The Covid-19 vaccines have been developed in record time, but this should not come as a surprise. Although Covid-19 is new, the phenomenon of coronaviruses is not new, and scientists have been studying them for more than 50 years. With the outbreak of Covid-19 specifically researchers could build on the mountains of knowledge about coronaviruses to develop a vaccine as quickly as possible. This background knowledge enabled scientists in China to fully unravel the RNA of the Covid-19 virus as early as January 2020 and as a result vaccine development could start almost immediately.

Vaccine development usually is an extremely expensive process, but in this case and given the huge demand there was no shortage of resources. The US government of Pres Trump launched Operation Warp Speed, which released adequate funding for vaccine development.

This is not the first time that a vaccine was developed for a pandemic within a year. In the case of the 2009 swine flu pandemic a vaccine was also developed within a year. Following a meeting in May 2009 to develop a vaccine the first trials for a vaccine started as early as July 2009.

Given this level of resources and demand, as well as the existing knowledge on coronaviruses and the specific knowledge on Covid-19 it is not unusual that a vaccine could be manufactured within a matter of months. This has enabled pharmaceutical companies to start clinical trials as early as May 2020, which eventually meant that phase 3 testing of most vaccines was completed by December 2020 and the successful candidates for human use could be approved.

This fear specifically applies to South Africa where the government insists on centralising the procurement and rollout of vaccines. It is a valid fear. However, one has to consider that there are various types of vaccines requiring different ways of transportation.

The Pfizer vaccine is the one that is most difficult to transport because it has to be stored at -70 oC in the long term. What is important is that according to the United States Food and Drug Administration (FDA) the Pfizer vaccine can be stored at normal refrigerator temperatures for up to a month. This allays most of the fears about a possible interruption of the cold chain. Refrigerator temperature cold chains are common in South Africa and are effective.

The other vaccines (Moderna, Johnson & Johnson) can be transported by using normal cold chain technology and should not pose any exceptional logistical challenges.

The present reality is that the long-term effects of Covid-19 vaccines simply are not known yet because not enough time has passed to determine such effects. This is one area where there is uncertainty, simply because of the fact that no clinical test can move forward in time.

Fortunately, vaccines are not something new and lessons can be learnt from the long-term effects of other vaccines. The history of vaccines shows that most side effects occur within two months after a person has been vaccinated. This history shows that long-term effects are a particularly rare occurrence for vaccines in general, simply because of the way vaccines work. Most of the material used to stimulate an immune response is excreted by the body within a matter of days.

The technology used in the manufacturing of vaccines has been used for many years with minimal long-term effects. mRNA has been used and studied since 1989, and the first experiments on mRNA technology for vaccines were conducted back in 1994.

Other technologies such as the viral vector used in the Johnson & Johnson vaccine have been in use since 1974. The adenovirus version is used specifically because of its safety in clinical studies of other vaccines.

Data show that the claims that people are dying in great numbers due to vaccination are simply not true. The risk of blood clotting and cardio-related side effects is small. Most of the side effects reported are mild and are similar to those of any other vaccine.

Data show that there is one risk that surpasses that of vaccines and that is not to be vaccinated. Should you decide not to be vaccinated, you have to give serious consideration to the risks that come with it. This includes your own health and the chances of contracting Covid-19, but also the risk of transmitting Covid-19 to other people. Non-vaccinated persons can also continue to spread the virus.

There is no viral Covid-19 protein in the vaccine. This implies that there is no way the vaccine can give you Covid-19 because the virus itself is not contained in the vaccine. The vaccine contains only a modified spike protein.

It is important to first explain what exactly the spike protein is The Covid-19 cell contains several small proteins surrounding it that help the viral cell to attach to your cells. These proteins give the Covid-19 cell that characteristic shape of a crown (corona) around it. Because of its unique nature, the spike proteins have been identified as the ideal target for a vaccine to be based on as all the mutations of Covid-19 have to contain a spike protein.

For the virus to spread, it is necessary for the viral cells to multiply – viral cells must therefore use the spike proteins to attach to your cells and then the viral cell itself has to multiply. The spike protein is not a virus on its own and cannot multiply on its own. Therefore, it is not possible to contract Covid-19 from the vaccine because there are no Covid-19 cells in the vaccine.

There is no viral Covid-19 spike protein in the vaccine.

Although the viral spike protein on its own can cause damage, it is important to note that vaccines produce a modified, harmless spike protein that is aimed at triggering an immune response so your immune system can then react better when the actual virus makes its appearance.

