While rich and middle-income countries are rolling out vaccines, South Africa is lagging. Our down payment towards a Covax vaccine will only translate into delivery after April. But the health minister has announced a glimmer of hope with SA having secured 1.5-million doses of the Oxford AstraZeneca vaccine.
More than 15 000 people have been testing positive for Covid‑19 each day this month so far and the number of deaths is also climbing. On Wednesday South Africa hit the highest daily death toll since the pandemic hit our shores, 844.
Hospitals are running out of bed space. The numbers are scary, yet we have not yet even reached the peak of Covid-19 infections. Fortunately, it seems like the government is making strides on procuring vaccines.
On Thursday, Health Minister Zweli Mkhize confirmed to parliament’s health portfolio committee that the government had secured 1.5-million doses of AstraZeneca’s vaccine for our healthcare workers. The batch will arrive this month. However, Mkhize’s plan to immunise 67% of the population by the end of this year might still be some way off.
“We are happy that the [Serum Institute of India] SII/AstraZeneca vaccine has already been approved by various regulators and is being rolled out in other countries,” Mkhize’s statement read, explaining that the South African Health Products Regulatory Authority (SAHPRA) would rely on regulatory work done elsewhere for this vaccine.
However, as of this week, only one vaccine manufacturer, Johnson & Johnson, had begun a registration process with SAHPRA. Several experts have told the Mail & Guardian acquiring vaccines has become a matter of grave urgency.
The vice president for research at the South African Medical Research Council, Dr Jeffrey Mphahlele, said the anxiety around access to the vaccine was wholly justified.
“Covid-19 is killing people, and there is an urgency to protect people. [The goal to vaccinate 67% of] the population is possible only if we can get the vaccines. But if they cannot be procured, then it will just be an ambitious goal,” said Mphahlele.
“It’s good to set that goal because then we can account. If there is no money no one is going to come to our rescue, we have to raise our own funds,” he said.
The deputy director general of the health department, Dr Anban Pillay, told the M&G that only a few vaccines had yet been launched globally.
Responding to criticism that South Africa had dragged its feet, he said: “When people say we have delayed they never explain which company we delayed with and consequently which vaccine would be available today. The offers that were available to us while the trials were still ongoing had no guarantee of delivery date or effectiveness of the vaccine. We were required to commit to an order quantity and pay a deposit immediately.”
He explained that the ministerial advisory committee (MAC) and the health department could have no certainty about those critical aspects.
Professor Barry Schoub, chair of the MAC on Covid-19 vaccines, explained that high-income countries grabbed vaccines even while these were still undergoing trials, leaving other countries, such as South Africa, with limited options.
He concurred with the health minister’s comments last Sunday that the department was negotiating with manufacturers and hoping for access to vaccines “as soon as possible.”
Medical aid schemes will carry the cost of vaccinating their members, as well as some non-insured South Africans, so that medical aid schemes will cover the cost of vaccinating about 30% of the population.
Ryan Noach, the chief executive of Discovery Health, told the M&G that about 15% of the population had medical aid scheme cover. As the vaccine was a prescribed minimum benefit, all medical aid schemes will pay for the vaccines from their risk funds, said Noach.
He added that the schemes would purchase the vaccines at a higher price than the government would be paying. The surplus generated would cross-subsidise non-insured South Africans, to get to the 30% total.
The Solidarity Fund and the government are funding 10% of the vaccines so far, and Pillay added that the national treasury is part of the procurement process. In response to the M&G’s question on where funding for the remaining 20-odd percent of the vaccines would come from, the treasury said it would provide details when the government makes announcements on Covid-19 vaccines.
As time passes, a more accurate picture of the country’s negligence or negotiation prowess will begin to surface. In the meantime, however, the death toll is rising.
Dr Richard Lessells, a senior infectious disease specialist at the University of KwaZulu Natal, said that while daily rates were high, they did not provide the full picture. There was a substantial underestimation of the actual number of infections because the number of people being tested was relatively low.
