Open letter: Conflict of Interest at the Third Biennial Conference of the African Research University Alliance

Open letter to: Member Universities and Centres of Excellence within ARUA

23 November 2021

RE: CONFLICT OF INTEREST AT THE THIRD BIENNIAL CONFERENCE OF THE AFRICAN RESEARCH UNIVERSITY ALLIANCE (ARUA), GLOBAL PUBLIC HEALTH CHALLENGES: FACING THEM IN AFRICA (17 – 19 NOVEMBER 2021)

We are a group of concerned public health practitioners and academics working in the fields of child health, nutrition, non-communicable diseases (NCD’s) and health promotion.

We are pleased that the Third Biennial Conference of the African Research University Alliance (ARUA) on Global Public Health Challenges: Facing them in Africa to be held from the 17th to the 19th of November will include topics relating to food governance, systems, and access to nutritious food as well as discussions on the role of NCDs in global health.

We understand access to nutritious food to be a key driver of global public health.i We also note the role of diet-related non-communicable diseases in exacerbating the Covid-19 pandemic worldwide, and in Africa. ii Finally, the role of the private sector in influencing food environments in Africa cannot be overstated, iii with corporate political activity and progressive health policies relating to the diets frequently at odds.iv

We note that Professor Lindiwe Sibanda (UP) as one of the main conference speakers will be providing opening remarks. We also note from the biography connected to this conference that Professor Sibanda is a serving member of the Nestlé International Board of Directors. We are concerned that URUA does not recognize this as a conflict of interest.

Nestlé is an international company with a product portfolio that includes infant feeding products, soft drinks, coffee and tea products. Nestlé is a behemoth in the food and beverage industry, reporting CHF 7.3 billion profit for the first half of 2021 (ZAR 122.9 billion/ NGN 3293.4 billion/ 4530 CFA billion). Nestlé controls the world’s most valuable food and drinks portfolio.v Per its own admission, more than 60% of Nestlé’s food and beverage portfolio are deemed unhealthy products.vi Nestlé has also been accused of engaging in harmful corporate practices including the use of child slave labour, vii illegally promoting- breastmilk substitutes, viii unfair labour practices, ix and massive water usage sourced from water-scarce areas.x We only list allegations levelled against Nestlé in 2021. We do not purport to take a position on these allegations, but we are concerned by the gravity and scope of these allegations.

Specifically, in South Africa, we have documented repeated violations by Nestle of the R991xi xii regulations related to infant formula marketing and recently academics and civil society voiced opposition to a recent Nestle sponsored event for mothers which was subsequently cancelled.xiii

We note the Carnegie Corporation which is funding this conference is committed to avoiding conflicts of interest as per its 2009 Code of Ethics.xiv We believe the member universities of ARUA share in this commitment. Public Health England defines conflict of interest as an inability to contribute impartially to a programme of work, research, governance or oversight functions.xv The WHO described a conflict of interest as a set of circumstances where there is a potential for a secondary interest to unduly influence or be reasonably perceived to unduly influence the independence or objectivity of the primary interest. xvi The World Public Health Nutrition Association classifies possible conflicts of interest as any engagement with commercial producers of unhealthy foods, and specific industry involved in infant feeding products, ultra-processed foods and sugar-sweetened beverages (all part of Nestlé’s product portfolio).

As academics and professionals, we may think we are immune to conflicts of interest, yet a Cochrane review found that industry funding leads researchers to favour corporations either consciously or unconsciously. xvii While a conflict of interest does not necessarily equate to collusion or corruption it is often “difficult to distinguish subtle, unconscious bias from deliberately concealed impropriety”. xviii It is also important to recognise that perceived conflicts of interest may be as damaging as actual conflicts as they may “tarnish the reputation of scientists, organisations or corporations”. As such governments, universities and international organisations such as the WHO, have put measures in place to prevent and mitigate conflicts of interest.

The first step in managing conflicts of interest is disclosure and transparency at the individual and institutional level in order to screen and identify individuals/institutions with conflicting interests. xix While this is indeed a necessary first step, it is not sufficient to eliminate the COI, and where serious conflicts of interest arise between an individual’s private interests and public duties, it may become necessary to prohibit that individual from taking on positions of influence, and/or participating in key decision-making processes. Alternatively, the individual or institution should be asked to divest and rid itself of any interest that may undermine its integrity and independent judgement.

