Experts broadly positive about digital vaccination certificates
Last week the National Department of Health announced plans to issue digital vaccination certificates to people who have received COVID-19 jabs. While the details were sparse, Minister of Health Dr Joe Phaahla said that the certificates will become available in “just over a week or so”.
But on a press conference this morning (17 September) Phaahla said that a team in the department is still working on the certificates and that an implementation plan will be presented to the National Coronavirus Control Council in the next ten days. He also said that other government departments such as home affairs will be involved in the process since this is not an undertaking the department can do on its own.
What we know so far
During last week’s press conference, Phaahla announced that the digital certificate will be in line with the World Health Organization’s (WHO) guidelines.
The WHO issued a guideline document on 27 August, outlining the implementation of digital vaccination certifications that contain an individual’s COVID-19 vaccination status, to support member states in adopting “interoperable standards for recording vaccination status”.
The WHO document stated that digital certification might take the form of barcodes, QR codes, or more advanced systems using mobile phone applications.
Phaahla said that vaccinated individuals who have been captured on the EVDS system (presumably almost everyone who has been jabbed) will be given access to a digital certificate that can be downloaded on a smartphone and that can also be printed. Phaahla’s indication that the certificate can be printed suggests that a printable barcode or QR code solution will be made available.
Phaahla also reassured the public that the certificate will not be required to gain access to public or essential services, but may be needed to access some entertainment, sports, and other events. He reiterated this point this morning, stressing that people will not have to show vaccination certificates when visiting government clinics or SASSA pay points.
He also explained that government is providing a “platform” or “facility” with the certificates. It will be up to universities, employers, sporting organisations, and so on to decide whether or not to make use of the platform to limit access based on vaccination status. “We will not interfere with institutions’ internal policy. The aim is not to punish anybody, but to protect each other,” Phaahla said.
Whether the certificates will be able to prove vaccination status when travelling abroad and exactly how this would work is not yet clear.
President Cyril Ramaphosa, in an address last Sunday evening, also referred to these certificates. He said further information would still be provided on so-called vaccine passports that can be used as evidence of vaccination “for various purposes and events”.
“The Department of Health is looking at a variety of mechanisms like they have in other countries to either do it electronically through a cell phone or some other form of demonstration,” he said.
Spotlight asked the National Department of Health for more information. Spokesperson for the Department, Foster Mohale said prior to the press briefing that the matter was still under discussion and that a public announcement will be made in the next week or two once all the systems are ready.
Certificate not controversial but its use may be
Andy Gray, a senior lecturer in Pharmacology at the University of KwaZulu-Natal said he welcomed the chance to have electronic and secure documentation of vaccination that is compliant with the WHO’s standards.
Gray explained that the certificate itself is not controversial as it is similar to the yellow fever vaccination certificate required for some international travel, but the use of the certificate could be problematic, particularly since only a small percentage of the country has been vaccinated.
By 15 September, the National Department of Health’s vaccination dashboard showed only 28.16% of the adult population had received at least one COVID-19 shot.
Gray added that the certificate may be used to limit access to certain venues or activities, which could be an acceptable incentive to get vaccinated, but only once a larger proportion of the population has been vaccinated.
“It is only viable once there is a high level of access to vaccination. It can be used appropriately as an incentive (to get vaccinated)… but care must be taken to avoid it being used in a discriminatory way, especially against those denied access to vaccination,” he said.
Public health lawyer, Safura Abdool Karim was also in favour of the certificate and said it was an important first step in being able to verify someone’s vaccination status in real-time. She added that a digital certificate will be less vulnerable to fraudulent copies than the current cardboard vaccination cards currently being issued.
According to Phaahla, “from a government perspective, [they] want to make available the certificate and make sure it has good protection and that it is reliable information derived from the EVDS”. “So when the certificate says you’ve had one Phizer dose, it must be real. When you update on your phone, the certificate will upgrade you to say now you’ve had two jabs.”
Distinguished Professor and Bioethicist at Stellenbosch University, Keymanthri Moodley also welcomed the announcement and said it will increase vaccine uptake.
“It is a move in the right direction. By requiring proof of vaccination, vaccine uptake will increase and more people will be protected from serious disease and death,” she said. “We can re-open our economy. It’s a win-win scenario for all. A public health ethics approach supports this development. The benefits outweigh the disadvantages.”
She cited several benefits, including improved vaccination uptake which will prevent serious illness, hospitalisation, and death. This, in turn, says Moodley will reduce strain on the healthcare system and improve the safety of healthcare workers, and allow healthcare facilities more space to treat non-COVID patients.
Digital format must not exclude those without access
Public health specialist and President of the Public Health Association of South Africa (PHASA) Dr Harsha Somaroo said that using a digital platform to show proof of COVID-19 vaccination is in keeping with international trends.
“However, I think that South Africa needs to have a hybrid approach to this. [For example] despite the availability of the digital option, we need to continue to issue paper vaccination certificates, as [fewer] than 50% of the population use a smartphone,” she said.
“If the electronic format excludes some people such as those without access to a smartphone, that is a concern,” Gray said. “It remains to be seen how the National Department of Health will manage access for those without smartphones, in particular.”
According to Moodley, the concerns about lack of access due to the certificate being digital can be addressed by having a paper-based certificate with a barcode that can be scanned (similar to our ID cards).
She added that in the extremely rare case that someone is not able to be vaccinated against COVID-19 for a medical reason, regular COVID-19 tests could be required to access indoor or high-risk venues.
Phaahla on Friday morning said that people will also be able to get the printout at the nearest vaccination sites where there are printing facilities. “If there is no printer, they will have to refer you to where you can get it printed, so it is not just for those with smartphones.”
More information needed
According to Somaroo, while a digital vaccination certificate that complies with the WHO standards is proactive and will likely support more international travel to and from South Africa, more information is needed.
“It would be important to understand the costs and resources involved, that it does not disadvantage anyone, and the background to how this strategy was judged to present an overall benefit for South Africans,” she said.
Somaroo also said it is essential that the government issues clear guidelines around the digital vaccination certificates and how these should be used to avoid inequities or impacting the rights of people who don’t have access to a smartphone.
Karim cautioned that concerns may emerge regarding the policies implemented in relation to the certificates.
“We are going to need to think very carefully about how these certificates are used,” she said.
According to Karim, concerns could include discrimination against those of lower socio-economic status, abuse by private actors, or use that violates human rights to an unjustifiable degree.
‘More important issues’
Russell Rensburg, Director of the Rural Health Advocacy Project, told Spotlight that he thinks the digital certificates are merely an administrative issue and while a lot of people care about these certificates, it is distracting us from more important issues around the country’s COVID-19 vaccination efforts.
“I don’t want to be dismissive; I just think we should be focusing our energies on getting at least the most at-risk population fully vaccinated and our conversation does not need to get distracted from that,” he said.
“I don’t think we’re talking enough about breaking down the data, understanding who is not taking it (COVID-19 vaccination) up – whether it’s vaccine hesitancy or access. We can’t just assume that its vaccine hesitancy… it could be other things,” he said.
He cited possible reasons for a lack of vaccine access as a lack of transport, not being able to wait the whole day for a vaccine, or vaccinations occurring primarily at health care facilities instead of community centres.