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Time to substitute evidence for emotion about vaccine delays

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OP-EDS

This week, a balloon of hope that thousands of healthcare workers would be well on their way to long-awaited immunity against COVID-19 was deflated as the government announced it wouldn’t dispense the one million doses of the Oxford/AstraZeneca vaccine as planned. The vaccine’s efficacy against the 501Y.V2 South Africa variant was unveiled at just 22%.

As this development was announced, my Facebook feed became increasingly flooded with frustrated community members calling out the “inept” government for buying one million vaccines that now need to be thrown away. “Typical South Africa!”; “Trust our country to get it wrong!” These were the comments attracting the most attention.

My mind went to a mere six weeks ago, when I followed a webinar in which Professor Barry Schoub, the chairperson of the COVID-19 Ministerial Advisory Committee on coronavirus vaccines, said that the government would be taking its time to evaluate the most appropriate choice of vaccines and rollout approach in view of the complexities of the population and variants here. This would be in contrast to countries like Israel that had already dived into a mass rollout. Interestingly at the time, I also came across similar “typical inept South Africa!” comments.

Aside from the apparent cynicism that has grown in our society – perhaps from inconsistency in public policy in so many facets of public life, COVID-19 being no exception – I believe a real understanding of levels of evidence of medical research is needed here. Sound medical decisions are informed by evidence. Evidence is graded into seven levels: randomised control trials occupying levels 1 and 2, control trials without randomisation level 3, case controls level 4, large reviews level 5, single studies level 6, and expert opinions level 7. So, without getting too technical, when you visit your doctor and (s)he tells you (s)he strongly believes in a new supplement, it may be a level 7 at most.

The risky and expensive process of rolling out millions of vaccines across South Africa ought to be informed by the highest level of evidence – randomised control trials (RCTs). An RCT involves recruiting thousands of volunteers and randomising them to two groups: one that receives the vaccine and one that doesn’t. However, the volunteers ought not to know who is in which group lest their preconceived beliefs and subsequent behaviour play a role in the outcome of their results.

In the context of a COVID-19 vaccine, to test whether an Oxford/AstraZeneca vaccine would work on our population, thousands of people needed to be recruited and randomly assigned to either a placebo or a real intervention group, and then followed for months to see whether there would be a difference in incidence of COVID-19 infections between the groups.

South African mainstream medical scientists have, thankfully, always been focused on these principles with a deep commitment to recommending interventions that do no harm and work scientifically. COVID-19 has been no exception to this. So, the above process was followed.

The Wits Vaccines and Infectious Diseases Analytics (VIDA) Research Unit has run the Oxford COVID-19 vaccine trial in South Africa for months, and has raced ahead to produce results as quickly as possible. It so happens that because of the immune pressure on the SARS-CoV-2 virus to survive amongst a relatively already exposed population, the virus mutated in November 2020.

It was only due to the rigorous efforts of units like VIDA that South Africa identified the variant so quickly and soon began to evaluate whether the Oxford/AstraZeneca vaccine would work here. It also soon became apparent that 95% of all cases in the second surge of the pandemic were, indeed, this new variant.

Stuck between a rock and a hard place of procuring stock while still awaiting results, the government secured its first shipment and cautiously forged ahead. Telling results have now followed, just before implementation.

We are all deeply disappointed by the failure in the efficacy of the Oxford/AstraZeneca vaccine against our local strain of COVID-19. But we should be equally encouraged by our scientists’ and the country’s commitment to balancing swift action against evidence-based results, which unfortunately takes time to unravel.

With this mindset, let’s take a moment to reflect on what we now know about COVID-19 in February 2021 that we didn’t know six or eight months ago through this evidence-based lens:

1.    The 501Y.V2 variant of SARS-CoV-2, causing COVID-19, was detected in the Eastern Cape in November 2020. It accounts for 95% of infections in South Africa today. It’s more transmissible than its predecessor, the original SARS-CoV-2 virus. (High-level evidence.)

