DM168 Covid-19

If we all don’t get vaccinated, the alternative is years of Covid-induced death and suffering

By Anso Thom, Christi Nortier, Estelle Ellis, Zukiswa Pikoli and Mark Heywood 23 January 2021

If you’re 18 and older, get vaccinated. That’s it. It’s not complicated. You’ll be saving your life and those of the people around you.

First published in the Daily Maverick 168 weekly newspaper.

The University of Johannesburg–Human Sciences Research Council Covid-19 Democracy Survey measured attitudes towards Covid-19 vaccination in South Africa. It showed that about two-thirds of the population definitely or probably want the vaccine. Yet, despite ample evidence of the safety and efficacy of vaccines, about a third of the population is still sceptical about vaccination, the survey revealed.

Shabir Madhi, Vaccinology Professor in the School of Pathology at the University of the Witwatersrand and Director of the Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, is adamant that the only chance the country has to get back to a relatively normal life is by taking the vaccine.

Speaking on a Daily Maverick webinar on Thursday night, Madhi said that although safety was of the utmost concern, the short-term results had shown that the vaccines are working and safe, and scientists were continuing to monitor long-term effects. “We can’t be in a situation where we wait five years to get long-term safety data, by which time the pandemic would have passed and the number of lives that would’ve been lost would be in the hundreds of millions,” said Madhi.

He said the big unknown, unfortunately, was how the vaccine would perform against the new variants, one first identified in South Africa and a new one in Brazil.

Madhi said South African scientists will in the next few days provide what is probably the most important information globally from the vaccine trials: information on whether the Covid-19 vaccines work against the variants. The results of these studies have implications not only for South Africa but also globally, in terms of the future development and roll-out of Covid-19 vaccines.

“One of the main reasons this variant has emerged in South Africa is because a large percentage of the population became infected and for the virus to survive it needs to somehow evade the immune response that has been induced against it, and the way to evade it is to undergo mutation. In short, the virus is adapting to what challenges its survival. To stop that from happening you want to get a huge number of people immune over a short period of time so you do not get this immune evasion when there is a lot of virus circulating,” he explained.

Professor Linda-Gail Bekker, deputy director of the University of Cape Town’s Desmond Tutu HIV Centre, an infectious diseases specialist and a vaccine scientist, cautioned that if only a few people get vaccinated we are not going to control the virus. The numbers won’t go down because we will still have sufficient transmission going on to keep the epidemic going.

“It needs to feed off itself and fuel the fire. If you don’t dampen it sufficiently then it will continue to burn. That’s the risk we run – yes, we might get some individual benefit but we won’t get the collective benefit if not enough people get vaccinated,” she explained.

Bekker explained that the individual who gets the vaccine is protected – maybe not completely, because not all vaccines are 100%, but their chances of not dying from the infection, or getting very sick, are improved.

“If enough people get vaccinated, we get this other, very important additional value, which is known as herd immunity. All that means is that enough people are protected that the amount of virus actually circulating drops very low. We all benefit, even if we have not been able to get vaccinated. That can only happen when sufficient numbers of people in the population have been vaccinated,” said Bekker.

She cautions that some might say, “‘I’m going to rely on my neighbour,’ but if everyone says that then we’re going to end up with not enough people getting vaccinated. So, we need enough people in the collective to say, ‘Okay, I will be the person to step forward and do this. The number we’ve heard is two-thirds, and we’ve heard this from the vaccine committee, who are experts, that 67% of the population need to have received the vaccine in order for us to receive this secondary benefit.”

Vaccine scientist and President of the Medical Research Council Professor Glenda Gray said there is a great deal of evidence that these vaccines “work quite spectacularly” and will save people’s lives. A vaccine will help the economy, the individual and the health system.

Gray said there is early evidence that the vaccine will reduce the chance of infection of one person by another, so community transmission will be dramatically reduced.

Professor Valerie Mizrahi, Director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town, confirms that if we fail to reach at least two-thirds of the people (67%), “it will just take us that much longer to reach herd immunity”.

