AIDS policy in post-apartheid South Africa has been shaped by persistent antipathy towards antiretroviral drugs (ARVs). This hostility was framed initially by President Mbeki's questioning of AIDS science and subsequently by direct resistance to implementing prevention and treatment programmes using ARVs. Once that battle was lost in the courts and in the political arena, the Health Minister, Tshabalala-Msimang, continued to portray ARVs as ‘poison’ and to support alternative untested therapies. Demographic modelling suggests that if the national government had used ARVs for prevention and treatment at the same rate as the Western Cape (which defied national policy on ARVs), then about 171,000 HIV infections and 343,000 deaths could have been prevented between 1999 and 2007. Two key scientific bodies, the Medicines Control Council (MCC) and the Medical Research Council (MRC) fall under the ambit of the national Department of Health. Although notionally independent, both have experienced political interference as a consequence of their scientific approach towards AIDS. AIDS policy improved after the Deputy President was given responsibility for coordinating AIDS policy in 2006. However, the undermining of the scientific governance of medicine is a legacy that still needs to be addressed.

The COVID-19 pandemic posed challenges for healthcare systems and political leaders across the globe. In this case study of Brazil, we argue that leadership failings at the highest level contributed to Brazil’s relatively high and escalating death rates during 2020. Drawing on an analysis of a large amount of textual documentation drawn from media reports, we emphasise the role and consequences of President Jair Bolsonaro’s political discourse and prioritisation of the economy. We focus on the first wave that swept across the globe between January and late June of 2020, arguing that Bolsonaro underplayed the seriousness of the epidemic, leveraged misinformation as a political strategy, promoted pseudoscience, and undermined the Ministry of Health. He also confronted subnational governments for adopting lockdown measures – a move that enabled him to blame regional governors for the short-term economic costs of COVID-19 related restrictions. We suggest that his denialist approach to climate change paved the way for his subsequent denialism of the seriousness of COVID-19 and for his undermining of social distancing, mask-wearing and other preventative responses supported by science. These sobering findings highlight the role that national leaders can play in undermining scientific approaches to both public health and the environment.

Jeremy Seekings and Nicoli Nattrass outline the class structure of post-apartheid South Africa and examine the redistributive consequences of the government’s economic growth path.