Why SA’s stop-start vaccine rollout is stumbling

South Africans can breathe a sigh of relief that the third Covid wave is behind them and the vaccination campaign is gaining momentum.

But by all accounts this is not good enough. The key demographic that is most vulnerable to Covid infection — people older than 50 — will still be far from immune if a new wave should hit.

By mid-October, 20-million vaccinations had been given. This was heralded as an achievement by health minister Joe Phaahla. At this rate — of about 142,000 vaccinations a day — 26.4-million doses will have been given by the end of November.

The Western Cape, slow at the start, recently drew well ahead. Mpumalanga is running last.

University of Cape Town public health medicine emeritus professor Jonny Myers says even the Western Cape’s rate of inoculation is not insurance against a fourth wave.

The number of vaccinations "is not high enough. The over-50s and over-60s need to have a high level of coverage — about 90%-plus," he says.

Myers says that technically SA may just have enough time to beat the next big wave in the critical age groups, but there appears to be a slowdown in people joining the queues to be vaccinated. Nationally about 60% of seniors have received their shots. Myers believes that for SA to reach a target of 90% in this category, 20 intense vaccination days are required, with seniors turning up in numbers.

This does not look likely. While problems in the supply of vaccines have been sorted out — after a number of pitfalls, including the Northern Cape’s focus on the Johnson & Johnson vaccine, which never arrived — there has been resistance.

Not enough people have access to vaccines, and this is especially true of poor people, Myers tells the FM. There is also a political overtone — what he calls "the hesitancy issue" of people not trusting the government. Some have been told by religious leaders to forgo vaccines, he says.

A worrying feature, Myers says, relates to the electronic vaccination data and procurement systems, which are controlled by the national government. The Western Cape has been deprived of critical information — including the age and co-morbidities of patients — since September 21.

National acting health director-general Nicholas Crisp says he "withdrew the authority" for Western Cape officials to access the official vaccination site "as the province broke the conditions of a data sharing agreement".

He says: "We are too busy with other system changes now for the whole country to focus on one province."

But Myers argues that the restrictions on the Western Cape are likely to constrain the province from achieving vaccination targets — including a 50% vaccination rate of adults by the end of the year.

Crisp says that overall, about 36% South Africans had been vaccinated by October 21 — about 14.4-million people.

The Western Cape had a percentage score of 45% (2.24-million), followed by the Free State with 42% (804,000), Limpopo with 41.6% (1.5-million) and the Eastern Cape with 41.54% (1.7-million).

Mpumalanga has the lowest score, with 29.63% (900,546). KwaZulu-Natal is second last, at 31.6% (2.28-million).

Gauteng, with the highest number of vaccinations (3.7-million), has achieved 33% coverage.

Crisp says the Eastern Cape and Limpopo led until mid-October.

Nationally, nearly 62% those older than 60 have been vaccinated (3.4-million people), as have nearly 55% of those aged 50 to 59. "Those are [the people] we are chasing. All the rest are nice-to-haves."

Crisp’s target for vaccinating the older groups differs from that of Myers. "[The over-50s] must get to 70%. Those are the people who end up in hospital," Crisp says. He says that if SA reaches a national vaccination rate of 50% of all adults by the end of the year it will be doing well.

Myers says: "We don’t know when the next wave is coming, but if the pattern we have seen up to now is repeated, we can expect it some time in January." But at the current rate, he warns, it is unlikely that SA will get to the target of vaccinating 70% of people over 60.

Explaining the wobbly rollout of vaccines, Crisp says the first big dip in doses occurred in August because SA ran out of vaccines. The weekly Eastern Cape rollout dropped from 176,000 on July 25 to 91,000 on August 15.

There was a major roll-out dip at this time, partly due to a delay in administering a batch of vaccines that had been donated by the US. "We lost momentum," Crisp says.

Vaccination rates began to dip again by September 26, as the Eastern Cape jabbed fewer than 90,000 people a week — fewer than half the 194,000 a week a month before.

Crisp acknowledges that departmental administrative weaknesses, particularly in Mpumalanga, where there was a lack of synergy with the private medical sector, have contributed to the stop-start nature of the rollout.

The rollout in KwaZulu-Natal had started well, but the July unrest led to a deterioration.

"The province has lost momentum quite badly," says Crisp.

Gauteng has a high concentration of medical scheme members, but "people are just not coming" and seem ambivalent about vaccination.

Still, most surveys indicate that antivaxxers constitute a tiny "6% or 7%", Crisp says.