ThefutureofthepandemicinSA

4 October 2021

What South Africa can expect from a COVID-19 fourth wave

By Jessica Spira

A fourth wave of COVID-19 may be inevitable for South Africa, but it doesn’t have to be as severe or devastating as previous waves. If we can drive vaccinations to reach as many people as possible, as quickly as possible, and act on our learnings and understanding of the virus to date, the outcome can be improved. This was the key message that came out of a recent series of closed information sessions hosted by RMB and The Solidarity Fund where some of the country’s leading healthcare experts shared their thoughts and projections on the future of the pandemic in South Africa.  

Jessica Spira, RMB’s Sector Head for Healthcare, opened with a reminder to the audience about the huge amount of vulnerable people in our country that don’t have access to adequate healthcare resources. However, with the help of organisations such as FirstRand’s SPIRE fund which has been working closely throughout the pandemic with the Solidarity Fund, supported by incredibly generous donors, there is a possibility to support the public healthcare system and limit the excess deaths from this dreadful disease.

Vaccinations are a key requirement to reducing the effect of a fourth wave – not in stopping people from getting COVID-19 altogether, but in preventing severe disease and death. South Africa has successfully secured sufficient doses to vaccinate 120% of the target population and we have sufficient capacity from the combined public and private sector ready to deliver 1 million doses every 3 days. National demand generation is now the major focus.

Herd immunity is not achievable

During the sessions, Prof Shabir Mahdi – Dean of the Faculty of Health Sciences and Professor of Vaccinology at WITS – emphasised that the concept of herd immunity is redundant, an argument that is becoming more widely accepted globally. It therefore shouldn’t be the stated objective of the vaccination program, and the way its intentions are communicated to the public. The total eradication of COVID-19 is unlikely in our lifetime.

The fourth wave will look different – to previous waves, and from province to province

Current scenarios illustrate that a fourth wave is likely towards the end of 2021. However, it won’t necessarily behave in the same way as previous waves. COVID-19 does not affect provinces uniformly, and, as movement is allowed between provinces, cross-pollination of the virus occurs. Some data suggests that 70% of South Africa’s population has already been infected with COVID-19. However, Mahdi emphasized that past infection only reduces the likelihood of reinfection by 25%, so mild disease is continuing and vaccines are still required for those who have contacted the disease.

The role of vaccinations – and communicating their efficacy – remains crucial

While South Africa’s vaccination program began later than desired, it has gained great impetus, with vaccinations widely available to everyone from the age of 18 and older. However, in order to stimulate demand, there has to be a concerted drive to communicate the safety and efficacy of vaccines among the unvaccinated and make the act of vaccination as simple and accessible as possible. Tandi Nzimande, Head of the Solidarity Fund, spoke of the Solidarity Fund’s targeted communications campaign to this effect, with a focus on not just getting the message out, but engaging with those who are hesitant.

Discovery’s Health Policy Actuary, Roseanne Harris, confirmed that only up to 60% of over 60s have been vaccinated – a number that needs to be increased urgently to reduce the burden of a fourth wave on the healthcare system. Mahdi believes this percentage needs to rise to 80-90% to have a real impact.

Private sector involvement

Martin Kingston, the Chair of the Steering Committee of Business for SA and the COVID-19 response, explained the organisation is following five workstreams to support all aspects of the vaccine rollout, in partnership with government. These include stakeholder engagement, communication and advocacy; finance and funding flows; information and data management; service delivery platforms; supply, allocation and delivery and stakeholder engagement, communication and advocacy. These workstreams are aimed towards a target of administering one dose to at least 28 million adults (70% of the 18+ population) by the end of 2021.

Vaccination and a prepared healthcare sector arms us for the future

While there is talk of other emerging variants, the main variant in this country remains the Delta variant. This is positive, as we have evidence that our vaccination program effectively combats this strain, and our healthcare system understands how to respond.

Through each wave, the private and public hospitals have managed to create protocols and systems to effectively manage COVID-19 waves. As we drive vaccinations, an active, mobilized private sector and organisations such as B4SA and The Solidarity Fund are crucial in supporting the government-led vaccination programme. Private sites were initially allocated 15% of available supply but are currently accounting for over a third of total vaccinations.

As we continue to better understand COVID-19, now, more than ever before, we have the skills in our arsenal to limit severe illness and death of our citizens. Leveraging these resources will be essential, especially in our current Level 1 lockdown and the increased freedom of movement and association it brings. We have a widely available vaccines with proven efficacy that can stave off serious future waves. It is our responsibility to continue driving take up of vaccinations and communicating the low risk of the vaccine with those who are hesitant, especially within more vulnerable population groups.

Spira is Sector Head for Healthcare at RMB