We are therefore concerned that Professor Sibanda’s leadership role in the conference, including hosting a workshop in her role as Director of the ARUA Centre of Excellence in sustainable food systems, while simultaneously holding a remunerated xx board of directors position with Nestlé constitutes a conflict of interest which may further compromise food and nutrition security on the African continent

Please clarify how this conflict has been investigated and how the conflict of interest will be managed.

Yours Sincerely,

List of Signatories:

NameInstitutional affiliation
 

Dr Chantell Witten

South African Civil Society for Women’s Adolescent’s and Children’s Health –

SACSoWACH

Prof Tanya DohertyHealth Systems Research Unit, South African Medical Research Council
 

Prof Karen Hofman

SAMRC Centre for Health Economics and Decision Science, PRICELESS SA,

Wits School of Public Health

 

Prof Susan Goldstein

SAMRC Centre for Health Economics and Decision Science, PRICELESS SA,

Wits School of Public Health

Lori LakeChildren’s Institute, University of Cape Town.
Dr Sara Jewett NieuwoudtSchool of Public Health, University of the Witwatersrand
Prof Ameena GogaHIV Prevention Research Unit, South African Medical Research Council
Prof Maylene Shung-KingSchool of Public Health and Family Medicine, UCT
Dr Catherine MathewsHealth Systems Research Unit, South African Medical Research Council
Prof Rina SwartDietetics and Nutrition, University of the Western Cape
 

Prof Mark Tomlinson

Institute for Life Course Health Research, Dept Global Health, Stellenbosch

University

Catherine Pereira-KotzeSchool of Public Health, University of the Western Cape
Prof Chris ScottPaediatrics and Child Health, UCT
Dr Louis ReynoldsPaediatrics and Child Health, UCT; People’s Health Movement
 

Prof Arvin Bhana

Health Systems Research Unit, South African Medical Research Council,

Centre for Rural Health, College of Health Sciences, UKZN

Dr Gillian SchermbruckerPaediatrics and Child Health, UCT
 

Dr Zoe Duby

Health Systems Research Unit, South African Medical Research Council;

School of Public Health & Family Medicine, University of Cape Town

 

Dr Wiedaad Slemming

Division of Community Paediatrics, University of the Witwatersrand;

SACSoWACH

Ms. Pumla DlaminiSACSoWACH Co-Chair
Ms Emmanuelle DaviaudHealth System Research Unit, South African Medical Research Council
Raul Mercer MD MScWorking group on Commercial Determinants of Child Health / CAP 2030
Precious RobinsonSACSoWACH Chairperson
Dr Elizabeth GoddardPaediatrics and Child Health, UCT
Mary KinneySchool of Public Health, University of the Western Cape
Prof. Ingunn Marie Stadskleiv

Engebretsen

 

Centre for International Health, University of Bergen, Norway

Jane BadhamGlobal Nutrition Consultant
Simela PetridouLa Leche League South Africa
Tamryn FrankSchool of Public Health, University of the Western Cape, South Africa
Stefan PetersonKarolinska Institutet
Leslie LondonSchool of Public Health, University of the Cape Town
 

Dr Annibale Cois

Division of Health Systems and Public Health, Department of Global Health,

Stellenbosch University

Prof Amy SlogrovePaediatrics and Child Health, Stellenbosch University
Dr Rahmat BagusGeneral Practitioner, IBCLC, La Leche League Leader South Africa
Dr Gabriel UrgoitiRX Radio SA
Dr Elmarie MalekPaediatrics and Child Health University of Stellenbosch
Joan TrubyLa Leche League South Africa
Prof Desiree LewisWomen’s and Gender Studies Department, University of the Western Cape
Vicky ReynellLa Leche League South Africa
Prof Mignon McCulloch 
Dr Wanga Zembe 
Maryse ArendtBFHI coordinator Luxembourg
Nzama MbalatiHealthy Living Alliance (HEALA)
Elisabeth Sterken, MSc Dt.Director INFACT Canada/IBFAN North America
Tony Waterston, MD FRCPCHInternational Society for Social Pediatrics and Child Health
Dr Christine MagendiePCP
Dr Dr Seth Christopher Yaw AppiahKwame Nkrumah University of Science and Technology, Kumasi, Ghana
Jeffrey GoldhagenInternational Society for Social Pediatrics and Child Health
Dr Lucy ReynoldsInternational Society for Social Paediatrics and Child Health
Suné GreeffEastern Cape Department of Health
Jenny WrightMilk Matters
Lebogang RamafokoTekano Atlantic Fellows for Health Equity
Scott DrimieDepartment of Global Health, Stellenbosch University
Delena StrydomIBCLC – Panorama Breastfeeding Clinic
Koketso Moetiamandla.mobi
 

