(Unless South Africa’s Covid-19 vaccine uptake improves soon, the country will be saddled with well over seven million expiring doses of Pfizer Covid-19 vaccine by July — with nobody to offload them onto. Photo by Tayfun Coskun/Anadolu Agency via Getty Images)
Unless South Africa’s Covid-19 vaccine uptake improves soon, the country will be saddled with well over seven million expiring doses of Pfizer Covid-19 vaccine by July — with nobody to offload them onto.
So says Dr Nicholas Crisp, the deputy director general of health and the man responsible for both Covid-19 containment and the roll-out of the National Health Insurance.
Crisp told the Mail & Guardian that vaccines were arriving in 1.5-million dose batches, but that, from May, expiry would loom large for the Pfizer drugs, although single-dose Johnson & Johnson doses would start to expire only next year.
“We have some Pfizer that will expire in May if not used — I don’t know the exact doses yet. All the April stuff is distributed, so that’s fine. Then for June and July there are large amounts, about seven million doses. Some of that will be used. At present we’re using about 75 000 doses per day, of which about 50 000 is Pfizer. We need to be at over 200 000 per day if there’s going to be no waste,” Crisp said.
Past exposure to Covid-19 is also a factor behind vaccine hesitancy, according to Professor Koleka Mlisana, co-chair of the ministerial advisory committee on Covid-19.
“People are saying, well if we’re at 80% of previous infections, why must I get vaccinated? Yet we’ve only vaccinated 48% of the population. So past exposure is also driving vaccine hesitancy,” Mlisana said.
“You can walk into any site and the long queues have disappeared completely. A significant number of sites have had to be closed.”
What to do with the surplus?
Asked if the surplus vaccines would be offloaded to other African countries like the controversial initial AstraZeneca batches were in 2020, Crisp responded: “We’ve tried to donate to other countries and offer it into the Covax pool, but all the other countries are doing the same thing. So, I’m afraid it looks like all countries are going to be dumping vaccines, which is rather irritating.”
However, it is South Africa’s alarmingly low vaccine uptake in the wake of the highly infectious but less dangerous Omicron variant that emerged late last year that is focusing the minds of public health experts.
Crisp pulled no punches about ongoing reports that levels of immunity were at 80% of the population,
“This nonsense of 80% natural immunity is a red herring. Remember that non-vaccine immunity from wild virus infections is not long-lasting — and it’s not nearly as strong as vaccine immunity. So, one must be really careful of saying we have 80% immunity,” he said.
“We have some traces of immunity in 80% of the population, (that is, hybrid immunity) — that’s all it says. But most of those people who were not vaxxed do not have an immune response that is satisfactory to prevent severe infection. That’s what’s not being told in the media.”
Looking at individuals who are vaccinated as a percentage of the adult population, South Africa is sitting at 48.5% — but for those fully vaccinated the figure is just 43.6%, Mlisana said.
“Keeping in mind that the aim of vaccination is to reduce severe disease and death, the highest risk populations were targeted first. Hence the percentage of people 60 years and older who have had at least a single vaccination dose stands at 68.6% with those between 50 and 59 years old (with at least one dose), at 60.6%. The proportion of people above 60 who are fully dosed is 62.6%.
“So, we’re not doing well. We’d really like to see close to 80% or 90 % of the older groups vaccinated. The UK is sitting at 87% and some countries at more than 90%,” she added.
Drivers of vaccine hesitancy
Professor Barry Schoub, chairperson of the ministerial advisory committee on Covid-19 vaccination, cites lack of access, apathy, anxiety and conspiracy as the four main drivers of hesitancy.
Mlisana says besides peer influence, two of the most powerful non-Covid factors affecting the current vaccination uptake in South Africa are corruption and the lack of service delivery.
“People are asking why they should trust a government that has failed to deliver services in 28 years of democracy. Besides this, corruption, especially around personal protection equipment [PPE[ tenders, has resulted in a growing distrust in government — across race groups,” she says.
“The other concern is around all the conspiracy theories, misinformation and disinformation circulating in social media. Because of the internet everybody can read what’s written — at the end of the day you have to ask where responsibility and accountability lie.
