A nurse draws the Pfizer vaccine from a vial at the Hillbrow Community Health Centre. The government’s electronic vaccination data system excludes those who cannot register online to receive the vaccine. (Photograph by Ihsaan Haffejee)
It has become a cliché to point out that a pandemic tells us much about our society. So does a vaccine rollout.
South Africa’s response to Covid-19 has failed to prevent roughly as many deaths as the rest of Africa combined because it is two countries. One lives like – and focuses on – “First World” Western Europe and North America, while the other looks much like the rest of Africa as well as parts of Asia and Latin America. The “First World” minority called the shots on how to fight the virus. Its vaccine plan shows why this is a problem.
At its centre is a monument to the pretensions of “First World” South Africa: a partnership between the government and business that produced the electronic vaccination data system (EVDS). Like everything else the “First World” elite comes up with, this “state-of-the-art” solution entirely ignores the needs of most citizens.
The government partnered with business because it buys into the deeply held “First World” myth that only private companies know how to get things done. And nothing appeals to the government and business more than information technology. It is shiny and modern and, in theory, can get the country to do exactly what you want while you remain at a safe distance from it.
The plan was that everyone entitled to the vaccine would register and receive a vaccination appointment. People’s place in the queue would be determined strictly by when they registered. This was yet another of those nice, neat solutions that have been dreamt up at planning meetings since the 1990s. In theory it is ideal. To be credible, a public programme must be seen to be fair: people must know who is entitled to what and that there is no favouritism.
But in reality it has been anything but fair – the only reason it has not become purely a freebie for the wealthy and connected is that some provinces announced at the outset that they would vaccinate people who were not registered, and health workers have either not let the EVDS get in the way of their duty or found a way of achieving at least some of the fairness the planners could not offer.
Blind and cruel
At the heart of the EVDS was a folly so obvious that anyone even slightly aware of how most people live would have seen it immediately: many who need a vaccine cannot register online. Assuming that everyone could do this breaks new records in “First World” delusion. The government’s “solution” was that people older than 60 should find a younger person to help them. So, in its mind, the problem was fuddy-duddy older folk who are not switched on to the latest technology, not poverty and exclusion. (The government now says people can register using cellphones, which is also likely to exclude many.)
This monument to “First World” blindness meant that health facilities could only do what the EVDS required – vaccinate only people who had an appointment – by turning away anyone who could not register online. One senior health worker aptly described this as cruel. It is also unconstitutional: the right to healthcare is not available only to phone users or laptop owners or those with access to younger people. So, provinces and government vaccination sites had no option but to vaccinate anyone who arrived who was over 60 or a health worker.
This was just as well because the EVDS does not seem particularly fair, even to those who can register. People who registered within minutes have still not received invitations, while others who registered later have. The reason may be the planners’ belief that they can control everything – so determined are they to match people with vaccination centres that many have been overlooked because the EVDS cannot yet match them with a site.
Nor do the grand planners seem able to ensure that everyone who says they are a health care worker really is one. It has become common to boast on digital media of the many ways of fooling the EVDS into registering you when you are not entitled to a vaccine.
Given this, what is happening at government clinics and hospitals is fairer than the EVDS. The very competent health workers who run the sites can establish first-hand – more accurately than the system – whether a person who walks in is over 60 or a health worker. Where people have been registered, the EVDS has been turned into a useful way of accessing their details. Health workers have turned it from a fantasy-laden instrument of control into a useful tool for serving people.
Delusions and unfairness
This is no doubt why public enthusiasm for the government centres is almost universal and why the national government – and the EVDS – have been forced to allow eligible people who have not been invited yet to be vaccinated anyway. But the delusions persist – the EVDS warns that it may change its mind later, apparently oblivious to the fact that it will be violating a constitutional right and declaring war on the poor if it does.
The favouritism also persists. An obvious unfairness is that priority has been given to “celebrities” both private and public. This is supposed to counter “vaccine hesitancy”, even though people who want vaccines vastly outnumber the number available. The effect is to give the connected a double bonus – they can jump the queue and bask in the glow of performing a public service.
Chances of fairness have also been undermined because private medical aids have joined the rollout. Discovery Health has vaccinated people who don’t qualify, and it still won’t tell those who do where they are in the line and why. Its excuse has changed repeatedly, although a clear theme is that it blames the government for its failings, a ploy it knows is bound to work given the prejudices of its suburban audience.
Why are medical aids dispensing vaccines? Their job is not to give medical treatment – they are meant to pay for it (in theory). Why should they be any better at dispensing vaccines than the government? Their role should have been restricted to paying.
If the aim was to make the suburbs more comfortable given their widespread belief that business is always right and the government always wrong, it would make more sense to distribute vaccines to neighbourhood pharmacies, which are way back in the queue. But these pharmacies don’t lobby the government or spend huge amounts projecting themselves as efficient and fair when they are neither.
So, the vaccine rollout plan is what we might expect from today’s South Africa. It assumes that “First World” suburbs are the country and either ignores the majority’s daily experience or blames it for its poverty. Inevitably, it assumes that businesses have capacity even when the only companies who are helping the vaccine campaign are the firms that developed them using heaps of their governments’ money.
The only reason many people are receiving vaccines is that provincial health authorities and health workers are making the rollout work as well as they can in a reality created for them by the “First World” planners. Which, of course, makes the rollout much like the country’s response to the virus against which the vaccines protect us – if we can get them.
This article was first published on New Frame