Who gets the shot, who gets the shaft?

The Covid-19 vaccine is finally being shipped to some countries, at least, which should mean the last days of lockdowns are coming and relief from the corona crisis is at hand. Now that the vaccine is available, the critical question is — who will be the first to get the vaccine and when will they get it?

This question has global and local implications. Globally, an obvious question is where South Africa will be on the list. We should know the answer to that question sooner rather than later. Assuming South Africa will come up quickly in the queue, the government will have some decisions to make.

There is an emerging consensus that medical personnel and essential workers should be vaccinated first. No argument there. After that, who’s next in line? 

What does the data tell us?

The data (or the science) is clear about who ought to be next up. It’s the poor. That is the group where the numbers are surging. That’s what the data tells us about my hometown of Los Angeles. Watts, one of LA county’s poorest communities, and Beverly Hills, one of the county’s richest communities, are about the same size in terms of population. The infection rate in Watts is almost 64% higher than that in Beverly Hills. The mortality rate is about 66% higher.  I spoke with a friend, Houston Congressman Al Green, about this trend and he indicated the same disparities are found in Houston as well.

My suspicion is that the numbers in South Africa are comparable. 


Where does the fire rage?

I’ve looked for Covid-19 data broken down by income, and it is hard to come by. But I think it would be safe to bet that the infection and mortality rates for Sandton and Alexandra are dramatically different. Although both are in Region E, that’s about all they have in common. Separated only by a highway, they couldn’t be further apart. Sandton is one of the country’s wealthiest communities and Alex is one of the poorest. 

I recently met with a community leader in Alex who said the impact of Covid has been devastating any way you measure it. I’ve heard no such stories, nor have I seen any evidence, that the same would be said of Sandton.

This is the primary reason poor communities and the poor should be given priority for vaccinations. It’s where the fire is raging in terms of infection and mortality rates. 

In California, which is where my hometown is located, every year we have wildfires. Similarly, there are wildfires, or veld fires, in the Western Cape. 

What if, during the fire season, all of the firefighting equipment was deployed to areas that were reasonably safe from wildfires and the really vulnerable areas were left to burn? People would be up in arms, and rightly so. 

It’s no less a contradiction to leave poor and working-class communities languishing instead of deploying obvious interventions in the face of this viral outbreak. The reason to target vulnerable communities is the same as dealing with wildfires. The longer we leave outbreaks, such as Covid, to rage out of control, the more damage that will be done at the point of the fire. The first stop for the delivery of vaccines ought to be countries like South Africa and communities like Alexandra.  

The fire will spread

The other side of this argument is that ignoring such communities increases the likelihood the fire will burn out of control and threaten us all. Viruses know no boundaries, and are no respecter of race or religion, gender or generation, class or community. Sandton is physically too close to Alexandra to think that an out-of-control viral outbreak would stop at the highway. The point is, during a pandemic we ignore the poor at our peril. 

If we took seriously the mission to combat Covid from the bottom up we could possibly cut future infection and mortality rates by up to two thirds. That would be quite an achievement. 

Government can’t protect us from every danger or threat, but it can clearly do a lot better than it has done. The response ought to be targeted to where the need is greatest. While this should seem obvious, when it comes to addressing the needs of the poor, any real response is more often an anomaly rather than what is done normally. Yet science and justice makes clear where the priority ought to be.

Now protect the newly vulnerable

Following the same line of reasoning, the next group, after the chronically poor and working poor, should be those that have recently joined the unemployment lines and breadlines because they’ve lost their jobs due to the lockdowns. Here the science is clear as well: the correlation between incomes and health outcomes is indisputable. 

The growing number of well-kept cars driving up to food pantries to get meals signals something important about those who are joining the legions of the vulnerable. Without vaccinations, we can expect (and will see) a surge in infection and mortality rates among those recently unemployed. 

It’s not that viruses hate the poor, it’s that viruses love poverty.

As South Africa finds itself in the midst of another surge, the vaccine can help break the cycle — but only if the right people, that is, the country’s poor, get the priority they deserve. 

As is so often the case when society is confronted with catastrophes of monumental proportions, the poor get shafted. This time let’s do it right. The prescription is pretty clear: don’t give them the shaft, give them the shot.

Ambassador Stith is a former US Ambassador to Tanzania. He is the non-executive chair of the African Presidential Leadership Center and author of A View from the Other Side: Locked Down in South Africa

The views expressed are those of the author and do not reflect the official policy or position of the Mail & Guardian.

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Charles R Stith
Charles Stith was former president Bill Clinton’s envoy to Tanzania and is currently the nonexecutive board chair of the African Presidential Leadership Centre, a Johannesburg-based NGO

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