Judy Kirkwood

IBCLC and Midwife, Developer of the The Best Start Feeding Initiative. Shark

Latch – breastfeeding technique (patent and TM)

Nicolette HenneyDietitian
Tobie MullerIBCLC, La Leche League Leader South Africa
Hettie GroveSACLC
Julia GaneLa Leche League Leader South Africa, Physiotherapist
Prof Neil McKerrowPaediatrics & Child Health, KZN
Carol BrowneIndependent nutrition consultant
Anna ShevelGood Food Network
Aadielah Maker DiedericksSouthern African Alcohol Policy Alliance
Prof Uta LehmannDirector, School of Public Health, University of the Western Cape
Prof Nicola ChristofidesSchool of Public Health, University of the Witwatersrand
Dr Tanya RuderDivision of Community Paediatrics, University of the Witwatersrand
Dr Anri MandersonThe Hoedspruit Hub, Limpopo
Alison BakerSouth African Certified Lactation Consultant
Dr Nandi SiegfriedChief Specialist Scientist, SA Medical Research Council
Tanya ThomasLLL Leader South Africa
Leana Habeck IBCLCThe Breastfeeding Clinic
Brenda PierceIBCLC
Dr Nanette JollyMedical Doctor, IBCLC, La Leche League Leader South Africa
Ana FrawleyLactation Consultant
Barbara ChambersIBCLC, CFT
Lynn ShierIBCLC, LACSA, Midwife
Pauleen NelsonIBCLC, LACSA, Midwife
Dr Nadine HarkerSpecialist Scientist, SAMRC
Mervyn AbrahamsNational Department of Health, SA
Alan RosenbergSouth African Organic Sector Organization
Dr Christiane HorwoodCentre for Rural Health, UKZN
Lynette SmitSACLC, IBCLC, CFT
Liezel EngelbrechtDietitian
Melissa ZwartSACLC
Kari OosthuizenSLT & LLL representative
Nicole MeyerLa Leche League Leader South Africa
Lenore SpiesPublic Health Nutrition Consultant
Maya BhardwajUniversity of Pretoria
Zani SmithDietitian & SACLC
Dr Michelle De JongUniversity of the Western Cape
Ulla WalmisleyUniversity of the Western Cape
Claire MoffattSACLC
Dorle VerrinderRD IBCLC
Lindie PittDoula
Katinka FourieIBCLC
Carey HauptRD SACLC MSc(Med)
Dr Khaleed SayedMBChB, Dip of Obs
Dr Natasha RamjeeMO in Paediatrics, Mowbray Maternity Hospital
Ceferino CenizoEarth And Man Foundation
Claire BracherM.Sc nursing RN. RM. IBCLC
Luyanda MajijaCommunication Manager, Vital Strategies
 

