The government's “total ineptitude” came under fire, with from eminent vaccine and infectious diseases experts Prof Shabir Madhi of Wits University calling on the government to stop administering second doses of the Pfizer vaccine for the time being and ensuring instead giving first doses priority.
Professor Shabir Madhi, the dean of health sciences at Wits who was dumped from the Ministerial Advisory Committee in a purge of those whose advice was unpalatable to the government, said the slow rollout was the latest example of its preference for dogma over science, reports Sunday Times.
Madhi criticised the “government's total ineptitude in adapting to science” by still rolling out second doses of Pfizer in a resurgence when those doses should be given as first doses to others. “After a single dose, protection is at 92%. After the second dose, it only goes up to 96%," he said. "It is too late for Gauteng, but the other provinces should change immediately.”
The number of vaccinations administered rose only modestly last week, reaching a new high of 136,954 on Friday. The health department's daily target is 250,000. Professor Jeremy Seekings, director of the University of Cape Town Centre for Social Science Research, and UCT economics Professor Nicoli Nattrass, who are tracking the vaccinations programme, said the programme needed to triple its pace.
Madhi, a former president of the World Society of Infectious Diseases, is frustrated by the slow rollout. “Government seems intent on creating obstacles rather than creating an enabling environment,” he said.
The rollout had proceeded with a “fixation on implementing technology rather than getting vaccines into the arms of people as quickly as possible, and that technology does not speak to our local reality”.
Madhi told the Sunday Times that electronic registration had “simply not worked” to get people to register before rather than on the spot, and short notice for appointments was problematic. The second major problem was that the government was "insisting that people without health insurance can't be vaccinated in the private sector".
Another difficulty was vaccinating at the peak of a resurgence. “During a resurgence, you would have 10% to 15% of people at the vaccine site already brewing the virus. Three days later they get COVID and end up in hospital and blame the vaccine,” Madhi said.
Madhi's predecessor as dean of health at Wits, Professor Martin Veller, said he was alarmed by the “massive strain” on Gauteng's health system, which coincided with “nonexistent” leadership in the provincial health department. “The situation is currently bloody awful,” he said.
On top of the delayed vaccines the “government is completely inept when it comes to lockdown implementation and continues to use them as terrible blunt instruments”. He said the government failed to use the evidence “that is right before it" on the enforcement of regulations that are proven to reduce transmissions”.
Professor Mosa Moshabela, the University of KwaZulu-Natal nursing & public health school dean, said the government was reactive and afraid to take risks. “Government is constantly in crisis response mode and does not look ahead to strategise. The public does not know what government's strategy is. Not knowing means one cannot support government's interventions.
“Bold risks should have been taken, like keeping the AstraZeneca vaccine. And it's incomprehensible that the vaccination process in Gauteng is so slow.”
Delta research playing catchup
Research has yet to catch up with a full profile of the effects of the Delta variant, which is displacing its Beta predecessor in South Africa.
TimesLive reports that a UK observational study showed “there may be increased risk of hospitalisation within 14 days of a positive test [compared with the Alpha variant]” but no increased risk of dying, said University of KwaZulu-Natal geneticist Professor Tulio de Oliveira in a presentation this week.
On Friday, SA Medical Research Council president Professor Glenda Gray said at a health department briefing that the single Johnson & Johnson shot worked better against Delta than against Beta. “We can see there is less immune escape in the Delta variant compared with the Beta variant, but over time both improve and the data shows that there is surprising durability by eight months,” she said.
The Pfizer vaccine, also being rolled out in SA, provides 94% protection against hospitalisation attributed to the Delta variant, the latest studies find. No scientific studies yet show that infections are more common among children, teens or younger adults, even though anecdotal accounts have raised this concern.
Dr Jinal Bhiman, principal medical scientist at the National Institute for Communicable Diseases (NICD), said that the Delta variant was spreading across provinces. “[It] is being detected in other provinces [besides Gauteng], including the Western Cape, KwaZulu-Natal, Limpopo, the Eastern Cape and Mpumalanga.”
The Network for Genomic Surveillance SA said the Delta variant accounted for 53% of infections in Gauteng and 45% in the rest of the country. In May the Beta variant accounted for 70% of the genomes analysed, but this dropped to 39% last month.
“The most prominent current symptoms are headache, sore throat, runny nose and sneezing,” said De Oliveira. “More work is needed to confirm if this is a consistent finding with the Delta variant or reflects the clinical profile of infections in certain age groups and/or in partially/fully vaccinated individuals.” South Africans who had been infected with the Beta variant have reduced immune protection against the Delta variant, he said.
Madhi said that in previous waves the transmissibility in a household was around 30%, but now with Delta, it had shot up to 100%. He said modellers in SA had not accounted for “so many mutations over such a short period of time” and that this could result from their expertise being more familiar with HIV and TB, which behave differently.
Madhi said preliminary data from UK studies had shown more severe disease but that their context is very different.
“Our population immunity is very different to the UK, as we found that 19% of adults and children had been infected before the second wave even peaked and it was probably closer to 35% at the peak. In the UK, it’s less than 10%, so we are afforded more underlying immunity whereas they may see more severe disease with the Delta variant.”
By the time of a fourth wave in SA, another variant could have emerged as an even fitter virus, leading to calls for a rapid increase in the number of vaccinations from just more tan 100,000 to 125,000 a day in the past week.
New variants on the horizon
Mail & Guardian reports that scientists are concerned over a mutation of the Delta variant. Commonly known as Delta Plus, the new mutation is also called the B.1.617.2.1 or AY.1 variant, and is a sublineage of the Delta variant. It has been identified in 11 countries, with 200 cases recorded as of 29 June, but has not yet been identified by WHO as variant of interest. In SA, three cases of Delta Plus have been recorded. According to Professor Tulio de Oliveira of the KZN Research and Innovation Sequencing Platform, the scientific community was keeping an eye on the new mutation because vaccines might not be so effective against it, and there is also a strong possibility that it could reinfection in those people who have previously been infected by earlier variants.
IOL reports that in a presentation delivered to the National Coronavirus Control Council , De Oliveira and Dr Richard Lessell from the Network for Genomic Surveillance SA said while the variant has been detected in one African country, it has not reached SA’s shores yet. The Lambda variant, also known as C.37, was first detected in Peru in December 2020 and has since spread to 30 countries. The WHO identified the Lambda variant as a “variant of interest in June. Last month, 90.6% of new cases in Arequipa and 78.1% of new cases in Cusco, Peru, were the Lambda variant, according to the Peruvian Ministry of Health. According to Public Health England, there is currently “no evidence that this variant causes more severe disease or renders the vaccines currently deployed any less effective”.
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