As the country proceeds with Phase 2 of the vaccine rollout plan, the government has still not addressed how undocumented people will register to receive the vaccine.
While some of the challenges experienced in South Africa's vaccine rollout programme can be attributed to external factors - including global shortages of the vaccine and the morally indefensible hoarding of vaccines by rich countries who could pay vaccine manufacturers in advance - the government's less than universal approach to health care further compromises the success of the national COVID-19 vaccine rollout programme.
Refugees, asylum seekers, migrants, and undocumented people are estimated to make up around 4 million of the people living in South Africa. That is nearly 7% of the country's total population. Although the Constitution guarantees access to health care services for everyone, documented migrants and undocumented persons are routinely prevented from enjoying this basic human right.
At SECTION27 we have been particularly concerned with the regression of migrants' access to health care services in recent years, given an increase in the number of enquiries from migrants and undocumented persons seeking help from our Advice Office - a pro bono legal office that attends to requests for help from the general public on a number of issues, including those that relate to undocumented learners and migrant health.
The government's COVID-19 vaccine rollout has not been clear on how undocumented persons can register to receive the vaccine. This is despite President Cyril Ramphosa's assurances, at the start of the national vaccination programme, that all adults in the country would be vaccinated irrespective of their citizenship or residence status.
Double-speak on migrants
When Minister of Health Dr Zweli Mkhize (currently on special leave) subsequently announced that government would not have the capacity to vaccinate undocumented foreign nationals, the President once again reiterated that "measures will be put in place to deal with the challenge of undocumented migrants so that, as with all other people, we can properly record and track their vaccination history". It has been several months since these announcements and yet there is still no clarity on the process to register and vaccinate undocumented people.
The electronic vaccination data system (EVDS), an online database where people can register to be vaccinated, remains an obstacle for undocumented people since it requires either a South African identity number, a foreign passport number or an asylum seeker permit number. Failing to address this also means millions of citizens without identification documents, including the homeless as well as some mental healthcare users, are excluded from registering.
South Africa's national COVID-19 vaccine rollout programme officially started with Phase one in May 2021. The government's vaccine rollout programme picked up from where the Sisonke Trial ended and continued with the vaccination of those who are in the health care sector. Phase two of the government's proposed vaccination programme subsequently opened for 5 million people over 60. Most recently, in light of concerns over the rising number of infections in the education sector and the expected arrival of Johnson & Johnson doses that would soon expire, the government was prompted to prioritise the vaccination of teachers and those who work in schools. Persons over 50 are expected to begin their vaccination from 15 July 2021.
The rollout of vaccines has been slow in South Africa with several setbacks and challenges. Presently, fewer than 1% of the population living in the country has been fully vaccinated. A larger number of people have received at least one dose of the Pfizer vaccine and the total number of people who have received at least one dose is around 5%. Speeding up the country's vaccination programme is critical, particularly as the country confronts a severe third wave with the rate of daily recorded cases potentially surpassing the national peak of both the first and second waves. On June 23, 17 493 daily cases were recorded. As it stands, it is unknown when the third wave will reach its peak and we have hardly made a dent in vaccinating at least 67% of the population, the proportion estimated to be necessary to achieve population immunity.
Inclusive approach needed
The nature of the threat posed by the COVID-19 pandemic requires a unified and inclusive approach. No science suggests that the spread of COVID-19 distinguishes between people along the lines of citizenship or documentation status. Furthermore, given the propensity of the virus to mutate, a rollout plan that delays reaching population immunity based on a discriminatory selection process threatens to undercut the efficacy of the vaccines currently available.
In this social and systemic context, migrant persons find themselves in a position where they experience severe disadvantages that predispose them to a uniquely compounded form of suffering under the pandemic. When the existing public health system in some ways already limits their access to health care services and the COVID-19 vaccine distribution plan only partially caters for them, it not only infringes on their rights but it undermines the objectives of the government's entire vaccination project.
The government should draw lessons from its policy measures for the HIV/AIDS epidemic where it adopted a comprehensive public health programme that provides free health care services and treatment to all persons in the country, without discriminating based on citizenship or documentation status. The national vaccine rollout needs a similar approach aligned to the principles of Universal Health Coverage which seeks to provide all people with access to the health care services they need, when and where they need them, without manufactured barriers and prejudice. South Africa's health system and vaccine rollout programme should strive to achieve this ideal and adopt timely and effective policies that reflect the need to accommodate the most vulnerable among us.
*Masipa is a communications officer at SECTION27, Ndlela is an attorney at SECTION27 and Baduza a legal researcher at SECTION27.
Note: This article is written by employees of SECTION27. Spotlight is published by SECTION27 and the Treatment Action Campaign but is editorially independent - an independence that the editors guard jealously. The views expressed in this article are not necessarily shared by Spotlight.