Anna Coutsoudis

Professor Emeritus, School of Clinical Medicine, University of KwaZulu-Natal,

Durban

Ann BehrNational Department of Health
Melissa Whitson 
Simone finkDoula, Yoga Teachers trainer, Bcom
Cristel CloeteBirth & Bereavement Doula
Jean RidlerIBCLC, RM, RN
Dr Surya EbrahimMowbray Maternity Hospital
Sandy BaymanWOMBS Doula
Irene BourquinWOMBS Doula Trainer, Registered Nurse/Midwife
Amanda NeitoLa Leche League Leader, South Africa, WOMBS Birth and Postpartum Doula
Lizl DunnWOMBS Doula, Breastfeeding Counselor
Pamela WilmentLa Leche League Leader, South Africa, WOMBS Doula
Dr Vanessa FarrEnvironmental Humanities South, University of Cape Town
Laura Sayce IBCLCIBCLC
Dr Sharon NyatsanzaNational Council Against Smoking
Sithabile ShobowaleWOMBS DOULA
Jane PittIBCLC – SOUTH AFRICA
Samantha CromptonRN, SACLC – The Baby Lady SA
Adriano CattaneoEpidemiologist (retired), Trieste, Italy
Bronwyn Balcomb, RD (SA), IBCLCRegistered Dietitian, South Africa
Anneleen De KeukelaerePeople’s Health Movement South Africa
David Pienaar 
Dr Max KroonPaediatrician, UCT
Ronel SorgenfreiRegistered Dietitian, South Africa
Vongani MkhabeleRegistered Nutritionist, South Africa
Michael HendricksPaediatrician, UCT
Vanessa BlackBiowatch South Africa
Marion Stevens 
Nikki SchaaySchool of Public Health, University of the Western Cape
Anton DelportSchool of Public Health, University of the Western Cape
Brittany KesselmanSociety, Work & Politics Institute (SWOP), WIts University
Prof Susan FawcusDepartment Obsterics and Gynaecology, University Cape Town
Manya van RyneveldSchool of Public Health, University of the Western Cape
Estelle WasserfallADSA, WOMBS doula
 

Prof Minette Coetzee

Children’s Nursing Development Unit, UCT Department of Paediatrics and

Child Health

Dr Hazel BradleySchool of Public Health, University of the Western Cape
 

Andrea Amos

Children’s Nursing Development Unit – Department of paeds and child

health, UCT

Prof Rachel WynbergDepartment of Environmental and Geographical Science, UCT
 

Angela Leonard

Children’s Nursing Development Unit, UCT Department of Paediatrics and

Child Health

Angelika PeczakHEALA
Prof Nick SpencerInternational Society for Social Pediatrics and Child Health (ISSOP)
 

Florian Kroll

DSI-NRF Centre of Excellence in Food Security; UWC Institute for Poverty,

Land and Agrarian Studies

Russell RensburgRural Health Advocacy (RHAP)
Zolile MlisanaRetired paediatrician
Emeritus Professor Marian JacobsUCT Department of Paediatrics and Child Health
Katinka Musavaya – IBCLCIBCLC – Maternal and Childhealth Zimbabwe
Prof Ashraf Hassen CoovadiaAcademic Head of Paeds Wits University
Dr Nomlindo MakubaloDCST Paediatrician Eastern Cape
Beatrix CallardAPN, RN, Windhoek Namibia
Thandi PuoaneEmeritus Professor
 

Prof Bruno Losch

Institute for Social Development, University of the Western Cape / DSI-NRF

Centre of Excellence in Food Security / Cirad, France

 

Prof Diane Cooper

Extraordinary Professor, School of Public Health, University of the Western

Cape

 

Prof Stephen Devereux

Institute for Social Development, University of the Western Cape / DSI-NRF

Centre of Excellence in Food Security / IDS Sussex, UK

 

Dr Simon Lewin

South African Medical Research Council and Norwegian Institute of Public

Health

 

Lisanne du Plessis

Division of Human Nutrition, Department of Global Health, Faculty of

Medicine and Health Sciences, Stellenbosch University

Marcus SolomonNational Coordinator Children’s Resource Centre
Rifqah RoomaneyPhD intern, SAMRC

 

Richard Matzopoulos

 

Burden of Disease Research Unit, South African Medical Research Council

 

Maurice Smithers

 

Southern African Alcohol Policy Alliance in SA (SAAPA SA)

 

Dr Edward Nicol

 

Burden of Disease Research Unit, South African Medical Research Council

 

Carole Dobrich

 

RN, IBCLC, International Institute of Human Lactation Inc.

