In late March, Johnson & Johnson’s (J&J’s) Covid-19 vaccine was authorised for use, with conditions, in South Africa. Five months later, the country has received a mere 4 264 400 (13.6%) of the 31.2-million doses it has procured — and only 3.2-million doses will be delivered in September, according to health department figures.
This means that by the end of this month, South Africa would have received about a quarter (23.4%) of its J&J supply — if J&J delivers the doses on time (we’ve seen several delays over the past few weeks).
Why is the J&J supply so crucial?
The jab requires only one shot and has less stringent storage requirements than Pfizer, which requires two doses. That makes J&J ideal to use in rural areas, where people may have to travel longer distances to vaccination sites, and may be less likely to return for a second shot. Access to complicated cold chain requirements is also limited in more remote districts.
J&J’s slow delivery
By the beginning of September, South Africa had administered just over 12.5-million vaccine doses, of which about one in 10 (2.3-million) were J&J shots (excluding the 500 000 doses used in the country’s Sisonke implementation trial). The proportion of adults who are fully vaccinated in rural provinces such as Mpumalanga (9.2%) and North West (11.4%) is far below the national average of about 15%. J&J vaccines would help speed up vaccinations in these areas.
With only four months to go until the end of the year, when the health department plans to have most adults vaccinated against the Covid-19, doubt is mounting about J&J’s ability to fulfil their contractual obligations. The company’s drug substance ( key ingredient) production delays earlier this year halted the ability of Aspen Pharmacare — a local vaccine manufacturer that “fills and finishes” vaccines for Janssen Pharmaceuticals and Janssen Pharmaceutica NV, the manufacturers of J&J’s jab — to deliver jabs. “Fill and finish” means Aspen imports the drug substance, mixes it with an inactive drug substance, puts it in vials and packages and labels it.
Why Africa is falling behind
Aspen has exported some of the J&J vaccines they produced to Europe even as South Africa and other African countries scramble for vaccine doses. The current license agreement between Janssen Pharmaceuticals and Aspen lacks transparency on how many of the up to 300-million annual doses Aspen says it can “fill and finish” will be dedicated to African countries. It also limits Aspen’s rights to determine to which countries the doses are allocated.
Although President Cyril Ramaphosa has announced that Aspen has initiated discussions with Janssen Pharmaceuticals about a full production license, there is no indication of a time line.
This is happening against the background of South Africa having contributed hugely to J&J’s research — one of the legs of the vaccine’s efficacy trial, the Ensemble study, was in South Africa and the country also ran the implementation trial, Sisonke, which looked at the real life efficacy of J&J’s jab among healthcare workers.
J&J is no stranger to this anti-competitive way of doing business. We have seen this before with their monopoly stranglehold of the drug-resistant tuberculosis (DR-TB) treatment, bedaquiline. Bedaquiline can cure more people of DR-TB than the older treatments and was developed as a joint effort by public and private entities and the larger TB community.
J&J’s medication monopoly
J&J still holds the patents on bedaquiline, which is why the drug is highly priced. This monopolistic way of doing things has impeded access to the treatment and left people with DR-TB taking TB medicines that need to be injected and often have devastating side-effects.
In light of their production difficulties and delayed delivery of the Covid-19 vaccines, Janssen Pharmaceuticals should instead grant Aspen a full technology transfer agreement, including production and distribution rights. This would give Aspen the power to produce and supply additional doses for South Africa and the rest of the continent, where only 2.5% of the population has been fully vaccinated. J&J should also share its intellectual property and have full technology transfers with other manufacturers in low- and middle-income countries through transparent agreements.
The Covid-19 pandemic has magnified the grave consequences of narrow political and commercial interests by pharmaceutical companies and some governments. The result is unequal access to lifesaving vaccines. It is an unfortunately familiar story that requires urgent action to change the ending. Allowing multiple producers of the J&J vaccine on the market would provide a more equitable and sustainable solution than the current piecemeal approach of limited “fill and finish” agreements.
South Africa should also take this opportunity to reevaluate its policies on clinical trial involvement to ensure improved access to future medical tools developed through the contributions of South Africans.
The millions of people in the global south who have not received Covid-19 vaccines, should not have to wait any longer. Everyone deserves an opportunity to be protected against Covid-19 as soon as possible. We need dramatically improved access to Covid-19 vaccines to help make that happen.