Mandatory jabs not on cards yet, but experts say pandemic requires special measures

Mandatory Covid-19 jabs for specific groups are being discussed by the ministerial advisory committee on vaccines, says its chair, professor Barry Schoub.

His confirmation came amid growing calls from scientists and health activists for compulsory vaccination of groups such as health workers and others who spend time indoors with other people.

But according to health department spokesperson Popo Maja, “compulsory vaccination is not on the table for discussion”.

Scientists told the Sunday Times this week that an individual’s right to decline a vaccine is not more valid than the public interest in the context of a dangerous airborne disease. Fatima Hassan, head of the Health Justice Initiative, said: “We are in a global pandemic and vaccines save lives.”

Unlike many other African countries, SA has plenty of doses available and it is “important for science to drive policy and laws, even if it in certain cases restricts other rights”, said Hassan. Wits University vaccinology expert professor Shabir Madhi said he is not usually a “fan of mandatory vaccination” but Covid-19 makes it necessary.

“There is a compelling case from a public health perspective to make vaccination mandatory, especially for individuals with a high level of engagement with others in closed settings,” he said.

This would include health-care workers and people who gather in indoor environments such as universities, which “could reopen and operate in a way as close to possible as the pre-Covid-19 era”.

Madhi said: “In these settings, if people choose not to be vaccinated, they should be compelled to undergo testing every three or four days at their own expense.”

Also, even though the vaccines don’t offer full protection against infection and transmission, “at a population level this becomes much more impactful when you have large numbers of people vaccinated”.

Professor Keymanthri Moodley, director of the Centre for Medical Ethics and Law at Stellenbosch University, said: “All high-risk environments, occupations and communal activities should have a mandatory vaccine policy. This is based on the common good and public interest.”

She said health-care workers and care workers in facilities for the elderly have a “professional and ethical obligation to prevent harm to those under their care as well as to their colleagues. Other public-facing essential workers have a similar obligation.”

Indoor venues and communal spaces are high-risk environments where proof of vaccination should be mandatory, she said, and vaccinated employees are “entitled to a safe working environment in terms of the Occupational Health & Safety Act and other legislation”.

Professor Wolfgang Preiser, a virologist at Stellenbosch University, said: “Not getting vaccinated is not really just a question of personal choice unless one agrees to not endanger others and to not demand medical care.” He said those who chose not to be vaccinated are at “high risk of infection and severe disease, which places an enormous burden on society and on contacts who are needlessly put at risk”.

Other emergency medical care is “now less available” due to Covid-19, so refusing a vaccine has multiple effects on others. However, discussions on mandatory vaccine policies should not detract from other efforts to get people voluntarily vaccinated, he said.

“Anti-vaxxers are still spreading their oftentimes delusional messages and sowing doubt in people who would otherwise follow the advice given by reputable sources and get vaccinated.”

Dr Nicholas Crisp, deputy director-general in the health department, said the notion of vaccine “passports” is a “vexed issue” that has both benefits and challenges. It could bring us closer to getting back to “normal life”, but could also be a “possible infringement of civil rights and privacy”. There is also “uncertainty of the duration of protection from a vaccine”, he said. “It is not an easy decision and that is not to say that at some point it won’t become viable or implemented, but it is still evolving.”

Gabriel Crouse of the Institute for Race Relations warned that “attempts at coercion” could “backfire by incentivising anti-authoritarians to resist vaccination”. He said since “herd immunity is a pipe dream”, people get vaccinated to save themselves, not to save the world, so “you are more likely to convince most people to vaccinate if you use that argument”.

Tian Johnson, founder of the African Alliance for HIV Prevention, and convener of the Vaccine Advocacy Resource Group, worries that in the context of poor communication on vaccines, mandatory policies could fall flat. “If mandatory vaccination for certain sectors identified as a result of clear data is to be supported, a significant risk is our current inability to communicate effectively about the pandemic, let alone those mandatory measures,” said Johnson.

However, in the early 1900s in the US, “the rate of smallpox cases in states with mandatory vaccination laws was almost 10 times lower than in states with no vaccination laws … Vaccine mandates have been linked to higher coverage rates and lower case numbers and ultimately played a key role in eradicating smallpox.”