The advent of the Omicron variant initially worrisome, and in various ways very damaging to the South African hospitality industry, has proved to be less serious than expected in terms of the health impact. Nevertheless there seems to be a reluctance on the part of health experts, to whom I referred in my last post, to now let go of their prime position in the media that they had occupied at the height of the pandemic and return to the less glamorous aspects of health care. A negative aspect of the pandemic aside from the direct consequences of the virus, has been the disruption of the wider ambit of health care services. In South Africa, the pandemic has impacted negatively on the routine immunisation of children, the management of patients with tuberculosis and cancer and those requiring non-emergency surgical procedures, much of which was set aside to allow for the management of COVID patients and the implementation of the vaccination program.
Most of the available data, which will need to be reviewed once the more detailed information is released by StatsSA in the years to come, reflects significant numbers of so-called “excess deaths”, many in those over 60 years of age, which have been attributed to the COVID-19 pandemic. It will be interesting to determine how many of the excess deaths will be attributed to the failure of adequate management of patients with infectious diseases such as tuberculosis and HIV/AIDS both of which are endemic in South Africa and similarly to determine the impact on the management of cancer and cardiovascular disease while routine health services were limited by the impact of the COVID-19 pandemic. I am not in any way minimising the impact of the COVID-19 pandemic on the population of this country but it is also necessary to contextualise this within the broader spectrum of the ongoing burden of disease in South Africa, with which in large measure the State health services have to contend.
Omicron while more infectious has had a far less serious impact on the South African population than initially feared. One consequence however has been the loss of confidence in the vaccines available in this country, which while they were initially purported to prevent infection have proved ineffective in doing so. It is true that available data indicates a lower incidence of severe illness and death amongst those vaccinated but the need for booster doses has made the general population sceptical about their value. In some ways this has played into the hands of those opposed to vaccination and limited the uptake of the vaccine in communities. A further fact that appears to have influenced the course of the pandemic in South Africa is the fact that widespread infections amongst communities have de facto increased herd immunity far beyond that achieved by the vaccine alone. This has prompted some to call for the lifting of all restrictions on the citizens related to the COVID-19 pandemic.
Let me be clear I am not opposed to COVID vaccination and have myself had the two initial doses of the Pfizer vaccine and an additional booster, but I do believe that the currency of those pushing for all to be vaccinated and the imposition of a vaccine mandate has become somewhat weaker. Accepting that fact, makes me favour a process to return COVID vaccination to the realm of annual influenza vaccines focusing in particular, as with influenza, on vulnerable groups such as those over the age of 60 years and those with underlying relevant co-morbidities. It is not in my view justified to continue diverting resources from other health services, which in South Africa were under resourced prior to the pandemic and are more so now, to continue with a specific and focused vaccination program for COVID-19.
After over two years, it is time to place the COVID-19 coronavirus and its multiple variants and those that are to come into perspective. The health services cannot continue to have a single focus but must return to a broader approach to healthcare and indeed the wellness of the population. In South Africa, known deficiencies in the health services both public and private have been further highlighted by the pandemic. These deficiencies are systemic and reflect poor management, wasteful utilisation of available resources, staff complements that are not fit for purpose and budgets that are both inadequate, maldistributed and poorly utilised. Add to this the fraud and corruption that has dogged the public health sector prior to the pandemic and has shockingly continued during the pandemic related to the procurement of personal protective equipment (PPE). As with the revelations in the recently release State Capture reports it has been rare for the perpetrators to be held accountable for their malfeasance. All these negative factors have and will continue to result in poor quality healthcare for those who bear the brunt of the South African burden of disease long after the pandemic has passed. Rather than a focus on a single virus it necessary to focus on the known deficiencies in the health services and act to address these in a meaningful manner. No workshops or task teams are required but rather allow competent individuals given the authority and the mandate without political interference to put right what is wrong.
