South Africa’s ‘dismally slow’ vaccine acquisition and roll-out means the country will effectively have to rely on natural infection to reach herd immunity, with an estimated 150,000 lives lost to Covid-19 already.
This is according to health economist, Professor Alex van den Heever, chairperson of Social Security Systems Administration and Management Studies at Wits University’s School of Governance.
Speaking as a guest in a Medztalk webinar on Thursday last week, Van den Heever said the government’s inefficient response to Covid-19 via a hard lockdown in March 2020 was hugely destructive to South Africa’s social and economic fabric – and failed to prevent transmission. This accelerated the country’s economic decline, halting production lines, choking incomes and forcing people to draw on their savings – with a catastrophic effect on government functions and finances in just two months – March and April.
“This was probably the worst effect you could have on an economy outside of a war,” he says.
Without Reserve Bank intervention creating liquidity by buying up government bonds in secondary markets, the government would have been left without anyone willing to lend it money.
“That’s how serious it got and how fast it happened,” he notes, estimating job losses in 2020 alone at 1,5 million.
The extended tobacco and alcohol prohibitions had cost the government R35-billion in lost tax revenue, excluding losses in excise duties, VAT and other taxes, meaning it jeopardised its own financial ability to respond effectively to the coronavirus threat.
Turning to the epidemic itself, Van den Heever said the latest data show that each level of lockdown bore little relation to the subsequent infection peaks.
“I don’t think we fully understood it – it’s driven by superspreader events. In the first surge the government didn’t accept that it’s an airborne epidemic, for example not warning against recycling air-conditioned air or even enforcing mask-wearing in closed spaces. Taxis were not limited in numbers or advised to open windows – all this drove the surge,” he says.
When the second, [variant], surge arrived from 27 December, new non-economy-harming restrictions were introduced, such as those on gatherings and curfews and the closing of liquor outlets and bars. From one data sounding made between 11 and 13 January, this showed an infection decline in every province at about the same time.
“This suggests there is a configuration of non-pharmaceutical responses that will work and not completely destroy the economy,” he explained.
All this begged the question of how many people were infected so far and how much immunity had been conferred. In the hardest-hit Eastern Cape, with its dismally managed healthcare system and infrastructure, Van den Heever estimates 60% of the local population to already be infected.
The national vaccination programme had been “dismally” managed.
“We certainly won’t be able to vaccinate the population into 2022. Somebody should be fired. It’s such a botch. How do you face 2021 without a significant vaccination programme?” he asked.
Van den Heever said India (from whose Serum Institute South Africa bought 1,5 million doses of AstraZeneca vaccine, only to shelve it and then sell it to the African Union based on a small, highly limited study), had stopped exporting vaccines due to fears of further major domestic surges.
He said that in South Africa, the immunity derived from the two infection waves might affect the severity of third or fourth waves, particularly in the most heavily affected regions.
He was sceptical about whether phase two of the vaccination roll-out, scheduled for early May, would be completed by the end of the year. (The Pfizer vaccines are due in mid-April and together with any Johnson & Johnson supplies, will be targeted at essential workers, people in congregate settings, those older than 60, and those with comorbidities).
Van den Heever added: “Natural infection will outstrip vaccinations in 2021 if the infection fatality rate of 0,8% is a correct indicator of true infection levels.”
Factors outside the pandemic would drive economic performance during 2021 and 2022. “We’ll have to rely on natural infection in South Africa and just live with the pandemic.”
The country’s economic performance would depend largely on other countries and whether local infrastructure programmes were delivered. He put the chances of domestic economic improvement at about 40%.
The government had tapped into the Unemployment Insurance Fund, (UIF), using half of it (R50-billion) for its Covid-19 support framework – but because contributors could only be identified when they claimed, it took up to three months to benefit anyone. Besides this, the UIF’s top structure had been suspended for “dodgy dealings” – “part of our government story during this period”.
“We need to make money available, but it’s either not deployed or, if so, not efficiently, with so much siphoned off and ending up in crooked deals. We need a huge spending programme, but the problem is, can we have infrastructure spending without having half that money stolen?” Van den Heever asked.
He said that when he correlated excess weekly death trends against new infection data, he came to an average provincial correlation coefficient of 96% (using SA Medical Research Council estimates of excess deaths). This excluded winter flu deaths.
Excess deaths preceded new infections on the graph curve, raising the danger that when scientists and politicians saw a new infection trend it was already up to three weeks old.
While the reporting system had improved hugely over the second wave, it remained below par.
Asked by one of the more than 800 webinar attendees whether it was a viable strategy to let the virus “run rampant” for the remainder of the year because there were already about 20 million South African adults infected (with conferred immunity or mild disease), Van den Heever was unequivocal.
“No, that would be a disaster scenario – 150,000 dead (based on his calculations) is an appalling record. Even the UK has fewer, and they’re not even counting their nursing homes. The problem with the rest of Africa is that record keeping is so poor that it (the virus) has probably been devastating the continent and we just don’t know.”
Meanwhile, Professor Shaheen Mehtar, infection control adviser on the Ministerial Advisory Committee, issued a strong warning to all healthcare facilities to increase their basic infection-control measures (non-pharmaceutical), to complement vaccination, which she emphasised was never 100% protective.
Top basic measures included sanitising and/or washing hands to protect all mucous membranes (eyes, nose and mouth) and ensuring good ventilation with at least 12 total air changes per hour in high Covid-19 risk wards and six-hourly air changes in general wards – all exhausting air outside the building.
Mehtar helped draw up infection-control guidelines for the World Health Organisation and the Africa Centres for Disease Control and Prevention.
OPINION: Chris Bateman