A risk-averse National Treasury, coupled with scant details on delivery dates from manufacturers, was behind SA’s delay and subsequent scramble to secure vaccines — a key step in halting the march of Covid-19.
President Cyril Ramaphosa had to get directly involved to secure the initial 1.5-million doses, which are set to be rolled out for health-care workers in the coming months.
Ramaphosa announced on Monday that SA has secured a further 20-million doses, but provided little detail.
The acquisition and rollout of Covid-19 vaccines will be the defining moment of Ramaphosa’s presidency, and of his legacy. It is crucial that his administration gets this right — a tall order for a government notorious for bureaucratic bungling, state capture and corruption.
As it is, the process is likely to expose the state’s weakened capacity, unless it’s driven directly by the presidency and is conducted transparently, bringing public and private partners alike on board, say experts.
It’s set to be a politically and financially fraught year. Ensuring that 40-million South Africans are vaccinated is a looming logistical nightmare.
The DA has already taken aim at Ramaphosa’s administration over the vaccine issue, and is likely to use it as a campaign platform in the upcoming local government elections.
Trade union Solidarity and lobby group AfriForum have taken things a step further, hauling the government to court over the vaccine issue. They’re challenging the decision that the national government will buy vaccines centrally, with no other party able to procure the product directly. (As things stand, most manufacturers are only dealing with sovereign states for now.)
Another severe challenge for Ramaphosa is a bizarre and worrying antivaccine sentiment in SA. It’s taken hold of some senior leaders in his own party, including one of his closest labour allies and a member of the ANC national executive committee, Cosatu president Zingiswa Losi.
This could be tricky for the health ministry too. The department’s vaccine strategy, seen by the FM, says organised labour is meant to run a "campaign to demystify vaccines".
Corruption is, of course, another key challenge. While Ramaphosa said in an interview after his ANC anniversary statement last week that there would be no hands in the till in the vaccine rollout, the ANC’s track record inspires little confidence.
Progressive Health Forum (PHF) convener Dr Aslam Dasoo says while it is clear the government dropped the ball and has had to scramble to secure vaccines, the news that 20-million doses have been secured is welcome.
But SA is not out of the woods yet.
"This is an endeavour bigger than anything we have ever done," says Dasoo. It is thus imperative that Ramaphosa uses his authority and the respect for his office to drive the process — and to bring together all partners who can contribute, he says.
The PHF and Dasoo were among the first to raise the alarm over the snail’s pace at which the government was moving to secure vaccines. It is far behind the developed world, as well as many developing countries, in negotiating procurement deals.
Vaccination is considered the best hope to loosen the grip of Covid-19, which has infected close to 100-million people worldwide and killed almost 2-million.
In SA, the furore over vaccines coincides with a second wave of infections that is far worse than initially anticipated, accompanied by a new, more readily transmissible variant of the virus.
By Tuesday the infection tally in SA was 1.2-million, with more than 33,000 deaths.
In an interview with the FM, health department deputy director-general Anban Pillay says though many countries secured vaccine doses in advance, even they are battling to get their hands on stock.
The only vaccine currently available from manufacturers is the Pfizer vaccine, he says. The AstraZeneca vaccine is available only in small doses for the UK, and the Serum Institute of India is the only facility that has started producing the actual product.
A big challenge for SA’s efforts to secure the vaccine, in Pillay’s view, has been risk aversion in the Treasury.
Under the Public Finance Management Act, goods must be delivered before payment is made. Any deviation from this (as would be required for an upfront payment to secure a vaccine order, for example) could only be agreed to by the Treasury.
The first problem, says Pillay, is that many manufacturers simply could not pinpoint a delivery date.
"That was a big challenge," he explains, as the Treasury "would have had to invest billions with nothing to show for it upfront".
At that stage — between August and October last year — there was also no certainty about the efficacy of the various vaccines.
Because the Treasury’s risk appetite was much lower than that of the health department, SA opted to first secure vaccines through the Covax facility — a global programme for equitable vaccine access, he says.
The FM understands that it was a tough sell to get the Treasury to even fork out for the Covax prepayment, which is why the department approached the Solidarity Fund.
Sources close to the process tell the FM that the Treasury was not convinced that a large volume of vaccines would be necessary. At the time, two studies on immunity in the Western Cape and Gauteng had just been released. They suggested that, given the significant antibody levels present in 30%-40% of the population in the two provinces, a "natural immunity" was being built.
In the Treasury’s view, if this was indeed the case, "why waste money on vaccines?" a source says.
It was at that point that health minister Zweli Mkhize, as well as players from the private sector via the Solidarity Fund, got involved.
When contacted by the FM, the National Treasury simply referred questions back to the health department.
The whole process was also undermined by hesitancy on the part of some advisers and officials in the health department, says Dasoo.
Comments from senior advisers to the minister that vaccines were not the "silver bullet", and then from the minister himself, did not help the situation.
He says Mkhize’s comments at a media briefing two weeks ago — when he told journalists that vaccines were a "game-changer" — were critical in turning around the situation, as they finally eliminated doubts about the government’s commitment to the vaccine process.
It is also heartening that the government has now entered into bilateral talks with vaccine manufacturers.
What is critical now is that the government uses the capacity in both the public and private health-care sectors for the vaccine rollout.
For instance, the pharmaceutical capabilities in the private sector, which is able to track medication to the last tablet, are essential for effective management and distribution.
As important to the success of the process is ensuring take-up by a "willing and co-operative populace", says Dasoo. A good start is for the vaccination of health-care workers to be seen by ordinary citizens.
Frontline health workers, doctors and nurses are by and large trusted by the general population. "When citizens see health workers take the shot, resistance to it will diminish," he says.
Overall, though, the health department’s plan on ensuring uptake is vague, saying only that organised labour, and community and civil society organisations, will work to mobilise people behind vaccines.
The Covid-19 vaccine programme is going to be the largest logistical endeavour SA has yet undertaken, with vaccination centres set to be built to complement efforts at workplaces and health-care facilities. A vaccination card will be handed to all those who receive the jab.
The government aims to vaccinate 40-million people over 12 months. With two doses required for each, the state will have to acquire 80-million vaccine doses.
Once the programme is up and running, it plans to conduct 316,000 vaccinations a day, employing 6,300 vaccinators on a full-time basis.
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