Although studies on rats show that the spike protein does not specifically stay at the injection site, the same studies also show that most of the vaccine stays near the injection site and then moves to the liver – as expected. The largest amount found outside these areas is 1,03% of the total vaccine dose and is found in the spleen.

The quantity of spike protein that a vaccine produces is 100 000 less than what is required to cause damage. Consequently, the spread of at most 1,03% to outside the vaccination site is not a substantial threat.

Only 271 incidents related to mothers who are breastfeeding have been recorded in the US’s Adverse Events Reporting System (VAERS system). Most of these pertained to where a breastfeeding mother developed on of the normal side-effects, such as headache or muscle pain. In only 23 incidents specific reference is made to breastmilk. These incidents do describe symptoms such as a baby with more appetite or having a runny nose.

However, there is insufficient data available to reach a conclusion and Solidarity advises breastfeeding mothers to consult their doctor in this regard.

Recent research has shown that ivermectin probably is effective in the treatment of Covid-19. Given the possible role ivermectin can play in the treatment of Covid-19, together with the safety of ivermectin in approved doses, it is inconceivable that it has not long ago been included as a possible treatment for Covid-19 in South Africa.

Ivermectin has now been approved for human use in South Africa and may be prescribed by any doctor. As with all medicines, it is very important to stick to the safe dose in order to avoid undesirable side effects

Ivermectin and a Covid-19 vaccine are not working against each other and focus on different sides of the treatment spectrum.By definition, a Covid-19 vaccine is of a preventive nature, while ivermectin probably is an effective treatment for Covid-19, especially in the early stages of the disease.

Consequently, there is no conflict between ivermectin and Covid-19 vaccines and the two may be used together against Covid-19. It is also strongly advised that you should consult your doctor and that you not get hold of the medication illegally. It is important that your doctor prescribes it to you and that you do not deviate from the prescribed dosage.

Vaccines and possible side effects are reported on in exceptionally great detail, and no exceptional deaths have been noted. On the contrary, the side effects of the Covid-19 vaccines are in line with those of other vaccines.

So far, more than 2,9 billion doses of Covid-19 vaccines have been administered without a significant number of deaths having been reported in the US or in Europe. The few serious side effects reported (blood clotting and heart disease) are exceedingly rare and are manageable, if dealt with.

On average, about 2 500 people out of 1 million receiving a Covid-19 vaccine should develop a side effect, most of which will be mild. If 1 million people get Covid-19, about 140 000 should end up in hospital with serious symptoms and about 23 000 should die.

A brief analysis of the reported side effects according to the Vaccine Adverse Events Reporting System (VAERS system) is as follows:

The VAERS data contains 331 630 cases reported as side effects out of 160 million who have been vaccinated.

Given the clinical trials most of these side effects are exactly as could have been expected.

Due to the mild degree of most of these side effects it is very possible that there could be underreporting of mild side effects. However, underreporting is particularly difficult in the case of deaths.

Of these 331 630 side effects there have been 3 523 deaths. If deaths within seven days after vaccination are considered then there are 1 972. That gives a percentage of 0,0013%, or put differently, 13 deaths for every 1 million. Please note – so far no causal connection has been made between these deaths and the vaccine. These deaths include deaths from vehicle accidents, injuries and terminal conditions.

For the sake of context: The current mortality rate for vehicle accidents in America is about 119 people out of 1 million.

At present there is no legislation in South Africa that compels employees to receive the Covid-19 vaccine, not even in specific industries where exposure is very high. Furthermore, the South African Constitution also gives protection, but the rights may be limited in certain circumstances. On the other hand, every employer has an obligation to ensure a safe and healthy workplace. A balance therefore has to be struck between individual rights, the obligations of an employer and the rights of the broader society.

Employers who introduce Covid-19 policies with a view to compulsory vaccination will have to measure such policies against current legislation.

In terms of the Occupational Health and Safety Act (No 85 of 1993), all owners, employers and persons in control of premises have a general duty to provide and maintain, as far as is reasonably practicable, a working environment that is safe and without risk to the health of their employees [section 8(1)]. This provision, however, does not automatically give an employer the right to make vaccination compulsory. Should an employer wish to introduce such a policy or rule, it will have to be justifiable on the grounds of the inherent requirements of the work and the risks at the workplace (not the employer’s preference or simply his own decision), which will be justifiable only in an insignificant number of cases. In general, however, it will not be fair or justifiable to require employees to be vaccinated.

