Introduction
This is the second of two briefs about COVID-19 vaccines. The first argued that in order to combat COVID-19, global equity to vaccine access is necessary. In order to achieve this equitable distribution, vaccine nationalism as well as poor government policy and governance surrounding vaccine access will have to be overcome. This brief sets out vaccine developments in South Africa as well as the various issues that are being faced by the government, the health sector and the people in accessing the vaccine.
The context
On the 26th of March 2021, South Africa commemorated one year since going into a nationwide lockdown. To date, official COVID-19 figures report that more than 1.5 million people have been infected with the virus since the first case was reported on home soil on the 5th of March 2020.[i] The official figures have been disputed by Discovery Group CEO and founder, Adrian Gore who estimates the actual number to be closer to 50%. According to Gore,
‘South Africa’s sky-high excess death number indicates that more than 50% of South Africa’s population have already been infected with Covid-19’.[ii]
This can be deduced from the fact that the statistics published by the South African Medical Research Council indicate that an alarming 137,731 number of excess deaths took place during the pandemic.[iii] An excess death is one which occurs above the number of expected deaths based on the previous year’s data.[iv] If you attribute most or all of these excess deaths to COVID-19 (as has been strongly suggested)[v] then this would mean that, over 30 million people have been infected with the virus, assuming a death to infection ratio of 0.4%.[vi] The discrepancy in these figures could be attributed to many factors, including inefficient mechanisms to record COVID-19 infections and deaths and statistics. Many individuals are too afraid or unable to travel to a hospital or clinic and therefore are dying at home.
South Africa and vaccine access and procurement
A year later, and it seems that the ‘new normal’ of masks and restrictions is here to stay. The only way that life will return to some semblance of what it was is to make use of the most powerful weapon that we have against the COVID-19 virus - the vaccine.
The Government of South Africa is the ‘sole purchaser of vaccines and will distribute it to the provincial governments and the private sector’.[vii] The Government will therefore be responsible for overseeing the entire vaccination process, from sourcing and distribution to the roll out.[viii] While there is support for this centralised approach, the government and particularly the Department of Health have not kept their promise of transparency and openness in regard to the vaccine procurement and distribution processes. This has affected public trust and confidence in both the institutional mechanisms as well as those leading the fight against the pandemic.
South Africa has not secured enough vaccines to vaccinate the entire population of about 58 million people.[ix] Instead, the South African Department of Health supports the WHO strategy of reaching herd immunity[x].
According to the WHO:
‘Herd immunity', also known as 'population immunity', is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. WHO supports achieving 'herd immunity' through vaccination, not by allowing a disease to spread through any segment of the population, as this would result in unnecessary cases and deaths’.
Once herd immunity is reached, the spread of COVID-19 will die out. The percentage needed to reach herd immunity differs from one virus to another and the exact percentage necessary for COVID-19 is unknown.[xi] South Africa intends to vaccinate approximately 67% of the population which translates to about 40 million people by the end of 2021.[xii]
The Current situation regarding the vaccine roll out
According to the Department of Health, as of 18 February 2021, South Africa had secured 11 million doses of the Johnson & Johnson vaccine which would be delivered throughout this year. A further 12 million vaccine doses have been secured through the COVAX facility as well as a number of other vaccines through the African Union’s African Vaccine Acquisition Task Team (AVATT) facility. Lastly, Pfizer has committed to delivering 30 million vaccine doses, most of which are expected to arrive mid-April.[xiii]
However, as of 12 May 2021, only 414 372 healthcare workers had been vaccinated out of a target population of 1.25 million.[xiv] At that rate, Professor Alex van den Heever, chairperson of Social Security Systems Administration and Management Studies at Wits University’s School of Governance, estimates that phase two of the vaccination plan would only be completed by the end of 2021 when it should have been completed during early May. He added further that natural infection will outstrip vaccinations in 2021[xv]. Furthermore, South Africa is in danger of a third and fourth wave, resulting in further mortality.
There are many reasons for the current slow roll out of the vaccines at this point in time. One such barrier was the delivery of a million AstraZeneca vaccines on the 1st of February 2021, only to be sold to the African Union just over a month later. The Oxford-AstraZeneca were declared unusable in South African conditions. South Africa’s actions in this regard went against the recommendations of the WHO, as well as many medical experts in the field, which stated the vaccine as safe and efficient to use.[xvi]
One can accept caution on the part of the Department of Health to use a vaccine that will not provide sufficient protection, specifically in regards to the B.1.351 variant. However, recent reports have stated that Health Minister, Zweli Mkhize, has indicated that South Africa will also not be using the Novavax vaccine which it could have already received from COVAX during its initial distribution phase and which has been shown to provide ‘100% protection against severe infection even by the variant’.[xvii] Unfortunately, with almost no transparency surrounding the choice of vaccines in South Africa, it is difficult to understand what is happening with regard to vaccine procurement and efficacy.
