Making COVID-19 Vaccination Mandatory: Challenges in South Africa

By: Dr. Olusola Bodede

The fast spread of COVID-19 Delta variant in South Africa led to a third wave of the pandemic. South Africa being a country with many investment opportunities attracts many travelers in and out of the country. As the infection rate of COVID-19 rises on daily basis, hospitals became overcrowded because admission of patients were beyond current capacity and beds were insufficient. Dr Angelique Coetzee from the South African Medical Association added that there is no guarantee that people will get bed in the ICU, irrespective of their health conditions because the ICU are overcrowded due to the high rate of infection.  As a result of this, Covid-19 vaccine became necessary for many South Africans, however others have a different opinion despite the rise in infection rate. South African government did all they could to encourage citizens to be vaccinated. Various measures were adopted to encourage people, most especially in areas where policies enforcing vaccination do not exist. Incentives such as money, food vouchers, medical insurance premium and retail discounts were provided in some places to those who chose to be vaccinated. In other areas, less attractive measures were being implemented such as weekly COVID-19 testing to mention but a few. Despite all these efforts by the government, some citizens chose not to be vaccinated. According to President Cyril Ramaphosa, statistics shows that over 4.2 million people out of 58 million population in South Africa have been vaccinated. Therefore, one will be tempted to say mandatory COVID-19 vaccination would have been the best option in order to reduce the spread of this deadly variant.  However, making COVID-19 vaccine mandatory had been a controversial issue in South Africa. Some people chose not to be vaccinated due to reasons best known to them while others refused to be vaccinated because they doubted the efficacy of the vaccine. Also, there have been various reports of side effects associated with the vaccine but then, everyone has a right to a healthy life and safe working environment. Employees who are vaccinated have the right to object to having unvaccinated employees in their working environment in order to protect themselves. The Disaster Management Act for COVID-19 regulations under regulation 14(3) states that any person “who intentionally exposes another person to COVID-19 may be prosecuted for an offence such as assault, attempted murder or murder”.

Findings shows that COVID-19 vaccines are safe for most individual, ranging from 18 years and older, including those with pre-existing conditions such as asthma, hypertension, diabetes, pulmonary, liver, kidney disease as well as chronic infections and auto-immune disorders. WHO Strategic Advisory Group of Experts (SAGE) recommended the Pfizer/BionTech vaccine for people aged 12 years and above. Also, children between the ages of 12 and 15 who are at higher risk of severe COVID-19 may be given this vaccine. There is also an ongoing vaccine trial for children by WHO and their recommendations will be updated perhaps there is a new development from their findings. There is need to educate people that vaccination will help to stimulate the immune system thereby protecting them from the virus. Although, there may be side effects such as fever, chills or headache as observed by few people but not everyone experiences this. The presence or magnitude of the reaction people have when vaccinated does not reflect one’s immune response to the vaccine. It is not mandatory to have side effects before one can be protected. Three phases of vaccination approach were adopted in South Africa; the first phase focussed on frontline health workers while the second phase centred on essential workers that are above sixty years and the third phase focussed on 18 years and above who have co-morbidities. However, these approaches were not effective because the Delta variants spread all over irrespective of class and age. This resulted in slow vaccine roll out and the situation became worst day by day due to the low supply of the vaccine.

COVID-19 vaccines have been known to have mild side effects which vary slightly among the available vaccines. Some of these side effects ranges from fatigue, muscle pain, high fever and chills. These side effects leave after few days. Hypersensitivity reactions can also occur which can be mild such as itching around the injection site or severe such as anaphylaxis leading to low blood pressure, breathing difficulty and skin rash. Severe allergies require urgent treatment

Challenges of mandatory COVID-19 Vaccination and their remedies

There are numerous challenges associated with mandatory COVID-19 vaccine, some of them are listed below.

• Initial inadequacy in vaccine procurement

There are several vaccines for COVID-19 but at least 13 different vaccines have been administered across 4 platforms. The first mass vaccination programme started in December 2020 and the number of vaccination doses administered is updated daily. However, administering vaccines in South Africa only started in February 2021 due to inability to promptly procure enough vaccine doses for the masses. Some of the initial factors responsible were legislation and/or policies on the importation and exportation, transfer of vaccine intellectual property rights and their socio-economic impacts on concerned countries. This resulted in a major setback in South Africa’s vaccine rollout, with only 16.7% of the population being vaccinated to date.

• Fear of the side effects

Most people refused to be vaccinated because of the fear of the side effects experienced by some who were vaccinated. Studies by Human Sciences Research Council from the University of Johannesburg revealed that about two-thirds of South Africans accepted the vaccine while about one third of the adult population remains unconvinced or doubtful, a percentage that is higher compared to other countries worldwide. A recent survey report by the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS-CRAM) discovered that indecision and delay in vaccination by South Africa was mostly caused by concerns about the side effects of COVID-19 vaccines, coupled with lack of access to reliable information about the vaccine. Awareness programs should be organized in order to convince people of the safety and efficacy of the vaccines.

• Inadequate motivations from the government

Although South African government gave out incentives to as many who are willing to be vaccinated but more incentives will encourage more people to be vaccinated. There are numerous other policy options, such as incentive schemes that have not yet been implemented in South Africa. Research on vaccine incentives is still ongoing and results from initial data suggests that the vaccine may have a positive impact. A number of states have already offered a variety of incentives such as money awards, lotteries with monetary or other prizes, free or discounted food but more are still needed.

• Access to the right information about the vaccine

One of the major challenges is inability to access the right information about the vaccine. South Africans must be educated that vaccination can protect them from getting seriously ill and dying from COVID-19. For the first fourteen days after getting a vaccination, there is no significant level of protection, but later increases gradually. For a single dose vaccine, immunity will generally occur two weeks after vaccination, while for a two-dose vaccine, both doses are needed to achieve the highest level of immunity.

Conclusion

South African government should acknowledge the challenges including the peoples’ fear towards vaccination and find means of alleviating their fears. Also, they must treat citizens with respect and make information about the vaccines more accessible by exploring policy avenues such as incentives, rather than enforcing compliance through the law.

Dr. Olusola Bodede is a Postdoctoral Researcher. He writes in his personal capacity