The world is changing fast and to keep up you need local knowledge with global context.
Johannesburg anaesthetist and intensivist, Dr Nathi Mdladla, gives us perspective on what many people are now questioning; with 80% of South Africans already exposed to Covid-19, what’s the point of mandatory vaccinations and vaccine passports? Omicron has a 29% lower severity in an already high sero-prevalent population, but it can break through already previously infected/vaccinated protection barriers. As Discovery Health’s CEO, Dr Ryan Noach warns, health systems could still be overrun by the sheer volume prompted by Omicron’s unprecedented community spread. Yet, Mdladla has some strong points to make. Anaesthetists, rendered inactive in theatres owing to cancelled elective procedures during past waves, ended up in ICUs and critical care units handling the overwhelm, making life and death decisions on a daily basis. That is unlikely now based on the evidence of Omicron. Yet, take it from whence it comes; here is a man who has faced coughing and spluttering severely ill Covid-19 patients … that counts for something. – Chris Bateman
South Africa’s Omicron conundrum
By Dr Nathi Mdladla*
The current South African Covid-19 summer is as confusing and surprising as the unexpected wave of infections in December 2020. This time, though, all experts had predicted was that there would be a fourth wave. Messages about people getting their first jabs, if still unvaccinated, were the order of the day. For those who received their single-dose J&J eight months prior (mostly healthcare workers) and those who were six months post their second Pfizer jab, November was apparently the best time for that booster dose to prepare for the fourth wave.
Nobody had any real idea how the next wave would manifest. Although, some experts gave definite dates (see Salim Abdool Karim’s prediction on 17 August 2021; that the fourth wave would hit on the 2 December and last 75 days). Would it be more severe or milder than Delta? How long would it last (could we draw from the previous three)? There were numerous speculations and confusing statements. The slow rate of vaccine uptake by South Africans was a serious concern. With less than 30% of the eligible population having received at least one injection and millions of doses about to expire – despite major drives and rapidly reducing age categories to use up as much of the available stock as possible – the picture remained desperate.
The South African government had refused to engage in early discussions about mandating vaccines for many months, even when these mumblings were happening in other parts of the world as early as May/June. The president even went as far as to say on national television that the government would never mandate vaccines (see https://www.youtube.com/watch?v=RGsLGs6NLDE). Although, in a slightly off-hand technique, the government said it would not interfere with private entities that sought to mandate vaccines in their establishments. This set the stage for the many companies with various incentives to make public statements and declarations that they would mandate vaccines for their employees, patrons, suppliers, clients and other contacts. Deans of universities met and adopted the need for mandates, and these universities came out, one by one, aligning their stance. Soon afterwards, some hospital groups declared mandates for their staff, even though most claimed more than 70% had been vaccinated. Only Netcare decided to hold a cautionary approach.
The strange thing in all of these mandate and vaccine passport discussions is that if you asked for clear and succinct goals for mandating vaccines in these establishments, nobody could give you a defendable explanation or science behind it. The real science tells us those working in the essential services sectors, forced to work during the first wave, had been maximally exposed through at least two waves of Covid-19 without a vaccine. Those who were susceptible had already been infected and some had sadly succumbed. These included individuals who worked in retail, passenger and goods transportation, police services, healthcare facilities, prisons and schools. We went through the third wave with mainly healthcare workers, the police, some categories of teachers and the elderly (over 60 years old) having received some form of vaccination. The Delta wave, which categorised the third wave of Covid-19 in South Africa, was possibly impacted by the vaccination drive in full swing in the middle of that surge, but not in the ways palatable to the government vaccine lobbyists and mainstream media who saw vaccines as the only strategy. Whereas previous outbreaks had followed a predictable pattern, the third wave saw a strange ‘blip’ at a time when cases should have been steadily decreasing. As yet, there is no defendable explanation for this.
As cases slowly rose, a new variant called B.11.29 was detected in some patients in South Africa and Botswana. South African scientists were the first ones to announce it to the rest of the world as a variant of concern; with high transmissibility but yet uncertain virulence as cases seemed to be mild. The rapid rise of positive incidental cases in the city of Tshwane made headlines and the vaccine rollout committee must have seen an ideal opportunity. Having been witness to the tactics used by people in that community, I would not be surprised if the opportune surge of ‘cases’ – coupled with a new highly mutated virus in the face of impending doses of vaccines that were about to expire – provided the best concoction to spark fear into hesitant South African citizens and those due for boosters. What followed is a catastrophe that has cost the country billions of rands and inconvenienced thousands of citizens with plans to travel abroad.
I believe the decision to share the information was not adequately considered. The potential impact and damage to the country’s image and tourism sector were not factored in by those who pushed or worked with the scientists to disclose the ‘new’ variant. Although not confirmed, there is speculation the president was not consulted as the last authoritative figure to decide on how to sensitively handle the situation. Interestingly, we had done the same the previous summer with the Beta variant, where we were the first to declare that particular strain, initially dubbed B.1.351.
The consequences were similar and, as with the current Omicron variant, it is clear Beta had been circulating in the UK (Kent variant) and other parts of the world long before South Africa declared it. This raises the worrying possibility that they sought to protect their own countries from the perceived fallout of being the first to declare the variant.