At this stage there is no legislation or precedents dealing specifically with labour legislation and compulsory vaccination. This is a new aspect that has come to the fore and so far there has been no amendments to our labour legislation. There are only the regulations implemented by the state in terms of the Disaster Management Act (No 57 of 2002), and even these do not provide for any obligation. In terms of the Occupational Health and Safety Act, all owners, employers and persons in control of premises have a general duty, as far as is reasonably practicable, to provide and maintain a working environment that is safe and without risk to the health of their employees [section 8(1)].

The Employment Equity Act (No 55 of 1998) requires employers to take steps to promote equal opportunity in the workplace by eliminating unfair discrimination in any employment policy or practice (section 5). In addition, nobody may in a direct or indirect way in any employment policy or practice unfairly discriminate against an employee on the ground of, inter alia, age, religion, conscience, belief or culture or on any other arbitrary ground [section 6(1)].

However, it is not unfair discrimination to distinguish between or to exclude persons on the basis of the inherent requirements of a job [section 6(2)(b)]. This is an important provision. It means that if, because of the nature of your work and the demands placed on you, there is a requirement for you to be vaccinated, discrimination may indeed be fair. This would, however, be justifiable only in an insignificant number of cases.

In conclusion, it will in general not be fair or justifiable to require employees to be vaccinated, and if an employer wishes to introduce such a policy or rule, it will have to be justifiable on the grounds of the inherent requirements of the job (not the employer’s preference of simply his own decision), which will be justifiable in only an insignificant number of cases.

At present there is no legislation in South Africa that compels employees to receive the Covid-19 vaccine, not even in specific industries where exposure is very high. Furthermore, the South African Constitution also gives protection, but the rights may be limited in certain circumstances. On the other hand, every employer has an obligation to ensure a safe and healthy workplace. A balance therefore has to be struck between individual rights, the obligations of an employer and the rights of the broader society.

Individual rights

• The National Health Act (No 61 of 2003) provides that no medical service (including vaccination) may be performed without the consent of the receiver, and such consent must be specific and must be given voluntarily after the receiver has received information concerning the proposed medical procedure, e.g. vaccination. There are exceptions to the consent for medical services, e.g. where the medical procedure is prescribed by legislation or by a valid order of court. In the specific cases the receiver will be obliged to receive the medical service. However, the Minister of Health has made the government’s position clear, namely that vaccination is not compulsory and that currently there is no legislation that makes vaccination compulsory. The receiver of a vaccine (the employee in this question) therefore has to make an informed decision and give express and voluntary consent for the proposed medical procedure.
• The right to bodily integrity (control over one’s own body) also is protected in section 12 of the Constitution. This right may be limited by the state, but the state will have to prove that the limitation is required for the performance of general justice and in the interest of the broader community. At present, the state’s position is clear because vaccination is not compulsory and may be received only voluntarily. Specific consent therefore is required before a person may be vaccinated.
• The Labour Relations Act (No 66 of 1995) (LRA) also affords protection against procedurally and substantively unfair dismissal. Should the employer wish to argue that compulsory vaccination is a matter of mutual interest, section 187(1)(c) of the LRA offers protection by providing that an employer may not dismiss an employee on the ground of his/her refusal to accept a demand in respect of any matter of mutual interest between the employer and the employee. If this is merely a unilateral decision by the employer, section 187(1)(f) specifically provides that dismissal is automatically unfair if an employer directly or indirectly discriminates against an employee on any arbitrary ground. Refusal to be vaccinated because of belief or religion could be seen as such an arbitrary ground. The mere decision by the employer to distinguish between persons on the ground of whether they are vaccinated or not, could in itself be viewed as an arbitrary ground, and for this reason dismissal on the ground of refusal or failure to be vaccinated could be automatically unfair.

Employer’s rights and obligations

• On the other hand, in terms of the Occupational Health and Safety Act all owners, employers and persons in control of premises have a general duty, as far as is reasonably practicable, to provide and maintain a working environment that is safe and without risk to the health of their employees [section 8(1)].
• Similarly, the same section 187 of the LRA and also the Employment Equity Act provide that an employer may distinguish between persons or may exclude persons on the ground of the inherent requirements of a job. This would, however, be justifiable only in an insignificant number of cases.

In terms of the Occupational Health and Safety Act, employers have a responsibility to protect their employees and other persons at the workplace and to maintain a healthy and safe work environment.

It is, however, also important to protect the constitutional rights of all persons, including those of employees. These constitutional rights include the right to equality before and equal protection and benefit of the law, the right to human dignity, the right to bodily integrity, the right to freedom of religion, belief and opinion, the right to an environment that is not harmful to people’s health or well-being and the right to health care services.

