Experts field key questions on the Covid-19 vaccine rollout

10 January 2021 - 00:00
By claire keeton AND Claire Keeton
SA will receive a million doses of the Oxford-AstraZeneca vaccine from the Serum Institute of India this month.
Image: Sergey Chayko SA will receive a million doses of the Oxford-AstraZeneca vaccine from the Serum Institute of India this month.

More than 60 Covid vaccines are being tested in human clinical trials, and 80 are in preclinical and animal trials.

This month, according to an announcement this week by health minister Zweli Mkhize, SA will receive a million doses of the Oxford-AstraZeneca vaccine from the Serum Institute of India. These will be given to health workers. Another 500,000 doses are due next month.

But many questions remain about the broader vaccine rollout, and this week the Sunday Times put some of them to three experts: Prof Barry Schoub, vaccinologist and chair of the ministerial advisory committee on Covid-19 vaccines; Prof Glenda Gray, vaccinologist and president of the South African Medical Research Council; and Dr Ryan Noach, CEO of Discovery Health.

When is the soonest a Covid vaccine is likely to be available to anyone in SA?

Schoub: In the first quarter.

Gray: Hopefully we will see the AstraZeneca vaccine arrive for health workers by the end of January.

Noach: Extensive work is under way with the ministerial advisory committee on Covid-19 vaccines, as well as the vaccine acquisition task team established by the minister of health, to secure further doses as quickly as possible. All indications are that global manufacturing of vaccines is beginning to accelerate, which will result in increasing availability as the year progresses.

How many Covid vaccine manufacturers is the government negotiating with, and which take priority?

Schoub: Negotiations are subject to nondisclosure agreements.

Gray: I am not sure who the department of health is negotiating with. If I were them, I would be negotiating with all manufacturers whose vaccines have shown efficacy, and all of those who have potentially efficacious vaccines: Pfizer, Moderna, AstraZeneca, Johnson & Johnson and Novavax.

When are the government's negotiations with vaccine suppliers expected to be complete and deliver results?

Gray: The first to arrive on our shores will be AstraZeneca, perhaps Pfizer will be next. If Johnson & Johnson works, that will be the vaccine introduced in February/March.

Comparison of Covid-19 vaccines.
Image: Graphic by Ruby-Gay Martin Comparison of Covid-19 vaccines.

Is SA likely to buy different vaccines from multiple suppliers or stick with one?

Schoub: SA will probably buy vaccines from multiple suppliers.

Gray: Hopefully the government will negotiate with everyone to bring in the 50-million or so vaccines required.

Noach: Given the shortage of Covid-19 vaccine supply globally in the short term, it's likely that SA will see three to four different South African Health Products Regulatory Authority [Sahpra]-approved vaccines in use during 2021. This should not be a concern as the safety and efficacy of these vaccines will be similar. All vaccines approved for use would have undergone the same rigorous testing and clinical evaluations.

When will the Covax vaccines become available in SA? In your view, what was the reason for the delay?

Schoub: In the first or second quarter. Negotiation delays [held up the process].

Gray: Covax vaccines are expected to be available at end of the first quarter, early second quarter. I am not sure of the reason for the delay, maybe because we delayed negotiating and paying.

If the government secures a deal with a manufacturer, can it roll out its vaccine if SA is still waiting for vaccines to be delivered from Covax?

Schoub: Yes, indeed. It will roll available vaccines out, not wait.

How many Covid vaccine suppliers are medical aids and private business negotiating with?

Noach: Three Covid-19 vaccines - Pfizer-BioNTech, Moderna and AstraZeneca-Oxford - have published results from phase 3 clinical trials and received emergency use approval in other countries. Most notable among the additional vaccines in the pipeline are the Johnson & Johnson vaccine and the Novavax vaccine.

The Johnson & Johnson vaccine is perhaps the most appealing of this group, mainly because it's a single-dose vaccine and can be stored at room temperature.

Prioritisation of vaccines for SA will be based, first and foremost, on safety and efficacy. Based on this, the AstraZeneca, Pfizer-BioNTech, Moderna, Johnson & Johnson and Novavax vaccines are all expected to be good candidates.

When do medical aids expect to reach an agreement that would result in any one of these vaccines becoming available?

Noach: Vaccine manufacturers have expressed a strong preference for engaging through government leadership in all countries. The pooling of procurement will certainly lead to better negotiation terms, more organised distribution and a well-co-ordinated national vaccination campaign. Isolated approaches to vaccine distribution are not sustainable and would forgo the economic and health benefits of aggregate population immunity.

Considering this critical imperative, the medical scheme industry is collaborating closely with the department of health to ensure access for all South Africans to the vaccine, and especially for the priority groups. Nobody can procure vaccines until approval has been secured by Sahpra.

Which co-morbidities will put a person in phase 2 part of the rollout, and what evidence of these will be required?

Schoub: Diabetes, hypertension, morbid obesity, underlying lung, heart and renal disease.

Gray: People with obesity, hypertension, diabetes et cetera. The evidence would be their clinical histories.

When will enough South Africans be vaccinated to stop the pandemic?

Schoub: Vaccination will be an ongoing process.

Gray: We need to vaccinate rapidly but do it in a strategic way to get the best bang for our buck.

Noach: We are in advanced discussions . to accelerate the availability of the vaccine to all South Africans to get 67% of the population vaccinated by the end of 2021 and ultimately reach herd immunity.