We have a crisis: South Africa urgently needs leadership to roll out Covid-19 vaccine mandates

Some have said natural immunity after Covid-19 is just as good as a vaccine. The evidence, however, suggests otherwise and shows that those with natural immunity are twice more likely to be infected with Covid-19 than those vaccinated. (Photo by Gallo Images / Brenton Geach)

By Mpiko Ntsekhe and Tracey Naledi

24 Oct 2021

South African society is lit up by discussion and debate about the place of vaccine mandates in the fight against Covid-19. Conspicuous by their absence in this crucial issue are those elected and appointed to provide leadership at local, provincial and national level.

About 35% of the nation is vaccinated, woefully short of the desired target of 90% most experts agree we need to avert the disastrous consequences of recurring Covid-19 waves.

While there are aspects of the South African response to Covid-19 to date that are commendable, the deafening silence on vaccine mandates that have proven effective elsewhere around the globe is hard to understand.

In July this year, France introduced a health passport with proof of either vaccination, a negative Covid-19 test or of past infection required to enter public places. This increased vaccine coverage to 75% and reduced hospitalisation and death significantly.

If this pandemic was a war and more than 250,000 South African lives had been lost, one can only begin to imagine the clamour for the state to do whatever was necessary to resist the invasion and end the carnage. And yet, according to the SA Medical Research Council, excess mortality has been a shocking 264,809 over the past 18 months.

Adding insult to this national injury, Stats SA recently reported a drop in life expectancy of 3.8 years in females and 3.1 years in males since 2020. Based on our HIV/AIDS experience, we know that this is likely to take years to regain and will undermine the National Development Plan goal of increasing life expectancy of South Africans to at least 70 by 2030. So, why are our leaders not seizing the opportunity of broad nationwide vaccine mandates for preventing further carnage in the country?

France introduced a health passport with proof of either vaccination, a negative Covid-19 test or of past infection required to enter public places. This increased vaccine coverage to 75% and reduced hospitalisation and death significantly. South Africa's Department of Health officially launched a digital vaccine certificate for those who received the Covid-19 jab. (Photo: techcentral.co.za / Wikipedia)

Opponents of vaccine mandates in South Africa include those who understand that vaccines are effective, but are uncomfortable about perceived and/or real infringements of individual liberties, choices and human rights and have a false perception of an absence of a “legal framework” that permits them.

Other commentators, including Professor Pierre de Vos, a respected constitutional law scholar, have penned very accessible articles explaining the legal framework that allows vaccine mandates for the greater good. History teaches us that, with rare exceptions, when societies are under siege, the key to overcoming adversity is a leadership that makes tough, sometimes unpopular, decisions to benefit society and help stop the suffering — even if they involve measures that restrict rights in the short term.

Is this not what informs the National State of Disaster Act legislation that has allowed the government to deny us the ability to worship, bury our dead and shut down our economy?

Also, among mandate opponents is perhaps a lack of an appreciation of the social solidarity value that requires even “low-risk” individuals to vaccinate so we can achieve community immunity that protects the most vulnerable. Other opponents’ scepticism is borne of the fact that even though vaccines are effective at reducing hospitalisation and death they do not completely stop viral transmissions. Nonetheless, breakthrough infections in those who are vaccinated tend to be mild and people are infectious for much shorter periods, thus reducing the community transmission risk significantly.

Others have said natural immunity after Covid-19 is just as good as a vaccine. The evidence, however, suggests otherwise and shows that those with natural immunity are twice more likely to be infected with Covid-19 than those vaccinated.

Opponents of vaccine mandates contest their overwhelming benefit for the greater good — versus individual and societal risk, for example, potential loss of access to social services, education and employment — especially if vaccine mandates are not implemented responsibly. In fact, the Government Gazette of June 2021 provides a framework for mandatory vaccination policy in the workplace that recognises and upholds constitutional rights. Unfortunately, few if any of the passionate opponents offer effective evidence-based alternatives to vaccine mandates that would ramp up vaccine coverage to the very high levels that we need at speed to reduce hospitalisations and death.

We do not deny that the most effective way to engage peoples’ concerns authentically is to educate, persuade and ultimately convert those that are vaccine hesitant to become vaccine confident. We are, however, concerned that, while the clarity and direction that trusted elected leaders can provide remains lost in a leadership vacuum, Rome will continue to burn. Public confusion, increased anxiety, vaccine apathy and hesitancy will thrive.

It should not be forgotten that the fourth wave is projected for some time in December. And, as with the first three iterations of the battle in this war, society’s healthcare and other resources will get redirected to the Covid effort with often devastating, but little spoken-about “collateral” damage to the most vulnerable members of society. The care of those with chronic disorders such as HIV, TB and diabetes, as well as those awaiting critical cancer and cardiac surgery, will inevitably be sacrificed as clinics and hospitals are repurposed to look after what will be mostly unvaccinated people.

And what of the short- and long-term physical and mental health toll this pandemic has taken and will continue to take on the much-lauded front line sacrificial lambs and their loved ones? Bear in mind that South Africa’s stretched healthcare workforce was barely coping with the country’s high disease burden in the pre-Covid period.

The ongoing epidemic of burnout, anxiety disorders and depression among healthcare workers is yet another form of Covid collateral damage, the long-term consequences of which few have had time to contemplate. Surveys conducted and presented by the University of KZN psychiatrist Dr Saeena Paruk indicate that mental health disorder rates that were already double rates found in the general public have increased by close to 40% during the pandemic.

vaccine mandate Some have said natural immunity after Covid-19 is just as good as a vaccine. The evidence, however, suggests otherwise and shows that those with natural immunity are twice more likely to be infected with Covid-19 than those vaccinated. (Photo by Gallo Images / Brenton Geach)

Elsewhere, we only need to look at well-documented rising rates of gender-based violence, child abuse, teenage pregnancy, substance abuse and substance dependency disorders in the country at present to get a glimpse of the magnitude of the problem we are experiencing — and that’s just in the short term.

We ask again, is it worthwhile for us to bury our heads in the sand on state vaccine mandates?

With regular reports in the media about record levels of jobs losses and unemployment, and a significantly depleted fiscus, increased poverty and hunger, what might have been under-emphasised is World Bank analyses suggesting that Covid-19 could have wiped out most of the economic and developmental gains made over the past two decades, further exacerbating poverty and inequality.

What additional hurt and harm to society are our leaders waiting for before they take the bull by the horns and lead from the front on the question of broad vaccine mandates? The single most important ingredient in the management of any crisis is effective leadership.

We welcome the Government Gazette on vaccine mandates in the workplace, but there is good reason to suspect that, without government-led, broad-based national mandates that extend beyond academic institutions and a few private companies, the race to effective community immunity may not be winnable.

We therefore propose that national leadership should seriously consider nationwide vaccine mandates now that we have good vaccine access with lower-than-expected demand. National leadership should call on leaders at all levels and from all sectors to rally society towards a common purpose, allaying anxieties and asking individuals and institutions to sacrifice for the greater good — and call on all of us to give practical meaning to the concept of ubuntu so that “you are more likely to remain alive because we are all vaccinated.”

Phakamani Maqabane and lead us! DM/MC

Mpiko Ntsekhe and Tracey Naledi write in their personal capacity. Ntsekhe is Professor and Chair of Cardiology at the University of Cape Town. Tracey Naledi is Deputy Dean: Health Services Faculty of Health Sciences at the University of Cape Town and Founding Chairperson of Tekano, Atlantic Fellows for Health Equity in South Africa.

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