Is South Africa’s bureaucracy up to
Digital certification looms, but questions remain on implementation, worldwide standardisation, fraud and the ethics of mandatory vaccinations
By the end of September South Africans who have been vaccinated will have a digital certificate or a vaccine passport. However, this will not force anyone to be vaccinated — yet.
The department of health told the Mail & Guardian that discussions to create a digital vaccine certificate are at an advanced stage for those who have been vaccinated. This is likely to open doors that could remain closed for the unvaccinated.
This follows an address to parliament’s National Council of Provinces earlier this month, where Minister of Health Joe Phaahla said that the government is looking at demanding proof of vaccination when people visit public amenities and that businesses “should” demand proof of vaccination.
Phaahla was definite that once the country had attained sufficient vaccine coverage this would be the case.
“Our own preference would be for people to come voluntarily to vaccinate, but as people want more freedoms [such as attending religious ceremonies or entertainment venues] and to access facilities, we are not excluding the considerations of a stage where [the people in charge of those facilities] would have the right to make certain demands,” he said at the time.
The department of health’s spokesperson Popo Maja told the M&G that how the vaccine certificates would be used to access amenities and recreational facilities was still up for discussion. He also stressed that there would be no restrictions on access to health services based on one’s vaccination status.
“The right to have access to health care services is a basic human right guaranteed by the constitution. Section 27 of the constitution provides that everyone has the right to have access to healthcare services,” said Maja.
“The department has no plans to impose restrictions on the access to health services based on the vaccination status. No government services will require vaccination to access them,” he said.
More than 6.88-million people have been fully vaccinated in South Africa. About 14.1-million jabs have been administered since the rollout started with the vaccination of healthcare workers as part of the Sisonke implementation study in February, and the first cohort of those aged 60 and above kicking off phase two in May. This number equates to 11.5% of the country’s near 60-million people. The department of health was aiming to have 67% (41.7-million) of the population vaccinated by the end of this year, a target that has since been revised to the end of March 2022.
The head of medicine at the University of the Witwatersrand and chief executive of Right to Care, Professor Ian Sanne, said the vaccination platform could be expanded to reach 600 000 vaccinations a day.
Sanne also said that policy discussions were ongoing regarding the digitisation of the Covid-19 card.
“At the moment [when] vaccination cards are issued, they have a unique identifier. The access to check whether the unique identifier is genuine or is fake is very restricted because the regulations related to the [Protection of Personal Information Act] need to be clarified,” he said.
The departments of health, home affairs and international relations are handling the move to make vaccine passports digital but currently, none of them has been able to disclose what the cost implications of this would be. The department of international relations is also waiting on the World Health Organisation (WHO) to have a global, uniform system for the vaccine passports.
Any certificate, says Maja, should be available on a smartphone, be printable and fraud-proofed.
Some vaccination sites currently capture information on paper, or data is captured incorrectly into the system, making this “relatively” straightforward technical solution for the digital vaccine passport a challenge for the department to implement, especially regarding managing queries on the vaccines administered, dates, or the identification of vaccinated people through an integrated call centre.
With such a step South Africa would join other countries such as Australia, the US and the UK in creating digital vaccination certificates or vaccine passports. Australia was already discussing a vaccine certificate via a QR code in July.
In the same month the UK unveiled plans that people attending large gatherings such as clubs would need to be fully vaccinated. The BBC quoted Prime Minister Boris Johnson saying that the government reserves the right to mandate certification at any point if it’s necessary to reduce transmission.
“And I should serve notice now that by the end of September, when all over-18s have had their chance to be double-jabbed, we’re planning to make full vaccination the condition of entry to nightclubs and other venues where large crowds gather,” said Johnson.
However in Canada, though the country is moving towards a vac
cine passport for gatherings as well, some mayors have come out strongly against such a step, saying that people should not be forced to vaccinate, especially by the government. In some provinces in the country, by mid-september, people will be required to produce a certificate before entering theatres, gyms and restaurants.
News site Japan Today reported that Japan is considering using vaccine passports to allow economic activities to resume. Japan’s draft policy states that businesses will be able to decide which services they will offer to those vaccinated and those unvaccinated. “Use of vaccine passports will be accepted widely” in the country, it says. However, the draft warned against inappropriate discriminatory behaviour towards those who are not vaccinated, such as refusing them entry into a school or a job.
The Zimbabwean government announced this week that government workers who did not want to get vaccinated should resign. Although the employees would not be forced to vaccinate, Zimbabwean Justice Minister Ziyambi Ziyambi said in a radio interview on ZIFM that although employees would not be forced to vaccinate, they should vaccinate to protect others or resign.
Labour spokesperson for the Democratic Alliance, the MP Michael Bagraim, said South African employees
should not be worried about the government copying the neighbouring country, nor should they be worried about being forced to get vaccinated.
A directive from the department of employment and labour is available for employers who intend on making Covid-19 vaccination mandatory. Despite that, there is currently no intention by the department to legislate for forcing employees to get vaccinated.
According to the consolidated direction on occupational health
and safety measure in certain workplaces, which was amended in June by the department of employment and labour, employers are obligated to assess the risk if they are intending to make vaccination mandatory.
“We are not working on legislation for mandatory vaccination in the workplace,” said the acting communications director for the department, Musa Zondi.
Though the Covid-19 vaccine is not mandatory for anybody in South Africa yet, other vaccines or medication are, for certain employees.
There are 42 countries in Africa and South America that have been identified by the US’S Centers for Disease Control and Prevention (CDC) as areas with high or potential risk of the yellow fever virus. Employees who had to travel to those identified countries would need to produce a yellow fever vaccination certificate before entry.
According to Bagraim, some potential employees had been overlooked for appointment when they refused to take a vaccine or medication.
“We have been working with a firm that sends employees into a malaria area, and they have made it compulsory for all their employees who are sent to those areas to take the medication. Those who have refused to take the medication have not been given the position,” he said.
Travellers to South Africa are expected to have been vaccinated against several diseases, including yellow fever, chicken pox, polio, shingles, influenza, hepatitis A and B, Covid-19, malaria, measles, rabies, typhoid, as well as diphtheria, tetanus and pertussis (in a combined vaccine).
Sanne highlighted that mandatory vaccination would only be feasible when at least more than 50% of the population had received at least one dose of the vaccines.
“I think that this is an interface between public health and the ministerial advisory committee’s advice on congregations of the population, and we do want to get to a point where the number of people that go to church and all religious gatherings is increasing… that would drive uptake. My personal view is that it is an outstanding way to incentivise people to vaccinate, and the incentive would be normalisation of the society, before [making a vaccine] mandatory,” he said.
Public health law expert Safura Abdool Karim told the M&G that South Africa currently has one vaccine passport for yellow fever.
“You go to a doctor and they give you the yellow fever vaccine and a card, which you present when travelling. It is not fool-proof. It’s very likely that if the government were to implement some sort of a vaccine passport it would be linked to an electronic database so that when you enter and exit the country it would verify the vaccine status,” said Karim.
Karim said this would be tricky because some countries only recognise certain types of vaccinations.
“Some countries will not accept a Sputnik vaccination or a Sinopharm vaccine as proof of vaccination. They want you to have a Pfizer or a Johnson & Johnson. This is complicated and has raised questions around vaccine equity, but South Africa has been using fully licensed vaccines so this may not be a problem for us.”