 

Jennifer Welch

 

IBCLC International Board Certified Lactation Consultant

 

Dale Hansson, RN, CFHN

 

BFHI Lead Assessor, Lactation Consultant

 

Janelle Maree

 

Director, Breastfeeding Advocacy Australia

 

Dr Magdalena Whoolery

 

MCH-IYCF Consultant and IBFAN Member

 

Prof Sharon Fonn

 

Wits School of Public Health

 

Ateca Kama

 

Chief Dietitian & Nutritionist, Ministry of Health and Medical Services, FIJI

 

Prof Alice Nte

 

Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

 

Milton Semenekane

 

South African Medical Research Council

 

Noloyiso Matiwane

 

North-West University

 

Hassan Mahomed

 

Division of Health Systems and Public Health, Dept of Global Health, Stellenbosch University

 

Jane Simmonds

 

South African Medical Research Council

 

Dikoloti Morewane

 

Botswana Breastfeeding Association

 

Jane Joubert

 

South African Medical Research Council

 

Dr Jane BattersbyUCT

 

Mr. Phillip Mokoena

 

Global Health Advocacy Incubator

 

Makoma Bopape

 

University of Limpopo

 

Maria van der Merwe

 

Independent public health and nutrition consultant

 

Bill Jeffery

 

Centre for Health Science and Law

 

Dr Anam Nyembezi

 

Senior Lecturer, School of Public Health, University of the Western Cape

 

Tara Callow

 

Pediatric Nurse Practitioner, MSN, CRNP USA

 

Prof Di Gray

 

UCT Department of Paediatrics and Child Health

 

Ravi Ram

 

Madhira Institute & PHM Kenya

 

Sarah Motha

 

Umphakatsi Peace Ecovillage

 

Ronel Beukes

 

Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University

 

Petronell Kruger

 

Public health lawyer and researcher at PRICELESS

 

Denis Joseph Bukenya

 

Human Rights Research Documentation Center (HURIC)

 

Jamiru Mugalu

 

People’s Health Movement Uganda

 

Dr Phumza Nongena

 

UCT Department of Paediatrics

 

Prof Yousuf Vawda

 

UKZN School of Law

 

Dr Natisha Dukhi

 

Human Sciences Research Council (HSRC)

 

Ms Bongekile P. Mabaso

 

Registered Nutritionist, PhD Candidate at UCT, School of Management Studies

 

Prof Salim S. Abdool Karim

 

Director: CAPRISA

 

Laurie Schowalter

 

HEALA

 

Patti Rundall

 

Baby Milk Action, IBFAN Global Council

 

Sam Waterhouse

 

Womxn and Democracy Initiative

 

Dr Gwen Norton

 

La Leche League Leader

 

Nadine Nannan

 

Specialist scientist, SAMRC

 

Duduzile Mkhize

 

 
Nomajoni Ntombela

 

IBFAN Africa
Dr Irena Zakarija-Grković

 

Croatian Association of Lactation Consultants; University of Split School of Medicine, Croatia

 

Nomajoni Ntombela

 

 
Nophiwe Job

 

Registered Nutritionist

 

Sasha Stephenson

 

Section27

 

Sally Raine

 

La Leche League Leader South Africa

 

Prof Julia Goedecke

 

Non-Communicable Diseases Research Unit, South African Medical Research Council
 Public Health Association of South Africa
 Rural Health Advocacy Project
 HEALA
Stuart GillespieNon-resident senior fellow, IFPRI
Rene WilliamsRetreat Feeding Initiative feeding community and serving to uplift those in need. Independent non Gov
Shireen Marks

 

Retreat Feeding Community Worker exposed daily to mothers and children dealing with affordability issues regarding feeding

 

Colleen BricklesRetreat Feeding Assistant working with kids feeding daily
Dr Anna HerforthIndependent researcher
Ralph HamannUniversity of Cape Town
Aviva TugendhaftSAMRC Centre for Health Economics and Decision Science, PRICELESS SA, Wits School of Public Health
Dr Thandi WesselsDistrict Paediatrician, Western Cape Dept Health, Department of Paediatrics and Child Health, Stellenbosch University
Prof Linda RichterDistinguished Professor, DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand

What is front-of-package labelling, and why does South Africa need it?

Easy-to-understand labels could save your time in the shop — and your health.

Let’s face it: Nutrition labels are hard to read.

In South Africa, confusing and overly technical nutritional information is buried at the back of the tins, boxes and bottles we buy at the store. But front-of-package labelling translates the information consumers need to know into simple language and puts it right on the front of foodstuffs.

At least 10 countries, including Brazil, Mexico and Chile, have already switched to front-of-package labelling or will in coming years. Now, South Africa looks set to join them.

