Episode 3: Prof. Shaheen Mehtar

Welcome to the third episode of ISAC's Living Legends in Infectious Diseases podcast series, hosted by Professor Ian Gould.

In this episode Ian Gould sits down with Professor Shaheen Mehtar (Stellenbosch University, Cape Town; Founding member and Past Chair, ICAN) to trace her remarkable journey from early training in Pakistan and the UK to shaping IPC across Africa. Through stories of mentorship, global outbreaks, WHO policy work, and building Africa’s first infection‑control unit, Mehtar reflects on decades of change in microbiology, AMR, Ebola, COVID, and the challenges of a continent “so huge people underestimate its size.” A conversation rich in history, humour, and hard‑won insight. 

Links:

Infection Control African Network

Thanks for joining us on ISAC's Living Legends podcast. You’ll find sources and guest information in the show notes and at the ISAC Academy.

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Transcript

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Ian Gould 0:06

Hello, and welcome to the Living Legends in Infectious Diseases Podcast, brought to you by the International Society of Antimicrobial Chemotherapy. My name is Professor Ian Gould, and I'm a recently retired consultant microbiologist at the University of Aberdeen. Each episode features a conversation with a leader whose work has shaped the field of infectious diseases. And today it's my great pleasure to speak with a long-time colleague and friend, Shaheen Mehtar, who is a living legend in particular the field of infection prevention and control. So welcome, Shaheen. Great to have you.

Shaheen Mehtar 0:46

Thank you.

Ian Gould 0:47

Tell me about your early formative experiences in the medical world.

Shaheen Mehtar 0:53

Okay, well, I did my MBBS from Pakistan and came to the UK because I wanted to do postgrad. I was looking at doing something in histopathology, but then I was doing a rotation in King's and bumped into Elizabeth Price, who was my registrar. And she definitely influenced me into going into microbiology. And it's something that I never look back on because it's so entertaining. Every 10 years, there's something new going on, there are outbreaks, the system's going on. And she was an amazing mentor. From there, I went it at UCH with Joan Stokes, the very, very famous Joan Stokes, who decided to completely re-educate me, introduce us to clinical ward rounds. And as you remember, those days there weren't many infectious diseases people. So the microbiologist had to do a lot of clinical work. So she made sure that we did all that and the on call at night, plus the laboratory stuff. From there, I was then went as a senior registrar to Mike Emerson, who was an amazing mentor and supported everything that we did. But he introduced us, or introduced me, to decontamination sciences, which was not very common, and also sent us all to Falfield [Engineering College] to go and crawl in ducts and look at bedpans and do all that sort of stuff. So at the end of the day, when we came out of there and we qualified, it wasn't difficult to do the membership exam. And I was very fortunate to get through it quite quickly. And then at the age of 29, I was appointed as head of microbiology at the North Middlesex Hospital. The other person who had an influence on my life, of course, was JD Williams, because he was very, very supportive and always wanted to make sure that we got to the right place at the right time and set up the senior registrar discussion groups and so on. So that was the basis of me going into microbiology.

Ian Gould 2:44

That's great. That's who's who of some of the leading names in the early years of what we might call the new specialty of clinical microbiology. You rapidly rose to the public's notice, certainly professional notice, by being heavily involved in networking in the UK. Do you want to tell us a little bit about the societies that you were involved in?

Shaheen Mehtar 3:07

Well, I was actually on several committees for the British Society of Antimicrobial Chemotherapy, found a member of the Healthcare Infection Society, was involved at the Association of Medical Microbiologists, was involved, obviously, as you know, as ISC. I was involved with ESCMID then and set up their nosocomial group. So we were, in fact, working a very wide network, and we were managing to do a lot of work by linking them. But that was not the only thing I was doing. I was also working a lot in low to middle income countries at the time. So I'd go off to Asia and spend a lot of time in the Philippines and around Thailand and so on in those days. So this was part of my need, if you like, to because I knew everybody could do microbiology or clinical microbiology and antimicrobial stewardship in the UK. But what was happening outside the UK? So my forte then became, or my desire then became to try and introduce simple infection control programs within other countries. And so worked in Asia, uh, China, obviously. We went off at the time to the Middle East, yes, and also to Eastern Europe and to Latin America and to South America. So there was quite an interesting group, and we met a lot of each other. Also, we met together through the various organizations that we've just mentioned. So it's ESCMID, it's ISC, it was all the other conferences that we attended where we started developing these sort of links and networks.

