South Africa has received all the 30-million Pfizer Covid-19 jabs it has procured from the drug manufacturer and the last batch that was delivered — a consignment of 4 831 560 shots that arrived between October and December in 2021 — expires at the end of July, health department data shows.
After that date, Pfizer jabs not used or redistributed to other countries will have to be destroyed and more doses are unlikely to be procured directly from the company. “We’ll see what the uptake looks like, and if needed, we’ll ask for our doses from Covax,” says Nicholas Crisp, who heads South Africa’s roll-out in the national health department. “But, we’re highly unlikely to procure more Pfizer doses after July, because we still have Johnson & Johnson (J&J) doses after July, which is also a good vaccine and should then be used.”
According to the health department’s dashboard, 24 339 805 Pfizer doses had been administered by the end of 8 March, but these doses include donations from the US (7 443 540) and jabs procured via Covax. In total, SA has received 39 272 220 Pfizer doses from its bilateral agreement with Pfizer, US donations and Covax.
Covax, the World Health Organisation and its partners’ international Covid vaccine procurement mechanism that mostly assists poorer countries who don’t have the financial resources to buy jabs directly from manufacturers, delivered 1 392 300 Pfizer doses to South Africa in June. Potentially, the country can procure a total of 12-million vaccine doses via Covax, but only if the body has vaccines available. “It’s however not yet certain whether we’re committed to all of those doses,” says Crisp.
In the case of the other Covid vaccine South Africa uses — J&J — 31-million doses were procured from the manufacturer, of which 20 380 200 arrived in 2021. The remaining jabs (10 619 800) will be delivered during the course of this year.
Moreover, South Africa has received 500 040 doses for its Sisonke implementation trial among health workers, but these were “research doses” that could only be used for the study and not for the country’s national roll-out.
In terms of booster doses, 240 878 doses for the second round of the trial were also donated to the study by J&J, but those vaccines are not included in the health department’s procurement figures, as they were donated directly to the South African Medical Research Council, who is the study sponsor.
How many COVID jabs have we got left and where are they?
According to the health department, South Africa has received a total of 60 606 060 Covid vaccines — 39 272 220 Pfizer doses and 21 333 840 J&J doses (this includes the Sisonke doses).
About 58% (34 965 340) of those vaccines had been distributed by 6 March, so they had been transported from central warehouses in Johannesburg to provinces.
“Central distributors” are specialised warehouses where Covid vaccines are sent first when they arrive in the country and are kept at temperatures at which they will last for the longest possible period. From there, the jabs are transported to either public sector provincial warehouses or private sector companies that do vaccinations.
At provinces, jabs are stored at various venues — provincial warehouses (also called depots), pharmacies at hospitals and also clinics and private pharmacies (depending on whether they have the required storage facilities) from where they are distributed to vaccination sites.
Of the vaccines that have been distributed to provinces, 92% (32 027 146 of 34 965 340 distributed doses) had made it into people’s arms by 6 March. That means, of the 60.6-million doses that the country had received by then, about 53% had been used.
In the case of the Pfizer jab, which requires two shots for full immunisation, 77% of people who had a first jab by 6 March had returned to a vaccination site to get a second dose.
What about boosters? Only adults (people of 18 and older) who are fully vaccinated — so those who have had two Pfizer doses or one J&J shot — qualify for a booster shot (a third Pfizer dose or a second J&J jab). Health department data shows 8% of fully immunised adults had received a booster dose by 6 March.
Does South Africa waste Covid-19 vaccines?
Health department figures show that South Africa has lost 1.4% of the vaccines it has received. This is because workers at vaccination sites sometimes don’t manage to extract all the doses from a vial, because a vial is opened towards the end of the day and there are then not enough people at a site to consume all the doses. Sometimes jabs were also not stored at the correct temperatures or not used before they expired.
“This level of wastage is in line with the internationally accepted rate of 5% or below,” says Crisp. “So the 467 135 vaccines that the 1.4% comes to might sound like a lot of jabs, but, it’s a low rate of wastage.”