At high-risk workplaces it is possible, because of the high risk of spreading Covid-19, that employees who have not been vaccinated could pose a risk to public health and the health of other employees.

It is important that the employer’s obligation to create a safe and healthy workplace be exercised with due regard to and protection of the constitutional rights of the employees.

In terms of the Occupational Health and Safety Act, employees are obliged to take responsibility for their own safety and health at the workplace and also for that of the other persons at the workplace. They also have to execute any lawful instructions given to them with regard to health and safety at work, and they must obey the health and safety rules and procedures prescribed by the employer.

Where there is no significant risk of Covid-19 infection at workplaces or with regard to the work, employees should be allowed to proceed with their work, even if they refuse to be vaccinated against Covid-19, but all preventive measures apart from vaccination must still be followed strictly. These measures include properly wearing masks, maintaining physical distance, washing hands and disinfecting, isolation and quarantine.

In general, employers may not compel employees to be vaccinated against Covid-19 without their informed written consent.

Employees may refuse to be vaccinated on the ground of religious beliefs, culture or medical reasons. In the case of medical reasons, employees should consult their doctors.

Employers in very high-risk areas may compel employees to be vaccinated against Covid-19 only in highly exceptional cases, but such action may not be taken unilaterally and arbitrarily and not without proper consultation with the employees and without having considered and implemented any and all alternatives.

In the event of an employee refusing to be vaccinated and vaccination of the employee is reasonable and essential, given the high risk of infection with Covid-19, or is an inherent requirement for his or her work, the employer must consider all alternatives, such as alternative placement, changing duties or the possibility of work at a safe distance from the high-risk area.

The short answer is: No.

The President of South Africa has said that nobody will be compelled to be vaccinated

The Children’s Act, 2005

• The Children’s Act (No 38 of 2005) provides in section 129 that children may consent to their own health treatment, provided they are over the age 12 years, understand the implications and are “of sufficient maturity”.
• This term is not defined in the Act, and neither does the Act provide how professional health care providers may determine whether a child is of sufficient maturity to exercise these options. Using this Act when the child himself or herself has to decide before the age of 18 years therefore will immediately cause confusion.
• Children above the age of 18 years may indeed make choices concerning healthcare. Consent to vaccination, other than compulsory vaccination, therefore may be obtained from such a child, provided that the child has been put in a position to make an informed decision. The pros and cons of the specific vaccination must be made clear to the child.

South Africa’s provisions and application of the Covid-19 vaccination strategy

The official strategy entails the following:

• Phase 1: Health workers, approximately 1,25 million people.
• Phase 2: Essential workers, approximately 2,5 million people; densely populated settlements, approximately 1,1 million people; persons over the age of 60 years, approximately 5 million people; and persons older than 18 years with proven underlying disease conditions, approximately 800 000 people.
• Phase 3: Persons over the age of 18 years, approximately 22,5 million people.

No provision is made for people under the age of 18 years.

Compulsory vaccination: Legal opinion, Advocate G Kemp

• The government does not foresee that compulsory vaccination against Covid-19 for all citizens of South Africa will be promulgated, and by implication this will also not apply to children.
• Vaccination against Covid-19 has not been promulgated as part of a legal obligation of vaccination for children (e.g. for German measles, polio and smallpox).

Child or adult:

• The South African Constitution recognises the Africa Charter and also the United Nations “Rights of Children” (UNCRO [2,3]) for the term “child”.
• These define children as individuals and as holders of certain rights. Children are not the property of anyone and have specific rights, including being able to make decisions as set out above.

Sections 12 and 34 of the Constitution:

• Everyone has the right to bodily integrity (security and control of one’s own body).
• Such right may in certain circumstances be limited by legislation and/or an order of court.
• Weighing up various rights should be taken into account before a specific right is denied.
• These sections are important because children, who also have rights, must be protected against discrimination.

Amending policy

• To make Covid-19 vaccination compulsory, the state will first have to get public participation by publishing additional information on compulsory vaccination in the Government Gazette.
• The state will find it difficult to achieve this, because it is inconsistent with the human rights of religious beliefs and the right to association (participation).
• The admission policy of public schools will have to change before compulsory Covid-19 vaccination can be implemented, and it will first have to be promulgated and published in the Government Gazette before becoming law.

