Q&A with a senior Covid government adviser on vaccine hesitancy and the new variant

With vaccine hesitancy continuing to grow, a new Covid-19 variant with multiple mutations has emerged. Chris Barron asked professor Koleka Mlisana, co-chair of the Covid-19 ministerial advisory committee (MAC) ...

With only 35% vaccinated, was this inevitable?

There's no straightforward answer. The complication in this country is the high numbers of HIV-infected individuals who may not be virally suppressed. So over and above the low rate of vaccination, that also allows the virus to mutate.

What percentage of the population are we talking about?

We've got more than 6-million people who are HIV-infected. According to figures before the pandemic, around 40% were not accessing HIV services. But the pandemic has severely disrupted health services, particularly for diseases like TB and HIV.

Would you say the higher the number of unvaccinated people, whether HIV-infected or not, the higher the likelihood of new variants and mutations?

Yes, that is correct.

What level should we be aiming at to minimise new variants?

Firstly, we need to get 100% of health-care workers vaccinated. We should be considering mandatory vaccination for them.

Has this been your advice to the minister?

That's going to come. We're discussing it at the moment. The second part is that the big group where we need to get as close to 100% as possible is the 50 years and above.

How?

I don't have an answer yet. It's important to identify the obstacles. We don't have an issue of vaccine access, we've got enough vaccine sites. So the issue is, what's causing vaccine hesitancy?

What's your answer?

A lack of information, and how do we negate the disinformation that is circulating.

Is the government doing enough?

Obviously not, because we are not seeing a turnaround. There's going to be a challenge  for government to identify a new strategy.

Is it time to make vaccines mandatory for everyone?

For me I would say, yes, it is time for that. For me it's the only solution we have at the moment.

Is this what you've been advising the minister?

We are currently drafting an advisory that says what the future must look like. Mandatory vaccination is part of that.

Shouldn't this have been your advice to the government some time ago already?

Probably, yes. But we are here now. We just need to make sure we expedite whatever is feasible at this point in time.

Is there any chance of controlling new variants if vaccination is not mandatory?

The first thing we need to do is strengthen antiretroviral services, because that's where the likelihood of mutations is going to be coming from. If we're talking mutations, we've got to talk antiretroviral therapy for HIV-infected individuals.

Has the government dropped the ball there?

Yes. Services have focused on the pandemic and we've let the ball drop insofar as other services are concerned. This needs to be corrected.

Has the MAC just woken up to this, or have you been advising the government all along to strengthen antiretroviral services?

We have been for a while. That it's important to integrate the Covid-19 response into the health-care system of the country.

Has the government ignored your advice?

I wouldn't say ignored, but the message has been going to the minister and to the department for quite a while.