“Until we get herd immunity we need to understand that waves will continue to affect South Africa. This is not what we want. Vaccines offer a critical way to deal with the pandemic and its social and economic ills. Until we bring the pandemic down, dealing with the economic challenges is going to continue to be difficult.”

Mizrahi explains that vaccines impose pressure. “We need to understand that we are always in a cat-and-mouse game when you’re chasing a pathogen [the organism that causes disease]. I like to think of it as that we’re in an arms race here.

A medical gamechanger

“All pathogens evolve. We need to hit hard and hit fast. Once you bring down the viral load, then the chances of escape are brought down. This is why it is important to promote the message that no one is safe from Covid-19 until everyone is safe from Covid-19.”

Bekker says vaccines have been a medical gamechanger. “We have been able to eradicate a couple of infections and certainly been able to control infections in many parts of the world. If vaccines are well developed, in other words tested for safety and efficacy, which the current Covid-19 vaccines are, then they can be lifesaving.

“We can control the epidemic, fewer people will get infected, fewer people will get severe illness and in the long run we will save lives. Vaccines save lives. The disease is our enemy … the intervention is our friend. The vaccine is yet another important tool in the fight against the pathogen,” said Bekker.

Are vaccine denialists (as opposed to those who are hesitant) a danger to us beating this pandemic? Bekker believes they are.

“I believe there’s a small group of full-on denialists. I’m using the HIV experience as my experience here. There was a small group of out-and-out denialists who were a huge problem. They were unstoppable and really had wacky ideas … I would almost argue that they know they are spreading misinformation but they continue to do it. There is some nefarious hidden agenda there. Those people you are probably not going to persuade, so I don’t think we should waste our time on them.

“Then there’s a much bigger majority who sit on the fence. They’re not sure. They’re hearing a lot on social media that they don’t know if they should believe. But they can be persuaded with good information, and I think that’s where we need to put our efforts and energy – and not in a disparaging or prejudicial way. We should really see them as people who need to be ‘evangelised’. They are the people who we patiently need to spend time with to educate them more correctly and make sure they are not in an echo chamber that reinforces false prejudices.”

Community-based champions

Dr Lydia Cairncross, a public sector doctor and activist with the People’s Health Movement of South Africa, said SA had a rich history of engaged, politically aware and proactive communities.

“We need to tap into that strength, as the Treatment Action Campaign so famously did around treatment literacy. Women and men have been organising in their communities throughout this pandemic: to feed hungry children, to help in taking care of the sick, to spread good information. This on-the-ground,  grassroots leadership needs to be respected, trusted and empowered to be champions of the vaccine message,” she said.

Cairncross added that if only a minority is vaccinated it will not stop the pandemic. “So, taking the vaccine is not only for yourself, it is an act of social solidarity because every person vaccinated adds to the population immunity … person by person, until we can achieve that goal. If not enough of us do this, the vaccine will fail.”

Addressing those who are vaccine-hesitant, Cairncross said SA has seen tens of thousands die, with almost everyone experiencing a death of a family member, friend or colleague.

“Our Covid-19 prevention measures as a nation are drastic and catastrophic to livelihoods, education, communities … Hearing that there are vaccines that work is our first glimmer of hope that we have something that could defeat the virus. It is potentially our way out of this cycle of Covid waves and lockdowns and thousands dying.

“Also, almost every person living in South Africa has already had several vaccines as children and a few as an adult. Vaccines have literally changed the life expectancy and health of everyone on the planet. We have no cure for Covid-19 and if we have even the smallest hope of preventing it, we must grab the chance.”

In the Eastern Cape health workers and emergency responders said they will gladly take the vaccine because they are at high risk, but their communities have had almost no education and are very sceptical. “Medics and [emergency] personnel are willing to take the vaccine because we are always in danger,” said one medic, who asked to remain anonymous. “But the public in general is not keen on it. They are extremely sceptical, fearing the side-effects,” he said.