“The recent Medical Research Council finding on vaccine hesitancy, which talks to how we can intervene, is a lot of folks saying, ‘I’ll vaccinate if you do.’ This talks to people who have influence over others.
“So, the two top moves to decrease hesitancy, I’d say, would be to make sure the correct information is disseminated widely. This means identifying experts in communication who can turn around the message for the different levels of the population and communities.
“Then the second is to ask who brings that message; who are the influencers in communities; who do people listen to (tailored to different age groups)? One thing government has done with some success is to create vaccination champions — volunteers who educate themselves and those around them. If you look at the HIV epidemic, the most successful education was done by those living with HIV, thus reducing stigma.
“We need those who’ve been infected with Covid and were previously resistant to vaccination but have realised the benefits as these champions — from all walks of life,” Mlisana says.
Vaccination statistics
Sharing the vaccination data as at 22 March, Mlisana said 33 105 213 vaccines had been administered to individuals, consisting of 8 082 241 J&J shots and 25 022 972 double dose Pfizer jabs. Of the J&J doses, 7 324 098 people had received a single shot, with 758 143 having had their second injection.
“Some four weeks ago, everyone who had had a J&J booster in the last 90 days was invited to have another booster, and that booster can be Pfizer. Of the 25-million-plus Pfizer shots there are 13 477 995 who have received the first dose and 10 370 005 who are fully vaccinated. Over and above that, 1 174 972 people came for their Pfizer booster,” Mlisana added.
‘Vaccine free’ folk share their views
Two “vaccine free” South Africans, one of whom spent a week in bed with Covid-19, shared with the Mail & Guardian their reasons for not getting inoculated.
Kim Riding, a restaurant manager in Kloof, Durban, got Covid-19 four months ago and admits to being, “quite fearful that I was going to become one of those stats”.
But the experience has not altered her views. “I’ve been taking Vitamin D3 at quite a high dose for years, plus 1000mg of Vitamin C daily, not to mention magnesium and zinc for a while,” Riding, a former nurse, says. “That helped me feel confident that I’d done what I could. I had that finger oxygen oximeter and the Hillcrest MediClinic checked in with me daily. I felt terrible, but quite safe. I’m a healthy 59-year-old with no comorbidities. Working in a café, I was hugely exposed, so I was relieved, but quite scared when I got it.”
Riding prefers the label “vaccine free” to “anti-vaxxer”.
“I had my polio vaccination and some others. But two highly regarded US scientists, cardiologist Dr Peter McCullough, and mRNA technology pioneer, Robert Malone, had a big impact on me and many like-minded friends. They are not extreme, are very balanced and what they say makes sense, she says.
Debbie Knipe, a retired Durbanville business owner of similar age, says her vaccine- free status is a natural result of her holistic lifestyle.
“I try to prevent and heal naturally, use a homeopath, and have had no antibiotics for donkey’s years now, so I firmly believe in a healthy, robust immune system. What really got to me with Covid was so many people saying you have to get vaccinated, or you’ll die. It’s really difficult to be forced to face having a vaccination I don’t want,” Knipe says.
“It’s a kind of emotional blackmail to say you’re putting everyone else at risk. With flu, doctors give you a couple of tablets and say go to bed for a few days. With Covid they say go home and when you can’t breathe, go to hospital. They should treat Covid at early onset.”
Knipe says that pre-Covid-19 she had a “100-day flu”.
“I coughed so badly, my ribs hurt. Now when my kids got Covid I got scared for them. Were they going to die? You hear all these awful stories. I want to know why people are still insisting on us getting vaccinated when so many people have already had Covid. How many millions are already vaccinated? Why is everybody going for boosters? When is it going to end? Is it working or not? There are just too many ‘what ifs’.:
She wishes there was “more transparency — so we can hear the medical doctors …who aren’t crazy conspirators, but have logical thinking and need a forum where they can speak. And whistleblowers too! We believe them when they blow the whistle on corruption or on stock-market scams, but with pharma, nobody wants to listen”.