Covid-19: What could SA's fourth wave look like?

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  • South Africa's fourth wave is expected to occur in December 2021 and January 2022.
  • While vaccination coverage is increasing, it is happening at a slow rate.
  • More efforts are needed to address vaccine accessibility and hesitancy, experts say.

It has been almost six months since South Africa launched its Covid-19 vaccination programme. To date, more than 23.1 million people (including adolescents) have received at least one dose – and close to 13 million people are fully vaccinated.

But a fourth wave is expected to hit the country early in December, and as experts have stated, its severity will likely depend on whether the country achieves its vaccination targets. 

One expert believes the country’s next surge may not be as bad as the last one.

“My feeling is … that the fourth wave is not going to be as bad as the third wave … but not as good as the best possible experience, had we attained a high coverage for vaccination,” said Johnny Myers, Emeritus Professor in Public Health, University of Cape Town. Myers was speaking during a webinar hosted by Tshikululu on Monday. 

Portugal, a success story

“It’s not going to be as good as, for example, if you look at the same situation for Portugal, you will see they have had a third wave after they had a successful vaccination campaign and this completely flattened their third death wave,” he said. 

Portugal is among the most highly vaccinated countries worldwide. According to several reports, there is barely anyone left in the country to vaccinate. By mid-October 2021, around 85% of its population had been vaccinated. They are now administering a third booster dose to people aged 65 years and older.  

“Portugal … virtually completely eliminated the deaths that would’ve ensued based on the [infections] case wave they had after the vaccination programme had already achieved its goal,” said Myers.

Elderly group coverage high

Health minister Joe Phaala recently said that if South Africa manages to inoculate 70% of its 50-years-and-older age group by the time the fourth wave arrives, the country’s hospitals will not be as overwhelmed as they had been during the previous waves.

Myers’ belief in a less severe fourth wave, compared to previous surges, is based on the fact that South Africa has a “relatively high” vaccination coverage for the over-60s age group.

“It’s quite high. It’s about 64% for the over-60s in the country that have received at least one dose of the vaccine, [and] which will make a big difference,” he said.  

However, Myers cautioned that even a 50% reduction in mortality in the fourth wave compared to the third wave amounts to about 55 000 deaths – "So we’re still talking about a serious situation,” he said.

Focusing on increasing uptake

With vaccine uptake slowing down, other experts on the panel discussed key factors associated with this, including issues around access to vaccination sites, vaccine scepticism, and misinformation. 

“Factors of access are relevant: whether people can access transport, can get to sites are important,” said David Harrison, CEO of DG Murray Trust. “We have to make it easier for people to get vaccinated. We may think that a R30 taxi fare is not much but on a pension of R1 900 a month, it’s very significant. So there need to be small guaranteed rewards or incentives that can reduce these costs, which must be part of the solution,” he added.

The government recently introduced such an incentive: from 1 November, a R100 Vooma Voucher will be given to all adults aged 60 and over, which can be spent at any Checkers, Usave or Shoprite store. 

Dr Salome Maswime, President of the South African Clinician Scientists Society, also weighed in: “There’s an issue of vaccine equity: what are the differences in uptake in the cities, towns, rural areas, villages, etc. – is the vaccine reaching everyone equally, or do those on medical aid, for example, have better access?   

“Just because vaccines are there and people can get it, it doesn’t mean people are going to use it. [We need to unpack] issues around perception, geographical distance, communication and messaging. Simply making it accessible isn’t enough,” she said.

Addressing religious groups

Addressing faith communities and religious groups are also fundamental to the vaccination programme gaining momentum, said Myers. 

“A lot of the vaccine hesitancy comes from religious groupings. There needs to be some policy approach to try to motivate religious leaders … who really have the best interests of their congregants at heart, to engage with the other religious leaders, of whom there are many, who have an anti-vax orientation.  

“That could in fact trickle down to the congregations as well. There has to be engagement there because there’s a massive problem in that area,” he said.

Efforts must come from all sectors

Apart from accessibility, Harrison said that there is a need to make vaccination “mean more to people and to increase the perceived value” of getting the shot.

While South Africa should celebrate its gains, it’s going to have to adopt a different set of strategies for the next six months to try and ensure that its vaccination programme is sustained, he said.

“We can’t let this vaccination programme fizzle, and that requires that we continue to ramp up, normalise and socialise vaccinations, and part of that is public communication and visibility in communities,” said Harrison. He added that efforts will have to come from the government, non-government organisations, and the private sector.

What will the end of the pandemic look like?

Covid-19 is here to stay, in that it will become an endemic disease where it will continue to circulate in communities, but the impact it has on the number of severe illnesses and deaths, illness will be less severe, as more of the population will have acquired immunity to the virus (either through natural infection or vaccination). 

“One year from now, I think ... Covid will be endemic in South Africa, which means it will still be there – it'll be mostly like a bad cold or a bad flu,” said Myers.

Myers added that the focus of vaccination should be on death cases, not infections, going down, he said.  

“The only thing we know about infections is that they’re not going to stop. Vaccinations are going to do very little for infections. You’ve got to focus on the deaths,” he said. 

'Let's do everything we can'

Harrison believed that South Africa was in a much better place now than with the past surges. 

He said: 

I firmly believe that in a year's time, both through the continuing development of science and the natural evolution of this pandemic itself, we’re going to be in a better place.

Still, he urged the importance of responsible behaviour until then: “But let’s do everything we can to ensure that we’re in a better place ... so that in a year’s time, we will be able to look back and say, ‘Yes, Covid is still with us but it is not something that is such a threat to all of our lives – it is something we can live with and we’re able to get back to living,’” he said.

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

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