Community leader Thembisile Nogampula said people were sceptical and confused about the vaccine. “There is no education in the communities. Similar to what had happened in lockdown, the community leadership is completely shut out. We are not involved. We are not part of the command councils. We are not part of the vaccine committees. Who is going to tell our people that it is okay to take the vaccine?”

Community health worker Winky Mngqibisa said she was very appreciative of the government’s efforts to get the vaccine into communities. “But people are very uncomfortable,” she said. “We need better education about the side effects. We all had that one flu injection that made us ill. They must come to tell us what it will do to us. There has been a lot of death in our communities and I think people will take it if they know more about it. The only thing we know is that there are many vaccines and that some of them are fake. We don’t know which one is best. In my community people say that the politicians must take them first so we can see.”

***********

Editorial: Humanity needs you

All South Africans over 18 have a duty to step up for the Covid-19 vaccine as it becomes available over the next few months – or we face being caught in wave after wave of deadly infections. SA’s strained public and private healthcare will collapse. The economy will die. If fewer than a third of those living in South Africa step up for the jabs, the destructive virus will be our daily reality for years to come.

There is much that government and healthcare providers can do. But the one thing those living in South Africa must do is to take the vaccine, which is proven to be safe and effective, so that fewer people fall ill and infect others.

South African activists were very successful at promoting HIV literacy. The Treatment Action Campaign did it brilliantly, going into communities systematically. We need to do the same with the Covid-19 vaccine. Civil society and community engagement are key. Every one of us, every activist, church leader, political leader, community leader, celebrities and influencers must get on board. Our lives depend on it. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.

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"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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All Comments 18

  • As long as all these experts, journalists and politicians understand that getting a vaccine is a CHOICE. I have had COVID twice, I am 100% confident of my immune system, and if I get a life-threatening disease I will accept that it was, for the most part, my own choices that took me there.

    • Chris : did you have two positive PCR tests backed by two antibody confirmation tests? The tests are all over the place. I tested Pos and had proper four-antibody lab test confirmation (very luckily no symptoms). My wife tested PCR negative but tested more antibodies than me! A friend tested PCR negative the Friday and went ICU the Sunday with 63% oxygen saturation and obv second test was positive. Don’t mess with this thing – everybody should be doing oximeter tests when even slightest doubts.

  • Excellent piece, thank you DM. Unfortunately, far too many of our fellow South Africans will not listen to this and continue to believe that the tried and tested Covid (and other) vaccines are somehow evil and more dangerous than the virus itself. The fact that there is no evidence to support this belief sadly doesn’t matter as they prefer to place their faith in hearsay, religious dogma, archaic cultural notions and conspiracy theories peddled by the selfish and fearful to foster support with the gullible to further their own selfish, greedy ends. What so many anti-vaxxers fail to realise, or wilfully choose to ignore, is the devastating impact their beliefs have on the vulnerable members of society. I’m all for free will and against making the Covid vaccine compulsory but hopefully without a Covax certificate you will be barred from entry to many venues, clubs, schools, offices, public buildings, national parks, countries etc.

