Health giant Discovery is the first JSE-listed company to mandate COVID-19 vaccinations for staff, in response to “a strong moral imperative”, writes MedicalBrief. It’s part of a growing impetus in South Africa, including in government, to “proof of vaccination” policies.
Health Minister Dr Joe Phaahla told Parliament last week that while the government was exploring the scope for businesses and public amenities to require proof of vaccination, there was no consensus on the issue. He said, however, that he was “quite certain” that once SA had attained sufficient vaccine coverage, business owners and the government could legally require the users of their facilities to be vaccinated.
President Cyril Ramaphosa told Parliament last week that employers had to strike a “delicate balance” when implementing mandatory vaccination programmes, but said every South African had a personal responsibility to ensure the safety of others in the ongoing Covid-19 pandemic. The president mentioned the competing interest of the individual right to accept or refuse a vaccine against the responsibility of employers to prevent the spread of the virus in their operations. Ramaphosa said the implementation of mandatory vaccination must be based on “mutual respect, which achieves a balance between public health imperatives, the constitutional rights of employees, and the efficient operation of the employers' business,” which might be difficult to achieve.
While vaccinations were important, Health’s acting Director-General Dr Nicholas Crisp said that forcing vaccination by law was the wrong approach. Crisp made these comments during a televised debate that included Deputy Justice Minister John Jeffrey, Discovery Health CEO Ryan Noach and public health lawyer Safura Abdool Carrim. Jeffrey predicted that legal debate over workers’ right to refuse jabs and employers’ duty to ensure health and safety in the workplace would reach the top court. ‘It’s a balancing issue and ultimately I think it will be up to the court,’ Jeffrey said. He speculated that it was likely the Constitutional Court would rule in favour of employers.
Short-term insurer Santam said it was considering following Discovery’s example. Private hospital group Netcare said vaccination remained voluntary for their employees.
Aspen Pharmacre CEO Stephen Saad backed Discovery’s move, saying that while he was unsure of whether he can legally introduce a similar policy at Aspen, on a personal level, he felt Discovery had made the right move and that sometimes it was “better to be a leader than a follower”. At the very least, those people who opt not to be vaccinated should be inconvenienced by getting tests every few days or once a week to show that they are Covid-19 negative, and should be blocked from certain areas without masks on.
Jo-Ann Ferreira, Discovery’s head of compliance, said the company was confident its decision would pass any legal challenge, since the Constitution makes provision for the limitation of certain rights for the safety of society.
Although no unvaccinated Discovery employee would be allowed access to the workplace from January 2022, the company said it would not automatically dismiss non-compliant employees.
Discovery SA CEO Hylton Kallner says the company will first negotiate with employees who have valid objections to being vaccinated and will dismiss employees only as a last resort.
In a statement to staff, CEO Adrian Gore wrote:
Last week we announced our intent to move to a mandatory vaccination policy effective 1 January for our SA-based employees. It received extensive media coverage and social media responses. It is a big step, and Discovery debated it at length and sought wide-ranging input. Ultimately, as a science-led organisation we feel a strong moral imperative to do this, given the need to curb the loss of life and the indisputable proof that vaccines work in doing so. I want to share our six-point rationale.
1. People are dying. We need to stop it.
We are living through an unprecedented health tragedy. Based on excess deaths data published by the SA Medical Research Council, we calculate there have been more than 220,000 excess deaths in SA due to COVID-19 since May 2020. More than 14,000 of our members have passed away, and we have experienced devastating loss of life in our own organisation. Every life lost is a life too many, and every effort to curb further loss must be taken.
With the projected onset of the fourth wave later in 2021, we must do everything we can to suppress it. Based on our actuarial projections, more than 30,000 lives can be saved if we are able to vaccinate more than 60% of our population over the coming months. We must act boldly, and now.
2. Our data are unequivocal. Vaccines work, and are safe.
Our data show vaccinated individuals have 50%-80% lower risk of infection, 70%-85% lower risk of hospitalisation and 90%-95% lower risk of death, compared with those who are unvaccinated.
