COVID-19 vaccine challenges and lessons learnt in South Africa

This article is part of the series The COVID-19 Vaccine Challenge: Contextual and Country Analysis.

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COVID-19 challenges in Africa are unprecedented. South Africa  is the worst-hit country in Africa, in terms of new daily infections. At the time of writing, the country has over 200,000 active COVID-19 cases and has clocked over 63,000 deaths due to COVID-19. The cases were fuelled by the highly contagious Delta variant that first surfaced and was detected in India. The divide between African countries in terms of income and access to resources along with a crippling shortage of COVID-19 vaccines has led to this predicament. The high volume of COVID-19 cases is not a surprise in South Africa for three reasons. Firstly, South Africa is an open economy. With many investment opportunities, there is high number of travellers moving in and out of the country. For this reason, the virus is spreading wildly with potentially more infectious variants that were transported into South Africa. One such recent fast spreading and virulent variant is the Delta variant that has made its way into the country. The rapid spread of this variant triggered a third wave that has strained hospital resources and capacities, with hospital admissions being beyond current capacity and beds for patients no longer sufficient. Dr Angelique Coetzee from the South African Medical Association said, “It’s a crisis out there, it doesn’t matter anymore whether positive or not, not even if you are extremely sick, there’s no guarantee that you will get a bed in ICU”. Saloshni Naidoo, Professor and Head of the Department of Public Health Medicine at the University of KwaZulu-Natal, had warned, “that the epidemiology suggests a third wave will occur in June or July of this year, which is South Africa’s winter season”.

The rapid spread of this variant triggered a third wave that has strained hospital resources and capacities, with hospital admissions being beyond current capacity and beds for patients no longer sufficient.

Secondly, socio-economic conditions and inadequate procurement of the vaccine pose a serious challenge. To date, according to President Cyril Ramaphosa, over 4.2 million people out of South Africa’s 58 million population have received one vaccine dose. The current number of vaccinated people is one of the lowest when compared with the world vaccine roll-out stats in the global North and the global South as well. The three-phased vaccination approach—the first phase focused on frontline health workers; the second phase on essential workers, congregants, people above 60 years, and those over 18 years who have comorbidities; and the third phase targeted over 18 years population—has not been effective at all. It did not yield good results because virulent COVID-19 variants spread through society irrespective of class and age. This staggered vaccination approach slowed the vaccine roll out and the situation was aggravated by under supply of the vaccine. Lastly, there is a mixed reaction to the vaccines due to conspiracy theories. This is the most distressing obstacle to the vaccination roll-out, i.e., COVID-19 hesitancies due to entrenched perceptions. For example, one of the reasons for vaccinate hesitancy is that the trials confirmed that the vaccines come with multiple potential side effects that could affect different social and demographic groups. It is for this reason that studies show that vaccine hesitant individuals comprise a diverse group of people with varying levels of doubt, indecision, uncertainty, or mistrust. The surveys conducted so far attest to this notion. The University of Johannesburg/Human Sciences Research Council study, the largest and most comprehensive study to date, suggests that about two-thirds of South Africans favour the vaccine but about a third of the South African adult population remains unconvinced or hesitant—a proportion that is higher than most countries in the world. The Food and Drug Administration worsened the hesitancy as it warned that the Johnson & Johnson COVID-19 vaccine could be possibly linked to a rare neurological condition that can cause paralysis. This was followed by temporal suspension of the vaccine that disrupted the staggered vaccination roll-out plan.

The Food and Drug Administration worsened the hesitancy as it warned that the Johnson & Johnson COVID-19 vaccine could be possibly linked to a rare neurological condition that can cause paralysis.

The other reason for the hesitancy that is deeply entrenched is the existing socio-political complexities in South African society. Given that the government is the sole procurer of vaccines, vaccine supply is highly politicised. The government is blamed for looking to the West for solutions when there are also options like the Russian Sputnik V vaccine available for procurement. Another entrenched perception is a socio-cultural dynamic where many individuals hesitant to be vaccinated are so due to cultural and religious beliefs. Many have more faith in indigenous medicines produced from indigenous plants. Mcebisi Junior Mabuza reasons that cultural preferences and religious beliefs play an important contributing role towards the overall consumer preference of medicinal plant products for primary healthcare. Given the three challenges advanced, there are two lessons over many others to be learnt in South Africa. First, the entrenched vaccination hesitancies due to health and political reasons deserve attention to boost confidence levels in the vaccination roll out. The government as a sole procurer of the vaccines should reach out everywhere in the global North or South for a long-lasting solution. Foremost, it must start from home to win the confidence of the local people as South Africa has a potential to produce and consume its own vaccine. This is a missed opportunity of a lifetime.

The government as a sole procurer of the vaccines should reach out everywhere in the global North or South for a long-lasting solution.

Lastly, the government should desist from reactive measures like repeated lockdowns when the third and fourth COVID-19 waves arrive but should instead target aggressive long-lasting solutions. It must target, for example, an accelerated vaccination roll out by procuring sufficient vaccines for the two-thirds of the population who are willing to be vaccinated. Experience dictates that hard lockdowns, such as lockdown level three and four, have damaging effects, leaving the economy severely affected. So, thinking that lockdowns will resolve the super spread of COVID-19 is misplaced. Lockdowns should be understood as a short-lived stopgap and reactive measure that is economically damaging and not sustainable. Today, the situation in Europe and Asia with high vaccination levels shows that COVID-19 can be defeated if two-thirds of the South African population could be vaccinated and this should be hurried to save lives. Also, the one-third population hesitant about consumption of vaccines should be allowed to consume medically-certified local remedies in the treatment of COVID19 symptoms.

• Healthcare
• Africa
• Africa
• Covid-19
• Cyril Ramaphosa
• Food and Drug Administration
• healthcare
• Lockdowns
• public health
• South African Medical Association
• Vaccine

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