“The numbers are scary enough; the numbers are likely very high every day,” he said.
He said the movement of people coming home from their holidays in January would make matters worse. In addition, the new virus strain, which was first observed in South Africa, is highly transmissible.
“Many other countries just like South Africa are finding it difficult to slow down the virus, and we are extremely challenged because there is a feeling that we cannot implement a hard lockdown because of the costs of that,” he said.
Lessells said it was essential to roll out vaccines to people who most need it, such as healthcare workers, the elderly, and those with comorbidities. However, there was still a need to reduce the number of people each individual is in contact with and to continue wearing masks and washing hands.
In a statement updating the nation on the country’s response to Covid‑19 dated 1 August, President Cyril Ramaphosa announced that a dedicated team from several institutions led by the Biovac Institute was preparing to manufacture doses of a successful vaccine locally.
Yet Biovac is yet to manufacture any doses.
Biovac is a private and public pharmaceutical company established in 2003 to revive local vaccine manufacturing capability after the country stopped producing vaccines locally in the 1990s. Its chief executive, Morena Makhoana, explained that the company is working closely with global manufacturers and the government in making Covid-19 vaccines available through importing a finished product, while it prepared for local manufacturing technology.
He was unwilling yet to disclose the parties Biovac are engaged with.
In terms of manufacturing, he said Biovac was considering obtaining the active pharmaceutical ingredients or “raw materials” to formulate and fill locally. “We will apply to the local authority for approval once completed.”
While Biovac is preparing to import and transfer technology to produce vaccines locally, South African pharmaceutical company Aspen has struck a deal with Johnson & Johnson to perform formulation filling and secondary packaging.
Though this manufacturing will happen in one of the country’s hardest-hit areas, Nelson Mandela Bay, hundreds of millions of doses of the vaccine will be shipped to other countries.
In August, Johnson & Johnson signed an agreement with the United States government for the large-scale production and supply of 100-million doses of the vaccine. It is also understood that it had signed a deal to procure six-million doses for South Korea.
The company will provide up to 500-million doses of its vaccine as part of an agreement in principle with Gavi, The Vaccine Alliance (formerly the Global Alliance for Vaccines and Immunisation). This vaccine alliance includes the Covax facility and will help 92 low- and middle-income countries procure vaccines.
Their vaccine is a single-dose product. If successful, it is estimated to remain stable for two years at -20°C, and for three months at 2-8°C.
“This makes the vaccine candidate compatible with standard vaccine distribution channels and would not require new infrastructure to get it to the people who need it,” the company said.
The middle-income countries with a shot
In December last year, middle-income countries in Latin America such as Colombia, Argentina, Mexico, Costa Rica, and Chile were able to roll out vaccines. The same applies to African countries such as Algeria, Egypt and Morocco, which were able to secure deals with manufacturers to immunise their populations.
According to the World Bank, middle-income countries are defined as economies with a gross national income (GNI) per capita between $1 036 (R15 538) and $12 535 (R187 917). Within this group, countries are further divided into lower-middle, middle, or higher-middle income groups.
On 24 December, Mexico, Chile and Costa Rica, upper middle-income countries, administered the Pfizer-BioNTech Covid-19 vaccine. On 29 December, Argentina started administering the first of 300 000 doses of the Russian Sputnik V vaccine.
On the African continent, Egypt announced on 21 December that it would roll out the Chinese Sinopharm vaccine in the coming week. It is reported that the first batch of the vaccine was delivered in December, with further doses expected this month.
Al Jazeera reported that each batch of the vaccine consists of 50 000 doses. The country plans to buy 40-million doses of the Sinopharm vaccine.
Morocco said that it had procured 65-million doses of coronavirus vaccines from China’s Sinopharm and Britain’s AstraZeneca. Algeria will begin rolling out the Sputnik V Covid-19 vaccine this month.
Tshegofatso Mathe is an Adamela Trust business reporter at the Mail & Guardian