In addition, our own data mirrors the international research, proving COVID-19 vaccines to be extremely safe. Fewer than one in every 20 Discovery members who received the Pfizer-BioNTech vaccine showed any signs of side effects within seven days of vaccination, and almost all were mild and resolved quickly.
In fact, the risk of adverse events post vaccination is extremely low, and as per global research is substantially lower than the risk of adverse events post COVID-19 infection. As an example, your risk of experiencing inflammation of the heart muscle because of vaccination is 73% lower than your risk of experiencing it because of contracting COVID-19 unvaccinated. To put it simply, once vaccinated you are at greater risk of dying from the normal flu than from COVID-19 (based on UK data, where more than 75% of the population is fully vaccinated).
3. There is a strong public health imperative.
People who are vaccinated pose less of a risk to others when they contract COVID-19. In fact, their transmission risk is 50%-80% lower should they inadvertently contract COVID-19. The public health imperative for vaccination at scale is therefore clear: reduce the risk of contracting COVID-19 in the first instance, reduce transmission risk, and reduce severe disease and death.
Furthermore, there is an economic argument: the cost of treating illness brought on by COVID-19, as well as the compounding cost due to missed workdays and business closures, is a cost borne by society and not the individual. The need to act in the greatest good of the public is therefore paramount.
4. Vaccine supply is no longer the dominant constraint; overcoming hesitancy is.
The government-led mass vaccination programme now has the capacity to vaccinate 400,000 individuals a day. It is free at the point of care, and there is ample stock. Unlike a few months ago where vaccine supply was the major obstacle to beating the pandemic, vaccine hesitancy is now the main hurdle.
We believe corporate SA has a strong role to play to ensure vaccination at pace and scale. Our hope is that other organisations will follow suit, with a profound systemic impact on vaccination take-up.
5. Taking the above into account, there is a clear moral and social obligation to pursue this.
Since the start of the pandemic we have attempted to assume a socially minded leadership position, in line with our core purpose to “make people healthier and to enhance and protect their lives”; and in line with our values, particularly, acting as a force for social good. In living this purpose we have deployed our capabilities to assist with vaccinating South Africans as part of the national rollout.
Taking this next step is crucial both ethically, given the scale of immune- compromised people in our country, and practically, given the degree of vaccine hesitancy being observed.
6. The law is an enabler of our policy, and not an impediment to it.
The issue of constitutionality has been raised vociferously since our announcement. Our position and approach has been vetted extensively, with wide-ranging input from various legal and constitutional law experts, and has been found to be defensible given the public health crisis and the overwhelming proof that vaccination is the single most important thing we can do to protect ourselves and others against COVID-19.
In addition, the law actually compels us to do everything possible to protect our employees from harm and ensure a safe workplace. This includes protecting employees from exposure to potential biological hazards, as required by the Occupational Health and Safety Act.
Taking the above six points into account, we are confident in our position based on the moral argument underpinning it. On top of this, the policyʼs implementation is guided by the principle of mutual respect, where all voices are heard.
The policy recognises the right of employees to object to being vaccinated and includes, where necessary and possible, exemptions and reasonable accommodation of employees. This considers the operational and business requirements of Discovery and the employeeʼs health, religious and other legal rights — seeking to balance individual rights with the right of all employees across the group. The steps we are taking to make all our buildings vaccinated-only zones include a similar appeals process.
The implementation will also include a comprehensive engagement plan — spanning education, counselling and logistic enablement — as well as the opportunity for employees to consult with clinical experts, health professionals, and Discovery and human resources leaders. The objective is to offer such compelling evidence and support during the remainder of the year that employees vaccinate voluntarily, and the mandate becomes nothing more than a filed policy come the new year.
The reality is itʼs necessary, and urgent. We are living during a devastating infectious disease pandemic. We have an accountability to provide safe workspaces for our employees and to act in our countryʼs best interest. Vaccination is our best hope of defeating the pandemic and restoring our national vibrancy and way of life.
Yes, there may be pockets of criticism and pushback, but we wonʼt shirk our responsibility to lead in this context, given what is at stake.
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