Used vials of the Johnson & Johnson Covid-19 vaccine. (Photo by Michael Ciaglo/Getty Images)
South Africa won’t be vaccinating children aged six to 11 against Covid-19, unless more money becomes available, says Nicholas Crisp, who heads the country’s vaccine roll-out in the national health department.
The local subsidiary of the pharmaceutical company, Pfizer, applied to the country’s medicines regulator, the South African Health Products Regulatory Authority (Sahpra), for approval of its Covid-19 vaccine for this age group last week, but a decision has not yet been made.
If Pfizer’s application does get approved, and the health department decides to vaccinate children in this age group, the country would need to buy new doses, because cget get jabbed with smaller quantities of the vaccines than adults.
Pfizer shots for children are packaged in different sized vials, explains Sahpra’s chief executive, Boitumelo Semete-Makokotlela. “It is completely different because it’s 30 microgram per dose for adults and 10 microgram per dose for children between 5 and 11 years, so you can’t use doses that arrive in adult vials for children.”
But Crisp says the department has “no budget set aside to buy more vaccines, given what we’ve already got” and won’t be able to afford to vaccinate this group.
The country’s Covid-19 vaccine ministerial advisory committee (VMAC) has not yet made a recommendation to the health department on whether to vaccinate children. The health department has to consider the committee’s guidance when making vaccine-related policy decisions.
Do other countries vaccinate children?
Clinical trials conducted by Pfizer show two 10 microgram doses, given three weeks apart, are 90.7% effective in preventing symptomatic Covid-19 in children aged five to 11 and this age group produces the same amount of antibodies as people aged 16 to 25, who are vaccinated with adult doses.
Vaccines for this age group were approved by the United States medicines regulator in October and by United Kingdom authorities in December. The UK’s health department has started to roll out jabs for children “most at risk of Covid-19”, for instance, those living with diabetes or children living with someone who is immunocompromised, and will extend its campaign to all children in April.
The US government’s Centres for Disease Control recommended vaccination for children aged five to 11 in November and by mid-January just over a quarter of that age group had been vaccinated.
Crisp says if the VMAC recommends that South Africa vaccinates children, the health department would need to approach the treasury “to discuss the implications” and ask for more money — because there isn’t any.
SA may have to destroy more unused vaccines than what the US donated to it
The country’s vaccination roll-out for people aged 12 and older has lost considerable speed with only about 42% of adults having been fully vaccinated and just over 3% of teenagers.
According to Crisp, 400 000 of South Africa’s Pfizer vaccines will expire by the end of March and seven million by June-July. “If we’re not able to use these doses in time, we will have to destroy them. It will be a crime. “It’s a process to destroy vaccines, so it’s an additional expense as well as a loss of opportunity to give people an immune response.”
The health department is talking to countries “to see who could use some of South Africa’s vaccines in the short-term” or “who would like to swap vaccines in the sense that we give them vaccines now and they give us some back at a late stage when we need them”, Crisp says.
But there are problems — many of the countries the department is in discussion with don’t have the capability to store Pfizer jabs. “It’s logistically difficult,” Crisp says. “The vaccines have to be stored at -70 degrees Celsius in central stores and then at minus 40 degrees in peripheral stores before they go out to vaccination sites. Not everybody has that kind of electricity and backup power supplies to maintain that kind of cold chain.”
The Pfizer vaccines that will expire (7.4 million in total) is more than the six million vaccines that the US donated to South Africa 2021.
The country’s Johnson & Johnson (J&J) doses will only expire in 2023, Crisp says.
The department’s goal was to have 70% of adults vaccinated with one dose by the end of 2021, but South Africa has, so far, only managed to reach 47% of adults. “At our current pace of vaccination, we’ll now only reach that goal in September,” Crisp says.
The World Health Organisation aims to have 70% of the world vaccinated with one jab by mid-2022.
The health department won’t buy Sinopharm or Sinovac
Because South Africa has more Pfizer and J&J vaccines than it can use, the country won’t be buying any other Sahpra-approved vaccines such as Sinopharm and Sinvoac in 2022.
“That would be a huge waste of money and a massive logistical challenge,” Crisp explains. “Every vaccine we introduce has got different storage requirements and needs different needles and syringes. It’s a massive, massive nightmare to do that.”
But healthcare workers, who were part of the Sisonke Covid-19 vaccine implementation trial and received one J&J dose plus a booster, may be able to get an additional Pfizer booster if the VMAC deems it safe to do so. This is because the health department this week introduced the mixing and matching of boosters. Trial participants, who received their boosters before this announcement, had no option of getting an heterogeneous (mixed) booster.
Studies show that mixing and matching generally works better than homogeneous (if the booster is the same brand as the jab originally used).
Says Crisp: “I’ve specifically asked that question to the VMAC and the initial answer was that a second J&J dose is quite adequate for a good immune response. But they are currently studying literature that’s available on booster after a second J&J jab and will advise on that soon.”
Moreover, Crisp says, South Africa’s requirement of PCR test results for entry into the country “is likely to change and be replaced by proof of vaccination certificates. We learn as we go and the phases of pandemics change. Some countries have already stopped using PCR tests and we’re discussing this here as well.”
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.