2.    The Oxford/AstraZeneca vaccine showed 70% efficacy against the original strain. A high standard trial showed only 22% effectiveness against the variant. This was for mild and moderate illness only though. (Level 1 – RCT on young, healthy people). (High-level evidence.)

3.    The Oxford/AstraZeneca vaccine’s efficacy against severe disease in South Africa is still unknown and being determined. (High-level evidence.)

4.    The Johnson & Johnson vaccine, which is a single-dose vaccine, showed a 82% efficacy against the original strain. This dropped against the variant to 57%, but the number remains high against preventing serious disease, hospitalisation, and death, even against the variant – 83%. This is very important. (High-level evidence.)

5.    Pfizer, Moderna, and Sputnik vaccines may achieve similar results against the variant. No trials have been released on them yet.

6.    All these vaccines are safe. The question remains which are effective in the South African context. (High-level evidence.)

7.    The second wave in South Africa is almost over. The R value is 0.43 at the moment. This means we are in a recovery phase. This is the lowest the R value has been since the pandemic began. (Middle-level evidence.)

8.    A third wave is probable – soon. As early as April – June. This is probably inevitable. (Low-level evidence – expert opinion.)

9.    The extent of the third wave is determinable by preventative, non-pharmacological behaviour. (High-level evidence.) Masks and social distancing are definitely here to stay for the next year at least. (Expert opinion – low-level evidence.)

10.  COVID-19 can be contracted twice – particularly with different variants being present. (High-level evidence.)

11.  COVID-19 is likely to last for the rest of our lives and become endemic. However, with the correct vaccination, its clinical effects can be attenuated and it will hopefully tend towards a more common cold. (Low-level evidence. Expert opinion.)

Let’s take a feather out of our South African scientists’ hat, salute our government for its transparency and its approach to following the science, and put up with the unexpected hurdles along the way.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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1 Comment

1 Comment

  1. Ray

    Feb 21, 2021 at 4:40 pm

    Lets be clear, the government is not following “the” science they are following “their” science

    The W.H.O. arrivied at a different conclusion using their science.

    While the dosing has to be figured out on the AZ vaccine, its undisputed that the vaccine promotes a very healthy immune response and is highly likely to prevent severe illness or death. Meanwhile boosters will be adjusted for new variants in the next few months.

    The vaccines should have been given out amd not wasted (my parents would have been grateful to get one), and this could cost thousands of lives in the next wave to a millon people who could have had protection from severe illnes

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Israel

Why Benjamin Netanyahu treats the Jewish media with contempt

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(JTA) Whether this week marks the last of Benjamin Netanyahu’s record-setting tenure as prime minister or is just a prelude to another never-count-him-out comeback, it seems a fitting moment to try to understand why he has consistently treated diaspora Jewish media with disdain.

It’s something I’ve experienced personally on several occasions, and may well reflect the prime minister’s attitude not just toward the Jewish press but toward American Jewry in general.

It seems ironic, if not baffling, that Netanyahu would be rude to the one group of journalists who are most sympathetic and accommodating. But then he is a man of many contradictions, with remarkable skills and ugly traits, towering oratory, and gutter-level charges, and great success in protecting Israel from outside threats while allowing the weakening of Israeli society from within.

I have interviewed the prime minister one-on-one in his Jerusalem office, attended a number of meetings he’s held with the press, and heard him speak many times in the United States (US) and Israel. Perhaps the most illuminating example of his contradictory behaviour dates back to a visit he made to the US when he first served as prime minister, from 1996 to 1999.

During that visit 25 years ago, Netanyahu’s staff scheduled back-to-back sessions for him with two separate groups of journalists in a small conference room at his Manhattan hotel. The first group consisted of about a dozen major media figures, including the network news anchors of the day and A-list reporters. The second meeting was with the same number of editors of Jewish newspapers from across the country.

