No vaccination means years of COVID-19-induced death and suffering

Professor Linda-Gail Bekker, the deputy director of the University of Cape Town’s (UCT) Desmond Tutu HIV Centre, an infectious diseases specialist and a vaccine scientist, cautioned that if only a few people get vaccinated, we are not going to be able to control the virus. Professor Valerie Mizrahi, the director of the Institute of Infectious Disease and Molecular Medicine at UCT, confirmed that if we fail to reach at least two-thirds of the people (67%), “it will just take us that much longer to reach herd immunity”.

The University of Johannesburg–Human Sciences Research Council Covid-19 Democracy Survey measured attitudes towards Covid-19 vaccination in South Africa. It showed that about two-thirds of the population definitely or probably want the vaccine. Yet, despite ample evidence of the safety and efficacy of vaccines, about a third of the population is still sceptical about vaccination, the survey revealed.

Shabir Madhi, Vaccinology Professor in the School of Pathology at the University of the Witwatersrand and Director of the Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, is adamant that the only chance the country has to get back to a relatively normal life is by taking the vaccine.

Speaking on a Daily Maverick webinar on Thursday night, Madhi said that although safety was of the utmost concern, the short-term results had shown that the vaccines are working and safe, and scientists were continuing to monitor long-term effects. “We can’t be in a situation where we wait five years to get long-term safety data, by which time the pandemic would have passed and the number of lives that would’ve been lost would be in the hundreds of millions,” said Madhi.

He said the big unknown, unfortunately, was how the vaccine would perform against the new variants, one first identified in South Africa and a new one in Brazil.

Madhi said South African scientists will in the next few days provide what is probably the most important information globally from the vaccine trials: information on whether the Covid-19 vaccines work against the variants. The results of these studies have implications not only for South Africa but also globally, in terms of the future development and roll-out of Covid-19 vaccines.

“One of the main reasons this variant has emerged in South Africa is because a large percentage of the population became infected and for the virus to survive it needs to somehow evade the immune response that has been induced against it, and the way to evade it is to undergo mutation. In short, the virus is adapting to what challenges its survival. To stop that from happening you want to get a huge number of people immune over a short period of time so you do not get this immune evasion when there is a lot of virus circulating,” he explained.

Professor Linda-Gail Bekker, deputy director of the University of Cape Town’s Desmond Tutu HIV Centre, an infectious diseases specialist and a vaccine scientist, cautioned that if only a few people get vaccinated we are not going to control the virus. The numbers won’t go down because we will still have sufficient transmission going on to keep the epidemic going.

“It needs to feed off itself and fuel the fire. If you don’t dampen it sufficiently then it will continue to burn. That’s the risk we run – yes, we might get some individual benefit but we won’t get the collective benefit if not enough people get vaccinated,” she explained.

Bekker explained that the individual who gets the vaccine is protected – maybe not completely, because not all vaccines are 100%, but their chances of not dying from the infection, or getting very sick, are improved.

“If enough people get vaccinated, we get this other, very important additional value, which is known as herd immunity. All that means is that enough people are protected that the amount of virus actually circulating drops very low. We all benefit, even if we have not been able to get vaccinated. That can only happen when sufficient numbers of people in the population have been vaccinated,” said Bekker.

She cautions that some might say, “‘I’m going to rely on my neighbour,’ but if everyone says that then we’re going to end up with not enough people getting vaccinated. So, we need enough people in the collective to say, ‘Okay, I will be the person to step forward and do this. The number we’ve heard is two-thirds, and we’ve heard this from the vaccine committee, who are experts, that 67% of the population need to have received the vaccine in order for us to receive this secondary benefit.”

Vaccine scientist and President of the Medical Research Council Professor Glenda Gray said there is a great deal of evidence that these vaccines “work quite spectacularly” and will save people’s lives. A vaccine will help the economy, the individual and the health system.

Gray said there is early evidence that the vaccine will reduce the chance of infection of one person by another, so community transmission will be dramatically reduced.

Professor Valerie Mizrahi, Director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town, confirms that if we fail to reach at least two-thirds of the people (67%), “it will just take us that much longer to reach herd immunity”.

“Until we get herd immunity we need to understand that waves will continue to affect South Africa. This is not what we want. Vaccines offer a critical way to deal with the pandemic and its social and economic ills. Until we bring the pandemic down, dealing with the economic challenges is going to continue to be difficult.”