Ian Gould 4:39

Just for clarification for the younger audience for this program, ISC was the previous acronym for ISAC, standing for International Society of Chemotherapy before the rename. Primarily, it sounds like you were networking and teaching. Is there any research that you did that you were proud of? Any great papers you think justified mentioning?

Shaheen Mehtar 5:03

I did a lot of work of investigative work, to be honest. I wasn't very good at publishing, I must admit. I was more curious than publishing. So I'd like to find out about something, and then that was it. That was good. I enjoyed that. So there were several papers published on the antimicrobial. We did some clinical trials, which were very useful. Looking at antimicrobials, new agents at the time coming through are very helpful. And whether these were available or not in those parts of the world. So when we were in India, for example, we found out that there were a lot of fake drugs going out very quickly at the time. I don't think it's happening anymore, but there were lots of those sort of things going on that made it very difficult to actually manage the antimicrobial stewardship program that we were trying to put into place because there was always a different group of people working on something that were not completely kosher, if you like, you know. So there was one piece of work which I really liked, and I brought back about seven tablets, as they were, for on ciprofloxicin. And we brought them in and we gave them to David Reeves, if you remember David Reeves, who looked at them and found that only two of them had any cipro in them. And most of them had absolutely nothing, obviously, but they were called ciprofloxicin. And one of them, of course, had about 150 grams of it in a 250 tablet. So it was interesting to just find out what's going on around you. And I'm not surprised that some of that sort of resulted in some of the antimicrobial resistors that we're seeing today. But um, there was a lot of usage. Then the other part that was really interesting was working with the Danish people, veterinarians particularly, looking at their antimicrobial resistance, which they had already started looking at. So that was really interesting.

Ian Gould 6:46

You're younger than me, but you might, or at least you look younger than me, you might recall, as I do in the early days of our trading, that some of our mentors were a little unconvinced about the relationship between prescribing and resistance. And maybe didn't quite believe that antibiotic stewardship was necessary. You know, we're talking about the the last days of the halcyon period of antimicrobial chemotherapy. Did you get the same um expressions?

Shaheen Mehtar 7:17

We were lucky. I mean, we were in North London, so everybody there was very, very intensely involved. Had come out of Joan Stokes' stables, and she was obviously, as you know, married to John Stokes, who was the president of the college. So we all had to understand what was going on. She was really keen that we got this right, you know, so there was no poo-pooing going on there. What we did have was a very strong antimicrobial policy program in in North London. And some of that training was done for us, or we went up to see Richard Wise, or we'd go up to see David Reeves, and they would emphasize the antimicrobial, the restrictive reporting, I think it was called at the time that we had. And so many of our hospitals had that in place. And we did surveillance with it, but it was very poor surveillance. I mean, you know, we just managed to do what we could. Nobody thought it was not a good idea. But they didn't know what the other issues were, so they didn't realize whether the water systems were affecting uh multidrug resistors, they didn't understand the sewage system, the travel. If you remember, there was a huge thing about people traveling back and forth from the Middle East and and from in the Near East coming in and out with the so those those sort of things only surfaced much later.

Ian Gould 8:28

You've played your part in various WHO committees. Was that before you left the UK?