As editor and publisher of The Jewish Week, I was invited to the second meeting. But thanks to an influential friend at the local Israeli consulate, I was allowed to attend the first meeting as well, though I was asked to keep a low profile.

When Netanyahu walked into the room with the media notables seated around a table, he was warm, friendly, and upbeat from the outset. He greeted them individually by name, shaking hands, making small talk as he moved gracefully around the room. During the session, he handled questions with aplomb, on point, articulate, and used colloquial expressions at times – it was easy to forget that he was the leader of a foreign country. He was thoroughly charming.

About 15 minutes after the meeting, while Netanyahu was taking a break, my Jewish media colleagues were ushered into the room. When we were settled in, the prime minister re-entered and immediately sat down at the head of the table. No schmoozing this time. He was all business and began, “OK, ask me your questions.”

A bit taken aback by the abrupt opening, the chair of our delegation asked if it would be all right for us to introduce ourselves briefly, stating our names and professional titles. Netanyahu agreed. When it was my turn, the prime minister looked closely at me and said, “You look familiar.”

I said, “I was with the first group here as well.”

What I wanted to add was, “I saw how engaging and friendly you can be if you want to make the effort. What’s your problem?”

For a split second, Netanyahu seemed a bit taken aback, but he just nodded and the introductions continued.

The mood of the session couldn’t have been more different to the earlier one. Though he was in the presence of loyal, influential Zionists who treated him with great respect, the prime minister was curt, contentious, and clearly couldn’t wait to be done with us.

“Ask me your questions.”

A few years later, when I was in Israel, I was granted a one-on-one interview with Netanyahu in his Jerusalem office. I was ushered in by an aide who announced my name as I sat down in a chair facing the prime minister. He wore a leather bomber jacket and was seated at his desk, reading through a document in front of him.

“Go ahead, ask me your questions,” he said without looking up. He was using a yellow outliner pen to mark his reading material.

I wasn’t sure how to proceed and waited for him to make eye contact. After a moment, he repeated his request. I waited again – it felt like minutes but was probably only a few seconds – before proceeding, reluctantly, with the interview.

I don’t remember the details of what transpired, only that I was thrown by Netanyahu’s rudeness, and that the agreed-on 45-minute session ended abruptly when an aide came in to announce that the prime minister was needed for a pressing matter. It seemed prearranged; the prime minister got up and followed him out of the office without a word or gesture to me.

One more: five years ago, at a Jewish media conference in Jerusalem I attended with dozens of colleagues from the US, Europe, and South America, Netanyahu addressed our group and was ornery from the outset. His manner was challenging and dismissive, interrupting the moderator, the Forward’s Jane Eisner, and suggesting alternative topics. At one point, he evaded a question about his government’s relations with American Jewry and responded, in effect, “Why not ask me about Israel’s impressive dairy output?” He then waxed eloquent on the subject, and had an aide display a chart on the wall with statistics about Israel’s prolific cows.

“After the session ended, some of the women journalists in the room were furious, sure that he acted as he did because I was the moderator,” Eisner wrote. “I appreciated their support, but male colleagues tell me that Netanyahu can be similarly dismissive to them, too.”

How does one explain this behaviour?

I turned to two close colleagues and veteran Bibi watchers – journalist and author Yossi Klein Halevi in Jerusalem and Mideast expert David Makovsky in Washington – and asked why they think Netanyahu treats the Jewish media so shabbily. Is it because he doesn’t respect us as journalists? Or because he believes that diaspora communities are less relevant to Israeli politics? Or neither, or both?

“Bibi treats his friends worse than anyone,” Klein Halevi responded, “which is why, at the end of the day, he doesn’t have any. He takes them for granted and abuses their trust. That’s why this new government is being led, in part, by three of his former closest aides,” Naftali Bennett, Avigdor Lieberman, and Gideon Saar.

“The American Jewish media was simply in his pocket,” Klein Halevi continued, “or so he assumed, and he could treat them with the special contempt he reserved for those on his side.”

