SA will have enough vaccines to weather the Covid storm, say experts. But whether they arrive ahead of winter or by the end of the year, and whether those who most need the shots will get them first, will likely pose bigger problems than the supply.
Drug manufacturer Johnson & Johnson (J&J) has not yet specified when SA will receive 11-million doses of its vaccine — a single shot that doesn’t require extreme cold storage and has been shown to prevent death from Covid. Those close to the process say 2.8-million doses will arrive between April and June, but no more are likely to arrive until winter, when Covid-19 infections may spike.
Pfizer is set to have about 2.8-million doses of its two-shot vaccine ready for SA from the end of March. But as of Tuesday, the government and the pharmaceutical company had yet to sign an agreement.
Aspen’s Stavros Nicolaou, who is working with Business for SA on the vaccine rollout and the private sector response, cautions that SA won’t get enough vaccines by winter, when people "cuddle and huddle" and are confined indoors, which drives transmission of the virus.
It is for this reason that Dr Aslam Dasoo, leader of the Progressive Health Forum, is pushing for the private sector to be permitted to buy its own vaccines now — provided they are distributed to those most at risk.
In the longer term, though, SA is unlikely to have "a dearth of vaccines", says Nicolaou.
In fact, a draft statement from J&J, which the FM has seen, suggests the firm is in talks with the government over the purchase of a further 20-million doses of its vaccine.
Overall, there’s been a general lack of information from the government about timelines for its vaccine rollout.
Dasoo, who is in regular communication with government, believes this is because the government itself doesn’t know when the vaccines will arrive.
However, he adds that the National Treasury has allocated rollout funding for 2022, suggesting that it is aware that vaccination will not be completed this financial year.
There is growing interest in the J&J vaccine — particularly since it became the third vaccine approved for emergency use by the US Food & Drug Administration.
It is not certain whether US approval will push SA further back in the vaccine queue. When asked about this, J&J simply reiterates that it has allocated 11-million doses to SA and a further 500-million to the Covax vaccine facility, which SA is part of.
But Nicolaou says "the singular focus of both the private and the public sector, health minister Zweli Mkhize and his team [and] Treasury colleagues is looking at rescheduling or accelerating some of the current supply pipeline".
Nicolaou is the strategic trade executive at Aspen, one of seven companies contracted to formulate and fill J&J vaccines.
It has offered to mix and package 300-million doses for J&J, but has yet to hear how many the drug company requires. It can, however, only start manufacturing once the vaccine has been approved by the SA Health Products Regulatory Authority.
What is really the subject of private sector discussions is how the larger vaccine rollout will work.
As those close to the rollout speak of politicians in more rural provinces apparently jumping the queue during the health worker rollout — and chaos at Steve Biko Academic Hospital, where doctors reportedly brought in nonqualifying family members for a shot — implementation is going to have to be a lot stricter.
Modelling by the private sector and Discovery Health suggests that SA will need to roll out about 250,000 shots a day if it is to distribute all vaccines as they arrive in the third and fourth quarters.
This will require that every public and private hospital is used, along with all pharmacies, occupational health units, mining hospitals, mobile clinics and tents at shopping centres, explains Nicolaou.
Dasoo, for his part, is sceptical that the supply will be large and consistent enough to keep up this momentum.
Vaccinologist Prof Shabir Madhi has a different take. He believes SA needs to "recalibrate" its expectations around Covid-19 vaccines, as only the Novavax vaccine has so far been shown to stop mild disease and likely transmission in relation to the variant of the virus prevalent in SA.
This means widespread vaccination won’t stop the disease spreading; the vaccines we have now can only prevent severe disease and death.
That’s why Madhi believes SA should have kept the 1-million doses of the AstraZeneca vaccine it is selling to AU countries and used them to prevent severe disease in the elderly.
In the end, he says, what is most important is to ensure that the 10-million people who most need the vaccine — those older than 65, the morbidly obese, the immunocompromised and diabetics — receive it.
"I think what we need to appreciate is that Covid-19 is not something that’s going to go away," he says.
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