Wastage is the highest in the Northern Cape (2.9%), where cold chain storage is a challenge and jabs have to be transported for long distances to sites. The second-highest wastage is in the Western Cape (2.7%). More Pfizer than J&J shots have gone to waste, as most doses administered in the country are Pfizer jabs (75.5%) and Pfizer has more complicated cold chain requirements than J&J.
When will our first Covid jabs expire?
J&J jabs have considerably longer shelf lives than Pfizer shots, because they are biologically more stable and have less stringent temperature storage requirements.
“Our J&J vaccines only expire in 2023, so expiry dates of those doses are not an issue right now,” says Crisp. “But our Pfizer jabs expire between seven and nine months after they arrive in South Africa.”
On 31 March, 108 750 Pfizer jabs will expire and be destroyed, says Crisp. Those shots are currently in quarantine at one of the country’s three central storage places in Johannesburg. Pfizer jabs are kept in special freezers at -70°C at central stores in order to last until their expiry date.
“The vaccines at central distributors that will expire in March, are, however, kept at room temperature now in preparation for destruction,” explains Crisp. “That saves us the cost of expensive freezer space.”
According to Crisp, the country will be able to use all the vaccines that expire in April (329 880 such doses are still at central stores) before their expiry date, but jabs expiring in May (1 496 190), June (5 873 190) and July (4 831 560) are a problem. Says Crisp: “At our current vaccination rate [we’re using about 70 000 Pfizer doses per day, according to the health department’s dashboard], we’re unlikely to be able to use all of our Pfizer doses before they expire.”
What plans are we making to prevent the jabs from expiring?
South Africa’s vaccination rate declined quite significantly over the December holidays and it then struggled to pick up thereafter. In October, for instance, an average of 157 309 daily doses were administered and that had decreased to 77 841 doses in December and 62 245 jabs in January.
But after the health department halved the waiting periods for second Pfizer doses (from 42 to 21 days) and boosters (from six to three months) and introduced an option for people to “mix and match” boosters (so you can have a booster with a different jab than what you were originally vaccinated with) at the end of February, the vaccination rate increased to between 80 000 and 100 000 doses per day the past three weeks. “The problem, however,” Crisp says, “is that most of the increase is due to people coming for vaccinations who are returning for second Pfizer doses or J&J and Pfizer boosters, so there’s a finite number of people who can be reached and then the numbers will decrease again.”
According to the health department’s dashboard only 27.5% (25 474) of Tuesday’s 92 395 vaccine doses that were administered were first doses — in other words, new people coming to be vaccinated.
In response to this, the health department, in collaboration with the US government and the public health organisation BroadReach Health Development, are sending specialist teams that include 350 community health workers into health districts with the lowest vaccination rates, specifically in KwaZulu-Natal and Mpumalanga, where immunisation rates in some areas are below 25%.
In addition to community health workers, the specialist teams include data capturers who collect patient information and nurses and doctors who assist patients. “They help with practical interventions so that people do not have to travel, pay for transport or spend a lot of time getting vaccinated,” said Dhirisha Naidoo of BroadReach in a press release. “Community educators will also be on hand to help people to register, discuss vaccinations in their mother tongue and dispel key misinformation that may be scaring people away.”
These strategies are all based on findings of the University of Johannesburg and Human Sciences Research Council’s vaccine hesitancy survey published in February, that found that the main reasons why people don’t get vaccinated in rural areas were because they didn’t know where to go (24%), vaccinate sites being difficult to get to (18%) and the high cost of getting there (17%).
Moreover, the health department is negotiating with Covax and the African Vaccine Acquisition Trust (Avat, the African Union’s vaccine initiative) to see if it’s possible to swop some of South Africa’s vaccines that will expire in June and July for vaccines that will expire at a later date, says Crisp. That way, countries that don’t currently have vaccines can use South Africa’s and then return jabs to the country via Covax at a later stage.
“We’ve let them know we potentially have five-million vaccines available, but haven’t had any formal offers. The challenge is that many western countries are also offering vaccines to Covax or Avat and several of the countries that those mechanisms help with access to vaccines don’t have the special freezers and consistent electricity supply and back-up generators to store Pfizer vaccines.”