Because we don’t jab on weekends, SA is 1.3m vaccinations behind

SA is in a race against time. As Covid waves come and go, and new variants emerge, it is now clearer than ever that there is only one route out of the mess we find ourselves in, and that is vaccination. On that front, there is both good news and bad.

The good news is that both of SA’s vaccines — Pfizer and Johnson & Johnson (J&J) — seem to offer strong protection against the delta variant that’s driving the third wave. So, if you’ve been vaccinated and developed an immune response (typically two to four weeks after vaccination), you’re unlikely to get severely ill from Covid.

The other good news is that vaccine acceptance is increasing over time. In an earlier round of the nationally representative National Income Dynamics Study: Coronavirus Rapid Mobile Survey (Nids-Cram) we reported that in February this year 71% of South Africans agreed to get vaccinated. In our latest results, launched today, this increased to 76% in April/May 2021.

The bad news is that the delta variant is twice as transmissible as the original Covid virus, and hospitals are again overwhelmed. Private sector hospital admissions in Gauteng, the Free State and the Northern Cape are exceeding the peaks experienced in the second wave, with hospital capacity in Gauteng (public and private) now sitting at 91% and rising.

Unfortunately, at the end of June only 5% of the population had been vaccinated with at least one dose of a vaccine, lagging behind countries such as Pakistan (6%), Botswana (7%), India (20%) and Brazil (35%), and well behind the US (55%) and the UK (67%). As of July 1, SA ranked 126th in the world, with the same vaccination rate as war-torn Libya (5.6%) and Venezuela (5.1%) — which are both essentially failed states.

A ‘priority’ — except on weekends

Why are we trailing in the vaccine stakes?

Originally, we were told supply was the main constraint. Yet we have 7.4-million doses of the vaccine in SA, and only 3-million people who’ve been vaccinated.

We were also told we didn’t have enough money. Yet in February, finance minister Tito Mboweni announced "total potential funding for the vaccination programme to about R19bn", made up of R6.5bn to procure and distribute vaccines, R2.4bn for provincial health departments to administer the vaccines and a contingency reserve of R9bn "given uncertainty around final costs".

Why is it that five months later SA only vaccinates its people on weekdays and not on weekends? News24 quotes health department spokesperson Lwazi Manzi as saying: "Basically, the provinces indicated they don’t have the budget to be able to pay the overtime over weekends."

And according to the Western Cape Treasury’s estimates, that’s correct: "operational costs" amount to R108 per vaccine dose administered, including contract staff, the hiring of additional nurses, overtime and the like.

If that figure is correct, it will cost provinces R5.8bn to administer 54-million doses (the number that’s needed to reach 40-million people, given that the Pfizer vaccine requires two doses while J&J needs only one).

That means the contingency reserve is necessary, but — at least at the time of writing — it had not been released to provinces, despite being technically "available".

So, practically speaking, what does this look like? The graph below shows the daily vaccination numbers from May 17 until July 4. It shows how vaccinations virtually disappeared on Saturdays and Sundays, as well as on the June 16 public holiday.

Using the average vaccination rates of the Friday before and the Monday after, I estimate that between May 17 and July 5, 1.3-million additional shots could have been administered if SA had vaccinated on Saturdays and Sundays, as well as on June 16.

Put differently, we are 1.3-million jabs behind schedule because we don’t vaccinate on weekends.

This comes back to capacity: the state is not able to implement its own plans, let alone expedite them.

In response to a parliamentary question from the opposition earlier this year, public service & administration minister Senzo Mchunu reported that 35% of the public sector’s 9,500 most senior managers in SA (at national and provincial level) "do not have the required qualifications and credentials for the positions they currently occupy".

Does this help to explain why, eight weeks into the national vaccination rollout, SA is still unable to source, unlock, transfer or distribute the funds needed to pay staff for overtime so that they can vaccinate people on weekends? How is it that the National Treasury announced R19bn in available funds in February, but in July the health department says there’s no money?

It’s as if we are fighting a forest fire on weekdays and then we send the firefighters home on the weekend because we can’t pay them overtime for Saturday and Sunday. See you on Monday.

There is another question: should nurses be the only people allowed to administer vaccines? The process is relatively straightforward and, given the limited number of nurses and the need to vaccinate 40-million South Africans, perhaps others should be authorised to administer vaccines.

This is what the US has done. In February it passed the sixth amendment to the Public Readiness & Emergency Preparedness Act for medical countermeasures against Covid.

