Like the rest of the continent, South Africa’s vaccination roll out has been slow and only a little over half of the country’s 40m adults have received at least one dose.

While some experts say this will limit the damage compared to previous waves, many are still predicting a grim Christmas and a potential surge of deaths as residents of Johannesburg travel to their home regions for the holiday season.

Health minister Joe Phaahla said the size of the fourth wave would depend on whether any new variant emerged and the movement of people during the festive season.

Johnny Myers, emeritus professor in public health, University of Cape Town, said: “My feeling is that the fourth wave is not going to be as bad as the third wave but not as good as the best possible experience, had we attained a high coverage for vaccination.”

However, Professor Myers cautioned that even a 50 per cent reduction in mortality in the fourth wave compared to the third wave would lead to about 55,000 deaths: “So we’re still talking about a serious situation.”

Vaccine hesitancy is emerging as a big problem in South Africa and Prof Myers said religious leaders need to be engaged. 

“There needs to be some policy approach to try to motivate religious leaders … who really have the best interests of their congregants at heart, to engage with the other religious leaders, of whom there are many, who have an anti-vax orientation.

“That could in fact trickle down to the congregations as well. There has to be engagement there because there’s a massive problem in that area,” he said.

Shabir Madhi, professor of vaccinology at the University of the Witwatersrand, Johannesburg, slammed the government for giving vaccines to 12 to 17-year-olds, saying that they should instead be prioritising boosters for older South Africans.

“Those vaccines should be used for people above the age of 60 who already received two doses because they are not adequately protected,” he said.

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