Vaccine advisory head hits back at pro-AstraZeneca colleagues

“Egregious” and “distasteful”.

That is how Prof Barry Schoub describes the implication by other experts that the sale of AstraZeneca to other African countries was unethical.

Schoub leads the ministerial advisory committee on vaccines, and has penned an incensed editorial for the SA Medical Journal, in which he lashes back at Prof Francois Venter (Wits University) and other experts who said that “SA should be using all the Covid-19 vaccines available to it — urgently”.

Venter and the other experts said that “sending the AZ vaccine to other African countries raises deep ethical concerns” as the B.1.351 variant “has been detected throughout Africa and may be responsible for the devastating second wave many countries have just experienced”.

They ask: “If the SA authorities truly believed that the AZ vaccine did not work, why was it sold on to the AU, and why would they purchase it?”

But, writes Schoub, B.1.351 “is hardly the ‘dominant variant circulating in much of Africa”, and the assertion by “Venter-hulle” is “not only loathsome but also totally wrong”.

“On the contrary,” he says, “it would actually have been highly unethical for SA to have rolled out one million doses of a vaccine of unproven efficacy, when it could have been of great value to economically disadvantaged African countries struggling to acquire sufficient vaccine, where B.1.351 is either undetectable or relatively unimportant”.

Schoub asked his colleagues to engage in discussions in a “respectful and professional manner” and said he hoped his rebuttal would “be the end of this distasteful, uncalled-for and damaging activity”.

The rebuttal details the MAC’s decision not to roll out AZ in SA. With such poor efficacy, it would drain much-needed resources, break public trust and create a potential threat of further “escape variants” of the virus that causes Covid-19 disease.

Venter and company had accused the MAC on vaccines of a lack of transparency: “We understand that a decision like this is complex, but as the reasoning behind it has not been made public, we are at a loss to explain the government’s action,” they wrote, adding that “politicians and advisory boards need to be transparent and explain decisions, and, if necessary, reverse them”.

They wrote that “SA has misapplied standards hampering the rollout of a vital and available tool to mitigate the epidemic. Moreover, it has gone against guidance from the WHO.”

Schoub, however, was angered by the implication that the suspension of AZ had been “shrouded in secrecy by the MAC on vaccines” when there were very sound reasons for the suspension.

“First, and fundamentally, there is currently no evidence that the AZ vaccine will effectively prevent severe Covid-19 disease caused by the dominant B.1.351 variant in SA,” he has written in an editorial in the SA Medical Journal, adding that the trial showed a “dramatic drop” in the vaccine’s ability to fight mild to moderate disease — from 70% and 79% in the UK and US respectively, to just 22% in SA.

The AZ vaccine’s “neutralising antibody production” is also “only fairly modest and several times lower than other vaccines” like Pfizer.

He took issue with experts who’d argued to give AZ a try anyway, in the hope that it had an impact.

This, he said, could “seriously damage” the “fragile public trust” in vaccination if the “real risk of multiple failures” came to fruition, and at the same time, the vaccine could create “a false sense of security” while not providing enough protection.

He said it would also be a mistake to “divert precious human vaccinator resources” and fuel the “global syringe shortage” by rolling out a vaccine with “unproven efficacy”.

Also, he said vaccinating a large group of people with a vaccine of “poor immunogenicity” (one that does not provoke a strong immune response by the body) would be a “recipe for the selection of even further escape variants”.

He said the editorial by Venter and company “ignores the centrality of the B.1.351 virus in the context of vaccines for SA”.