Public schools vs private schools

Public schools

• At present, public schools have no right to deny access for children who have not received vaccination.
• The Bill of Rights makes it clear that no child may be denied access if the necessary certificates of compulsory vaccination cannot be produced, and by implication this will also apply to Covid-19 vaccination.
• The Department of Basic Education has placed an obligation on school principals to advise and assist parents in this regard.
• The core principle of “no discrimination” on the ground of religion, gender and culture will apply at all times.
• This will also apply with regard to denial of access to education. The state’s obligation to provide education to all children of South Africa as set out in the National Schools Act is a statutory provision that compels parents to enable children to receive education.
• Of course, no mention is made of Covid-19 vaccination. This pandemic is exceptional, and there is no legislation in terms of which vaccination is compulsory.

Private schools

• Private schools are entitled to determine their own admission requirements, but such requirements still have to comply with the Constitution of South Africa.
• The right to bodily integrity (control over one’s own body) is protected in section 12 of the Constitution.
• Furthermore, section 9(3) and (4) of the Constitution provides protection against discrimination on the ground of, inter alia, religion, conscience, belief and culture.
• In terms of this, an admission requirement that requires vaccination could possibly be viewed as discriminatory and therefore unconstitutional.

Fair procedures

• Schools, whether public or private, will have to clearly inform parents and children under the age of 18 years about the pros and cons of Covid-19 vaccination, should vaccination be insisted upon.
• Discussions (public participation) and a proper consultation process will have to be followed first, apart from the limitations to the rights of individuals enshrined in the Constitution.
• Parents and children will have to thoroughly study and understand any documents to be signed before consenting to Covid-19 vaccination.

In summary

• Public schools may not deny any child admission because such child has not been vaccinated against Covid-19.
• The Constitution protects the rights of children and also of parents to take part or not to take part in anything that is not a statutory obligation.
• The decision to receive Covid-19 vaccination for admission to education therefore rests with parents and children as set out above.
• Although highly unlikely, there may be an insignificant number of circumstances where private schools may make vaccination compulsory, provided that such schools do not infringe the Constitution of South Africa.

At present there is no legislation in South Africa that expressly compels people to receive Covid-19 vaccines. We would, however, like to approach the issue from two sides – firstly when the state is a role-player and secondly when a private body, such as an airline company, is involved.

State as role-player

• As supreme authority of the land, the state is bound by the Constitution.
• Chapter 2 of the Constitution gives every citizen of the Republic certain fundamental human rights, and the state cannot summarily infringe these rights.
• We refer specifically to the right to human dignity (section 10), life (section 11), bodily and psychological integrity (section 12(2)) and the right to freedom of religion, belief and opinion (section 15).
• These and other rights may, however, be limited in terms of section 36 of the Constitution. This section reads as follows:
  Limitation of rights
  36(1) The rights in the Bill of Rights may be limited only in terms of law of general application to the extent that the limitation is reasonable and justifiable in an open and democratic society based on human dignity, equality and freedom, taking into account all relevant factors, including –
  (a) the nature of the right;
  (b) the importance of the purpose of the limitation;
  (c) the nature and extent of the limitation;
  (d) the relation between the limitation and its purpose; and
  (e) less restrictive means to achieve the purpose.
  (2) Except as provided in subsection (1) or in any other provision of the Constitution, no law may limit any right entrenched in the Bill of Rights.
• Therefore, the state can limit human rights by means of legislation that has been passed by Parliament.
• President Cyril Ramaphosa, however, made it clear in his speech on 01 February 2021 that the state would not force any person in South Africa to receive the Covid-19 vaccine and that the vaccine would not be administered to anybody against their will and that the vaccine will not be administered in secret.
• The power of the state to enforce vaccination of people by means of legislation therefore does not appear to be a consideration at present.
• However, the government requests and encourages South Africans to be vaccinated against Covid-19.

Private body as role-player

• Section 9(3) and (4) of the Constitution reads as follows:
  (3) The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth.
  (4) No person may unfairly discriminate directly or indirectly against anyone on one or more grounds in terms of subsection (3). National legislation must be enacted to prevent or prohibit unfair discrimination.
• From this section it may be concluded that nobody may be directly discriminated against on the ground of their religion or belief not to be vaccinated.
• Because the state cannot make vaccination compulsory, airlines may find it difficult to justify vaccination as a prerequisite for the use of their local services.
• At the same time, airlines also have certain statutory duties regarding the vaccination requirements of other countries.
• In the case of international travel, airlines could possibly require vaccination, depending on whether the country of destination requires vaccination.
• In conclusion, at present there is no prospect of the state putting any restrictions on you if you are not vaccinated.

