First it was whether to take the jab, now health-care workers must decide which one

09 February 2021 - 07:00 By Graeme Hosken and Alex Patrick
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AstraZeneca says its vaccine appears to offer only limited protection against mild disease caused by the SA variant of Covid-19. File photo.
AstraZeneca says its vaccine appears to offer only limited protection against mild disease caused by the SA variant of Covid-19. File photo.
Image: Joe Giddens/Pool via Reuters

To vaccinate or not to vaccinate? That was the question put to health-care workers on Friday. And the responses were mixed.

But things changed two days later, when health minister Dr Zweli Mkhize announced on Monday night that the rollout of the AstraZeneca vaccine to health-care workers — who were first in line for the Covid jab — would be temporarily halted after disappointing results on the vaccine's efficacy for mild and moderate infection from the Covid variant dominating in SA. However, it is likely that the vaccine is effective against severe infection.

Instead, the Johnson & Johnson (J&J) vaccine would be the preferred option.  

So now the choice for health-care workers isn't just whether to take the vaccine, but also which one to take. 

The SA Medical Association (Sama) said it would leave it up to its members to decide which was best for them.

Since the Covid-19 pandemic first hit South African shores in March 2020, front-line workers have worked tirelessly and at great personal risk. Stories of sacrifice and loss, both personal and professional, are plenty on the country's frontline. While infection numbers drop and the arrival of vaccines brings renewed hope, these workers have seen this trend before. They're gearing up for an inevitable third wave. From ambulance, to hospital, to graveyard - MultimediaLIVE takes you to the frontline of SA's fight against Covid-19.

The problem is compounded, however, by the fact that the country has already received a million doses of the Oxford/AstraZeneca vaccine for health-care workers — but, in a surprise only found out when the shots arrived last week, they expire on April 13.

Sama chairperson Dr Angelique Coetzee said the association could only advise on the science that they were aware of.

Sama is a professional association for public and private sector medical practitioners.

“It's important to understand that efficacy is only in terms of disease severity where the current emphasis is on severity, hospitalisation and death — so J&J are the only ones with such data and the vaccine efficacy was 57% in moderate to severe disease, where nearly all cases were all due to infections with the new variant,” she said.

She said the clinical efficacy for hospitalisation and severe disease was 85%, including with the new variant, and that the J&J study also included people above the age of 65 with comorbidities.

She said it was a single-shot vaccine, which needed to be stored between 2ºC and 8ºC.

“The Oxford [Astra]Zeneca vaccine will protect three in four people against the variants from the first wave, but only one in four people from the new variant from the second wave and [has] only 22% efficacy in mild to moderate disease. [There have been] no studies for clinical efficacy in moderate to severe disease and hospitalisation. So Sama is waiting for further studies to be conducted,” said Coetzee.

Sama will not tell our members what vaccine to take — it will be their choice to make.
Dr Angelique Coetzee

The AstraZeneca vaccine also needs two doses, given as long as three months apart.

Coetzee said the studies done on this vaccine in SA were predominantly on healthy people with the average age of 31. This, experts said on Monday night, was one of the reasons the  study didn't look into the effectiveness of the vaccine on people who had severe infection.  

“We ... need to understand that the government is currently looking only at efficacy in terms of mild, moderate and severe disease with hospital admission and death prevention. So no trials have been done on herd immunity [nor] if you would be able to spread the disease once vaccinated.

“Once vaccinated, all the projections that we [have] done are regarding previous experiences with HIV trials and so on in terms of transmission, and there is still uncertainty whether one can use both vaccines that need to follow.

“There are also concerns about immune-compromised patients — studies [still] need to be [done] there.

“And so Sama will not tell our members what vaccine to take — it will be their choice to make.” 

When TimesLIVE spoke to Coetzee on Friday, she said it was prudent for doctors to get the vaccine as they were on the first line working with Covid on a daily basis — but, she said, doctors still needed to understand more about the virus and so Sama was receiving lots of questions around vaccines.

The three main questions doctors are asking Sama were:

  • How effective was the vaccine and would they be able to spread the virus if they had received the vaccine?
  • If the doctor had a compromised immunity, would the vaccine still be able to protect them from the virus? (This after a research paper stating the vaccine was only 47% effective in the immune-compromised).
  • Doctors understand they would probably not end up in hospital after having the vaccine — but they were asking about how effective the vaccine would be on the new virus variants.

