South Africa is considering making vaccination against Covid-19 mandatory for access to public services and businesses as it tries to boost the take-up of jabs ahead of a fourth wave of infections driven by the Omicron variant.
The latest surge in infections in Africa’s most industrialised economy is increasing at a faster pace than previous waves, making vaccination all the more important, scientists have said.
The seven-day average of daily cases has risen to more than 4,800 as of this week, compared with just a few hundred cases in the middle of last month, scientists said on Friday in a briefing by the health ministry.
About a quarter of the population in the African country hardest hit by the pandemic, which discovered the new variant in late November, has been vaccinated. The rollout has been held back by a late start, early supply shortages, and more recently distribution problems and a lack of communication to allay worries about safety.
Reluctant to introduce a hard lockdown, President Cyril Ramaphosa has launched a debate on the introduction of vaccine mandates.
“We realise that the introduction of such measures is a difficult and complex issue, but if we do not address this seriously and as a matter of urgency, we will continue to be vulnerable to new variants and will continue to suffer new waves of infection,” he said in a televised speech late last month. Any plan will emerge after consultations with labour and business.
The sharp rise in infections in Gauteng, South Africa’s economic and travel hub, indicates that Omicron may be more infectious and the first detailed study into the heavily mutated strain suggests it is more likely to cause reinfections than previous variants.
But hospital admissions have been dominated by the unvaccinated, suggesting that vaccines will still protect against severe illness with the new variant.
However, at current rates, about 4m South Africans aged over 50 could still be unvaccinated as 2021 ends, when the fourth wave could be at its most intense.
The country has recorded nearly 3m Covid cases. Analysis by the South African Medical Research Council suggests there have been more than 273,000 deaths in excess of normal levels in South Africa since May 2020, far beyond an official toll of about 90,000.
After previous waves were met with repeated economy-wide lockdowns, business in particular has called for a more targeted approach.
“We need to rapidly move to a situation where only vaccinated individuals should be allowed to travel in buses, taxis and aeroplanes, or to eat and drink in indoor establishments such as restaurants and taverns,” Martin Kingston, the chair of Business for South Africa, a body set up in the pandemic, said after the discovery of the Omicron variant.
With unemployment at nearly 50 per cent in the third quarter, jobs-based mandates are hard to enforce. “On paper [mandates] sound great, in reality they could be very difficult to implement,” said Russell Rensburg, director of South Africa’s Rural Health Advocacy Project.
Discovery, the country’s biggest medical scheme, said this week that nearly all of its 10,000 employees had been vaccinated, up from about a fifth when it announced in September that a mandate would take effect in 2022. Other insurers have similar measures and elite universities are introducing mandates for students.
Cosatu, the biggest trade union federation and a political ally of the ruling African National Congress, has said that it favoured such measures over a repeat of job-destroying lockdowns. “Any restrictions going forward must be imposed on those who fail to vaccinate,” it said.
However, powerful public sector unions remain reluctant. South Africa’s Public Servants Association — representing nurses, teachers, and police officers — said it was encouraging members to get jabs, but added that “many people are still afraid on the effects of the vaccine, and making vaccination mandatory will add to this anxiety”.
Fears about side effects and a lack of clear information on the subject have fuelled hesitancy, according to ‘social listening’ reports for South Africa’s health ministry.
Other barriers include costly transport to reach vaccine sites and ‘micro-supply’ problems of doses running out, particularly at local mobile units or pop-up sites, even though there are now plenty at the national level.
The government this week doubled vaccination vouchers for over-50s who are yet to get their first jab to R200 ($12.50) as compensation for transport fares.
“We should have just been at malls at the beginning,” rather than depending on clinics for vaccination sites for early stages of the rollout, Rensburg said. “Teachers had to leave schools to get vaccinated, rather than health workers going to schools.”