Despite the AstraZeneca setback, there’s still a lot to cheer about

The honeymoon phase might be over and reality has bitten, but there is still much to celebrate as vaccines show high promise in tackling Covid-19.

This is the sentiment of two of the country’s top scientists, both of whom are at the coal face of Covid-19 research in SA: prof Glenda Gray, who leads the SA Medical Research Council (SAMRC), and vaccinology professor Shabir Madhi from Wits University.

Madhi said in March last year, when scientists said we would have a vaccine within 18 months, he felt “sceptical” but “seven have been authorised by at least one regulatory authority”.

“They have all been highly efficacious against the earlier variants — some up to 95% — and this is phenomenal success for a first generation of vaccines,” he said on Tuesday.

Madhi said safety had been established in all seven vaccines.

The two scientists were speaking on a Maverick Citizen panel, hosted by Mark Heywood, on Tuesday night after news at the weekend, and confirmed on Monday, that the AstraZeneca vaccine was not effective against mild and moderate Covid-19 infection.

Madhi described this early success as a “honeymoon phase” that preceded the disappointing news South Africans recently received about the AstraZeneca vaccine.

How might our marriage to vaccinations look in the wake of this honeymoon phase ending and the setback?

We are in an incredibly important phase and with the emergence of the variants. We need to look at the impact of those variants on the vaccines already developed.
— Prof Glenda Gray of the SA Medical Research Council

Madhi remains upbeat, saying in addition to the seven safe vaccines already developed, “there are 35 in late stage human trials, and much of the scientific community has turned its attention away from what they were focused on” to put their weight behind tackling the pandemic.

Gray also remains upbeat.

She said: “It is exciting that millions of doses are being rolled out across the globe. The huge injection of public money has also accelerated the process, with governments putting money in so manufacturers could go ahead even at financial risk.”

However, this doesn’t mean there won’t be “concomitant controversies” that go with the rollout.

“We are in an incredibly important phase and, with the emergence of the variants, we need to look at the impact of those variants on the vaccines already developed,” said Gray.

“We must look at the second generation of vaccines. That doesn’t mean they [first generation vaccines] shouldn’t be rolled out or evaluated in populations where they have been found to be efficacious.”

Gray is also pinning hope on the Johnson & Johnson (J&J) vaccine, which requires a single dose and has shown efficacy against severe disease, hospitalisation and death, including in the case of the so-called SA variant.

She said it could be a game-changer for health workers.

“They have borne the brunt of this epidemic and have seen terrible things. They have had to manage Covid-19 infections among their other work and have seen their colleagues admitted to hospital and dying. This does represent an emergency use for a vaccine.”

She said the data from J&J is 10 days old but already the US Food and Drug Administration has approved it, and in the next few days the European region will do so too. A rolling submission has been submitted locally to the SA Health Products Regulatory Authority.

Madhi said despite the disappointing news at the weekend, there was no need to dump the AstraZeneca vaccine. He said while it was not effective against mild and moderate infection, it was likely it was effective against severe Covid-19 infection.

“I don’t think we need to halt the [vaccine rollout] programme. What we can’t do is say all healthcare workers should be vaccinated. Among the healthcare work force, 75% probably don’t have risk factors and are not over the age which predisposes them to severe disease. If you vaccinate all healthcare workers with the AstraZeneca vaccine, 75% of the healthcare force is not going to derive any benefit.

“With the other 25% there is good reason, in the absence of other options which have been proven to work, to vaccinate with the Johnson & Johnson vaccine, if it’s available, and if not, with the AstraZeneca vaccine.

“The same thing applies to other parts of the public workforce and everyone else. For people at higher risk of developing severe disease there are two choices: remain unvaccinated until a resurgence appears, or take your chances with a vaccine known to be safe and likely to protect against the disease and death. That includes the AstraZeneca vaccine,” said Madhi.

Gray, however, was more circumspect about the AstraZeneca rollout, and has suggested waiting for the J&J vaccine, which is likely to be more beneficial.

She said: “I view vaccinations in terms of individual and public benefit. In terms of AstraZeneca, I think we have to look at the data.”

Gray said a clinical trial in progress into the AstraZeneca vaccine would be of huge value. In this trial, 30,000 people were being evaluated and the results would be crucial.