This limits the medical liability of military officers administering the vaccines. As the US military explains, the act "allows the department of health & human services to issue a declaration to provide legal protections to certain military personnel involved in mass vaccination efforts".

As a result the US army has now administered more than 1-million vaccine doses.

One option for SA to consider would be to have some of the country’s 70,000 community health workers administer vaccines under the supervision of nurses at big sites with clinical oversight.

What is the point of issuing a Disaster Management Act (and perpetually extending it) if the government doesn’t use it to avert the disaster? If the Health Professions Council of SA is obstinate that only nurses can give an injection, then it ought to explain why this is the case.

Could parliament not issue a similar liability waiver for trained and supervised community health workers for the duration of the pandemic? After all, there have now been 3-billion doses of Covid vaccines administered worldwide with no side effects in 99.99% of cases. Covid vaccination is now the most-studied medical event in history.

As it is, the government is well behind its own rollout plan, having vaccinated only 60% of the target for the end of June (3-million of a forecast 5-million people) and is an entire age-category behind schedule. That’s no surprise: SA is administering about half (130,000) the number of daily doses required (250,000) to meet the target of 40-million vaccinations by February 2022 — and that’s only on weekdays.

This points to a lack of coherent leadership. Former president Jacob Zuma, under whose watch thousands of incompetent cadres were deployed to (and remain in) high office, is now only a few steps from prison. Our health minister is on paid leave due to allegations of corruption, and the chair of the interministerial committee on vaccines, Deputy President David Mabuza, is in Russia for a "medical consultation" and has taken "long leave" for the trip.

Put in context

Why does all of this matter? Because the pandemic is causing suffering on a scale SA has not seen before. The latest Nids-Cram results paint a grim picture of the socioeconomic impact of the pandemic.

The survey shows that in April and May this year, 10% of SA households with school-going children said that at least one child in their household had not returned to school since the beginning of the year. That means school dropouts for those aged seven to 17 years have more than tripled, from 230,000 before Covid to 750,000 in April/May.

In other words, an extra 500,000 children have dropped out of school.

Whether this will amount to a temporary break from schooling or permanent dropout is, as yet, unknown. But previous research shows that the longer children remain out of school, the higher the likelihood of falling permanently out of the system.

By June the average primary school child has also lost 70%-100% of a year of learning, compared with previous years. That is to say, the average grade 3 child in June 2021 knows about as much as the average grade 2 child in June of 2019.

These sorts of losses will take more than a decade to recover.

Ongoing rotational timetables mean that children’s access to free school meals is also compromised. While this has increased from 46% in November 2020 to 56% in April 2021, it’s still below the pre-pandemic level of 65%. The department’s own reporting to the high court confirms this.

Throughout all the waves of Nids-Cram, respondents were asked if anyone in their household had gone hungry in the previous seven days because there wasn’t enough money for food. If there was a child in the household, another question was to ask if any child had gone hungry.

Using the latest Nids-Cram data, Martin Wittenberg and Nicola Branson at the University of Cape Town estimate that in April 2021 about 10-million people and 3-million children were in a household affected by hunger in the previous seven days.

The study also revealed the ways that Covid has affected South Africans differently. Though by March 2021 men’s employment had largely recovered to pre-Covid levels, women’s employment was still 8% lower than in February 2020.

To add insult to injury, women have also not benefited from the two Covid government relief grants (the temporary employer/employee relief scheme and the R350 social relief of distress grant) at the same rate as men, despite being more affected by job losses. They account for only 35%-39% of the beneficiaries of these grants.

Holding the line

The latest set of results from Nids-Cram (wave 5) is also likely the last round of data collection for this research project.

The aim of the study was to collect reliable data on a broadly nationally representative sample of South Africans to help policymakers and the public make informed decisions in the immediate aftermath of the pandemic. It was always scheduled to be five waves, which are now complete.

The Nids-Cram collaboration, made up of more than 30 researchers from six local universities, has generated 67 research papers over the past year, covering everything from hunger and employment to vaccine acceptance and mental health (available at cramsurvey.org and the data is available for download at DataFirst).

It has been a privilege to work with such dedicated academics, and it has cemented in my mind the critically important role civil society has to play in holding the line.

In different ways and at different times civil society has stepped into the gap created by the government and held it to account. Investigative journalists, for example, were the ones who exposed the rot of state capture and the looting of state-owned enterprises such as Transnet and Eskom, estimated to be at least R50bn.

For what, though? There is a shamelessness about those who have been exposed, who refuse to resign in the face of blatant evidence of their corruption and moral debasement.

