The politics of vaccine rationing

ANTHONY BUTLER: Why jab teachers, who are at less risk than taxi drivers?

Some will view this as successful blackmail by the powerful SA Democratic Teachers Union

 First published in BusinessLive PREMIUM

24 JUNE 2021

Is the government’s plan to ration Covid-19 vaccines falling apart? SA faces extreme vaccine scarcity, and the department of health has only a vague framework for allocation. In phase one, 1-million health workers were to be vaccinated, followed by the current second phase, in which 16.5-million over-60s and other vulnerable groups are due to receive protection. The third phase should cover a residual 20-million.

The government has rightly been keen to avoid rationing on the basis of power and money. In the early years of the HIV/Aids pandemic treatments went to those with private medical insurance, key workers in large companies, and public servants with medical aid. City-dwellers and the middle classes were advantaged. The less educated, the poor, and those living in rural areas were in effect excluded.

When it comes to Covid-19 vaccines the advantages of the wealthy have been partially neutralised by government controls. The priority initially given to the elderly was fully justified. The young, after all, are mostly unaffected by the virus, and almost all countries have placed protection of the old at the heart of their vaccination strategies. Governments may also prioritise people who are especially open to infection, those whose vaccination benefits the whole of society because they are potential spreaders of the virus, and those who allegedly play some “essential” or “critical” role.

This is where the trouble begins. The list of “essential workers” always starts with doctors and nurses because they are directly exposed to the virus. Hospital cleaners, porters and ambulance drivers are even more vulnerable. Beyond the health system, critical worker lists around the world have expanded in various directions. The US Centres for Disease Control and Prevention included the police, firefighters and care home workers. Other governments have listed staff in transport, waste management, water delivery, electricity, logistics, communications, retail, pharmaceuticals and finance.

In SA, we have placed teachers at the front of the queue. Yet children do not pose a high transmission risk, and teachers may be more likely to be infected at home than at school. Most of them are too young to fall seriously ill, and older members of the profession can be catered for through age-based rationing. Why are we taking vaccines from over-60s who may die — and overwhelm our health system along the way — and giving them to young teachers? Most of the arguments presented — children being seriously disadvantaged by school closures and long-term inequality effects — concern the refusal of teachers to return to the classroom.

Some citizens will be sympathetic. Other organised interest groups, however, will view this as successful blackmail. The SA Democratic Teachers Union is, after all, the country’s most powerful workers’ organisation. Teachers are privileged, their salaries placing them easily in the top 10% of income earners. Without a clear and transparent justification for vaccine priority, other less well-paid formal sector employees will also demand special treatment: the police, the military, prison guards and frontline public sector workers who interact with the public.

Other groups equally or more exposed to coronavirus infection, such as retail sector employees, restaurant workers, mineworkers and minibus taxi drivers, will want to join the front of the queue. Members of these “aggrieved groups” are starting to believe they deserve priority, and they resent the advantages granted to others. Meanwhile, unvaccinated over-60s are castigated as “self-excluders” from the programme, even if they live in rural areas.

Those worst affected by Covid-19 are not the rich or unionised public sector workers. They are the poor — who cannot isolate, live in high-prevalence communities, share cramped accommodation, use crowded public transport and suffer the comorbidities of poverty — and they are also the old. No allocation system is perfect, but perhaps the government should stop picking beneficiaries and just stick to the principle of rationing by age?

• Butler teaches public policy at the University of Cape Town.

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