Covid-19 vaccine: SA's race to nab the jab hots up

As a record number of new infections overwhelmed some hospitals this week, SA's long-awaited vaccine programme went into overdrive, with the first jab expected to be administered by the end of January and the government in "advanced" negotiations with vaccine manufacturers across the globe.

Health minister Zweli Mkhize told the Sunday Times that despite concerns by some over the perceived slow pace of securing vaccines, SA will complete its vaccination programme "with many other countries that started ahead of us". 

A comprehensive document on the rollout was distributed to stakeholders this week, revealing that the government aims to vaccinate up to 316,000 people a day. It says the government will need 6,300 full-time vaccinators, who will each administer the vaccine to as many as 50 people per day.

Over and above nurses and other health-care workers, the government will also recruit vaccinators from post-community service nurses and doctors, contract nurses, and final-year medical and nursing students.

Mkhize also confirmed that the government has been in talks with Russia and China since last year to possibly acquire vaccines manufactured there. This follows concerns by the South African Communist Party that the document distributed this week mentions only vaccines being manufactured in Western countries.

"We have ongoing negotiations with China on the basis of what they have been able to produce," Mkhize told the Sunday Times.

"We have had contact with Russia. I had a meeting with the ambassador in September and we brought the Russian team to meet with the vaccine ministerial advisory committee. There have been continuous interactions.

"We are not looking on one side, we are looking at everything that will come because this is a huge programme."

Russia is fifth on the list of global vaccine makers, with most doses of its Sputnik V under contract through pre-purchase agreements, according to Bloomberg's Covid-19 Vaccine Tracker. However, no phase 3 trial data has been released and the vaccine has not been peer-reviewed. A similar situation exists at China's state-owned pharmaceutical giant, Sinopharm.

Mkhize said SA "has spoken to its allies".

"We have an order coming from India, which is based on the fact that we have a relationship with India," he said.

He was referring to a deal announced this week in which SA will get 1.5-million AstraZeneca vaccine doses from the Serum Institute of India. They are due to arrive this month and next.

The deal comes as SA records massive spikes in infections. By Friday, SA had 212,226 active cases of Covid-19 - meaning one person in every 280 has the virus.

Total infections to date are at 1,192,570, which means one person in every 50 has received a positive test. The true number of infections is believed to be much higher.

On Friday SA chalked up its highest daily number of new confirmed infections - 21,998 - and the highest daily death tally (616) not accompanied by an explanation attributing this to a data backlog.

New mortality records were set 13 times in the 17 days between December 22 and Friday, and the 11 days with the highest number of new infections have all occurred since December 23.

Active infections have grown more than sixfold since a low of 33,753 on November 12, and are now 22% higher than they were at the peak of the first wave in July 2020.

Some hospitals this week confirmed having to turn away critically ill Covid-19 patients due to a shortage of staff and beds.

Mkhize said the plan is to vaccinate 40% of the population over 12 months.

"We have not wasted time and South Africans need to be assured that everything is on course. When the president said April [for the first vaccine], it was because Covax said the earliest they can deliver is April.

"Now we have a batch coming, we can deliver in January. People need to understand that we are handling this issue with urgency and a sense of responsibility."

The AstraZeneca vaccine has not yet been registered with the South African Health Regulatory Authority (Sahpra), but Mkhize said this will not cause delays in the rollout.

"Sahpra will use reliance where vaccines are recognised by regulators that we have a written relationship with, plus the World Health Organisation."

Mkhize said the government is at an advanced negotiation stage with other manufacturers.

"We had not done that at the beginning because we needed to see which vaccines are becoming successful. Other countries put bets before vaccines came out. For us it would have been irresponsible to do that when we don't have resources. We couldn't afford to do that."

This week the health department confirmed it is in discussions with South African pharmaceutical giant Aspen over access to a Covid-19 vaccine. About 300-million doses of the vaccine developed by global health-care giant Johnson & Johnson are to be produced at Aspen's plant in Port Elizabeth.

The government is also negotiating with Pfizer for a supply at a discounted rate.

Mkhize said the challenge in vaccine acquisition is not a lack of funding, as the Treasury is obligated to shoulder most of the financial burden, but longer waiting periods and a lack of large consignments.

"What we are finding is that some of them, while we would have been happy to receive their vaccines, they don't have vaccines immediately available. Others have them in lower doses than what we are asking for."

Mkhize said the vaccine acquisition task team members have unique skills and are working around the clock to make sure the government meets its targets.

The team is led by Discovery founder Adrian Gore and is made up of senior leaders in the government and private sector.

It was instrumental in this week's announcement that medical aids, many of which have already committed to purchase vaccines for their members, will also subsidise vaccine purchases for those who are not covered by private health insurance.

Business leader Sandile Zungu, one of six people on the team, said more progress will be made in the next week.

Speculation is that the Treasury will provide between R8bn and R10bn through re-allocation of the budget over the medium term, with private medical aid schemes and the Solidarity Fund providing the rest.

The Council for Medical Schemes said details are still being finalised with the government. It has been reported that medical schemes could provide up to R7bn.

Business, through the Business for SA platform, has also been asked to assist if there is a funding shortfall, said business leader and B4SA chair Martin Kingston.

He said the private sector will also provide the government with skills, resources, and capacity to allocate, distribute and administer the vaccines, as well as help with tracking and tracing and monitoring for any adverse effects of taking the vaccines.

"Logistics and distribution are where business can play a role . You can see the mining sector playing a significant role in vaccinating employees or families or communities around them because they've got the infrastructure to do that," said Kingston.

The vaccines, once received by the health department, will be purchased by approved suppliers which will allocate these to provincial health departments and private health-care facilities.

Vaccinations, according to the document distributed this week, will be administered in three phases. The first phase will see limited doses being administered, at work and through a few vaccination sites, to a targeted 1.25-million people made up of frontline health-care workers.

This will be followed by a larger number of doses - including the vaccines from the Covax facility - being made available to the elderly (5-million citizens over 60 years old); 2.5-million essential workers; 1.1-million people in overcrowded settings; and 8-million with comorbidities. These will be administered through public and private health facilities, including pharmacies and mobile clinics, and via work-based vaccinations.

The last phase will be open to up to 22.5-million adults through all platforms but with a focus on primary health care.

The ministerial advisory committee is still mulling over whether pregnant women will be vaccinated, as safety for both mother and child is still unknown and vaccination is currently not recommended.

"Guidance will be updated as new evidence becomes available," the document says.

Guidance is also awaited in the case of those who have contracted Covid-19 and recovered.

The government will take a leading role in the negotiations for acquisition of the vaccines and the funds will be pooled in one account managed by the Solidarity Fund, but the rest of the project will be carried out in collaboration with the private sector.

This will see the creation of a national vaccine co-ordinating committee co-chaired by health director-general Dr Sandile Buthelezi and Dr Lesley Bamford, a chief director in the department.