The debate on whether only vaccinated people can access public places or work environments is entering a new phase. While business, government and labour appear to have reached agreement, many are still looking to President Cyril Ramaphosa for decisive action on what must be one of the most difficult problems for any democratically elected leader, anywhere. It also demonstrates democratic societies’ real governing challenges during the pandemic. 

While it appears that many in the middle (and chattering) classes are now persuaded there should be mandatory vaccinations, it is by no means clear that this would be the right choice for South Africa. In fact, it could have negative outcomes and make life harder for those who are already, through no fault of their own, outside the economy.

The real question is: what is the desired outcome? If it is to have as many people vaccinated as possible, then various factors should be considered. And mandatory vaccinations may not be a silver bullet.

While on his trip to West Africa this week, Ramaphosa was asked, on a plane, whether he supported mandatory vaccinations. 

He answered: “I’ve left the question open and said I’d like a discussion to ensue in the country. We live in a country where people have a number of strong views for and against. And my task as a leader is to nudge everyone in the same direction. And through the dialogue I said we should have. And hopefully get everyone to move in a direction we will all be aware, as South Africans, of a danger of not being vaccinated. 

“So I believe very strongly in vaccinations and vaccinations are our strongest weapons in the fight against Covid and we should give our people a chance so they can go through this and see the dangers of not being vaccinated.”

For some, perhaps the continually disappointed middle classes, this was “another example” of Ramaphosa refusing to lead through not taking a strong position either way. 

For others, particularly his critics on Twitter who support Radical Economic Transformation (RET), this was proof that he was going to try to force mandatory vaccinations.

But this may simply be an indication of how complicated the issue is.

The point has been made, several times, that governance becomes close to impossible for democratically elected leaders during a pandemic.

Imagine, for a moment, if Ramaphosa had said that he believed vaccinations should be mandatory.

There would be an unholy alliance of some religious groups, RET faction members, several unions, AfriForum and the Strange Right immediately spouting forth against him.

If he had said he disagreed with mandatory vaccinations, stating something along the lines of, “It’s up to individuals to decide”, that would have led to an equally vociferous reaction from those who have persuaded themselves that mandatory vaccinations is their route back to the life they used to live.

This suggests that in fact his answer was correct.

He was responsible in that he stated his firm belief that vaccinations work, and that people should get vaccinated. But he also trod the careful political path of not taking a hard decision either way.

In any democracy, to force someone to have an injection, a medical procedure, so they can enjoy the freedoms they had in the past is an important step. While lawyers can argue about rights and responsibilities and politicians can make decisions, in the end it cannot happen without consent.

As David Harrison points out in a wise piece in Daily Maverick this week, we should be wary of trying to institute a policy that is impossible to enforce. 

Of course, it would be foolish to try to force people to be vaccinated when the government does not have the ability to actually compel that, or perhaps even to deliver to the tens of millions who are still unvaccinated. 

The problem for Ramaphosa is that emotions on the issue are running high.

People who have spent their lives building businesses for their families, their workers and the families of their workers are desperate for the pandemic to end. It is entirely human for them to demand a policy of mandatory vaccinations to make that happen. For them, they are vaccinated, the vaccines are thus obviously safe, and if everyone is vaccinated their lives will be repaired.

But this is not the case for others. They will simply see this as “the rich” trying to force them to do something they do not want to do. And to have an injection they do not trust.

Any democratically elected leader needs to manage these tensions and to do that, trust is absolutely vital. Without it, it will be impossible to convince people to get vaccinations that they do not trust.

And as UKZN Public Health Professor Mosa Moshabela has suggested, the real issue is not a lack of trust in vaccinations. It’s a lack of trust in institutions, and the people who insist that everyone should get vaccinated.

Within this, of course, are those who deliberately undermine trust in those institutions.

When you have a former president who deliberately claims that judges cannot be trusted, and the leader of Parliament’s third-biggest party making the same claim, can it be any surprise that judges are no longer trusted?

It is possibly these consistent claims that have led to the Afrobarometer finding that only “43% express trust in courts of law”. 

At the same time, those who ultimately make these decisions — politicians — are also distrusted. The incredibly high levels of corruption relating to the procurement of personal protective equipment (PPE) at the start of the pandemic surely undermines any trust in institutions related to health. (The Special Investigating Unit is investigating contracts relating to 11% of the total PPE procurement during this time.)

This suggests that any indication the president is trying to force mandatory vaccinations could increase this distrust and people will resist vaccination.

It must be asked whether mandatory vaccinations are really the correct policy step for our country.

It is worth quoting Professor Anthony Butler at length on this issue. He said in Business Day that, “Mandates and passports will do nothing to improve coverage for the poor, the vulnerable, the less well educated and those living in rural areas, who account for the vast bulk of the unvaccinated population. Vaccine boosters, designed to address waning immunity, may cement these long-term disparities between the rich and the poor. 

“The same fifth of the population that enjoys access to formal sector jobs, private education, private medical care and security, will also become embraced, over the longer term, by an endless system of vaccine updates, mandates and passports.”

This gets to another problem: those who are outside the formal economy are those who are most likely to be unable to get a vaccine, and to have been given the least reason to trust both the formal economy and the government. They will now have still more obstacles to entering formal employment.

This could provoke much more distrust and anger. The system, literally, will be working against them.

All of this indicates that the decision on vaccine mandates is not simple. It will have longer-term consequences than simply the hoped-for end of the pandemic. Any responsible leader needs to take these consequences into account.

It should also be clear that this is not just a legal decision; it is a governance decision. It should involve politicians making decisions on behalf of those who elected them, in full compliance with the law.

This shows how complex the issue is — and why it is not as simple as just a legal policy of mandatory vaccinations. DM

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