wrote it herself. Just a tiny thing. But you wonder. I bought some aspirin. I felt terrible on the long journey home via Morocco, and was glad not to be stopped following a full body temperature scan.
When I got to Heathrow I declared myself to the health workers meeting west African flights. My temperature was raised, but the nurse told me to sit quietly and hopefully it would go down – and it did. I didn’t feel any better and eventually went to my GP, who carefully put on gloves to examine me. I had picked up a virus – but it wasn’t Ebola. A week later, Pauline Cafferkey, a Scottish nurse who had been volunteering in Sierra Leone, made the same journey. Her raised temperature was not picked up at Heathrow and she went on to Glasgow. Later she was airlifted to the Royal Free in London, where she was admitted to an isolation unit with Ebola. Her condition became critical. She pulled through and was released on 24 January but had a relapse in September, from which she also eventually recovered.
Cafferkey benefited from the advantages of a well-resourced health system. In Sierra Leone her chances would have been, at best, 50-50. Her experience shocked the UK, but the fear of Ebola disappeared with her recovery.
Throughout my two decades reporting on global health stories, leading scientists have constantly told me that a pandemic was just round the corner. But neither this, nor my experience of covering Ebola and Aids, prepared me for what hit the world in January last year.
I picked up on the WHO statement on 8 January. “China’s Sars-like illness worries health experts”, ran our headline the following day. On 22 January, the government announced that people arriving at Heathrow from Wuhan would be screened. But the WHO drew back from declaring this a public health emergency of international concern. The following day, we put up a video I had made with the team at the Guardian. “What is the coronavirus?” got nearly 10 million views on YouTube, an all-time record for the Guardian.
People were clearly anxious. Maybe it was because I was calm about Covid, having looked Aids and Ebola in the eye, but I somehow became a go-to person for reassurance. I tried to give the facts and demolish the scare stories. Elderly and frail people were the most at risk. This was not an indiscriminate infection like cholera or dengue.
I’d been writing about horrible, infectious diseases for two decades without managing to reach people beyond those who already knew something about them. Now I was in demand, constantly getting radio requests, as well as doing Guardian podcasts and more videos. I was glad to do them, if nervous. It was important to get it right. I was astonished to be recognised one day on the street; my daughters thought it was great. It felt odd to me – I’ve never wanted to be on camera.
I have to admit that in January 2020 I didn’t actually think coronavirus was going to cause the UK much of a problem. We had a sound history of keeping infections out, with no cases of Sars and only a few of Mers (another coronavirus, but thought to be spread by dromedary camels). We had three or four Ebola cases in total, and all survived. But in early February, Gabriel Leung, a professor at Hong Kong University and an expert in Sars, was passing through London on his way to a major meeting on the new coronavirus at the WHO in Geneva. He agreed to meet me for breakfast straight off the plane in an elegant restaurant in Mayfair. I held out my hand. He offered his elbow.
I nearly laughed, and said we used to do that when I was covering Ebola in Sierra Leone. Then I realised he could not be more serious. He told me that 60% to 80% of the world could be infected by this virus if it wasn’t contained, and that we should consider taking the sort of measures the Chinese had in Wuhan. I remember walking out into the wintry London street, looking at people rushing to work and wondering whether our lives were about to change radically. I went back to the office and wrote the story with great care, worried about the possible impact, and we ran it as the front page splash on 11 February.
But nobody seemed to take much notice. Politicians found it impossible to believe that the scenes in Wuhan could be repeated in the UK. In spite of alarming TV pictures from Italian hospitals in late February and early March, we still didn’t lock down. It wasn’t until 23 March that Boris Johnson told us we must stay home. Who would have thought that more than a year later most of us would still be under restrictions.It has been extraordinary to be at the centre of the biggest news story of the decade. Covid has been often the only story in the world all this time. Covering it has come with a huge sense of responsibility – and has been exhausting to the point of burnout. It was impossible even to escape thinking about it, because it was all anyone wanted to talk about – friends and strangers. And, like everyone else, I’ve found it hard to sleep.
I had already decided to move on from the Guardian before the pandemic hit, to escape the rigours of daily news and spend time writing books. I’d hoped it would be over by the time I left, but while the UK may be through the worst in terms of Covid deaths, it’s far from over for much of the world. We need global solidarity. It’s morally right to ensure people in other countries are fully vaccinated, and it’s in our own interest, too. Variants will emerge where the virus is spreading, and some of those could be deadlier than the strains we’ve seen so far, and evade the vaccines we’ve been given.
After more than 20 years of reporting on global health, I still feel that it is this connection to the rest of humankind that matters. We need that recognition people felt for Grace – the understanding that we are the same people, just in different circumstances. We fall out over politics, philosophies, religions and the pursuit of money as well as happiness. But health is fundamental. We ignore diseases that spring up in other countries at our peril. There has been dengue in New York and TB in London. And now we have a coronavirus pandemic paralysing the world. What more does it take to understand our interconnectedness?
Over the past year, sitting in the tiny box room at home that has become my office, I have felt the exhilaration of doing work that really mattered. I felt that about Ebola, Aids and other stories I’ve done, but, for now at least, nobody doubts the importance of global health. I so hope that will last.