Shaheen Mehtar 8:35

I've been working with the WHO since 1993. Kurt Naber had set up the Urinary Tract Group, and we were looking at that and so on and so forth. But the the whole WHO concept changed as we moved along. So what came out of a lot of work that was done by the global IPC unit of um Benedetta Allegranzi was that we had to look at infection control as a pillar of AMS, because the rest of it had expanded so widely. And that's exactly what I did when I came to South Africa. So we started looking at this as a way of making sure that if we could stop transmission, which is IPC is equal to transmission, if we could stop that, then the rest of it should actually be working together and falling into place. And that is why we set up all the training that we did on the postgraduate diploma is based on that, the fundamentals courses based on that, everything else is based on that. But the guidelines from the WHO were very much involved with the outbreaks at the time, which is Ebola and COVID and all that, but also looking at some of the antimicrobials. Now I wasn't in the group that was doing the antimicrobials, I was in the group that was doing the infection control aspects of things. So yes, it was difficult because all the data that came came from high-income countries, but the policies were applied to low to middle-income countries. So for somebody like me on that committee, it was my job to make sure that it was acceptable within the context of where we were, because otherwise nobody would follow. So and I think that was quite important to do, to put it back into perspective for the countries that were using it.

Ian Gould 10:12

COVID obviously happened only relatively recently. When did Ebola first become a major concern?

Shaheen Mehtar 10:20

Okay, my first encounter with uh Ebola was in Gulu in 2002. I was just happening to do something else, and then we got these seven, eight people admitted who came in uh looking not so well, and of course were then diagnosed with Ebola, but we had no PPE, so we had to use plastic bags, bin bags, scarves, glasses, and there were myself and four other people. We dealt with these seven or eight, and none of us got infected. I mean, but we managed it quite well. So it's only when the whole thing happened in West Africa that we went across there again, and we were involved in setting up programs with them and working with the WHO and CDC and several other people that were there, and really pushing the infection control aspects of things as best we could. It was a very, very trying, but very interesting time for me. I mean, I learned so much there, you know, with the Ebola. And we were involved in obviously the documentation that went together and all the policy making and so on. So yeah, it was quite interesting. I had the advantage of having worked in many low-to-middle-income countries to see what was available and to be able to apply it. So I enjoyed that very, very much.

Ian Gould 11:29

When did you actually go to South Africa and what took you there?

Shaheen Mehtar 11:33

Uh I left the UK in '97, post apartheid. Mose could come back. He was in exile. He could come back.

Ian Gould 11:41

So your husband.

Shaheen Mehtar 11:42

Yes, my husband, sorry, yes. And he had been away for 40 years. So for him, we were actually in Prague and we at a meeting, at a conference, and we watched Nelson Mandela being released, and he said, Oh, I want to go home. So I said, Oh, okay. So he said, Well, I've been away, I mean, lived in your country, and I've lived, you know, all over the place. I want to go home. So that's all right. I said, why don't we decide when we get home? So we just went and when we landed in at Heathrow, he said, Well, what do you think? And I said, Well, let's do it. So we did. So we just jumped up and we came. I was very fortunate when I came here. I was actually head-hunted by Tygerberg and Stellenbosch University. Um, and they very kindly gave me a professorship and I set up the unit of infection control, which was the first of its kind in Africa, as we know. And that then started rolling over things and moving things out and getting things going. So what brought me in South Africa was uh my husband, basically. It's a move which I absolutely think was the best thing ever. It was really the best move ever. I wouldn't think of being anywhere else except here. It is just the most fascinating country and the continent. It was very involved with the continent, Africa CDC, and so on. So very, very interesting to see the differences that we can make with very little apart from you know getting long documents, which I don't really look at. But you know, you actually try and work your way through systems as they exist. So yes.

Ian Gould 13:10

Correct me if I'm wrong, but that Prague meeting in 1997 would have been an ICC.

Shaheen Mehtar 13:16

Yeah. That was in Durban.

Ian Gould 13:19

Quite possibly. What are your best memories of the heady of the big congresses like the ICC?

