All people aged 60 or older who get their first Covid vaccination in November will automatically receive a R100 grocery voucher redeemable at Shoprite, Checkers or U-Save supermarkets across the country.
The “Vooma Voucher” will be sent via SMS to the cell number used to register for vaccination and will be triggered as soon as the process is complete.
The aim is to make it as easy as possible for unvaccinated older people to come forward before the fourth wave hits – probably early in the new year.
We must do everything we can to crush its mortal power. More than 80% of all Covid-related deaths in South Africa have occurred in people older than 50, and 60% in people aged over 60.
For every one death, there have been four admissions to hospital. Each hospitalisation for serious or critical Covid infection costs the public health sector an average of R75 000 and the cost to families and the broader economy is far greater.
While the vaccination itself is free, people still have to get there and even paying a taxi fare may mean that the family goes hungry that day.
One of the findings from the vaccination site visits conducted by the department of planning, monitoring and evaluation is that older people complained of hunger and lack of food as they waited in the queues.
Often, cost is just one issue keeping people away, but it may just be the deciding factor when it mixes with the other anxieties that make people hesitant.
This is why, with the support of a five philanthropic foundations, the department of health will pilot the provision of small incentives to reduce the cost to the client of vaccination.
A number of other countries have tried incentives as a way to boost vaccination uptake. The most successful seem to be those that offer a small guaranteed reward rather than the chance of winning big in a lottery.
This is the logic of the voucher – an immediate and tangible benefit for everyone in the target group.
This pilot is being implemented now because vaccinations among people aged 60 and above have pretty much flatlined, with 6 000 jabs a day in this age group compared to 80 000 at the height of the rush, when the programme was first extended to older people.
Three out of five individuals (62%) in this age group have now received at least one vaccine dose but at the current rate, we will end the year with close to two million of people over 60 still at risk for serious infection and death because they haven’t yet had the jab.
Arguably, the main problem now is not a lack of information, but sufficient motivation in the face of life’s daily trade-offs and worries.
As it stands, the vast majority of those 600-plus and unvaccinated (87%) do not have medical aid. Given South Africa’s wealth profile, this is to be expected but it suggests that transactional costs related to transport and sustenance may be a significant factor in hesitation.
The massive publicity around the first Vooma Vaccination Weekend at the beginning of October spurred 34% more people than expected to come forward for vaccination – but the added “Vooma” was more appealing to younger people.
Rates of participation by older people did not budge, which strongly suggests that pumping more messages at them is not going to drive uptake above the critical thresholds needed to keep our economy open during the fourth wave.
This strategy is not without risk. There may be some offended by the fact that they have already gone for vaccination and so are not eligible for the grocery coupon.
However, by far the gift of greatest value is the vaccine itself, which has spared many of them hospital costs and family trauma.
Others may criticise the ethics of rewarding those who have “done the right thing”, but they should not forget that many of the 150 000 people aged 60 and older who have died of Covid were caregivers of young children or the main contributors to household income.
It seems churlish to wrangle over the ethics of a R100 grocery voucher if its incentivising power prevents serious illness and death.
Experience across the world is that marginalised communities are less likely to seek healthcare even when access does not appear to be a major problem.
We have had similar experiences here, too. Where buses and taxis have offered free rides to vaccination sites, the uptake has been poor.
These realities belie the notion that supply-side approaches to healthcare are sufficient and “willingness to travel” is as important as access to transport.
Perhaps a more valid concern is that provision of incentives now may disincentivise people to come for booster shots.
While this may be a real concern, the very purpose of the voucher is to level the playing field – to bring in those who are unsure about a first dose.
We know that once people have received a first dose they are more likely to come for a second jab.
Mental barriers to vaccination are not as high the second time around.
- Harrison is the CEO of the DG Murray Trust. He is currently leading the demand acceleration strategy for the national department of health.