Makovsky believes Netanyahu views the diaspora Jewish media in the larger context of his attitude toward American Jewry – seen as declining dramatically in relevance.

On a practical level, he noted, diaspora Jews don’t vote in Israeli elections and so are “less central for his [Netanyahu’s] purposes to cultivate”. Similarly, the prime minister focuses mainly on Israeli media, which he views as either for him or against him, so the diaspora media is less important.

The prime minister has told those who meet with him privately that with the exception of the Orthodox, “American Jews will last another generation or two … due to assimilation and low fertility rates,” Makovsky said. “This has enabled him to discount the liberal attitudes and voting trends of non-Orthodox American Jews and not think of the impact of a few of his policies on the relationship.”

In addition, Netanyahu has said in private that as long as he has the support in America of evangelical Christians, who vastly outnumber Jews, and the Orthodox Jewish community, he’s in good shape.

We’ll know in the coming days the shape of Netanyahu’s immediate future. But even if the “change” coalition is sworn in, no one who knows Bibi Netanyahu believes he can be counted out.

  • Gary Rosenblatt was editor and publisher of “The Jewish Week” from 1993 to 2019.

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OP-EDS

Pull up masks for the third wave

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With the plummeting temperatures across South Africa, our community has once again descended into concern and despair as new COVID-19 infections skyrocket. This round seems even closer to home.

My cell phone is once again saturated with COVID-19 contact questions. For me, it has been a week of encouraging maximal caution among community members against the backdrop of having witnessed the devastating bereavement that this virus has recently unleashed on a few patients and close friends.

We need to understand that pandemics are dynamic. In the first article I wrote for the SA Jewish Report in March 2020, I spoke of a predicted short-term future of “pumping the breaks on social distancing” by epidemiological experts. These is precisely how this pandemic has ensued. South Africa is well into its third surge, and this is the time for this “pumping”. Let’s give some context.

As of 7 June 2021, there are 21 700 active cases in Gauteng alone, a number that’s probably better estimated as 31 000 due to untested individuals. Over the past seven days alone, there has been a 36% increase in cases. Most notably, the positivity rate of cases has increased from <4% to >13% in just a couple of weeks.

The Jewish community, unfortunately, outshines these humbling statistics, with 235 new cases loaded on the Hatzolah Wellness Programme in the past week (1 to 8 June 2021). This is more than its maximum number of cases at the peak of both the first and second waves. My own practice has admitted more COVID-19 patients to hospital in the past month than it has admitted over the past six months.

Another change in the dynamic of this wave is the astounding transmissibility amongst children. I clearly remember the claims of “COVID-19 doesn’t affect children” last year. This week, I have diagnosed COVID-19 in several young children under the age of seven.

However, let’s not despair that this picture was unexpected, nor that we are ill-equipped to deal with it. Let’s understand that it’s in our power to curtail the pandemic and overcome it.

On a societal level, there are several vaccines emerging on the market that have each shown demonstrable efficacy against serious disease. It’s important to understand that breakthrough infections may still be reported after vaccination, but the level of immunity attained by the vaccines has shown impressive results against serious disease and death across all variants, including the South African variant.

In the world’s history of viral outbreaks, there has been a pattern of viruses mutating into variants that are clinically milder, although endemic, and which haven’t imposed ongoing significant risk to life. It’s thought that the Russian flu of 1889 was most likely a coronavirus itself which mutated into a more tolerable disease that eventually abated without a vaccine! Even in our own lifetimes, we have seen the famous H1N1 “swine flu” impose less of a real threat to individuals each year, in spite of the fact that this virus is far from eradicated and still rears its head each winter.

Professor Barry Schoub, virologist and the former head of the National Institute for Communicable Diseases, explained to doctors on an online education webinar this week that the goals and likely outcome of the vaccination programme isn’t to eradicate COVID-19 but rather to convert the SARS-COV-2 virus into just another coronavirus that, at most, causes mild disease. This goal is reachable and probable.