Shaheen Mehtar 13:27

You remember how many thousands of people would be there. So before anybody went anywhere, we'd actually communicate amongst friends and say, okay, we're staying in this place and we're doing this, and we're all going to go off together and do that. So we had sort of like a cabal of people wandering around who had these places. And it was amazing because you learned so much, you know, not only socially, but also uh academically, learned a lot, met a lot of people. To my mind, it was absolutely vital. I would always include young people. So I always wanted to bridge the gap between the elderly and the very snobbish and the oh god, they don't know what they're talking about, group, and the young ones, you know, who'd come up and sort of say, let's let's give them a chance. And so I learned a lot. The the ICC was really, that was the International Congress of Chemotherapy, was huge, if you remember, because there was a whole cancer side, and then there was the antimicrobial side. And I think it was a good idea to bring it down into the antimicrobial one. It gave everybody an opportunity to concentrate on what they wanted to do. And then we got into the situation when there was ECMID, and so ESCMID was actually part of the competition, or to go there or go there. And then ISID, which I was very, very fortunate to be allowed to sit on their committee and their board. So there were lots of things now moving out of the infection control part, taking infection control with them, but moving into antimicrobial resistance. So there were three, four big organizations, including ISAC, you know.

Ian Gould 14:52

Do you think that these professional societies will continue to play such an important role in networking, education, research?

Shaheen Mehtar 15:00

Well, yes and no. Yes, because you need to meet people that you've heard of and spoken to. I mean, the the the last time I went to ESCMID was in Madrid, and I'm bumped into Ian Phillips again. I haven't seen him for years. Absolutely essential for my soul to see him, to know that he was well and so on. The no is then because so much is online, so much is or you know, virtual, that I mean, I can go into become a hype part of the hybrid group that's going to be doing ESCMID or ICPIC or whatever, and just go online and then do it. But it's not the same contact. And I realize now that we do all our courses online, it's the same thing to give that personal touch. You really have to know how to handle the system. So you have to be a mentor, you have to be available for conversation, you've got to be linked to this. And I think it's a completely different ball game. Somebody come and talk to us about drugs and whatever else, or antibiotics and so on, and you go, yes, yes, yes, thank you. And then you just pick up the phone and talk to a mate and say, Are you using this stuff? And they say yes. And so, what do you think? Well, okay, thanks. Or you go and sit in a talk that is sponsored by a company, you walk outside and you say to them, is that true? And they say, Yeah, well, so whatever, you know. So you get a lot of reality coming back when you're at the conferences, I think.

Ian Gould 16:14

Is personal attendance at Congresses within Africa as successful? I know in the past, perhaps it's struggled because it's difficult to paradoxically perhaps to visit neighbouring African countries. It's easier to get on a plane to London.

Shaheen Mehtar 16:28

Yeah, the continent is huge. It's huge. People underestimate the size of the continent. I mean, everything apart from Russia and Canada fits into Africa. It's such a big geographical group, which is one of the reasons that we had to move into virtual because people couldn't afford to come. The registration was inexpensive, but just to get here and to stay here for five, six modules was impossible. So if you remember when ISAC came to Harare, you remember how difficult it was to do lots of things. Okay. So what we do with ICAN is we have one major ICAN conference every two years. The alternate year, we go and do a workshop in one of the countries that have got a National Society on Antimicrobial or sort of infection control society, or and bring in WASH and IPC and AMR. So we do that with them so that we actually rotate it around so people can come and go. The last ICAN conference we had in Cape Town last year, we had about 560 people. For us, that's a big conference. It's nothing like ICC where you've got 15,000 people, you don't know who's who the whole of Kyoto was just one big ICC sort of thing. It's a very different thing. I personally prefer smaller meetings. That's one of the reasons the HIS meetings were so lovely, because they were smaller and we all knew each other. Going to the Central Sterilizing Club, exactly the same thing. You knew everybody, so you could talk and communicate and discuss and so on. So I think the pros and cons for both, but I personally would prefer to have a smaller meeting.

Ian Gould 17:58

Are things moving forward, Africa-wide, in in terms of networking and meetings? You you mentioned ICAN, which you uh were very much at the forefront of forming, but are any of the big international societies helping as they should?