Mizrahi explains that vaccines impose pressure. “We need to understand that we are always in a cat-and-mouse game when you’re chasing a pathogen [the organism that causes disease]. I like to think of it as that we’re in an arms race here.

A medical gamechanger

“All pathogens evolve. We need to hit hard and hit fast. Once you bring down the viral load, then the chances of escape are brought down. This is why it is important to promote the message that no one is safe from Covid-19 until everyone is safe from Covid-19.”

Bekker says vaccines have been a medical gamechanger. “We have been able to eradicate a couple of infections and certainly been able to control infections in many parts of the world. If vaccines are well developed, in other words tested for safety and efficacy, which the current Covid-19 vaccines are, then they can be lifesaving.

“We can control the epidemic, fewer people will get infected, fewer people will get severe illness and in the long run we will save lives. Vaccines save lives. The disease is our enemy … the intervention is our friend. The vaccine is yet another important tool in the fight against the pathogen,” said Bekker.

Are vaccine denialists (as opposed to those who are hesitant) a danger to us beating this pandemic? Bekker believes they are.

“I believe there’s a small group of full-on denialists. I’m using the HIV experience as my experience here. There was a small group of out-and-out denialists who were a huge problem. They were unstoppable and really had wacky ideas … I would almost argue that they know they are spreading misinformation but they continue to do it. There is some nefarious hidden agenda there. Those people you are probably not going to persuade, so I don’t think we should waste our time on them.

“Then there’s a much bigger majority who sit on the fence. They’re not sure. They’re hearing a lot on social media that they don’t know if they should believe. But they can be persuaded with good information, and I think that’s where we need to put our efforts and energy – and not in a disparaging or prejudicial way. We should really see them as people who need to be ‘evangelised’. They are the people who we patiently need to spend time with to educate them more correctly and make sure they are not in an echo chamber that reinforces false prejudices.”

Community-based champions

Dr Lydia Cairncross, a public sector doctor and activist with the People’s Health Movement of South Africa, said SA had a rich history of engaged, politically aware and proactive communities.

“We need to tap into that strength, as the Treatment Action Campaign so famously did around treatment literacy. Women and men have been organising in their communities throughout this pandemic: to feed hungry children, to help in taking care of the sick, to spread good information. This on-the-ground,  grassroots leadership needs to be respected, trusted and empowered to be champions of the vaccine message,” she said.

Cairncross added that if only a minority is vaccinated it will not stop the pandemic. “So, taking the vaccine is not only for yourself, it is an act of social solidarity because every person vaccinated adds to the population immunity … person by person, until we can achieve that goal. If not enough of us do this, the vaccine will fail.”

Addressing those who are vaccine-hesitant, Cairncross said SA has seen tens of thousands die, with almost everyone experiencing a death of a family member, friend or colleague.

“Our Covid-19 prevention measures as a nation are drastic and catastrophic to livelihoods, education, communities … Hearing that there are vaccines that work is our first glimmer of hope that we have something that could defeat the virus. It is potentially our way out of this cycle of Covid waves and lockdowns and thousands dying.

“Also, almost every person living in South Africa has already had several vaccines as children and a few as an adult. Vaccines have literally changed the life expectancy and health of everyone on the planet. We have no cure for Covid-19 and if we have even the smallest hope of preventing it, we must grab the chance.”

In the Eastern Cape health workers and emergency responders said they will gladly take the vaccine because they are at high risk, but their communities have had almost no education and are very sceptical. “Medics and [emergency] personnel are willing to take the vaccine because we are always in danger,” said one medic, who asked to remain anonymous. “But the public in general is not keen on it. They are extremely sceptical, fearing the side-effects,” he said.

Community leader Thembisile Nogampula said people were sceptical and confused about the vaccine. “There is no education in the communities. Similar to what had happened in lockdown, the community leadership is completely shut out. We are not involved. We are not part of the command councils. We are not part of the vaccine committees. Who is going to tell our people that it is okay to take the vaccine?”

Community health worker Winky Mngqibisa said she was very appreciative of the government’s efforts to get the vaccine into communities. “But people are very uncomfortable,” she said. “We need better education about the side effects. We all had that one flu injection that made us ill. They must come to tell us what it will do to us. There has been a lot of death in our communities and I think people will take it if they know more about it. The only thing we know is that there are many vaccines and that some of them are fake. We don’t know which one is best. In my community people say that the politicians must take them first so we can see.”