During the initial vaccine implementation programme, which is being implemented as a phase 3b research experiment, women who are pregnant or who were planning to become pregnant within the next three months were excluded from the study.

Subsequent batches received which do not form part of this research experiment will not necessarily contain these exclusions.

At present, local as well as international experts advise pregnant women and women running a high risk of contracting Covid-19, or those with a high risk of contracting serious infection, to discuss the matter with their own medical practitioners and to make an individual, informed decision they are comfortable with. The reason for this is that the risk of transferring the virus from mother to child is much higher than the risks associated with the vaccine.

An electronic vaccination data system (EVDS) for vaccination against Covid-19 has been established for the registration of health workers in South Africa. All health workers, whether in the public, private, clinical or non-clinical work environment, who want to be vaccinated should register on this system, but only health workers may register on it.

Health workers have to register general information such as their identity numbers and names on the EVDS system, as well as information regarding their places of work.

This information will be used to refer them to a registered vaccination point. The EVDS system will also be used to communicate with the registered health workers.

An SMS indicating the date, time and venue where the vaccine will be available, will be sent to registered health workers. When at the point of vaccination, they will receive a unique code.

Health workers who do not have access to the internet may approach any health service facility for assistance to register on the EVDS system.

Access to the EVDS system may be obtained at http://vaccine.enroll.health.gov.za/

Queries in this regard may be emailed to the Department of Health at evds.hcwselfregistration@health.gov.za and further information may be obtained from the EVDS self-registration portal at https://sacoronavirus.co.za/2021/01/27/evds-self-enrollment-portal-slideshow/. A user guide with general instructions on the registration process may be downloaded here.

In terms of the Covid-19 vaccination programme, vaccination will take place in three phases, beginning with the most vulnerable people in South Africa. It is proposed to have vaccinated 67% of the people in South Africa by the end of 2021 so as to achieve herd immunity.

The three phases will take place as follows:

• Phase 1: Begin with the first-line health workers, who are exposed to people with Covid-19 every day, with a target of 1,25 million people.
• Phase 2: Focus on workers in essential services (2,5 million people), persons in congregate settings, such as nursing homes, adult-care facilities, shelters for homeless people, institutions of detention and prisons, and schools (1,1 million people), persons older than 60 years (5 million people) and persons older than 18 years with live-threatening disease conditions (target 8 million people).
• Phase 3: Focus on all other persons older than 18 years (target 22,5 million people).

As in the case of health workers, the people in the groups covered by phases 2 and 3 also have to register on a system, and they will be allocated to a specific vaccination point.

Particulars of all persons who have been vaccinated will be stored on a national register, and they will receive a vaccination card.

The national Department of Health will give guidance and will inform the population on what groups will be next in line for vaccination. This will depend on the availability of doses as well as on the coverage of the previous priority group.

Aged persons will be vaccinated during phase 2 of the national implementation programme, after the health workers. There is no indication yet as to when phase 2 will begin.

Yes!

At this stage there is no certainty as to how the strength and duration of protection by natural infection compares to that of vaccine-induced immunity, although vaccines appear to be more effective.

Both forms are likely not to be permanent, but vaccines may generate a stronger immune reaction than natural immunity.

Vaccines administered following a primary infection could serve as an additional immune booster.

The South African ministerial advisory committee on vaccines recommend a period of between one and six months before a vaccine is administered following a previous infection.

Some authorities, such as the Centers for Disease Control and Prevention in the US (the CDC), recommend that an individual should consider his or her risk of re-infection (which is unlikely following natural infection, but is not impossible) within three to six months, allowing other persons without previous infections (and therefore without any protection) the opportunity to receive the vaccine in the context of limited supplies.

Receiving the vaccine while a person is still in isolation following active infection is not recommended.

A vaccine is a medication that is administered to people and that contains inactive or weakened parts of a specific organism (virus or bacterium) to activate the immune system of people to identify a biological threat and to produce antibodies to neutralise such threat and in so doing develop acquired immunity against the organism. The continued production of these antibodies determines the effectiveness of a vaccine.

Infection through the vaccine is not possible. The AstraZeneca, Johnson & Johnson, Pfizer and Moderna vaccines do not contain any real SARS-CoV-2 virus (the virus that causes Covid-19), nor any parts of the real virus.

These vaccines only contain the genetic recipe for one of the proteins of the virus.

It is impossible to construct an entire virus from only a single protein. It is like trying to build a car if you have only the side mirror. If a person develops Covid-19 during the days following vaccination, it will mean that the person had already been infected and had been in the incubation period (the period between when a person is infected and the appearance of the first symptoms).