    • Dear Geoff, with reference to your rigid dogma and hyperbole, the following:
      Unlike the article above which exhorts you not to be ‘disparaging or prejudicial’, recognising that there is a huge amount of often misleading social-media noise, you are precisely that. Stereotyping people who are sceptical about THESE vaccines as ‘anti-vaxxers’ is puerile and unhelpful. It ignores the fact that many have garnered the wrong information or have a good reason not to take the vaccine; you, however, have decided that all of them (myself included) base this on “hearsay, religious dogma, archaic cultural notions and conspiracy theories peddled by the selfish and fearful to foster support with the gullible to further their own selfish, greedy ends”. Huh? What bollocks! Whilst some, even many, might indeed be influenced by such narratives (although the ‘selfish, greedy ends’ bit defeats me), many such as myself will, based on sound medical advice, and taking the age group and comorbidity risk factors into account, decide whether it is sensible to take a vaccine or not. Part of that decision will include broader family, community and societal safety considerations, as it should. There will remain many people for whom taking a vaccine at this point in time is likely irrelevant (e.g. Chris Wilkins – twice hit by Covid – taking a vaccine now will probably be a waste of time and might expose him to additional risk) or not recommended (for various medical reasons – allergic reactions etc.), or against their strongly held beliefs (religious or otherwise). So who are YOU to waltz off into a vicious and judgmental diatribe against them? The conscious use of words such as “the devastating impact their beliefs have on the vulnerable members of society” is a very obvious ploy to ‘tar and feather’ such people as being callous in their regard for the lives of others – it’s uncalled for, wrong and shows an evident lack on insight and care. Provided such people maintain the dictated hygienic control measures, there will be no such devastation (or do you not believe that these current control measures work?)***. And please – that ‘liberal fascist’ and profoundly hypocritical final sentence where you declare your utter support for ‘free will’ while advocating a nasty and cooercive ‘Covax certificate’ is blatantly morally wrong. Perhaps you haven’t understood the societal impact of that silliness? And do you understand that SARS-CoV-2 is now endemic, constantly mutates, and will henceforth likely (logically) require the periodic vaccination of the entire SA population with the latest vaccine – do you think that is sustainable? I notice that the above article refers to mutation but makes no attempt to link it to the eventual necessity to update the vaccine(s) and re-inoculate vast populations. Instead, it seems to hold out as fact the HOPE that this single round of vaccination will do the job – highly unlikely. Of course, also hopefully and probably more likely, it will attenuate – but who knows when, and who knows how long ‘anti-Covid’ diktat will remain in place. Meanwhile, as someone who has probably had more vaccinations than you (I gave many years of service to this country during the course of which I had a rather large number of additional vaccinations of various sorts), I will reserve my right to decide on balance of risk to my family, community, myself and society whether I will take ‘the vaccine’ whenever such becomes available; as with the flu vaccination (which my family and I took pre-winter last year), I will repeat the decision-making process every time such an updated vaccine becomes available. As for a ‘Covax certificate’, I will agitate against it!
      *** I’m acutely aware that large sectors of SA society cannot maintain the non-recommended ‘lockdown’ measures etc. Vaccination programmes should look to prioritise such communities ahead of better-off locations (though still after health workers, people with comorbidities etc).
      *** The current wave has peaked countrywide – R0 is now well below 1.0, although there has been a slight uptick in the last 24-48 hours.
      *** The driver behind the mutation of the ‘new SA variant’, as described above, is speculative (my opinion, of course, but I’m sure research will be done in due course).
      *** I’m glad that the experts have decided that 67% is the number. I would love them to tell us all how they came to that conclusion – perhaps those facts, placed in the public domain, would help convince more people to take the vaccine in the interests of the greater good. If, however, the number is actually 80% (and we don’t reach it) or 40% (and we spend excessive national treasure and lives going for a bigger number), what then? At least the MAC should be open and honest with public – we aren’t children.
      *** And for all that the TAC have managed outstandingly well in saving so many lives (they are undoubted HEROES!), HIV remains the largest killer of people in SA at around 140,000-150,000 thousand deaths per year (WHO stats) – that is concerning, as it indicates a high level of resistance to a properly informed and changed behaviour on the part of a large number of SA citizens.

      • Thanks for your response Richard, this is certainly a controversial topic and needs to be debated. I would, however, say your repeated use of ad hominems directed at me detracts from the quality of this debate. You’ve also assumed that my list of reasons why people belief the vaccine is not for them is exhaustive and also somehow directed at you. I understand that there are many reasons why people believe that it either won’t work or is more dangerous to them than the virus, but very few are based on medical science. You’ve also assumed to have had more vaccinations than me for some reason, not that it’s relevant anyway. There’s nothing hypocritical about my assertion that while vaccination should not be compulsory it may lead to discrimination against those who refuse to vaccinate – it’s merely a prediction. If you want to debate this properly, stick to the facts and avoid assumptions and insults, that never works.