Otherwise, she said, doctors were saying they were willing to get the vaccine as soon as possible.

Consulting physician and GP Grant Lindsay began working for a large mining company in July specifically to consult on Covid. The company, which operates in the Northern Cape, Mpumalanga and Limpopo, employs 2,100 people.

“We took the decision to wait and see when the vaccine would be available to the mining industry. We have been told it will cost R20bn to cover the whole industry in SA and the government is expecting the company to cover the costs. When it becomes available we will make that call. It’s also going to be different in each province as every province will have its own [rollout system]," said Lindsay.

He said the company had created its own field hospital for its employees in Bapsfontein, Ekhuruleni.

“We were concerned with people not being able to get admitted to hospitals, so we built the field hospital to accommodate our employees — at no cost to the employees. We also have a vehicle with oxygen which can take [the sick] straight to the field hospital.”

He said he would not be taking the vaccine himself.

“There have been no animal trials and it is still very early in the study — nowhere in history has there ever been a vaccine created this quickly.

“Vaccines are also not without their risk. The main thing to worry about is serum sickness [an immune response that's similar to an allergic reaction]. It has the same reaction as yuppie flu [aka chronic fatigue syndrome — a condition with fever, aching, and prolonged tiredness and depression, typically occurring after a viral infection].”

Excitement, uncertainty at Tembisa Hospital

Tembisa Hospital medicine consultant Dr Mpumi Smith said he was excited about the vaccine.

“We really want it. I know first-hand what this disease is like. It’s terrible. I have survived it myself. Even though I have had Covid-19, the antibodies do not last that long, so this jab will be like a booster shot for me.”

He said all of his colleagues were keen to be vaccinated.

“It is going to make a huge difference, especially to those who have not yet had Covid-19. It will provide people extra protection especially given how unpredictable it is. It doesn’t matter if you are old or young, it can take anyone’s life.”

He said while they did not know when they would be inoculated, they were hearing it could be on February 14.

“We have heard Valentine’s Day in the Western Cape and KwaZulu-Natal, but we do not yet know for sure. We definitely hope it will be this month.”

Smith said it was easy to register for the vaccine.

“You just do it online. You upload your identity number, name and address and then you wait to get it.

“Everyone needs to get the vaccine. None of us doctors are skeptical about it and don’t believe the rubbish that it will change one’s DNA.”

Dr Portia Ngwata, who oversees Covid-19 patients at Tembisa Hospital and who is head of internal medicine, said she was very excited.

“We expect to be inoculated on February 17. All of the doctors under me have signed up for the vaccine. They continue to ask when we will be inoculated. We will get our jabs at the hospital.

It will go a long way to protect us front-line workers who have been in the coalface of this fight day in and day out. The fight has been relentless.
Dr Portia Ngwata

“I do not doubt that we need it. It will give us good protection and reduce admission, complications and mortalities among people infected with Covid-19.

“It will go a long way to protect us front-line workers who have been in the coalface of this fight day in and day out. The fight has been relentless.”

She said if people did not take the vaccine they could be placing themselves and others at risk.

Tembisa Hospital nurse Lydia Dikeledi, who deals with Covid patients, however said she had very little information on the vaccine.

“All we have been told is that we must be vaccinated. I don’t have enough information on what its made up of or the side-effects to know if it is a good vaccine or not.

“I have been Googling to find out more information on whether we actually need it. I am also not sure when we will be vaccinated. What I can say is that we need to be given more information.”

She said though she had nursed Covid-19 patients, she had not contracted the disease.

“That’s because I followed the rules, wore masks, sanitised and looked after myself.”

Dr Gerrit de Villiers, chief clinical officer of Mediclinic Southern Africa, said Mediclinic requested vaccines to cover about 37,000 health-care workers in their hospitals.

“This figure includes staff, affiliated doctors and allied health-care workers, as well as supporting and subsidiary services such as ER24 and MHR [health-care and nursing recruitment agency] as per the national department of health guidance.

“We remain committed to engaging with the department across this process to ensure that we are able to assist all health-care workers in our facilities.”


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