Neither will vaccination result in positive laboratory PCR tests or antigen or antibody tests.

Vaccines prevent diseases – they do not cause diseases!

With regard to side-effects, one should distinguish between the expected side-effects based on the functioning of the vaccine, and the side-effects that are unexpected and serious.

When the body has an immune reaction, chemicals are released to fight the virus, and this causes symptoms such as fatigue, fever and muscle ache.

Because vaccines simulate natural infections and deceive the immune system into thinking that infection has taken place, the immune reaction – and therefore also the symptoms – are the same. However, because it is not the real virus, the symptoms usually are milder and fade away within a short period (usually between 24 and 48 hours).

The pain experienced during vaccination is a common occurrence but is not unique to the Covid-19 vaccine. There is no reason for concern, because it is normal while the body is learning to fight the foreign intruder.

Other symptoms that may be experienced are muscle ache, increased body temperature, fatigue and headache. It is important to note that these symptoms are the result of the body’s immune system reacting and developing protection for in case the body is exposed to the virus in future.

With regard to unexpected, acute reactions that require medical treatment or could cause death, Covid-19 vaccines are extremely safe and such symptoms are very rare.

It is important to know the difference between a harmful event and a counterreaction. 

Any uncomfortable or unexpected reaction experienced following vaccination is reported as a harmful event and will be investigated. This does not mean that the vaccine was the cause, but merely that it occurred at the same time as vaccination.

A panel of experts investigate harmful events to determine the causes. If there is evidence of a link between the vaccine and the harmful event, it is classified as a counterreaction.

Following the application of a vaccine there will always be harmful consequences, because life goes on and things do happen to people (such as accidents, injuries, other diseases, etc). We should therefore be concerned only if there are violent counterreactions, because these reactions may be linked directly to the vaccine.

Allergies

• The most important consequences experienced following the administration of the Covid-19 vaccine is an allergic reaction in people who are allergic to some of the ingredients used in the Covid-19 vaccines.
• Hypersensitivity is rare and typically occurs only in people with a history of allergies, and it happens within 15 minutes following administration of the vaccine. According to the CDC, the occurrence of such allergic reactions is very low, approximately 1 in every 6 million doses.

People should discuss their questions and concerns about allergic reactions (and any other medical questions and concerns) with their doctors. The doctors can determine whether the benefits of vaccination outweigh any concomitant risks.

Depression, loneliness and an unhealthy lifestyle may weaken the body’s immune system and may decrease the effectiveness of certain vaccines, and this also is the case with Covid-19 vaccines. This negative effect may, however, be mitigated by taking simple steps, such as following a healthier lifestyle, exercising and sleeping.

The major objective of a vaccine is to prevent serious illness or death as a result of the virus. If we can change Covid-19 to an infection similar to an ordinary cold, life can go on as before.

All the approved vaccines are highly effective in preventing serious infection and death, thereby contributing to bringing an end to the pandemic.

The number of people receiving the vaccine is even more important than what vaccine is received. Even a vaccine that is 100% effective but is administered to only a small number of people will not be of much use.

For a considerable time to come, it is likely that a variety of vaccines will not be available at the same time.

Which vaccine a person is going to receive, therefore will depend on what vaccine(s) is/are available at a given time and/or what recommendations are available for the use of certain vaccines for certain subgroups of the population.

Further variants of the Covid-19 virus could, however, require other vaccines or administration of vaccines.

In the words of E. John Wherry, an immunologist of the University of Pennsylvania:

 “The vaccine offered is the vaccine you want.”

It is not about vaccine against vaccine now, but about vaccine against the virus.

Rumours have been spread that vaccines contain “microchips”, making it possible to monitor or trace all movements of people.

There is no microchip in any vaccine and there is no evidence to support any allegations to this effect.

Receiving a vaccine cannot enable anyone to trace people.

Vaccines undergo strict clinical tests by the manufacturers and the governments of the countries where they are developed, and in South Africa also by the South African Health Products Regulatory Authority (SAHPRA). If there is any microchip in any vaccine it will never be approved for use by SAHPRA.

The Covid-19 vaccines do not penetrate your DNA.

Vaccines like those of Pfizer and Moderna use mRNA, which is related to but different from DNA.

To penetrate your DNA, the mRNA will have to penetrate the cell’s nucleus and then change from mRNA to DNA.

mRNA cannot be transported into the cell’s nucleus, and humans do not have the required enzymes to convert mRNA to DNA.