For South Africa, this was a clear short-sighted and miscalculated move that has backfired badly. Not in the circles of the expert advisers and not being privy to the current inner workings of the advisory committee, one can only theorise as to what drove the messaging and narrative and to what end. The immediate and apparent goal would have been to increase the uptake of vaccines. South Africa had just requested a delay in the delivery of further vaccine stock from J&J and Pfizer as we were worried about the doses that were about to expire. The emergence of Omicron would have been a great opportunity, not to be missed. Indeed, the vaccination rate got a boost after those announcements, but at a higher cost. We are now back on the red list of nations banned from entry into certain countries even if fully vaccinated. EU member states have discouraged citizens from travelling to South Africa owing to the emerging highly infectious Omicron. South African travellers – whether vaccinated or not – now need to test and are subjected to a 14-day hotel quarantine in some countries at their own expense. The summer of 2021, yet again, looks bleak…
Omicron is potentially the gift that all South Africans should celebrate and embrace, a very mild illness for most, affording us the chance of durable natural immunity in persons who have yet to contract other strains of the virus. But the joy of having a circulating coronavirus that behaves just like a ‘bad flu’ for both the vaccinated and the unvaccinated is somehow not palatable. A group of scientists, all of whom are very much pro-vaccine as a sole intervention strategy, were at pains to write a letter to The Lancet, lamenting the victimisation of South Africa for sharing sequencing information about a mild inconsequential virus, which although more contagious than Delta, has not been associated with high hospitalisations or deaths.
Back home, the messaging has not reflected what we are telling the world. If we are dealing with a milder virus that seems to breach vaccine protection (including boosters) more effectively than Delta but causes less severe disease in even the unvaccinated, then why hasn’t the conversation changed in South Africa to reflect the emerging reality? The emergence of Omicron requires an immediate revisitation of strategy:
- There is no urgency to push for the current vaccines if indeed they are not effective – Pfizer is already talking about a 3-dose vaccine for Omicron.
- All discussion of mandates should cease immediately and all institutions with timelines for these should suspend them.
- Vaccine passports have been rendered obsolete, both here and abroad.
Israel, Gibraltar, Chile, Seychelles, Malaysia, UK, Germany and many other highly vaccinated countries with high infection rates have been telling us something the advisers to the South African government have been more than unwilling to accept. The repeated message from these countries – before boosters – has been that the vaccinated can get infected, carry as much virus as the infected unvaccinated and can infect just as much as the unvaccinated, with natural immunity from previous infection being superior.
South Africa is probably the first country to have a surge with booster doses having been administered with an impending wave. Pfizer is aware that even its booster dose is not effective against Omicron at a less than 23% prevention of infection. Yet, what they like least of all is that it is not superior to not being vaccinated. While it is clear Omicron is milder for all, Pfizer still wants to capitalise on its contagion without admitting complete failure while stimulating investor confidence by talking about specific Omicron boosters. It also appears caught up and uncertain about whether to still sell what it claims is 70% protection against hospitalisation. Two doses in nations still lagging in vaccination rates, like South Africa, versus pushing for a specific three-dose Omicron booster regime for highly vaccinated nations? It’s a tough choice for big pharma to make.
South Africa should be leading the scientific discussions about this right now. However, with conflicted scientists (who are funded by the vaccine lobby) advising the government – and a mainstream media that sees it as their duty to push the government narrative at all costs and to the detriment of everything else (including early treatment options) – South Africans have been left vulnerable. Add to this, sadly, a complicit judiciary, industry and big business leaders who are not allowing a balanced discussion and discourse, and who are happy to use their powers to subjugate the masses through threats and coercion. By falling in line with the official narrative, we may have set ourselves up negatively in the long run as far as all matters of government intervention and especially health are concerned.
One thing that is scientifically clear is that the first wave, which was the milder of the first three waves in South Africa, was the one the low-risk population should have gone through without lockdowns. The science shows that people who survived the alpha variant tend to have durable, robust and complete immunity better than that from vaccines up to the current Omicron. It confirms the now widely held consensus that it was a mistake to lockdown those at low risk of severe disease and death. Omicron is behaving the same and is possibly even less virulent. This may be a second opportunity for the country to act on the available science and not be driven by fear alone. It only serves the agenda of those who see profits to be made in a crisis by pushing a narrative in favour of only handlers and funders.
Discovery’s data claims that at least 80% of South Africans have been exposed to Covid-19, with a high level of possible community natural immunity. With all the above, it is hard to imagine why anybody thinks mandatory vaccinations and vaccine passports make sense in the South African context. They are definitely not entirely in the interest of the health of citizens, especially individuals and the masses at low risk but who face a higher risk of adverse events. They are of no benefit to the recently recovered, and they confer no benefit to the current circulating strain.
- Dr Nathi Mdladla is a Cardiothoracic Anaesthetist and Intensive Care Specialist.
- NEASA’s Gerhard Papenfus: there are better pandemic-fighting options than mandatory vaccines
- Sakeliga: Why we’re against lockdown and mandatory vaccines
- Adrian Gore: Why we support mandatory vaccinations – we don’t have the luxury of time
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