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07 October 2021 | Story André Damons
Dr Nicholas Pearce, Head of the Department of Surgery in the Faculty of Health Sciences at the UFS, Prof Adrian Puren, Acting Executive Director of the National Institute for Communicable Diseases (NICD), Prof Glenda Gray, President and CEO of the South African Medical Research Council (SAMRC), and Dr Angelique Coetzee, Chairperson of the South African Medical Association (SAMA), were the panellists at the University of the Free State (UFS) Thought-Leader webinar, themed Why vaccinate?

Panellists at the University of the Free State (UFS) Thought-Leader webinar, themed Why vaccinate, felt it was critical for everyone in South Africa to get vaccinated in order to return to a sense of normality and to a university environment where lectures and learning not only happen in the lecture room, but in the ‘informal’ academic environment. 
Large numbers of the community need to be vaccinated to halt the progression of the pandemic and to maintain non-pharmaceutical interventions. 

Dr Nicholas Pearce, Head of the Department of Surgery in the Faculty of Health Sciences at the UFS, Prof Adrian Puren, Acting Executive Director for the National Institute for Communicable Diseases (NICD), Prof Glenda Gray, President and CEO of the South African Medical Research Council (SAMRC), and Dr Angelique Coetzee, Chairperson of the South African Medical Association (SAMA), were the panellists. This was the fifth webinar (28 September 2021) in the series, which is part of the Free State Literature Festival’s online initiative, VrySpraak-digitaal. 

Critical that everyone get vaccinated to return to a sense of normality

Dr Pearce indicated that patients seemed hesitant to present to both private and state health-care facilities during the COVID-19 pandemic. This resulted in patients presenting in the final stages of cancer (stages 3 and 4 as opposed to stages 1 and 2). “The quicker we are able to exit the COVID-19 pandemic – and we will probably never totally eradicate it as it might become endemic – we can go back to treating other medical conditions that are currently not being optimally managed,” said Dr Pearce.

He is also concerned that the impact of the pandemic on other medical diseases (such as mental issues) will only become visible over a number of years. We must be careful that we do not forget about the non-COVID diseases, according to Dr Pearce. 

Dr Pearce said it was critical that everyone be vaccinated in order to return to a sense of normality. The COVID-19 protocols of social distancing and the wearing of masks have left a mental toll on us as a society. He said depression and suicide are on the rise, and if we want to go back to a sense of normality, a large number of people need to get vaccinated.

The economic problems caused by COVID-19 are huge, as a large number of people have stopped their medical aids in the Free State. Some of the other economic problems due to COVID-19 is that a larger number of the younger population got infected during the third wave, which means that many breadwinners lost their lives. In the medium and long term, this is going to have huge economic repercussions. 

Vaccine acceptance increased among South African adults

Armed with figures from a recent study by the Centre for Social Change at the University of Johannesburg (UJ) in collaboration with the Developmental, Capable and Ethical State research division of the Human Sciences Research Council (HSRC), Dr Coetzee illustrated the importance of getting vaccinated. 

The study found that even though hesitancy dropped by 5%, vaccine acceptance increased to 72% among South African adults.

She said according to the study, South Africa faces two significant challenges. “First, if all 72% were actually vaccinated, we would still be 8% short of the government’s target of 80%. So, we know that government has secured significant vaccines to vaccinate the entire adult population and that the supply of vaccines should no longer be a concern as we had seen earlier this year. What we need to do is to convince some of the people who are currently hesitating about the value of getting vaccinated.”

Acceptance among the older age group has risen substantially by 11% when comparing the results from round three (December 2020 to 6 January 2021) with round four (June 2021 to July 2021). Said Dr Coetzee: “But what is still concerning is that the acceptance among those aged 18 to 24 years has actually declined from 63% to 55%.”
The second challenge that came to the fore, continued Dr Coetzee, is one of access. “We have said many times before, vaccines should be brought to the people, and not the other way around. Finally, we are now seeing that this is starting to happen, but I think it is too slow – especially in the rural areas – and maybe a bit too late. Let’s see what is going to happen going forward.”

According to Dr Coetzee, the message must be clear: We need to vaccinate to save the health-care workers and to save lives and maintain the non-pharmaceutical interventions. She said it does not matter how many times people are told to get vaccinated, they still want to take their chances with the virus. 

Aim higher to achieve herd immunity

According to Prof Puren, the threshold for herd immunity of about 67% vaccinated adults in South Africa now seems to be more mythical. “We should be aiming higher than that, meaning 90% or higher in terms of the proportion of the population being vaccinated in order for us to have a more endemic control,” says Prof Puren. 

“A large number of people in South Africa have been infected with COVID-19, but there is still a significant proportion of people that have not experienced this virus. Herd immunity is about the indirect effect of protecting those individuals who are susceptible. So, it’s a particular threshold of the number of people who had an immune response.” 

Prof Puren said there will have to be a breakthrough in infections. Vaccines do work, they are effective. It is possible for us to achieve endemic control, and vaccines are the critical component to do that. 

Important benefits of vaccination are to gain control of the academic year

“The questions about the benefits of mandatory vaccination at university – to prevent hospitalisation and deaths.  With vaccination, you also impact isolation and quarantine challenges. If you have good coverage of vaccinations, institutions will not have to keep closing classrooms, or hostels. It will help keep the workforce open. 

“One of the important benefits of vaccinations is to gain control of the academic year. All the universities have suffered, having to move to online learning where a lot of students don’t have the luxury and privilege of having data available to them all the time.”

“The issue of hybrid learning is important, and you will still see a lot of hybrid learning going on as we go into different surges. But students still need interaction, they still need face-to-face teaching, and they still need the interaction, the socialisation. We have to maximise the university experience,” said Prof Gray.  

In answering the question – would it be beneficial for employees and institutions to formulate and implement a vaccination policy – Prof Gray said it was a critical move to open up academic institutions.  

She agreed with Prof Puren that the 70% is almost mythical, and that a higher level of vaccination will be needed to start controlling the pandemic. 

“Why should we vaccinate? Why should we try and control the transmissions in our country? We have to do that, because we need our economy to start, we see how we have been affected by being on the red lists of certain countries. This affects our economy, our tourism, and jobs. A lot of people have lost jobs. If we want to interface with the rest of the world, we are going to have a discussion around making sure citizens are vaccinated.”


• The recording of the webinar can be found here  

 Passcode: nJv%p7Rp

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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