SA faces a perfect storm as the Covid third wave batters its shores. Our only defence, as President Cyril Ramaphosa said this week, is vaccination. But a combination of government ineptitude, bad luck and possible vaccine hesitancy is crippling SA’s vaccination efforts.
The vaccine rollout has given the DA ample fodder for attacking the ruling party. And the EFF has now joined the fray: on Friday, it’s planning a march — a "march to save lives" — to the office of the SA Health Products Regulatory Authority (Sahpra).
The EFF wants Sahpra to authorise the use of Chinese and Russian vaccines in SA, to address a shortage of doses and accelerate the rollout.
Sahpra, for its part, said this week that the Chinese and Russian vaccines are in the process of being vetted for approval. It will not "be pressured to allow the public access to any product that has not met the necessary regulatory requirements".
As it stands, SA is set to miss its target of vaccinating 5-million people over the age of 60 by the end of June. And experts have raised concerns over whether it will reach the target of herd immunity — in other words, vaccinating 40-million people — by the end of this year.
This has come into sharp focus as a devastating third wave batters Gauteng, SA’s most populous province. Already, daily positivity rates have surpassed the peaks of both the first and second waves in Gauteng.
As the FM went to print on Tuesday, high-level discussions were under way to decide whether to place the province, also the country’s economic hub, in a higher level of lockdown and increase restrictions on gatherings and movement.
Health department deputy director- general Nicholas Crisp tells the FM that the government is constantly in a process of balancing its vaccination stocks with the number of people coming forward for their shots. But when manufacturers actually deliver the stocks, he says, is something "we just do not have control of".
Crisp says delivery is sporadic and often deadlines are missed as vaccine manufacturers battle to meet demand. "We try to pin them down to a date," he adds, "but it is a competitive market."
What this all means is that the authorities need to keep seven days’ worth of vaccine doses in the pipeline at all times to ensure there’s consistent momentum in the rollout.
"Think of it as petrol in a tank," says Crisp. "You would not drive until there is absolutely no petrol left." Similarly, he says, "we have to ensure the pace matches the amount of stocks we are sure will be delivered.
"Imagine if we ran out and had to stall halfway through the process; we would be slated for being useless."
How much of a problem is vaccine hesitancy in SA? Not much, agree experts. But Crisp says there’s been a slow uptake among people over 60, with only about 50% registering for shots. It’s unclear, however, if the remaining 50% are unregistered due to hesitancy or logistical issues.
Interestingly, there is less uptake in urban areas than in some rural ones. Limpopo, for instance, has the highest uptake — about 70% — due to the provincial health department getting churches, communities and traditional leaders involved in the rollout.
There was some concern in February over hesitancy among teachers after a survey by the SA Teachers Union found its members were sceptical about Covid vaccines. But the union’s Chris Klopper tells the FM they have since come on board: as many as 87% of the union’s members are excited to receive the vaccine.
The rollout of the vaccine among teachers commenced this week and is set to hit full steam by Monday, with 300,000 Johnson & Johnson (J&J) jabs set to be administered.
In addition to vaccinating teachers, the government is expected to ramp up the rollout this week, with the interministerial advisory committee considering whether to expand the eligible age range.
In a Talk Radio 702 interview this week, Mmamoloko Kubayi-Ngubane, the acting health minister, said the government was set to consider whether to open the registration portal for people aged 40 years and above.
According to Crisp, such decisions will be taken with the current and forthcoming stock levels in mind.
At present, the government is in a relatively comfortable position, with about six to seven weeks’ worth of doses on hand. That will allow it to step up the pace — but thereafter it will once again be operating "on a wing and a prayer", he says.
"We are not total idiots, we do know what we are doing and are trying hard to serve the people," he says.
It is understood that Kubayi-Ngubane is set to hold a briefing on Friday where a key announcement will be made, following discussions at a meeting of the interministerial committee on Wednesday.
Unfortunately, the bottom line remains that SA is far down the priority line for vaccine manufacturers, because it began negotiating for vaccines way too late. Most countries began negotiating between August and September 2020, but SA got the ball rolling only in January 2021, and only after pressure from academics.
Wits University’s Prof Shabir Madhi says this is why even countries that "oversubscribed" — obtaining three and four times the number of doses needed for their populations — are ahead of SA.
He speaks of a "series of miscalculations, including delays in beginning negotiations, putting all our eggs into the Covax basket, then selling the AstraZeneca doses we did receive".
It is too late to change any of this now — but it does mean SA is "at the back of the queue", says Madhi.
What it means:
SA is far down the priority line for vaccine manufacturers because it began negotiating far too late
— What it means:
Though the government has been punting the idea of locally manufactured vaccines, this, too, remains an overly ambitious endeavour.
On Monday Ramaphosa, along with World Health Organisation secretary-general Tedros Ghebreyesus, announced that a hub for the transfer of mRNA vaccine technology would be housed in SA.
That will go a long way to boost the local manufacturing of vaccines for developing countries, and it’s "a step in the right direction", said Ramaphosa. (It also won’t deter the government from its commitment to see an intellectual property rights waiver for Covid vaccines.)
But Madhi is not as optimistic, saying it will take a few years for the technology hub to begin working — and then not in the way many may envisage.
"The establishment of this hub is not going to matter for at least three years and it does not equate to the manufacturing of vaccines," he says. "Any notion that it will assist us out of our current predicament in the foreseeable future is unfounded," he adds.
SA has not had vaccine manufacturing capability for the past 20 years, says Madhi. The last locally manufactured vaccine was produced in 2001. It’s unlikely that this capacity could materialise in the next few years.
Even the idea that pharmaceutical firm Aspen is "manufacturing" the J&J vaccine in SA is false, says Madhi; its facility in Nelson Mandela Bay is simply a "fill and finish" operation.
"The notion that SA will be able to do in two or so years what it could not do in 20 is simply misleading the public," says Madhi.
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