Health workers in Alexandra test people for Covid-19. Picture: THULANI MBELE
Health workers in Alexandra test people for Covid-19. Picture: THULANI MBELE

The coronavirus “second wave” and new, more infectious 501. V2 variant continue to wreak havoc across the world. In SA pressure is mounting on the government to secure vaccines to protect its vulnerable population.

Yet it remains unclear whether the available vaccines will work with the new variant. Citizens’ anxieties are increasing as they seek assurances government is unable to give.

While it is encouraging that the government has secured 1.5-million doses of AstraZeneca’s vaccine from India, concerns remain over the reliability of further supplies and the exclusion of ordinary citizens from the decision-making process concerning the vaccination rollout. There has been little, if any, public participation, with the result that there is real fear among some citizens that the government’s decisions may be disconnected from their needs.

Our constitution calls for public engagement in decision-making processes. It is therefore imperative that political leaders and policymakers include the public in vaccine conversations. The vaccine acquisition and allocation processes involve challenging trade-offs that will have an effect on citizens directly and indirectly.

The limited public participation in vaccine discussions and decision-making so far may also be contributing to the worrying level of unwillingness in some communities to be vaccinated. According to an online survey conducted by the World Economic Forum in August, one in three South Africans was unwilling to be vaccinated.

While the survey did not delve into the reasons for this reluctance, the message is clear — there is significant opposition to vaccines in SA, and it is therefore imperative that factors contributing to this are addressed through consultation with communities to secure their buy-in.

What can be done to address public hesitancy with regard to vaccines in general, and Covid vaccines in particular? First, government-citizen co-operation must be a priority. The vaccination programme won’t work if there is no buy-in from the public, and getting that buy-in requires building trust.

Second, policymakers and politicians need to be sensitive when it comes to the vaccine allocation process. This must not only be rational, fair and aligned with human rights principles as enshrined in our constitution, but must be seen to be equitable. No section of the populace must be left behind or excluded, for any reason.

It is laudable that the medical schemes are considering subsidising the cost of vaccines for South Africans dependent on the public health system. However, the government will still need to secure funds to meet any shortfalls so that even those members of our society who are not on medical aid can access the vaccine without undue delay. Public deliberations on this matter are important so that decisions take citizens’ views and concerns into account.

Third, since the spread of the virus does not seem likely to abate any time soon, the possibility exists that the adjusted level three lockdown restrictions will continue for several more weeks. The extent to which this might affect the immunisation programme is not yet known, but it will be useful to have public engagements about such possibilities to ensure there is no unnecessary public resistance. Such co-operative public engagement is vital to deepen trust and confidence between the state and her people.

Fourth, civil society has a significant role to play in ensuring a successful vaccination programme. The sector is the glue that binds the state and her citizens. In building trust and confidence in the government’s response to the Covid second wave the sector and the government need to work together as partners.

In this co-operative approach citizens’ needs are brought to the fore as the sector represents their interests. Moreover, civil society is critical in facilitating public health communication, which helps mitigate conspiracy theories and other misinformation that fuels misconceptions about the vaccine and its efficacy. This preparatory work in securing a concrete partnership agreement between the government and civil society is crucial before the vaccine rollout programme begins.

Citizens’ voices need to be included in all vaccine decision-making processes. This is a constitutional imperative that must be heeded by the government, politicians and policymakers. An extensive public education programme is required to ensure citizens understand the benefits of vaccination and to allay any fears they may have about vaccines. This is important to ensure that there is enough buy-in from the public to minimise opposition and allow the 67% “herd immunity” target to be achieved.

Citizens’ voices must be heard in all of these processes.  

• Dr Kariuki is executive director of the Democracy Development Programme. He writes in his personal capacity.

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