    • Taking the vaccine is a choice !
      Getting the virus is a choice !
      I self protect and keep away from danger spots .
      Oh yes , new strains , more virulent !
      The same prevention methods apply to both !
      I assume it was designated a ‘Communicable Disease ‘ ?
      Such as HIV ?AIDS ?
      40 years on and 20000 die yearly from it !
      What does that medication cost ?
      yes , the miracle of science , all fast tracked !
      And as admitted above , there are NO long term trials as yet !
      Why does my belief threaten others ?
      I should feel offended by your comments .
      The evidence is in protection , plain and simple , follow the rules and the virus must die .
      Which is not like Aids/HIV !
      You propose that we all must be Covax Cert card carriers ?
      Yet all those places have a ‘Wear a mask’ /sanitise regulation already ! .
      Countries are banned regardless !
      Even when eventually vaccines are rolled out , fully .
      I will still do the same , it is the new way of my life 🙂
      We have 100000 doses arriving soon .
      Will note how long it takes for that to happen . Then x 400 !
      Administered by whom ? Kept cold where ?
      The already over worked and broken health system ?
      Forget the other sick folks ?
      Still no guarantee either .
      That only happens when there are no more new cases or deaths !
      The virus was ‘negligently ‘ allowed into SA !
      For those with STML , that was March 5th 2020 !
      Fact not fiction , well documented !
      As with the vaccine the ANC dragged its heels and did nothing , while assuring us our ‘borders are secure’ , yes , they lied to us !
      They did nothing of the sort !
      The stable door was broken and the horse just walked out !

      • Yep. And another little elephant in the room – as I understand it, the fiscus doesn’t even have the money for vaccinating 67% of the population (estimated, I heard, at about R21 Bn). But, given that they manage to find the wherewithal, what to do for the remaining 33% (if the magic herd immunity number is actually 80%, for instance)? And, of course, the very idea of a ‘Covax certificate’ becomes even more prejudicial in this case, since fully 1 in 3 people won’t be given a vaccine anyway…… Unless our rulers give up and allow private enterprise (not a PPP such as BioVac) to import their own vaccines…… and even then, many won’t be able to afford it.
        I like the idea that everyone who can do so pays for 1 or more others who can’t afford it. A publicly available application could be set up by, say, the Solidarity Fund, to accept vaccination-linked donations into a special account. Such funds can then be used to buy more vaccinations directly, thus recouping some of the current spend and serving to purchase more doses for the as-yet ‘un-dosed’. One could even then just log in and donate. This would be far better than a special tax which would route it through the corrupt coffers of the ruling ANC and be far less efficient.

  • Leading by example is a great way. If we take two small but comparable communities and vaccinate everybody in Springbok and nobody in Velddrif then the stats will speak for themselves. Within day 60 Velddriff will be demanding the vaccine. I can’t have that allergy risk one but will definitely grab the J&J one the moment I have the opportunity. And I’ll pay for mine plus pay for ten other people.

    • Not a useful comment. What is your source? What other determination is there? Are you implying that the epidemiologists, whose livelihood comes from such science, are wrong?
      Yes, all we can do is HOPE, as my parents must have HOPED that the polio vaccination would work back in 1967, which it did for decades, until the programme lapsed in the Eastern Cape and there was a resurgence of the vile disease.

  • I am disappointed by DM’s stance on ‘vaccines at all cost’ approach. It’s overly simplistic at best. Most importantly, it completely ignores the many other options we have to reduce our resistance to this disease, many of which are lifestyle and diet related. For example, how can we acknowledge that both diabetes and obesity are the major co-morbidities without ackowledging that both of these can be treated to a significant degree through changes in diet and lifestyle? I have no problem with a safe and effective vaccine being rolled out, especially to those who are vulnerable such as frontline workers, but we need to stop being pressured into thinking that this is the only solution. It’s PART of the solution.

