MAC co-chair, Prof Koleka Mlisana

By Chris Bateman

Besides peer influence, two of the most powerful non-Covid factors affecting the current lowest-ever vaccination uptake in South Africa are corruption and the lack of service delivery.

That’s according to the co-chair of the Ministerial Advisory Committee, (MAC), on Covid, Prof Koleka Mlisana, who in probably her most forthright interview yet, says people are asking why they should trust a government that has failed to deliver services in 28 years of democracy. Besides this, corruption, especially around Personal Protection Equipment, (PPE), tenders, has resulted in a growing distrust in government – across race groups, she says.

“The other concern is around all the conspiracy theories, misinformation and disinformation circulating in social media. Because of the internet everybody can read what’s written up – at the end of the day you have to ask where responsibility and accountability lie,” she adds.

Recipient of the SA Medical Research Council’s prestigious President’s Award for Outstanding Leadership in Health Sciences last month, Professor Mlisana led the way in SA’s HIV/AIDS research, setting the base line for research into HIV pathogenesis and disease progression.

For two years, she followed a large cohort of HIV negative women sex workers and those with multiple partners, following up intensely those who acquired HIV to better understand acute HIV infection in women, dividing them up into slow and fast progressors. This provided the base for most of SA’s globally admired subsequent HIV research.

Asked to expand on the current lowest-ever levels of Covid vaccination, Mlisana says they have dropped from a high of 200 000 per day to around 70-80-000 per day currently.

“You can walk into any site and the long queues have disappeared completely. A significant number of sites have had to be closed. People are saying, well if we’re at 80% of previous infections, why must I get vaccinated? Yet we’ve only vaccinated 48% of the population. So past exposure is also driving vaccine hesitancy,” she says.

Prof Barry Schoub, Chairperson of the MAC on Covid Vaccination, told MedBrief Africa, that access, apathy, anxiety and conspiracy were the four main drivers of hesitancy, but stopped short of ascribing apathy to government corruption and service delivery dysfunction.

He dismissed anti-vaccination groups like Panda labelling them a ‘very loud minority,’ adding; “any sensible person can see they’re mavericks.”

Fake news aggravates matters

Mlisana said people contributing to fake news in the confusing Covid media milieu had stopped asking what value they were bringing, while many social and mainstream publishers were ‘just looking for hits.”

“The other interesting recent MRC finding on vaccine hesitancy which talks to how we can intervene is a lot of folks saying, ‘I’ll vaccinate if you do.’ This talks to people who have influence over others. So, the two top moves to decrease hesitancy I’d say would be to make sure the correct information is disseminated widely. This means identifying experts in communication who can turn around the message for the different levels of the population and communities. That’s critical. Then the second is to ask who brings that message, who are the influencers within communities, who do people listen to? (tailored to differing age groups for example). One thing government has done with some success is to create vaccination champions – ordinary volunteers who educate themselves and those around them. If you look at the HIV epidemic, the most successful education was done by those living with HIV, thus reducing stigma.

We need those who’ve been infected with Covid and were previously resistant to vaccination but have realised the benefits as these champions – from all walks of life,” she says.

Mlisana describes debating whether SA is reaching the right funding levels to mitigate Covid is a “quixotic endeavour”.

Vax funding efficacy, not more money

“I don’t think we’ll ever get to the right funding level. There are too many issues. I mean, if we’re not able to appoint healthcare workers during a crisis, we can’t expect the vaccine programme to have enough funding. The question then becomes; even if funding is available, who is managing it? It’s critical that it is available and well managed. There was probably enough funding for PPE, but it did it get to the people?” she asks.

Sharing the vaccination data as at March 22nd, Mlisana revealed that 33 105 213 vaccines had been administered to individuals in single dose Johnson and Johnson jabs, consisting of 8 082 241 J&J shots and 25 022 972 double dose Pfizer jabs. Of the J and J jabs, 7 324 098 people had received a single shot, with 758 143 having had their second injection.

“Some three weeks ago, everyone who had had a J and J booster in the last 90 days was invited to have another booster, and that booster can be Pfizer.  Of the 25 million-plus Pfizer shots there are 13 477 995 who have received the first dose and 10 370 005 who are fully vaccinated. Over and above that 1 174 972 came for their Pfizer booster.

That’s the entire spread of combinations. It can get confusing when you talk about the percentage vaccinated because you need to check whether the person is talking about the total population or the adult population – because we recently added the 12-17 year olds’,” she says.

“If you’re looking at individuals vaccinated as a percentage of the adult population, we’re sitting at 48.5% – but for those fully vaccinated the figure is just 43.6%.

Keeping in mind that the aim of vaccination is to reduce severe disease and death, the highest risk populations were targeted first. Hence the percentage of people 60 years and older who have had at least a single vaccination dose stands at 68.6% with those 50 and 59 years old (with at least one dose), at 60.6%. The proportion of people above 60 who are fully dosed is 62,6%.

“So, we’re not doing well. We’d really like to see close to 80 or 90% of the older groups. The United Kingdom is sitting at 87% and some countries at more than 90%,” she observes.

On vaccine mandates she had this to say:

“It’s very interesting, there are people in my own family who were not keen to be vaccinated – until workplace vaccine mandates came. Whichever sectors go for that, it will help us. As for government leading by example here, you’d think it would be easy to order teachers and police to get vaccinated, for example. But it just would not go down well with unions and labour, and government doesn’t want to go there. It’s clear they won’t go down that route but instead they’re saying anybody who mandates, they will support.”

Mlisana said South Africa was no longer in ‘disaster mode.’

“We have now lived with SARS-C0V-2 for more than 24 months and a lot has been learnt. It’s clear now that we are beyond the disease containment phase as more than 80% of the SA population has been exposed, as shown by the various seroprevalence studies. It therefore means we need to look at mitigation factors, to determine how to live with the virus and ensure integration of Covid disease management into the general health system of the country. The lifting of the state of disaster is inevitable, (probably next week), but what is important is how we then integrate Covid into our lives and also have regulations in place to allow efficient adaptation and effective response should there be a new turn of events that requires restrictions,” she concluded.