A fault on the side of government has been the delay in setting up a compulsory no-fault compensation mechanism to deal with any claims arising from any adverse effects experienced as a result of the Johnson & Johnson vaccine.[xviii] According to News24, Johnson & Johnson is now refusing to hand over ‘detailed delivery schedules until the mechanism is in place and conforms with guidelines set out in the agreement’.[xix] The Johnson & Johnson vaccine is well suited to South Africa due to the fact that it is a one dose vaccine. A one dose vaccine would be particularly beneficial for people who have difficulties travelling, such as those in rural areas or those without income sufficient to access a clinic.
The Minister of Health announced on the 13th of April that the roll out of the Johnson & Johnson vaccine would be suspended, pending ongoing investigations into the development of a rare type of blood clot in the brain that was reported in six women in the US. One has to weigh up the risks of halting the vaccine roll out, which is already extremely behind schedule, with the extreme rarity of the developing blood clots. These clots were found in 6 of the 6.6 million US citizens which translates to less than 0.0001% of the vaccinated population. While 6 lives lost are 6 lives too many, the danger of delaying the vaccine roll out any further could result in many more lives being lost due to South Africa’s looming third wave.
The Minister shed a light on the current situation by stating that:
‘there is good news in the midst of this development. I am happy to announce that we have successfully negotiated for another 10 million doses from Pfizer and, of these, we expect just under 2 million to be delivered in May. This therefore means we have secured 30 million doses of Pfizer vaccine for this financial year.
This also reassures us that, in the extremely unlikely event that Johnson and Johnson rollout is completely halted, we will not have any impediment to proceed with phase two of the rollout with Pfizer. We are confident that the rollout of Johnson and Johnson will resume and so, with 30 million doses of Johnson and Johnson and 30 million doses of Pfizer secured we now have enough doses to exceed the 40 million we were targeting this year.’
Due to the slow roll out of the vaccine and the uncertainty surrounding the start of the next phases, some South African’s are embarking on what is becoming known as a ‘vaccination vacation’. For example, you can travel to Zimbabwe and receive a vaccine for approximately $70 (+-R982.94). This may seem tempting for those waiting on the government for the lifesaving jab but should not be done without prior research and investigation of the border protocols, specifically in regards to countries who may not be allowing South African’s to travel across their borders at the moment.
Conclusion
Although Government continues to report on the numbers of secured vaccine doses and vaccine success stories, it is evident that herd immunity is not yet in sight. As the above brief indicates, South Africa’s efforts to engage the most powerful weapon against Covid-19, the vaccine, are not proceeding as they should due to procurement issues, slow distribution and the looming third wave. Vaccine nationalism has threatened the effectiveness of the COVAX facility designed to equitably distribute vaccines to developing nations, but cannot be completely blamed for South Africa’s slow roll out. While the public was promised openness and transparency surrounding the vaccine process, there have been closed doors and secrecy. This is not satisfactory when lives are in danger.
Sophie Smit
Legal Researcher
sophie@hsf.org.za
[i] SABC Digital News ‘CORONAVIRUS: Your daily update’ (9 May 2021), available here.
[ii] Business Insider South Africa ‘more than half of South Africans have been infected with Covid estimates Discovery CEO’ (17 February 2021), available here.
[iii] South African Medical Research Council ‘Report on Weekly Deaths in South Africa’, available here.
[iv] Kyle Cowan ‘Evidence mounts that SA’s Covid-19 death toll is not accurate, could be double reported 20 000’ (14 November 2020), available here.
[v] Business Insider South Africa ‘more than half of South Africans have been infected with Covid estimates Discovery CEO’ (17 February 2021), available here.
[vi]Iaonnidis found, from 61 studies and eight preliminary national estimates, that infection fatality rates ranged from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.23%. See John P A Ioannidis, Infection fatality rate of COVID-19 inferred from seroprevalence data, Bull World Health Organ 2021;99:19–33F, available here.
[x] World Health Organisation ‘Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19’ (31 December 2020), available here.
[xi] World Health Organisation ‘Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19’ (31 December 2020), available here.
[xiv] Vaccine Updates: South Africa Corona Virus Online Portal, available here. As well as Sunday Times ‘231,605 healthcare workers vaccinated, 46 new Covid-19 related deaths bring toll to 52,648’ (27 March 2021), available here.
[xv] Chris Bateman ‘‘It’s such a botch’: SA’s vaccine delays and Covid lockdown proved deadly – Prof Alex van den Heever’ (28 March 2021), available here.
[xvi] Bhekisisa Team ‘Why South Africa isn’t using the AstraZeneca jabs it bought’ News24 (29 March 2021), available here.
[xvii] Katherine Child ‘Top secret: what’s going on with SA’s vaccine plan? The public might want the rollout facts, but all the government offers is buck-passing, incoherence and murkiness’ BL Premium (8 April 2021).
