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Ethical conundrums: Will South Africa use the vaccination carrot or the stick?


Born in Cape Town, Natale Labia lives in Milan, Italy, and writes on the economy and finance. Partner of private equity firm Lionhead Capital Partners. MBA from Università Bocconi. Supports Juventus.

The Covid-19 pandemic and ensuing vaccination campaign that have engulfed the world over the last year and a half continue to present a number of fascinating and inevitably insoluble policy and, moreover, ethical conundrums. Most recently, it is whether citizens should be enticed, convinced, coerced or forced into receiving a vaccine?

First published in the Daily Maverick 168 weekly newspaper.

South Africa’s own vaccination campaign has gathered pace after a glacial start. As of 3 August, according to Our World in Data, 7.57 million doses have been administered, enough to vaccinate 5.03% of South Africans fully.

This might seem paltry, and it is. At this current rate of about 200,000 doses a day, it should take until mid-next year to achieve the much-vaunted 75% immunity of the population. Thankfully, however, the trend is in the right direction, with the number of doses administered increasing.

While South Africa’s campaign may still be in its infancy, the experiences of other countries that are further along the torpid winding labyrinth of enigmas presented by the vaccinations are instructive.

Getting vaccinated is a decision that ultimately all individuals need to make. According to neo-classical economics, individuals are rational and will assess the utility of attaining a vaccine against the costs.

Data from the Lancet on studies done in Israel shows that two Pfizer BioNTech vaccines are up to 94% effective at preventing serious cases of Covid-19. This is clearly an incentive to go for a jab.

Likewise, if you are vaccinated, you are less likely to contract the virus and pass it on to (potentially unvaccinated) family and friends. Despite what the textbooks might say, humans are social creatures.

Yet the costs of getting a vaccine are substantial, in many cases prohibitive. While the doses themselves may be free, there are costs of travel, of time, of hassle to book the thing – and then, critically, there are perceived unknowns as to what the side effects of a vaccine might be.

In SA, as in other countries, distrust of vaccines is considerable. While estimates vary, studies done in April by the South African Medical Research Council show that around 18% of South African adults would either definitely not or probably not take a vaccine, while 15% are unsure. Experience in the developed world suggests the first half are easy, but from then on it gets tougher.

There is also an interesting “free riders dilemma”. If one is unwilling to get vaccinated but the rest of the population is inoculated, then the virus will be unable to spread. However, if everyone has this mindset, then no one will get vaccinated and waves of contagion will persist.

This presents yet another dilemma. If the only way that economies can escape the shackles of this virus and prevent further lockdowns is to ensure that 75% of the population are vaccinated, how does one shift the calculus to ensure that getting vaccinated becomes a rational choice for all adults?

Developed countries have shown that it is relatively easy to convince around 50% of the population to get vaccinations, but above that there is a substantial share of the population who are reluctant.

The US and the UK have pushed the carrot approach, with President Joe Biden arguing that $100 cheques should be offered for each vaccine, while Prime Minister Boris Johnson has suggested discounts for Deliveroo home delivery and Uber rides for the young and vaccinated. However, since June, vaccination rates in the US have plummeted. Libertarian Americans could be the biggest obstacle to their own freedoms.

Europe, meanwhile, has tried a more deliberate approach. French President Emmanuel Macron has been characteristically forthright, passing a bill last week that not only mandates all health professionals to be vaccinated but that will require all citizens to show either a negative Covid-19 test or proof of vaccination on entering bars, restaurants or public transport, let alone sports stadiums or concerts.

Prime Minister Mario Draghi of Italy has followed suit, as from 8 August all Italians who want to live a relatively “normal” life will have to show proof of immunity in the form of the electronic European Union green pass. While protests ensue, the whip has been cracked.

Debates have raged over the sensibleness of this. Is it constitutional? Should it be allowed to happen in a modern liberal democracy? Are we living in an Orwellian 1984 where we have to have QR codes scanned just to go out for dinner?

Those who are pro the measures argue that while this may be a curtailment of freedom, it is not as much of a limitation, as vaccinations are the only way of avoiding further lockdowns and restrictions to liberties in the European autumn. The argument is that the only way to reattain freedom is to be robbed of the freedom of choice of vaccination.

Such debates and policy decisions will have to be confronted by Cyril Ramaphosa and his Cabinet to ensure SA does not endure repeated waves of infections and lockdowns.

As the vaccine roll-out in South Africa gathers pace, expect by the spring that all those who are not averse to being vaccinated will be fully jabbed, leaving a worrying percentage of the population requiring either incentivisation or coercion.

Will the president risk imposing restrictions on the rights of the non-vaccinated? While it may be unpalatable and could be politically toxic, it may become essential. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for R25 at Pick n Pay, Exclusive Books and airport bookstores. For your nearest stockist, please click here.


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  • Once everyone has had the opportunity to be vaccinated we have to open everything up 100%. When the unvaccinated die, they die. We can’t wait for them to learn the hard way

    • You can always give a brother refusing to vaccinate a list of things you want to inherit when he dies of COVID complications . While at it you might add a note of how you will respond when people tell you ‘sorry for your loss’. What about that offensive , but vaccinated mother in law. It might be a good time to tell her you are not vaccinating. Do you think she will still visit, especially when she has a ton of co-morbid illnesses. Crazy times to manipulate things to suit oneself or encourage loved ones to vaccinate.

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