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Slow registration delays South Africa’s vital vaccine roll-out

Low registration for the Covid-19 vaccination by people aged 60 and older means either too few or too many doses of the Pfizer vaccines are being delivered to vaccination sites, according to Stavros Nicolaou, who leads the Business 4 South Africa Covid initiative and works with the health department.

And about one million doses of the Johnson & Johnson (J&J) vaccines are being held back at the Gqeberha factory.

The net result is a delay in the vaccination of vulnerable older people who made up the bulk of deaths and hospital admissions in the last variant-driven wave.

“One of the biggest hiccups is aligning stock against the Electronic Vaccination Data Registration System (EVDS). When registration is so low, the stock is parcelled out accordingly,” said Nicolaou.

An example of the negative effect of the supply/demand conundrum is that, as of 24 May, the department of health’s list of vaccine sites showed just 18 Clicks Pharmacies branches whereas Clicks initially said it had 51 sites. 

The demand/supply equation varies wildly from site to site. Instead of going to EVDS-designated private vaccination sites, many frustrated people are visiting public sector sites where some are accepted upon mere display of their identity documents. This move has been celebrated by many experts including Glenda Gray, chief executive of the South African Medical Research Council and Sisonke trial roll-out principal investigator, who said as many people as possible needed to be vaccinated as soon as possible.

Helping the uninsured

Nicolaou said: “We also need a system to enable uninsured people to arrive at private facilities — we really need to get that right. At least there’s been a scale up from a very slow start on May 17, with 52 000 people vaccinated on Tuesday, 25 May, which represents a significant step up.”

From 24 May, the two-dose Pfizer supplies began arriving weekly 630 000-dose batches.

But the only vaccine currently available is Pfizer. 

Johnson & Johnson (J&J) committed to supply 1.2-million doses of its vaccine to South Africa — through the “fill and finish” Gqeberha factory — from the end of April and another 900 000 from the end of May. But 1.2-million J&J vials have been held back for safety reasons at the factory since May 17, the phase 2 roll-out inception date. 

This freeze has been caused by a single lapse in infection control involving antigen vials manufactured in Baltimore in the United States and shipped to the Gqeberha factory. Although J&J has now taken over the running of the emergent facility in Baltimore, the US Federal Drug Administration has put a global freeze on any further distribution as a safety precaution.

Gray said: “I don’t know if they fully realise the impact it has on countries like ours, where we’re dependent on just two vaccine brands.”

Nicolaou said that some roll-out relief will come from the ministerial advisory committee decision to administer the second required Pfizer dose 42 days, instead of 21 days, after the first jab. Trials had shown that, barring any cold-chain breaks, this delayed second dose had equal efficacy.

“We’ll keep scaling up with a view to getting between 250 000 to 270 000 out per day from July onward. If we can do that, we can meet the 40-million herd immunity target by the first quarter of next year,”’ he added.

Release of J&J supplies ‘critical’

Government and private sector sources said it was becoming “critical” that the J&J supplies are released as soon as possible. 

Alex Welte, of the South African Centre for Epidemiological Modelling and Analysis research centre, said studies showed that Covid-19 vaccines had better “cross reactivity” (protection across strains) than natural infection – but with vaccinations at 1% of the population, this was of little help.

 “Also, we don’t have any strong evidence I’m aware of that the variant has changed, so I don’t think we need to ‘catastrophise’. There must be some blunting of the wave via natural immunity. I’m cautiously optimistic but we mustn’t drop our guard,” he added. 

Welte said although increased restrictions were inevitable with a second wave, if schools closed down again it would be an educational catastrophe. 

“Hopefully, the government’s counter-measures will be proportionate to the need,” he said.

He agreed with infectious diseases expert Ian Sanne that social distancing, wearing a mask and hand-washing and sanitising were the most powerful levers currently available to mitigate an infection surge. 

Shabir Madhi, a top vaccinology researcher and dean of the Faculty of Health Sciences at the University of the Witwatersrand, said the single most effective tool to slow the rate of transmission was to avoid indoor spaces, especially those that were poorly ventilated. 

“It doesn’t make sense to sanitise as you enter a mall and then sit down at an overcrowded restaurant where nobody is wearing a mask,” he said.

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Chris Bateman
Chris Bateman is a freelance journalist

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