  • I have a yellow fever certificate. It was compulsory to present it on arrival in Kenya. Tens of thousands of travellers present compulsory immunisation certificates at ports of entry all over the world – because it is compulsory. Make COVID-19 vaccination compulsory for travellers on all public transport, unless there is a health imperative that prohibits it. Sorry if that violates your claims to freedom, there’s not much freedom in death, if you’re honest.

    Much is made of “the side-effects” of vaccination. What are those exactly? (Try Googling “vaccine side-effects” and list on a piece of paper the ten most serious ones). And more importantly, are these so-called “side-effects” any worse than the death, mutilation, and disability that bacterial and viral infection causes?

    There are plenty of activities that are compulsory in life, even if unpleasant. Taxes are unpleasant and have a decidedly negative side-effect on my cash flow. I could actually list ten compelling reasons why taxes impinge on my personal freedom. But they are compulsory. And by paying my taxes I show that I am an adult and responsible member of society. Furthermore, what makes compulsory immunisation about your freedom, any how? There is no direct line between population inoculation and your personal freedom. Zero. It’s only your privilege that thinks that.

  • I just don’t understand why we have only a one track approach here and are not listening to the advice one of the WHO’s top consultants on how to get this pandemic under control with a combination of measures. Given the many valid practical questions raised by Richard Breytenbach and Scott Gordon concerning just how successful we can expect SA’s vaccine rollout to be, I cannot see the logic of putting all our eggs in the one vaccine basket. It is simply astounding to me that our various government authorities seem to have virtually zero interest in ALSO rolling out a cheap, effective and totally safe treatment for Covid 19 with just as much vigour as they are pursuing mass vaccinations.

    Professor Andrew Hill, the specialist consultant from Liverpool University hired by the WHO to perform a meta analysis on Ivermectin trials for COVID-19, presented his most updated findings on 19th Jan to a group of South African doctors over Zoom and answered their questions. (You can see this on the Facebook page of Minara Chamber of Commerce). Prof Hill now has 2100 reliable data points from 18 properly designed trials showing that Ivermectin improves outcomes by 75%. He will have more than 7100 data points by mid February and is expecting the final result to come in in the range between 48% and 85%. (For comparison, he says the best current treatment, dexamethasone, is at only 20% improvement in outcomes). He says there is now only a one in 5,000 chance that the final trials results will prove ivermectin to be unhelpful!! Given that it is well know to be totally safe at anti-parasitic dosage levels (routinely taken by 250 million people a year already) there are no real risks in using it at what currently looks like the most effective dosage of 0.4mg per kg for 5 days.
    But he notes that many countries like South Africa currently have no stock of Ivermectin products intended for humans, so he recommends ordering Ivermectin “at risk” immediately (just like Britain did with ordering and paying for vaccines that looked promising, but were not yet fully proven), knowing that by the time the stock arrives in the country it will be possible to make a final medical decision on use because by mid-Feb evidence will have reached the threshold for reliable conclusions. (He says in the unlikely event that it proves ineffective the stock can always be resold to countries that need it to treat all the existing conditions it is good for – so zero financial risk in such a strategy).

    Prof Hill’s approach is completely scientific, conservative and cautious and yet he says with the data we already have it now makes no sense to delay placing orders until all the trials are completed, then approve it, and then wait another 6 weeks or more for stock while 1,000s more people die! (And with SA back of the queue again as every nation on earth suddenly scrambles to get more Ivermectin from mid-Feb).

    Also, based on his extensive experience in HIV treatments, Prof Hill outlines a strategy for the combined use of vaccines plus Ivermectin across a population which has a real chance of rapidly stamping out Covid altogether (and far more quickly than even the best possible outcome expected from using vaccines only). No wonder that this combination approach is what India is already doing!
    What do we have to do to get the SA regulators to act on the pursuit of a much more effective treatment to save lives (Ivermectin) in parallel with a vaccine?

  • I am 69 years old and have several comorbidities and will HAPPILY get vaccinated – my question is when can we expect the vaccine to reach us high risk people (I live in Cape Town) and will it be one with a better than 50 percent effectiveness? (Okay, that’s 2 questions…)

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