In January, government officials and medical experts were under pressure to arrange vaccines for a frustrated population desperate for a return to normality and fed up with lockdowns, alcohol bans and the ensuing economic fallout. Six months later, the country is literally awash with vaccines, but demand is falling off a cliff as apathy sets in. What to do?

To date, 9.7-million South Africans have been vaccinated, a considerable improvement on the 1.2-million who had received the jab by 1 June. But this is 19% of South Africa’s adult population, a far cry from the 90% coverage that is required to contain the virus, reduce mortality rates and lessen the impact of the anticipated fourth wave.

“The slowdown is alarming,” says David Harrison, CEO of DGMT, a not-for-profit that has been coordinating donor support for SA’s fight against Covid-19 with the National Department of Health. “We saw a big drop-off in the number of over 60s getting vaccinated, but the pattern in other age groups is proving similar.” For instance, the 40s and 50s reached about 300,000 per week about three weeks ago, plateaued, and are now down to about 200,000 a week.

At this point just under 30% of women and 20% of men aged 60+ are vaccinated. In the 50-59 year bracket, the number drops to 12% and 8.4% respectively, and just more than this in the 35 to 49-year bracket.

Both business and government are starting to think seriously about incentivising vaccine uptake. 

Already there is movement, with Wimpy offering free coffees to those recently vaccinated and Game offering a 10% discount on Wednesdays. Discovery Life was the first non-retail business to entertain incentives, announcing that being vaccinated against Covid-19 will now be considered when determining life insurance premiums and benefits for new clients. “Through our premium PayBack reward mechanism, we are offering all qualifying new clients their maximum possible payback for the first year of their new policy,” CEO of Discovery Life Riaan van Reenen said. 

Increasingly, a conversation around incentives is being held across the business spectrum, from MTN to Pick n Pay.

“The priority for us all is to persuade as many people as possible to get vaccinated,” says David North, Pick n Pay’s head of strategy. “Like others, we are concerned that vaccination rates seem to be slowing — just at a time when there is a good supply of vaccines in this country. We are looking at the question of incentives, although experience internationally suggests that these have limited impact in persuading those who are slow or hesitant to be vaccinated.” 

Vaccine lotteries have been rolled out in both Canada and the US, and US President Joe Biden recently urged states to offer $100 incentives to people who get vaccinated. Prizes like trips and vacations are being used to entice the fence-sitters to go out and get their shots.

Whether any of these strategies will work in the current pandemic is hard to say. Financial incentives to improve other vaccine uptakes for children have proved effective in Ghana, and lottery tickets have been used to boost the uptake of HIV treatment in a trial in rural KwaZulu-Natal. Whether such incentives would encourage people to get vaccinated against Covid-19 remains to be seen.

In the US, the state of Ohio launched a “Vax-A-Million programme” in May, according to an article in The Economist. This enabled individuals who had received one dose of a vaccine to opt into a lottery that would reward five people with $1-million each and five people with full scholarships to an Ohio public university of their choice. 

The initiative cost $5.6-million, and according to a study published by the University of California, it averted around $66-million in healthcare costs.

“As business, we are encouraging people to get vaccinated and while rewards and incentives may not necessarily solve the problem, I think we should try all avenues available to encourage people to do so,” says Busi Mavuso, CEO of Business Leadership SA.

But incentives cannot replace doing the hard yards and tackling the barriers. “There are both supply and demand factors that we need to consider,” says Harrison. On the supply side, are vaccines accessible enough? To expect someone receiving an R350 grant to pay R25 for a taxi to get the jab is unreasonable. South Africa has 3,000 public and private vaccination sites. Is this enough? “If a site is more than 5km away then people don’t see that as part of their environment. This taps into the vaccine apathy we are seeing,” Harrison says. One solution is to incorporate roving or pop-up sites into the programme, which were used effectively in the UK.

On the demand side, there are three clusters of people — those that are willing and able to get the vaccine, provided they have sufficient information to do so; those that can be nudged over the line, providing government can reduce the barriers and opportunity cost; and those that are vaccine-resistant. “I think this latter group is more erodable than we think,” he says. In the absence of proper information, people become anxious and open to conspiracy theories. The answer is to put the information in people’s hands in their own language, supported by true to life stories of those who have been vaccinated.

This is the route that PnP has adopted. It has redoubled its efforts, communicating with employees and customers on why vaccination is the right thing to do for themselves and their families. “We have made it practical, easy, and convenient for our staff to get vaccinated as quickly as they can,” says North.

The Minerals Council of SA reported that its member companies have vaccinated 105,927 employees. “We know that a critical element of vaccine hesitancy is simply not being able to easily and conveniently get access to the EVDS system and to vaccination sites, as well as having sufficient confidence in the efficacy and safety of vaccines, says Roger Baxter, CEO of the council. “By taking vaccines directly to the vaccinees with the support of our trusted partners in organised labour we directly address this issue.”

One company has already reported an 83% vaccination uptake, with some of the larger companies heading towards 50%. Similarly, universities, like Rhodes, are coordinating the vaccination process for students, ensuring a fast track roll-out. 

When this road runs out, incentives are an option worth considering, says Harrison.

While those offered by Game, Wimpy and Discovery Life are to be applauded and celebrated, the possibility exists that they are reaching a population that is already vaccinated or would be, regardless. 

The reality is that “in a cash-strapped and economically polarised society like ours, financial incentives may be the game-changer. The truth is that 14% of our population is chasing the R350 grant and foreign nationals are desperate,” says Harrison. “Just providing someone with a voucher to buy groceries to the value of R100 could be the incentive they need.”

It is a subject fraught with risks. After all, a financial incentive such as a food voucher may anger someone who is already vaccinated.

Business and government are assembling an integrated team under the oversight of the National Department of Health to look at how to stimulate demand. Incentives (positive and negative) are central to that proposition. 

“Vaccinating one man 65 years and older saves us healthcare costs of R843,” says Harrison. “This cost does reduce with age — for instance, vaccinating a 30- to 39-year-old saves R45 of healthcare costs because of the differential mortality — but every one counts.

“The idea is rapidly gaining momentum, but ultimately the National Treasury will have to make the call; after all, it will be required to put some money on the table.” 

The question is, can it afford not to? DM/BM