On the ground, we have learnt over the past 16 months how to drop the number of new infections quickly. The old thinking was “stay home, save lives”. The new thinking is “don’t let your guard down, even with your most trusted friend”. I have had a plethora of patients recounting to me recently that they were infected by “a harmless interaction”. During previous peaks of this pandemic, we have learnt that the attention to simple details like interacting with loved ones with masks religiously worn, wearing the masks properly, interacting in only well ventilated spaces, and not participating in unnecessary shared meals have each been paramount.

There is, indeed, understandable COVID-19 fatigue after 16 months of social curtailment, but it’s important to realise that previous peaks have been short lived and the prediction is that in six to eight weeks, we’ll once again be able to relax some of these measures.

The biggest question at the forefront of most lay people’s minds at the moment is, “Will this pandemic ever end?” We can be deeply grateful for the formidable achievements of Israel, the United Kingdom, and the United States (US) amongst other developed nations that have answered this question with a resounding “yes”. The US, with a population of 328 million people, has vaccinated 52% of its population. Its infection rates have decreased from 208 000 new cases per week in January 2021 to 14 000 per week in June 2021. Israel, which has vaccinated about 60% of its population, recorded its first day this week with zero new cases in spite of conducting 7 575 tests on the same day. Israel’s positivity rate is now 0%, with only a handful of active cases in the country, and Israelis are no longer are required to wear masks in outdoor public spaces! Developed countries and past pandemics have taught us that this pandemic will indeed end.

So, what is the week’s take-home message? We must understand that prevention is better than cure. We can relatively easily prevent COVID-19 infections; to cure complicated patients is far more challenging. Let’s pull up our socks for the next few weeks and bring the infections in our community under control. Let’s look forward to future widespread vaccinations that will indeed eventually be offered to all adults, and we really can look to a brighter future without the overhanging clouds of COVID-19.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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OP-EDS

Jews should draw a line under latest social-media pogrom

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It’s a cold autumn night in Johannesburg. I lie on my bed preparing for my pending aliyah, my laptop resting on my thighs, writing. Suddenly my phone vibrates, I continue, it vibrates again, I focus on these words, the third buzz grabs my attention, and like most of us today I can’t stop myself from running to check the latest notification. Is it work? A friend? Maybe a funny meme worth sharing to the family group? No! It’s a vile message of hate, one I have become all too accustomed to as a Jewish and Israel-rights activist.

Over the past two weeks, there has been a silencing of Jewish voices across platforms with verbal violence that can be described only as a social-media pogrom. The terms used to demonise Israel such as “apartheid”, “genocide”, and “ethnic cleansing” have been meticulously designed to silence Jews. In a world where cancel culture is the modus operandi, the Jewish state is being spun into a web of lies designed to cancel us from the conversation.

What we are experiencing now is nothing new. Jews make up 0.2% of the global population and yet we find ourselves, once again, on the other side of an obsessive, vicious campaign of lies. Every time antisemitism re-enters society, it masks itself as social justice.

It’s sold as speaking truth to power. It functions by turning the Jew into whatever a given society hates or fears most. Under Nazism, the Jew was the race contaminator. Today, when the greatest sins of the world are racism and colonialism, Israel, the Jew among the nations, is being demonised as the last bastion of racist colonialism.

Antisemitism will always be a political question. Atrocities against Jews didn’t succeed because individuals didn’t like Jews, it was because political movements convinced the public that stripping Jews of their rights was in their best interest. To achieve this without any pushback, antisemitism is hidden in plain sight. This is why from the Middle Ages until now, antisemites have said they weren’t antisemitic just anti-Hebrew, anti-capitalist, anti-globalist, and of course the all-too-familiar anti-Zionist.

It’s interesting for me that Jews are coined “colonisers”. Native peoples can’t colonise their indigenous homeland and aren’t referred to as foreigners or settlers. The West is attempting to turn history’s most successful indigenous rights liberation movement – Zionism – into settler-colonialism.

