What we lose in the jostle to get vaccinated

Dr Heidi Matisonn is a senior lecturer in philosophy in the School of Religion, Philosophy & Classics at UKZN.

Dr Christine Hobden is a senior lecturer in ethics and public governance at the Wits School of Governance and an Iso Lomso Fellow at the Stellenbosch Institute for Advanced Study.

“Don’t wait for the SMS — just walk in to any of the sites and if you’re prepared to wait, you’ll get vaccinated.” This message, or a variation thereof, was doing the rounds in the initial days of the second phase of the vaccination roll-out. And since many vaccination sites are now publicly welcoming walk-ins, it might seem that not much has been lost. As our over-60s have slowly begun to be vaccinated, we might be tempted to overlook the chaos amid deep relief that the process is finally under way. 

Anger has, however, flared at those who do not qualify, yet have been vaccinated by exploiting loopholes, or blatantly lying about their healthcare worker status. What should we make of these “vaccine cheats”? Is public health specialist Dr Nicholas Crisp right that dishonest people are spoiling a good system, or is the system presenting good people with the opportunity to do a “bad” thing?

It would be disingenuous to ignore the fact that a complex system is up and running, and all things considered, those running the roll-out made well-informed decisions, given constraints beyond their control (such as the J&J delay). That said, even if we choose to focus on the best efforts of those managing a difficult task, we should not ignore what we stand to lose when what is experienced on the ground is different from what we were informed would be the case. 

Aside from the obvious issue of how queue-jumping by non-eligible candidates undermines the national roll-out, which in turn affects our safety, equally concerning was that access to the vaccine, even for those eligible, has for many in these early weeks been all about one’s connections: large numbers of people who were vaccinated without appointments were able to do so because they were alerted by someone they know who works somewhere or who knew something. Just as the distribution of capital in South Africa is deeply unequal, so too is the distribution of social capital and because of this only those who have it could take advantage of the loopholes in the system, and sudden walk-in availability, and thus access life-saving treatment.

In a previous article, we suggested that our obligations to one another as citizens exist whether the state enforces those obligations or not. But if the state fails — through inefficiency — to enforce these obligations we stand to lose more than efficient access to goods. While, of course, efficiency is key in the vaccination roll-out, we should stay alert to the ways even small failures here can have long-term impacts on the health of our democracy. 

Free-for-alls for access to essential goods erode the social contract by moving us away from thinking about what we owe one another, to — out of necessity — thinking about how we can secure things for ourselves. While the current system is not entirely a free-for-all, there are many over-60s (and their loved ones) currently anxiously trying to work out how best to secure their vaccine in the face of no appointment SMS and those around them making their own way. As one participant in the Daily Maverick webinar with Crisp (6 June) put it, “I’m a rule follower, but when should I give up waiting for my SMS?”

Acknowledging our duties to one another as citizens entails recognising what is fair. Willingness to shoulder the burden of these duties — for example, by waiting our turn for vaccination — requires the (hopefully justified) belief that the state will find a system to distribute the burdens fairly.  It is absolutely accurate to claim, as Crisp did, that “my neighbour’s health is my health” (and hence we should not begrudge others from being vaccinated before we are), but when there is ambiguity in the processes of the state, the responsibility of moral decision-making is shifted back on to the citizens. Should I wait or walk in? Whose turn is it? Should I cheat? Why is it their turn, not mine? Is this fair?

When the burden of deciding what is fair is shifted to citizens, our trust in the state, and in one another, is eroded. The state is trusted with these sorts of fairness decisions precisely because it is so hard to prioritise fairness when the personal stakes are high. This is especially true when we cannot be sure that ultimately the system will reward fairness (will we eventually get our SMS?). 

When the state encourages individualised thinking at the cost of the collective, it risks citizens beginning to wonder: do we even need the state? We do, of course, need our state, but we need it to do its job for us so that we can do ours as citizens. 

It is the job of a democratic state to do the calculation about fairness in an impartial, informed and just way. It is the job of the state to protect its citizens from the temptation to make a morally dubious decision by communicating adequate, accurate and reliable information. It is the job of the state to reduce the opportunities for corruption by having systems that work.

If the state doesn’t do its job, it becomes extremely difficult for citizens to do theirs. DM/MC