Covid-19: SA must vaccinate more adults above 50 years before fourth wave – Prof Madhi

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  • SA's next Covid wave may be less severe than previous ones, unless the virus evolves into more worrying variants.
  • Vaccination can, however, prevent this, but uptake among the older age groups has been slow.
  • In order to prevent hospitals from being overwhelmed, high risk groups must get vaccinated.

It would be “extremely surprising” if South Africa does not experience another resurgence, but such a resurgence is expected to be less severe than those of the past, said Professor Shabir Madhi, Dean of the Faculty of Health Sciences and Professor of Vaccinology at the University of the Witwatersrand.

Madhi was speaking during a virtual webinar hosted by My Health 360 on Friday, 15 October. 

“[This is due to] immunity that has been evolving in the community against severe disease, either through past infection or vaccination,” said Madhi.

Recently calculations by Discovery Health indicated that 80% of South Africans may already have contracted the virus during the past three waves. 

Vaccination in older age groups

Although close to 20 million adults in South Africa have been vaccinated against Covid-19, Madhi said that a greater uptake is needed in the older age groups, who are at greatest risk of Covid-related severe illness or death, by the time the country reaches the next resurgence which is expected in December.

Currently, about 50% of people between 50 and 59 years and around 60% of people above the age of 60 years have been vaccinated, but that figure needs to escalate to roughly 85 to 90% of people above the age of 50, he said. 

“If we’re able to do that, even when we experience a resurgence, what won’t occur is an overwhelming of our healthcare facilities,” said Madhi.

Virus may evolve

However, the fourth wave may turn out to be severe if the virus evolves into more transmissible variants or escapes protection induced by the vaccines.

“There are likely going to be new variants that arise over time,” said Madhi. “And that’s more likely to happen the more the virus is circulating. And the reason why there would be more virus circulating is because people are unvaccinated.

“When people are vaccinated, the amount of virus that transmits is reduced, and even when people do have breakthrough infections [an infection after vaccination], they shed the virus for a shorter period of time which means that the mutations are less likely to occur,” he added.

Vaccines continue to protect

The main focus of vaccination is the prevention of severe disease and hospitalisation, said Madhi. Describing the effectiveness of the Pfizer and Johnson & Johnson (J&J) vaccines, he said that both continue to provide high protection.

Protection by the Pfizer vaccine against hospitalisation and death caused by the Delta variant is greater than 90%, even six months after people have been vaccinated, said Madhi. 

For the single-dose J&J jab, based on data from healthcare workers in SA, protection against hospitalisation is in the region of about 70%, which is why the government is considering offering a booster dose to these individuals.  

Benefits of boosters

Modelling data currently indicates that a vaccinated individual will have lasting-protection against severe disease and death for at least two to three years, said Madhi. 

However, this may be different for people above the age of 65, and those with compromised immunity, such as those who have cancer, had an organ transplant, or have autoimmune conditions.

For this group, the Covid-19 Vaccine Ministerial Advisory Committee (VMAC) has advised the government that an additional dose should be offered, health minister Joe Phaalha stated on Friday, 15 October. However, this should happen strictly under a referral by a medical practitioner, he said.

“But for a healthy individual, two doses of the Pfizer vaccine ... should confer protection for two to three years, if not longer,” said Madhi. 

Vaccinating younger age groups

Vaccinations will open to children aged 12 years and older from 20 October. Discussing this decision, Madhi said he’s not convinced this is necessary.

“Firstly, we need to be clear that when we vaccinate that age group, we’re not vaccinating for individual protection, but rather to try to reduce the number of people that could transmit the virus in the community.”

Healthy children in the 12 to 17 years age group have a low risk of Covid-related hospitalisation. The case for children with underlying medical conditions is different, added Madhi, and they should be vaccinated.

“But for the general population, the main reason we’re vaccinating children between 12 and 18 years is really to reduce the ability to transmit the virus, so it’s an indirect protection that we’re trying to enhance. But that is not going to assist much if we have a significant percentage of people above the age of 50 that are unvaccinated,” he cautioned.

Focus should be on high-risk groups

The focus and priority of vaccinations in South Africa should not be about the number of people that are vaccinated. Instead, it’s about “getting the right groups of individuals vaccinated”, said Madhi.

“We will be missing the target if we now try to expand vaccination without having a concerted effort to get 90% of people above the age of 50 years to be vaccinated. Will I take my child to be vaccinated? I probably will… Is it going to assist the country moving forward? It’s not, unless we couple that with ensuring that we get 80 to 90% of people above the age of 50 vaccinated,” he said. 

Vaccination: fatal side effects

Based on the best data available globally, the chances of a fatal side effect from the vaccine is probably within the region of one to two people per million of people vaccinated, said Madhi. By contrast, the number of people that have died due to Covid in SA is 4 000 per million.

“Unfortunately, there are the chances of fatal side effects from vaccination, but the chances of that occurring are nominal. So when we talk about side effects, it's something we need to keep an eye on and be concerned about, but it’s also something that we need to put into context of other risks that we face on a day to day basis in a country such as South Africa,” he said.

Mandatory vaccination

The policy of mandatory vaccination is needed in certain spaces, including in healthcare settings, higher education institutions, restaurants, clubs, pubs, and any place where people are likely to gather – especially where there are other individuals at risk of developing severe disease should they contract infection, said Madhi.

“The policy of mandatory vaccination is not just about individual protection – it’s trying to do it for the common good. And it can be in a workspace, for example, where you’ve got a 60 year old that has been vaccinated, but because of their medical condition, they’re not fully protected even against severe disease.

“That individual is unfortunately at risk [of hospitalisation or death] if there is a large percentage of other people that are unvaccinated [and infected], who are in that space, and who go on to transmit that virus to that individual that took care to and did the responsible thing to be vaccinated,” he said.

'Mainly up to the citizens'

South Africa is one of the fortunate countries that managed to secure enough vaccines for their populations, considering many other low-income countries haven’t yet received sufficient doses, said Madhi.

“And now it’s mainly up to the citizens who will determine how Covid continues in South Africa, and whether we will need to go to further levels of restrictions.

“We can get rid of our masks and all our other interventions as early as next year, provided that we get the high risk individuals vaccinated, with at least 90% of them being fully vaccinated for the next resurgence,” he said.  

*For more Covid-19 research, science and news, click here. You can also sign up for our Daily Dose newsletter here.

READ | If SA had rolled out AstraZeneca vaccine, up to 22 000 deaths could have been prevented – Prof Madhi

READ | How years of vaccine groundwork allowed the Covid-19 jabs to be developed in under a year

READ | Covid-19 reinfection likely in unvaccinated people, US researchers find

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