Why are we in the dark about how many over-50s have been vaccinated in South Africa?

Emeritus Professor Jonny Myers is an occupational health and public health medicine specialist in the Centre for Environmental and Occupational Health Research at the Department of Public Health and Family Medicine, University of Cape Town.

Why are meaningful vaccination statistics at national, provincial and health district level not readily available in the public domain? Such data are essential for public health surveillance and for determining the risk of future severe Covid-19 disease, hospital admissions and death. They are critical tools in determining vulnerability at the local level so that action can be taken by public and private organisations and the community to seek, find, persuade and get the unvaccinated vaccinated as soon as possible. There is not a moment to spare. 

The national Department of Health is letting us down by keeping relevant vaccination statistics out of the public domain. The vaccination statistics that the department makes available daily on its website have limited value for Covid-19 surveillance because numbers of vaccinations given are not meaningfully broken down by age group, province or health district.  

From a public health point of view it is essential to adopt a risk-based approach to vaccination performance at every level in South Africa, from the suburban level all the way up to national level. Because age is the strongest predictor of Covid-19 severity, hospital admission and death,  those over 50 years of age are at greatest risk. Surveillance should be principally directed towards this population segment. We need to know on a daily basis what proportion of over-50s has been partially vaccinated with a single dose, and what proportion has been fully vaccinated. Only near-full coverage of those older than 50 will ensure that the next and fourth wave will not yet again be severe, and result in another 100,000 or more unnecessary and preventable excess deaths.  

If we are to find those over-50s who are unvaccinated, we need to know what proportion of over-50s in the population are vaccinated nationally, in every province, and in every health district.  

Currently our national vaccination coverage with at least one dose is a miserable 20% of the total population. We have no idea what percentage of people over 50 are vaccinated. The percentage of the total population vaccinated hardly moves, creeping slowly from week to week since vaccination began in earnest on 17 May 2021. Having come to the end of our third wave, we are now in a critical period of opportunity to prevent severe Covid in an upcoming fourth wave before it is too late. 

To my knowledge, and I have made many attempts to find out, relevant vaccine statistics are only made available by the Western Cape premier in his weekly digicon where some meaningful statistics on vaccination coverage broken down by age group are provided. Currently in the Western Cape about 60% of over-60s and 39% of 50- to 59-year-olds have received at least one dose. This coverage is simply not enough to prevent a severe fourth wave of hospital admissions and deaths, based on experience in other countries. 

For the rest of South Africa no information is available at national or other provincial level for vaccination coverage for these two age categories, for those who have received at least one dose, and for those who are fully vaccinated. Yet this is what we really need to know, and it cannot be calculated from the available information on the Health Department’s website.  

This website only provides the rather meaningless total number of vaccine doses given by age group, not the number of people partially or fully vaccinated. About 58% (or 9,280,000) of all doses given have been given to those over the age of 50. We are forced to do only a rough calculation with these unhelpful figures. There are approximately 16 million over-50s in the population, about eight million between 50 and 59 and another eight million over 60. Assuming that everyone gets two doses and is fully vaccinated, this translates to a mere 29% vaccination coverage for over-50s. If everyone only received one dose, then the coverage would rise to 59%. The true number who have received at least one dose will lie between these two, but will be nearer 29% than 58% as most vaccines administered to date are Pfizer. This coverage is dangerously low. Moreover, some provinces are likely to have much lower coverage than others. There is also likely to be unevenness between different health districts and subdistricts.

It is vital that we know as soon as possible where the numbers of vaccinated over-50s are low, so that we know where the vaccination effort needs to be directed to prevent another dismal wave. If we had this information in public view (such as on TV every night) we could enlist the whole of society to assist with this in a targeted way.

We are now entering a brief trough between our third and fourth waves,  and as there needs to be a period after vaccination to achieve protection, we do not have more than a couple of months to play with before cases once again begin to rise in the fourth wave. 

In a perilous situation like this, the question needs to be asked: why are vaccine rates broken down by age group, by province and by health district and indeed by subdistrict, not available daily and published by national and provincial health departments? And a corollary question:  why is there not more agitation from the public and the media for this crucial information? DM/MC