Why are vaccines being used for workers not the elderly?
After watching the televised 'virtual media briefing' last Friday, Nicoli Nattrass and Jeremy Seekings conclude that the government's vaccine rollout 'strategy' appears to have been modified yet again, with a shift in focus from the vulnerable to the employed. They argue a moral economy of targeting the elderly and people with co-morbidities is being supplanted by a political economy of targeting favoured categories of workers. Last week the government was roundly criticised for a vaccination rollout that has been delayed, slow, muddled and apparently less and planned. At dawn on Friday morning, the national Department of Health finally called  at very short notice  a virtual media briefing. Experts were rolled out to support the Acting Minister of Health in convincing us that the government really does have a strategy. The government might have some neat Powerpoint slides, but there is insufficient evidence yet of a coherent, transparent strategy. As a strategy emerges from the muddle, it appears to entail some major and questionable changes in direction. In the language of lockdown, this emerging new strategy might be called Strategy 3B adjusted. According to a briefing slide, the vaccine programme is in 'phase 2', targeting' senior citizens, aged 60 and above, congregate settings, frontline workers and those living with co-morbidities'. Phase 1 targeted health care workers. Hitherto, Phase 2 has targeted the elderly, who are most at risk of hospitalisation. The prioritisation of those with co-morbidities has long been dropped: Technical concerns to do with 'verification' trumped moral concerns as well as the strategic objective of reducing pressure on the health system. Complex registration system  The Acting Minister acknowledged that the effort to vaccinate five million elderly people was not on target. Many elderly people are finding the registration system too complex. Many are not yet within each reach of a vaccination site. The Acting Minister said that the Department of Health was 'working around the clock' to find ways of taking vaccines to the elderly. Her department officials rightly emphasised the need to open more sites, especially outside the metros. If the government was serious about targeting the elderly, it would have allocated the 300,000 Johnson and Johnson (J&J) vaccines newly arrived in the country to rural sites. In some provinces, the rollout to the elderly is being held up by a shortage of vaccines in some provinces. Since the start of the government rollout, there has been substantial unused vaccine in the system, suggesting that the government has been hoarding and then rationing the supply of vaccines to the elderly. Instead, it should expand the supply of vaccines to clinics, scrap the appointment system and deploy mobile vaccination teams to the places where elderly people gather (churches, shops, post offices, ATMs). Some provinces are already being creative but without a sufficient supply of vaccines. The other provinces need urgent assistance. J&J vaccines to workplaces  The J&J vaccine is a single jab, which means that no further expensive efforts will be required to reach the elderly in rural areas to administer a second dose and complete the vaccination process. It is well designed for rural use as it is easier and safer to transport than the Pfizer vaccine. Yet, inexplicably, the government has allocated all the incoming J&J vaccines to workplaces, where the double dose Pfizer vaccine could more easily be administered. This is symptomatic of a broader shift in focus from the elderly  most of whom are yet to be vaccinated  to workplace vaccination programmes. Nicholas Crisp, the Deputy Director-General of Health who has become the public face of the vaccination programme, implied that the decision to allocate the J&J doses to 'accelerated' workplace programmes was because they had a short expiry date. This is no excuse. All vaccines should be used within ten days of arriving in the country, regardless of expiry data. It seems likely that political pressure  or what Crisp has previously referred to as 'conflicting demands'  has altered the vaccination programme. These demands were apparently resolved through consultations in the National Economic, Development and Labour Council (NEDLAC). Research by trade unions identified certain 'sectors' as economically important and susceptible to COVID-19. Sites were reportedly identified through a mix of technical requirements ('site readiness') and concern for an equitable allocation across provinces. Pilot workplace sites  We learned on Friday that some vaccines have already been used in 'pilot' workplace sites. Two thousand people have been vaccinated in a mine in North-West Province and 700 in a factory in Gauteng. A further 145 workplace sites are planned along with a 'special allocation' of vaccines for taxi drivers in Gauteng, a rollout at an unnamed 'state-owned enterprise in Mpumalanga and for 'public service' workers in the Western Cape. Vaccination for educators across the country is imminent. Vaccination of the military and police are in 'advanced stages of planning'. READ | 300-000 doses of J&J vaccine for SA: Teachers ready within days says Aspen  The million or more J&J vaccines arriving in the country over the next month or so appear to have been allocated to these workplace programmes. This reprioritisation is at the direct cost of expanding vaccines to the elderly and those with co-morbidities. The government has disguised this change of direction by insisting that age-based vaccination will proceed at the workplaces, in other words prioritising those workers aged 60 and above. In practice, the government is rolling out the vaccine to the favoured workplace, regardless of whether the workers there are in direct contact with the public and regardless of age. We learned from the media briefing that vaccination at workplace sites would not require prior registration on EVDS. 'Bulk uploading' onto the EVDS will occur after the fact. Apparently, back doors to the EVDS system are open for workers  especially, it seems, workers in the predominantly unionised sectors that have been prioritised  but not for most elderly people or anyone with co-morbidities. Our vaccination strategy has shifted from a moral economy of targeting the elderly, to a political economy of targeting favoured workers. - Professor Nicoli Nattrass is with the department of economics at UCT  - Professor Jeremy Seekings is director of the Centre for Social Science Research at UCT  To receive Opinions Weekly, sign up for the newsletter here. Now available to all News24 readers. Send your letter or article to opinions@news24.com with your name and town or province. You are welcome to also send a profile picture. We encourage a diversity of voices and views in our readers' submissions and reserve the right not to publish any and all submissions received. Disclaimer: News24 encourages freedom of speech and the expression of diverse views. The views of columnists published on News24 are therefore their own and do not necessarily represent the views of News24.