Shaheen Mehtar 18:14

So we set up ICAN in 2008, and we had a meeting with ISC twice. Okay. One was in Harare in Zimbabwe, one was in Kenya, and there was support that we did the basic course for AMR, AMS, and infection control together. So we did a lot of collaboration between them. Now people are coming up. So we've got ICARS coming in and they do workshops with us. And GPPS comes in and does workshops as well. WHO will come in and do workshops. So we've got our main conference for the three days, but on either side we have workshops. And those are very, very much more intimate workshops. People can come and talk and chat and whatever. And just recently, React has decided to come and join us. We would get people from Africa CDC, and when we could, we could get the American CDC to come down, or the others around to bring in some of the outside knowledge, but a lot of the inside knowledge. So the students, well, our students, or even people who weren't our students, a lot of publications. We got them to do a lot of abstracts. And if their abstracts went well, we'd ask them to present at ICPIC or at ESCMID. I must admit, we haven't done a lot with ISAC, which we should, because, you know, I've been, as you know, we have been on the board with you guys as the African representatives, and Sade became part of it and so on. So we really need to think that through. I think that would be a good one. ISID was very much linked in with ICAN as well, and we would we wrote books and things together or chapters together. So there has been collaboration because the real market for all your organizations is in fact Africa. There is the gap, you know. Even though many of them have studied and they've done exceptionally well, we're trying to get more publications. But I think that is something that we need to pick up on to see how we can improve the publication, the research side of things. How do you learn about something? And I'm the worst of all, but how do you learn about something and actually get around to publishing it? So when I did my doctorate, which is by my MD, I did something which was actually very infection controlled. Okay, so just comparing two towns that had no HIV in the middle of nowhere in the Karoo, and looked at their TB. And one we actually added a young girl who has done the trick. She was doing their training for them and looking after them. And the other one we just left. And basically they managed because the mother and the children and the mothers and everybody were involved, the whole community was involved. They reduced their TB rates in a year by almost uh three-quarters. The only places left were the Shabeens and with them, you know, whether the men were hanging out and they didn't want to work, whatever. But I think the point I wanted to make was that you can do some really practical things in Africa. They are not good at reading long documents. The best thing that happened to a lot of my students was Chat GPT, because they don't want to read, but they can say, oh, can you tell me? But what they now have to do is once they've done Chat GPT, they've got to put that in the context of what we are asking them to do. So they get the knowledge without having to slog through a lot. And I think what the societies can do and think about is to improve the research and the ability to publish good papers.

Ian Gould 21:25

In terms of pandemics, Africa probably suffered more than most from HIV and consequently resurgence and tuberculosis and Ebola, but maybe not so bad as far as COVID was concerned. It did so well with COVID.

Shaheen Mehtar 21:41

Well, I can tell you about South Africa because it's brilliant, it was. So we got our first case on the 20th of March. The Ministry Advisory Committee on COVID was set up on the 22nd of March, of which they very kindly asked me to be part of it as the infection control person. We wrote the policies, including the masking policy. Which was out by the first of April, and it was circulated across the country by the 5th of April. So everybody had to wear a mask, they had to socially distance, they had to get their hands done, blah, blah, blah. All that stuff that we did together. And I think it reduced our mortality rate by at least 75%. That was one. Secondly, we could go and sit outside. You didn't have to be stuck in the house, even if you're under quarantine or whatever. You could sit under the tree and talk and chat and do whatever you wanted. Thirdly, we had a younger population, but our elderly were not affected because we haven't got, we do have, in some groups we have, but not everybody has these old age homes or these residential places. So that was helpful. The places where we had the worst problems were churches and religious organizations, and number two at the funerals. That's where the transmission was taking place. So that we were very lucky and we were very fortunate that we did manage to contain it really well.

Ian Gould 22:59

And for the future, I mean AMR and AMS no doubt can continue to be a likely problem. What do you think about them? Oh, yeah.

