/ 1 October 2021

South Africa’s move to Covid alert level 1 is good for business, but what about health?

Safrica Health Virus Vaccine
Scientists say the country needs to significantly improve vaccination rates (Emmanuel Croset/AFP)

The balancing act between saving lives and saving livelihoods continues as South Africa moves back to alert level one after a 130-day Covid-19 third wave. 

President Cyril Ramaphosa addressed the nation on Thursday, 30 September, announcing a later curfew, larger gatherings of up to 2 000 people outdoors and the sale of alcohol up to 11pm. 

The president noted immunisation rates were still “far too slow” and encouraged people to get their jabs. 

With local government elections taking place on 1 November, Ramaphosa said campaign activities leading up to the elections might cause a surge in new infections.

Speaking to the Mail & Guardian, the public health specialist for the Western Cape’s department of health, Professor Hassan Mohamed of Stellenbosch University, outlined the current state of the nationwide vaccination drive. 

At the beginning of the week, more than 17-million vaccine doses had been administered nationwide, and 8.5-million adults were fully vaccinated. 

“This is less than 25% of the adult population. While recognising that this is ahead of many countries, this is far from satisfactory for us to relax restrictions. It is still not at an acceptable level particularly in poorer communities,” said Mohamed. 

Considering South Africa from a public health perspective while also recognising the need for the economy to reopen, Mohamed argued that “it would be better to not go below level 2 restrictions”.

Helmuth Reuter, ​​professor and head of division of clinical pharmacology at Stellenbosch University, agreed that the country should remain on lockdown level 2 “until a higher vaccination coverage [is reached] and until the completion of elections.”

Since the start of the pandemic in March 2020 the government’s balancing act between saving lives and protecting livelihoods has been difficult and in many instances criticised by other political parties. 

The Democratic Alliance has, with the shift to each lockdown level, said the government should open up the economy. And although the Western Cape Premier Alan Winde had, before Ramaphosa’s announcement, asked for restrictions to be lowered to level one, Cape Town mayor Dan Plato added his voice to call to end the State of Disaster. 

Plato said in a statement on Friday: “After more than 18 months, businesses can simply no longer endure this back-and-forth of changing lockdown levels. They experienced severe strain with reduced income and job losses trying to adapt and survive in these very challenging circumstances. As we approach the summer and peak tourism season, we need to give the economy the best chance at recovery.” 

Mohamed argued that a balance between opening up the economy and maintaining some control measures was needed. 

“A balance needs to be struck and we need to significantly strengthen our vaccination efforts and keep infections at a low level if we wish to move in the direction of some kind of normality,” said Mohamed, who believes that Covid-19 will be present for many years. 

“We need to adapt accordingly. This means some forms of infection control needs to continue such as mask-wearing, physical distancing, good ventilation and limiting gatherings.”

He said the fourth wave of Covid-19 “is currently projected to occur at the end of the year”. 

Reuter said that looking at previous patterns he expected the fourth wave would “probably” start in December and last until March 2022. 

Dr Benjamin Kagina, a senior researcher in vaccinology at Vaccines for Africa at the University of Cape Town, said that with low transmission rates, high vaccination coverage rates and people adhering to health protocols, “it is possible to avoid a fourth wave”.

“The challenge is the public fatigue in practising preventative measures as well as the emergence of new variants that are more transmissible and waning of vaccine-induced immunity,” he said.