Yes, provided the vaccine is sufficiently effective against the coronavirus and all its variants.

Herd immunity is achieved when a sufficient number of people in a community have been vaccinated against a disease or have already had the disease.

Herd immunity does not necessarily mean that people who have been vaccinated or who have already been infected are now immune, but it does mean that persons who are not immune are living in a community where so many people are immune that those who are not immune will enjoy much greater protection from getting the virus than in a community where much fewer people are immune.

The effectiveness of vaccines in preventing symptomatic Covid-19 infection is measured at two levels – firstly, to what extent they prevent light to mild infection, and then to what extent they prevent serious infection (hospitalisation and death).

It is important to understand that a variant does not have the same impact at these two levels. A decrease in effectiveness usually is noticed with mild infections, while the vaccine remains relatively effective against serious infections. For example, there is proof that the Johnson & Johnson vaccine is 57% effective in preventing light and mild infection, but 85% effective in preventing serious infection and 100% in preventing death.

The protection afforded by a vaccine depends on how well the stored immune memory can be applied following vaccination. The extent to which the immune system can offer protection depends on how similar the protein(s) of the real virus is compared to the protein(s) used in the vaccine. If the number and type of mutations in the DNA sequence of the virus change the protein to a large extent, the immune system will not be able to recognise and fight it as effectively, because it differs too much.

If a vaccine is not effective against the variant or if a new variant appears after vaccination, an effective vaccine against such variant will have to be developed and administered so as to develop a new herd immunity against that variant.

Yes, for sure.

Much more data concerning the effectiveness and safety of the Covid-19 vaccines is available than on ivermectin to prevent Covid-19.

The public should bear in mind that although ivermectin is used in other countries for certain diseases, high-quality studies regarding its safety and effectiveness for the prevention and treatment of Covid-19 are still underway and we therefore expect more credible answers to these questions in due course.

Bearing in mind the fact that people are free to choose to receive the vaccine or not, the use of ivermectin is not sufficient to prevent Covid-19, and therefore the Covid-19 vaccine still has to be received.

While the controlled use of ivermectin has been approved by SAHPRA, it is not a substitute for the Covid-19 vaccine. SAHPRA has undertaken to issue guidelines for human use of ivermectin for Covid-19, and these guidelines are being awaited.

The South African Council for Medical Schemes has added the Covid-19 vaccine to the list of prescribed minimum benefits (PMB).

This means that the vaccine and its application have to be funded on all medical scheme options for all beneficiaries.

Some medical schemes have gone so far as to undertake to vaccinate a person without a medical scheme for Covid-19 for every member of the medical scheme being vaccinated.

Medical schemes usually pay only in emergencies for PMBs provided by a medical practitioner who is not on that scheme’s list of designated practitioners. Only accredited vaccination centres will be allowed to administer Covid-19 vaccination. Medical schemes therefore are likely to all negotiate with their healthcare provider networks, who will qualify for accreditation and registration, to vaccinate their members.

It is advisable for members of medical schemes, prior to receiving vaccination, to make sure that their medical scheme will pay for it, and it is important for members of medical schemes to make sure that they are vaccinated at the correct vaccination centre as approved by their medical schemes.

At present, the NDOG allows only certain healthcare facilities to administer Covid-19 vaccines.

This will be expanded as soon as stocks increase and purchase and distribution channels have been confirmed.

It is expected that general practitioners will indeed be allowed to administer the vaccines during later phases of the implementation programme.

Patients should, however, make sure that the facility where they receive their vaccine have the necessary clinical expertise and equipment to monitor and manage patients once they have received the vaccine. 

It is also advisable, however, prior to receiving vaccination from your doctor, to make sure that your medical scheme will pay for it and that your doctor has been approved by the medical scheme to administer PMBs such as the Covid-19 vaccine.

This will depend on the vaccine administered.

The Johnson & Johnson vaccine is a single dose, while most of the other vaccines, such as the Pfizer, AstraZeneca, Moderna and Sputnik V vaccines, require a second dose a couple of weeks after the first one.

These prescriptions may change as further research is conducted concerning what method offers the best and most durable immune protection.

Should a new variant of the Covid-19 virus appear after you have been vaccinated, regardless of the vaccine used, and the vaccine used in your case is not effective against the new variant, you will have to be vaccinated against the new variant as soon as an effective vaccine against it has been developed.

Scientists are already looking at the possibility of mixing some of the vaccines so as to apply the first dose of the one and the second dose of another vaccine.