Expert opinion both in South Africa and internationally are in agreement. Vaccination is our strongest defence against an increase in severe Covid-19 as the fourth wave hits us with the highly transmissible Omicron variant.

On a national level, we need to urgently move from asking to strongly nudging people living in South Africa to vaccinate. We have been asking and encouraging for six months.  Our vaccination sites have changed from queues to trickles. Even pop-up sites at shopping centres and taxi ranks aren’t that busy. 

In mid-November in Jozini, KZN, I spoke to a motivated nurse who was strongly encouraging people in a busy shopping mall to vaccinate on her loudhailer. In four hours, her team had administered eight Covid-19 vaccines. She was at a loss on how to turn the trickle into a stream. On 25 November, we were only using 120,000 of the 300,000 available vaccines doses that are available daily. South Africa had managed to fully vaccinate 16.5 million people (35.5% of the adult population). After our Family Meeting last Sunday, we have seen an uptick in vaccinations (approximately 150-170,000 per day) but still well below what is required and what we have capacity to do.

Let’s face it — those that actively decided to vaccinate, have largely done so. The more recent government and private sector focus on increasing vaccine access with more fixed vaccination sites, pop up sites, longer hours, weekend hours, R200 vouchers and access for undocumented people is already supporting those who were struggling to get vaccinated due to transport costs, distance to vaccine sites, work, exam or other obligations.  

We now have a lot of people for whom vaccination (or second vaccination) is not a priority or who do not want to vaccinate.  Our quickest win to increase vaccination is to make vaccination the priority very quickly.

We know from other countries’ experiences, implementing vaccine passports (health pass, green pass, safe ticket, corona pass) to access public spaces, public events and crossing borders (including internal borders) works to increase vaccination uptake and supports tourism, transport and other industries during a pandemic. The countries that implemented vaccine passports early achieved higher vaccination rates and many countries are now following suit. For example, despite high public scepticism towards vaccination and public protest by the French, implementation of the “health pass” on 12 July is accredited with contributing an additional 4-5 million people getting the jab. 

Our December holidays and festive season are a time most South Africans have been looking forward to since March 2020. We want to see our families, friends, go on holiday or return home. This is many people’s current priority. Extensive migration around the country (especially from Gauteng) starts in two weeks and with it, we have the highly transmissible Omicron variant. While the variant has been identified in five provinces already and is likely in all nine provinces. Migration into every urban suburb and rural village will significantly and quickly contribute to a steep curved fourth wave with case rates and hospitalisation beyond our management capacity.   

We need to turn the December holiday priority into a Covid-19 vaccination priority. This means we need to move beyond asking, to strongly nudging people to vaccinate.  

The South African government needs to pragmatically implement vaccine passport regulations this week before the holidays set in. Proof of vaccination should be required for at least all public transport, restaurants, bars and public events. 

We already have a vaccine passport system in place. The problem is that it relies on smartphone penetration and being tech-savvy to navigate the online system. To implement vaccine passports in South Africa, we need a simple and pragmatic system that is possible for everyone — including those without phones, data or tech capacity. The system does not need to be perfect, but must be possible to implement now. It should have little to no set-up requirements and should not be administratively or financially burdensome for any person. We can do this by: 

1) Accepting and requiring the presentation of each person’s vaccine card — the piece of paper given at vaccine sites as proof of vaccination (or your vaccine passport if you are privileged enough to be able to access one). Where these have been lost, a person can simply go to any vaccination site to obtain a replacement. We need to accept that these are simple to forge and some people will cheat. We can discourage forgery to some extent by requiring random vaccine status checks.

2) Providing a public access web portal to EVDS that allows any user (flight check-in/bar/event management company/taxi driver) to randomly confirm a person’s vaccination status. The portal would simply require the user to insert the person’s unique identifier on their proof of identity (identity document/driver’s licence/passport/permit/alternative unique identifier provided at vaccine registration). Such EVDS portals already exist for other purposes and should be simple and quick to adjust for public use. The user could immediately confirm that the person has been partially or fully vaccinated. No other medical information contained on EVDS should be accessible. The legal case for mandatory vaccination has previously been made, public access to confirm vaccination status for public safety is significantly less burdensome to argue.  

The onus would be on specified businesses or government departments who provide services directly to the public to do random checks of persons presenting their vaccination cards to enter the premises or public transport. Random checking, rather than confirming vaccination status for every person, would ensure that businesses can still run (and reduce the risk of queues increasing transmission risk). The degree to which implementation is policed by government could be aligned with policing of previous level restrictions.  

To make this work, we need to appeal to the tourism, transport and other face-to-face service provision industries to champion and implement vaccine passports. This can be done before government regulates. Nothing is stopping requiring the presentation of vaccine cards on entry now. 

These and other industries should also be taking their own steps towards assuring the public of the Covid-19 safety of their businesses. Many employers have strongly and successfully encouraged staff vaccination — these businesses should market their businesses as “Vaxed” — advertise at storefronts, bar entry, restaurant front doors — “All staff on these premises are vaxed”.  Imagine the peace of mind for many people who have to travel in minibus taxis every day, if they were able to choose to board the taxi advertising “This taxi driver and tout are Covid vaccinated”. 

We have two weeks before the holiday season is upon us, lets prioritise vaccination now. DM/MC

Lynne Wilkinson is a public health specialist at the International Aids Society and the University of Cape Town.