The clock is ticking for South Africa ahead of fourth Covid-19 wave in December, analysts warn

South Africa’s vaccination programme is in a race against time, with the fourth wave of Covid-19 infections expected to hit the country in December 2021 and into January 2022, says the Actuarial Society of South Africa (ASSA).

Based on the group’s analysis of the Covid-19 experiences in South Africa and several other countries at different stages of managing the pandemic, ASSA believes that there is sufficient evidence to suggest that a fourth wave is likely to emerge in December.

The severity will most likely depend on whether South Africa achieves its vaccination targets, it said.

As of Sunday, 24 October 2021, only 29% of South Africa’s adult population was fully vaccinated against a target of 67% by the end of 2021.

South Africa applies a 42-day waiting period between the first and second dose of the Pfizer vaccine, which means that unvaccinated South Africans will have to get their first jab before the end of October to be considered fully vaccinated with Pfizer towards the end of December.

People are considered fully vaccinated two weeks after their second Pfizer dose or after their single Johnson & Johnson jab.

Actuary Adam Lowe, a member of the ASSA Covid-19 Working Group, says while it is unlikely that South Africa will avoid a fourth wave of infections, the severity will most likely depend on whether the country is successful in building immunity in the majority of the adult population through widespread vaccination to augment any natural immunity present.

This is especially true in the elderly and other vulnerable groups.

South Africa’s experience could mirror that of many countries with large-scale vaccine rollouts, most notably the United Kingdom, with a significant wave of cases but only a muted wave of severe infections and deaths, he said.

However, achieving this would require many people to come forward very quickly to be vaccinated, he said.

“The logistics of the rollout would have to be significantly enhanced to ensure vaccines reach especially the rural and less technologically enabled population, as well as overcoming the vaccine hesitancy and outright anti-vaccine sentiment which still exists.”

What to expect 

An analysis of experiences in other countries by the ASSA Covid -19 Working Group shows that a high vaccination rate appears to have a material impact on the severity of Covid-19 infection waves.

Lowe says Italy and Germany, for example, appear to be at the start of their fourth waves, but without significant peaks in either cases or deaths yet. In Italy, 73.5% of its population is fully vaccinated, while Germany is at 66.7%.

He added that a study of the United Kingdom and the US indicates a similar scenario where case numbers remain high but severe infection and death rates are still comparatively low.

According to Lowe, the UK and the US achieved relatively high vaccine rollouts and significantly eased lockdown restrictions before the onset of their third waves. In the UK, 71.3% of the population is vaccinated, and in the US, fully vaccinated people account for 64.5% of the population.

Lowe said the statistics from the UK and the US seem to indicate that vaccination rates play a role in reducing severe infection leading to illness and death even in a population where the virus continues to spread.

The two countries that appear to be out of sync with the wave patterns experienced by the rest of the world are India and Brazil, which are amongst the hardest hit by the pandemic.

Lowe said that both appear to be experiencing one huge infection wave with no discernible wave patterns. Only 37.4% of the population is fully vaccinated in India, while Brazil has vaccinated 69.4%. Both are also among the most populated countries in the world.

Lowe said that since no country has yet experienced a full fourth wave, it is impossible to predict the South African experience.

However, data is emerging that shows that some countries – notably the UK – have weakened the link between cases and deaths, most likely through a comprehensive vaccine rollout.

Lowe said that he does not discount that increasing levels of natural immunity also play a role but suggests that vaccination provides a more certain method of ensuring widespread immunity in a population and managing population immunity over time as infection levels vary.

Lowe explained that in modelling the Covid-19 pandemic, it has become evident that the key drivers determining the waves of Covid-19 infection are:

• The infectiousness and transmissibility of the particular virus variant prevalent in a population;
• Population behaviour that influences the spread of the virus, such as gatherings, mask-wearing, and social movement; and
• The degree of immunity already presents in the population, whether acquired through vaccination or previous infection with the virus.

Lowe cautioned vaccinated people against letting their guard down too quickly because one of the potential triggers of a severe fourth wave that cannot be disregarded is the potential of a new variant emerging against which the existing vaccine could provide insufficient protection.

Read: Updated level 1 lockdown rules for schools and travel in South Africa