We need to stop calling it "stepping aside": they remain on full pay, perhaps until they go to jail, and even then they may still get paid. Just this month it was reported that former ANC councillor Sibongiseni Baba has been sentenced to 10 years in prison for rape — yet he is apparently still paid his monthly salary, despite being in jail.

Will Zuma, too, get his R3m taxpayer-funded annual salary when he is in jail? Perhaps that is for the judicial branch to decide.

The judiciary and independent institutions have also held the line, driven by the moral fortitude of people such as former public protector Thuli Madonsela and justices Raymond Zondo and Sisi Khampepe.

There is a deep sense of poetic justice at play in SA’s Constitutional Court.

Ten years ago, Jacob Zuma appointed Mogoeng Mogoeng as chief justice — a contentious appointment at the time. While most of his 10 years have been less controversial than expected, things went south at the end of last year when he opened in prayer at a public event: "If there be any vaccine that is of the devil, meant to infuse triple-six in the lives of the people, meant to corrupt their DNA, Lord God Almighty may it be destroyed by fire. in the name of Jesus."

Recently, he announced he would be going on "long leave" until October 2021, when his decade-long tenure is set to come to an end anyway.

In March 2021 President Cyril Ramaphosa appointed Khampepe as acting chief justice.

Originally appointed by Nelson Mandela as a truth & reconciliation commissioner in 1995, Khampepe became a justice of the Constitutional Court and, earlier this year, was asked to act as chief justice since Zondo had his hands full.

Last week, in a 127-page judgment, Khampepe lambasted Zuma, explaining that his conduct "smacks of malice", that his accusations were "utterly bereft of supporting facts" and concluded that in the process of dismissing two summonses from the Zondo commission and then further dismissing the summons of the Constitutional Court compelling him to testify, he had acted in an "indubitably vexatious and reprehensible manner". Hence, he was sentenced to jail for 15 months.

Khampepe’s wisdom is worth quoting: "It would be nonsensical and counterproductive of this court to grant an order with no teeth. Here, I repeat myself: court orders must be obeyed. If the impression were to be created that court orders are not binding, or can be flouted with impunity, the future of the judiciary, and the rule of law, would indeed be bleak. I am simply unable to compel Mr Zuma’s compliance with this court’s order, and am thus faced with little choice but to send a resounding message that such recalcitrance is unlawful and will be punished."

Khampepe added that the judiciary, without any "purse or sword", has to rely on "moral authority to fulfil its functions".

Indeed. The past three years have been a moral reckoning for SA.

The judgment against Zuma has placed the constitution front and centre in our national discourse, showing that everyone is equal before the law, and even presidents can go to jail. Yet that same constitution also outlines other rights and obligations that we can no longer ignore.

As Khampepe reminds us, we are tied together by an ideal of a multiracial country, where all have equal worth and where reconciliation is possible.

Yet reconciliation also means sharing wealth and protecting dignity. How can we claim we are all equal when 10-million South Africans and 3-million children experience hunger on a weekly basis?

As rich South Africans we are failing our fellow citizens, as is clear from the tax data, which shows that the wealthiest 5% of South Africans have been the main beneficiaries of economic growth post-apartheid. While this group is now multiracial, it is also only this group where the big gains have been made.

Research by Aroop Chatterjee, Léo Czajka and Amory Gethin, presented last month, shows that in 1994 the average white South African earned seven times more than the average black South African (a 7:1 ratio). This came down to 4:1 in 2019. But this was entirely driven by the rise in incomes of the richest 5% of black South Africans. If you exclude that group, the ratio in 2019 was the same as the ratio in 1994.

In a nutshell, racial income inequality in SA has fallen since 1994 — only because of significant income growth among the richest 5% of black South Africans, not because of improvements for the poorest 90%.

And other research by Ihsaan Bassier and Ingrid Woolard shows that the real incomes of the wealthiest 1% of South Africans doubled between 2003 and 2016.

This issue is one of moral conviction. In a middle-income country no-one should go hungry. In her judgment Khampepe reminds us that the country we aspire to be is founded on rights and obligations made explicit in our constitution.

But it is not only the right to equality that must be upheld; it is also that "everyone has inherent dignity and the right to have their dignity respected and protected ... Everyone has the right to have access to sufficient food and water."

No-one has to tell us it is morally unacceptable that one in six South Africans experiences hunger on a weekly basis. It is a blight on our national conscience and one that we can (and should) do something about.

Spaull, from Stellenbosch University’s economics department, is the co-principal investigator of the Nids-Cram survey