It’s proof positive that the far left’s form of antisemitism is rooted in projecting its own white societal guilt from the past onto the Jewish people and our self-determination. Thousands of years of historical and archaeological evidence show that Judaism and the beginning of the Jewish people began in the kingdom of Judea and Israel. After Roman colonisation about 2 000 years ago, ethnic Jews were exiled from their ancestral homeland and subsequently settled in every corner of the world.

In an act of blatant neo-colonialism, the American story is viewed as the universal prism through which all societies must be understood.

Completely ignorant of the specificities of Israel/Palestine, these neo-colonialists fit the square peg of the conflict into the round hole of American history. Jews are bizarrely cast as the white oppressor, and Zionism a movement of white supremacy, while Arabs who look exactly like Israelis are cast as people of colour.

This blind and seemingly ignorant superimposition of American racial politics must not be mistaken for naivety, it’s purposeful and dangerous as it normalises antisemitic attitudes in society.

The effect of this has been seen and experienced by us all with the recent violence. We are living in an era of white versus black, straight versus gay, oppressor versus victim. The allowance for nuance and complexity seems just not to exist anymore. I’m beginning to suspect that it’s not that attacks on Jews in the West are the unfortunate and unintended consequence of the persistent demonisation of Israel, but rather the demonisation of the Jewish state is undertaken so as to re-legitimise attacks on Jews in the West.

Denial is the weapon of choice for many antisemites. They deny the Holocaust, deny the ethnic cleansing of Jews in the Middle Eastern Arab states, and now they deny that we even originated from the Middle East.

With a 500% increase in antisemitic attacks in the past two weeks, the silence of the non-Jewish world is deafening, but history shows us not shocking. On an emotional Monday morning during the conflict, I wrote this on social media to many of my non-Jewish friends who had engaged with misinformation, the spreading of antisemitic tropes or anti-Israel bias: “You sat at my Shabbos table. You listened to us sing ‘Next year in Jerusalem’ on Passover. You ate my apples dipped in honey for a sweet new year. You told me how much you love challah. You love hummus, you love bagels, you love Jewish humour films. You are a humanitarian, an anti-racist. You are against hate. You walk with BLM. You march for gay pride. You love everything Jewish besides for Jewish people. You are silent! Replace the word ‘Zionist’ with ‘Jew’, and one can understand how the Nazis successfully killed 2/3rds of the Jewish population with the help of millions of regular everyday citizens.”

We must no longer try to convince anybody of our humanity. We know our humanity. We are no longer interested in false interpretations of our history. We know our history. In solidarity as a community, we must now say, “No more! In the spirit of our ancestors, we are once again resolved to take charge of the Jewish destiny.”

From generation to generation, we were unwelcome guests in the diaspora. An annoyance to the world like a mosquito buzzing in the dark, and that’s where they are right, we are an annoyance. The non-Jewish world has done everything in its power to isolate us from the orders of society, and time and time again, we revolutionised those very orders.

Abraham with his one G-d, Moses with his ten commandments, Jesus with his second cheek ready for the next slap. Einstein. Kissinger. Kafka. Marx. Herzl. Ben Gurion. Meir. I truly had hoped the rise of intersectionality would chant from corner to corner in solidarity with Jews – “lesson learnt: never again”. But that never happened.

Again, we are alone, but this time not from nowhere, we are from where we always have been, Israel, our home. Zionism has given us as a community the space to be liberated from millennia-long persecution. When we were sold into slavery out of Israel, our ancestors made a promise to one day return us home. We are the ones lucky enough to live their dream. It truly is a miracle of biblical proportions. Cherish it. Nurture it. Am Yisrael chai – the people of Israel live.

  • Samuel Hyde is an audio engineer/music producer and a Jewish and Israel-rights activist. He worked at the Cape Town Holocaust & Genocide Centre educating youth on antisemitism and its function in society.

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