A six-fold leap in new Covid-19 infections this week means the government must press the panic button for vaccine mandates, say leaders in medicine, ethics and business.
The introduction of compulsory jabs in workplaces must be streamlined, according to proposals sent to the government this week by the National Economic Development and Labour Council (Nedlac).
Business Leadership SA CEO Busi Mavuso said mandatory vaccinations are needed to save the economy from further crippling lockdowns and avoid the expanded unemployment rate — now at a record 46.6% — reaching 50%.
This would be a “recipe for disaster” and unrest, she said. “We are going to sit here naïvely thinking that the July riots were a once-off.”
Professor Keymanthri Moodley, a bioethics expert at Stellenbosch University, said the government has been caught dragging its feet.
“Despite suboptimal vaccine uptake over several weeks, vaccine mandates were not introduced at a time they were most needed,” she said.
This was when they could have helped to ease the impact of the forth wave of infections driven by the highly transmissible Omicron variant, she added.
Moodley's criticism came amid confusion over the vaccine mandate task team announced last Sunday by President Cyril Ramaphosa.
On Friday, health department director-general Sandile Buthelezi told a media briefing that “the president has put in a task team which is working on that [mandates]".
But department spokesperson Foster Mohale said the team has not yet been established. “A formal announcement will be made once it is known [who is on the task team and what the timelines will be]. This is a work in progress,” he said.
The department's deputy director-general, Dr Nicholas Crisp, said: “My understanding is that it will be an interdepartmental team. This is not a health function. It affects many other functions and the private sector.”
Moodley said it is “concerning that a task team was not established sooner and that political expediency was prioritised over public health and safety”.
• 1.2m: Weekly jabs record, set at the beginning of October
• 642,600: Jabs last week, the lowest since the mass rollout began
— IN NUMBERS
Ramaphosa's remarks during his “family meeting” last Sunday sparked a sharp rise in vaccination numbers this week. Between Monday and Friday daily jabs averaged just over 195,000, 64% higher than a week earlier.
But the rise in the number of jabs was outpaced by a surge in infections, which by yesterday meant SA had 75,130 active Covid-19 cases, more than three times higher than the previous Saturday. New infections gathered pace during the week and yesterday's total of 16,366 was nearly six times times higher than the 2,858 reported a week earlier.
Many of the new infections are in children, who are not eligible for vaccination. Crisp said the South African Health Products Regulatory Authority has not yet received an application to register vaccines for use in under-12s, though Pfizer is expected to apply early in 2022.
Professor Jeané Cloete, a paediatrician at Steve Biko Hospital in Tshwane — the first epicentre of the Gauteng Covid-19 resurgence — said her hospital has seen many children with Covid-19.
“We have seen children and younger children being admitted but they are not necessarily more ill at the moment,” she said. “But they definitely have symptomatic Covid.”
Mavuso said in the absence of guidance from the labour department on workplace vaccine mandates, many employers are going ahead with them anyway.
“Quite a few companies have actually done it because productivity is not at the level that it should be with people working from home,” she said. “It’s just that they are not screaming from the rooftops.”
Nedlac executive director Lisa Seftel said the organisation's business, labour and community partners have made a number of proposals to the government about the vaccination programme.
They include strengthening health and safety directives to allow vaccinations to become mandatory if workplace risk assessments require them; restricting access to certain venues, gatherings and events to vaccinated people; and simplifying and enforcing regulations on maximum capacity at gatherings, venues and events.
Nedlac's annual summit on Tuesday will feature a keynote speech by Deputy President David Mabuza, who chairs the interministerial committee on vaccination and who was supposed to receive the task team's report by today, according to Ramaphosa.
Seftel said more details of the Nedlac proposals on mandates will emerge at the summit, which will also hear from professor Koleka Mlisana, who leads the ministerial advisory committee on Covid-19.
The Congress of South African Trade Unions (Cosatu), which previously opposed mandatory vaccination, changed its stance this week. “We encourage everyone to vaccinate,” said Matthew Parks, Cosatu’s deputy parliamentary co-ordinator. “Beyond that we’re giving space for engagements to take place.”
Two years into the pandemic, several countries have mandatory vaccine policies and Dr Samukeliso Dube, general manager at health-care group AfroCentric, said SA needs to catch up.
Moodley said the importance of mandates has been under discussion since August and “the ethical and legal justification has been established in the context of a public health emergency”.
Shabir Madhi, professor of vaccinology at Wits University, said: “Mandatory vaccination should be the gateway for people to indulge in indoor activities, including going to shopping malls, bars, clubs, cafes and certainly work and educational spaces where large numbers of people gather.”
Madhi blamed the failure to reach vaccine targets on the wrong focus. The government has failed to work on its vaccine advocacy when it counted most, and the AstraZeneca episode “fuelled doubts about vaccines and how well they would work as the virus, unsurprisingly, continues evolving”, he said.
He was referring to the government’s sale of 1-million doses to other African countries when it came to light that the Beta variant reduced the vaccine's efficacy against transmission but not against severe disease and illness.
All 12- to 17-year-olds recently admitted to Tshwane hospitals with Covid-19 were unvaccinated, according to the National Institute for Communicable Diseases (NICD), and all under-5s were from homes where parents were unvaccinated.
Cloete said the only way of protecting under-12s is for the older population to be vaccinated. “If the teenagers and the 20-45 group are vaccinated, then we will protect the smaller children that cannot be vaccinated at the moment.”
Wits Ezintsha professor of medicine Francois Venter said it is too early to comment on many aspects of Omicron and the resurgence in infections, “but Gauteng [is seeing] a very rapid upswing, and the rate of spread is remarkable from what I see”.
Madhi said reinfections in those who have had Covid and breakthrough infections in the vaccinated “will likely be more than experienced with Delta”.
The most recent statistics from the NICD show Omicron “dominates November sequencing data at 74% of genomes”, with Delta — dominant until the end of October — accounting for the rest.
According to the World Health Organisation, the new variant is prevalent in at least 23 countries. It is spreading more quickly than scientists’ ability to pinpoint its relationship with antibodies, severe disease and vaccines, so the next few weeks will be crucial.
“The Omicron variant has a number of mutations that are predictive of it being less sensitive to antibody activity induced either from vaccines or past infection,” said Madhi.
That is why reinfections and breakthrough infections abound. However, “these infections are less likely to progress to severe Covid and death, as the other arm of the immune system (T-cells) that probably plays the major role in protecting against severe Covid will be relatively spared despite the mutations that have transpired”.
The “rapid spread” of Omicron can be explained by its high transmissibility, but “that itself is of less concern if people remain protected against severe Covid. It's too early to compare transmission in this wave to other waves, as we don’t know whether the variant will eventually outcompete the Delta variant”, Madhi said.
“All that we can do is look at the ratio of cases (assuming the same testing rate as in the past) and the hospitalisation rates. Currently there is no indication this has changed. The next two to three weeks will be informative, as severe Covid usually lags behind community rate of infection.”
Wits health economist Gesine Meyer-Rath, a member of the South African Covid-19 Modelling Consortium, said: “It is important to remember it’s not only transmissibility that is a factor here but also immune escape. This is the ability of the variant to neutralise antibodies from either previous infection or vaccination. How much of this will bear out we will only know in the next few weeks.”
She said the consortium scenarios released in November “included a hypothetical immune escape variant” as the team knew “this possible factor could convey an advantage to a new variant given the very high levels of previous infection in South Africa”.
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