Shaheen Mehtar 23:10

Absolutely and totally. I think we have to look at it slightly differently now. We are emphasizing a lot in our courses about the infection control aspects. So if you can stop transmission, we can stop transmission of AMR. But we have to look at our built environment, and we've got that in the course. We one huge module on the built environment, looking at water, sanitation, hygiene, and all that sort of stuff as well. All those are the bits that make a big problem with Africa. The environmental, the One Health program is now going quite well, but we still need to develop a lot more because there's open defecation wherever it might be, or they've broken down sewage systems, etc. So I think there is work to be done, but we do have a problem, maybe not as bad as some other countries, but we do have a problem with multi-drug resistors. There's no doubt about it. I think the person that probably would be best to answer that would be probably Mark Mendelson, because he's done a huge amount of work on it in South Africa. And he's also moving it out to the rest of Africa. But from our point of view, our job is to actually stop the transmission. If we can just do that, we can reduce the use of antimicrobials and hopefully save some lives.

Ian Gould 24:15

Is there any way of securing better quality antibiotics, less counterfeit, better access to newer engines?

Shaheen Mehtar 24:23

We don't have counterfeit, we've got generics, we've got lots of generics. So we don't have the counterfeit part of it though. However, I don't know the answer to that. Because you know, we've got 10 million HIV-positive people. So for there, we have to buy generics because there's no other way we can actually deal with their antiretrovirals. But for the antibiotics, they are generics and they're made by companies that are reputable and they know what they're doing and apparently work quite well.

Ian Gould 24:47

Bit of a crystal ball gazing to where you see the future in infectious diseases, particularly thinking of the next pandemic, where is that going to come from? What's that going to evolve?

Shaheen Mehtar 24:59

I didn't ever think that I would see anything like COVID in my lifetime. I don't think it's going to be bacterial, because I mean we know about the AMS and we know about, you know, the AMR and all that stuff going on with the bacteria. I think the viruses are going to really, really have a go. There's a release of viruses, you know, the zombie viruses and all these other guys that have been around for 50,000 years and they've suddenly turned up and they've decided, okay, right, you know, this I'll turn now. So I think it'll probably be viral. However, we need to put systems into place that reduce again, I'm gonna keep saying this, reduce the transmission. You know, that's the only way, whether you look at the air or the hands or the feet or the whatever, you know, the surfaces. You have to reduce that transmission if you can. And that's what we have to learn. I don't think we've learned enough about the built environment. Uh, thanks to Mike Emerson, we know a lot about it, but we didn't do much with it, as you know. There's a lot of that. But the bacterial side of it, I think, you know, that's gone.

Ian Gould 25:54

But uh, in terms of a global pandemic, it's surely likely to be a zoonosis. Do you think the situation in Africa is generally better than it is perhaps with the wild food markets in China?

Shaheen Mehtar 26:07

No, I I don't know the answer to that. I think in Africa, our zoonosis are related to the forests. So it's all to do with bats and like we did with the COVID, and we did maybe the Ebola, and it's people eating off the forest floor and eating their bushmeat and so on and so forth. In China, it's also about eating and traditional stuff and so on and so forth. So it could be a zoonosis. I agree with you. I think it probably will be a zoonosis, but most of our infections are coming from animals. Now we know that, you know, so that is a bit of a situation. I like I said, I didn't really expect that anybody would see COVID. That was such a big outbreak, big pandemic. All of us were working 40, 50, 60, 70 hours a week and not being very well with it, you know. People are fainting around, they were sort of dropping and they're getting TIAs, and I mean all sorts of things were happening because it was so stressful. We didn't know what we were doing. And when the government would come to us and say, What do you guys think? And we said, We don't know. We're looking at it, and I could only look at it from a respiratory point of view, which was not entirely the whole story, but anyway, and also look at what we could do to maintain it in that regard. So I don't know what the next zoonosis is going to be, but it'll definitely be airborne.

Ian Gould 27:17

Shaheen, that'd been a fascinating discourse. Not only to hear uh your uh magnificent history and all about your new life in South Africa, and by the sound of things, there are many more interesting things for you to work on. And uh here at Isaac, we wish you all the best for the future. And thank you. Thank you very much.

Shaheen Mehtar 27:37

Thank you. Hope to see you one of these fine days. You take care.

Ian Gould 27:40

Indeed. Indeed. We look forward to that. Bye bye.