Globally, front-of-package labelling can take different forms.

In some countries, front-of-package labelling looks like a traffic robot, colour-coding the levels of nutrients of concern like salt or sugar based on whether they are low or high. However, research from Australia and the United Kingdom has found this form of front-of-label packaging may be ineffective.

In other places, food may carry a badge that says that it’s a healthy option overall. Lastly, some countries may choose to use front-of-package labels that simply say how many servings, for instance of fruits or vegetables, are in a given food.

But “high in” front-of-pack warning labels, which clearly identify products that are high in things like sugar, salt, saturated fat or trans fat — what experts call “nutrients of concern” — are the most effective at helping consumers spot unhealthy foods.

1. Why does South Africa need a front-of-package label? 

South Africa needs front-of-package labelling to help consumers make better choices and live healthier lives.

Globally, ultra-processed foods often high in salt, sugar and fat are more available than ever before in low and middle-income countries, including South Africa. A diet high in sugar, salt and fat can put you at risk of developing a range of conditions such as obesity, high blood pressure, type 2 diabetes and heart disease — or what are often called non-communicable diseases (NCDs).

More than six out of 10 women above the age of 15 in South Africa are overweight or obese, putting them at risk of developing life-threatening illnesses, shows data from the most recent South African Demographic and Household in 2016. Overall, the World Health Organisation estimates that almost one in three South Africans were obese in 2016. About 13% of children in South Africa are also over weight – more than twice the global average.

As a result of trends like this, more people in South Africa are dying from NCDs than ever before, according to Statistics South Africa. Diabetes, hypertension and heart disease are all among the top 10 leading causes of natural death in the country, according to the latest figures from 2017.

In a 2012 national survey, about one in five people surveyed either had high blood pressure or were on track to develop the condition unless they changed their dietsAbout a quarter of adults had high cholesterol levels, which can increase your risk of heart disease and stroke.  

2. Do front-of-package labels really work to change the way people shop and eat? 

Yes. Front of package labels that state a food is “high in” or has “excessive” amounts of nutrients of concern – think sugar, salt and trans fat, for instance – are proven to help consumers tell if a food is healthy or not.

For instance, in one study shoppers who were presented with sugary fruit juices bearing these warning labels were less likely to view the beverages as healthy, according to a 2020 study published in the journal Preventive Medicine. Fruit juices are often a hidden source of sugar in many people’s diets who may mistakenly believe them to be healthy.

Consumers were similarly better able to identify unhealthy yogurts, juice, crackers and bread when these products came with front of package warning labels, another 2020 study in the journal Food Quality and Preference found.

But these food warning labels don’t just help consumers make better choices at the till. Several studies, including one conducted among more than 600 young people, found that front of package labels can also make people less likely to buy unhealthy food in the future.

And front of package labels can save lives and money. In Mexico, front of package labels warning of excess nutrients of concern like sugar and salt are expected to avert more than a million cases of obesity in Mexico and save the country more than R25 billion in healthcare costs over five years, researchers found in another 2020 study also featured in PLOS Medicine.

3. But South Africa already includes nutritional labels on food, aren’t these good enough?

No. Several studies have shown that people globally and in South Africa have trouble reading traditional nutritional labels — even if they might not know it. Researchers in India, Mexico and South Africa have all found that many people actually understand nutritional labels less well than they think, found a 2015 article published in the Global Health Action journal.

For instance, most people in a 2011 study in the North West reported regularly reading nutritional labels. But when scientists quizzed study participants on how well they understood these labels, test scores revealed that even frequent readers did not always understand how to use labels to make better food choices.

A third of participants didn’t even read labels.

4. When will South Africa introduce front-of-package labels?

It’s not clear when South Africa’s national health department will release new draft guidance on front-of-package label requirements. It will be the first step in a long road to consumer-friendly policies that will help counter big corporation’s influence on what we eat for a more food-just South Africa.

Until then, scientists across the country are working on new research that will help guide the country’s rollout of new, easier-to-use labels that will save consumers’ time — and health.

The Healthy Living Alliance (HEALA) is a coalition advancing food justice in South Africa. For updates, follow us on Twitter or subscribe to our newsletter.