The government’s plans to destroy 8.5m COVID-19 Pfizer vaccine doses at the end of October cast a damning spotlight on how the country’s vaccination campaign has missed the mark, say some experts, and are a symbol of the Health Department’s ineptitude and mistakes in managing the vaccination drive.
The situation also raises questions about the fate of a further 10.1m stockpiled doses of J&J vaccine that will expire between June and September 2023, writes Ufrieda Ho for Spotlight.
The country’s rate of daily vaccine doses administered has dropped to a fraction of its peak last year – even though millions have still not been vaccinated. South Africa’s fully vaccinated population, according to Our World in Data, stands at 33% as of September, far off the initial 70% target set at the start of the vaccination drive early in 2021. By comparison, Rwanda reports an 83% fully vaccinated population, Botswana’s vaccinated population is at 66%, and Mozambique’s at 42%.
‘Shocking indictment’
Some public health researchers and specialists are blaming the failure of the campaign not on people’s deepening complacency or jab hesitancy but on the Department of Health’s missteps and mistakes in managing the national vaccination drive from the start, in the first quarter of 2021.
“Destroying these vaccines is a shocking indictment of a programme that has been badly run from inception. What is incomprehensible is why there was no expertise in mass public health programmes from the beginning,” says Professor Francois Venter, divisional director of Wits University’s health platform, Ezintsha. Venter was also a member of the Ministerial Advisory Committee early in the pandemic.
“This was always going to fail because the Health Department and the private sector had this incredible confidence that they could, by magic, make this a success even though they had no track record.
“The key to getting people to take up any kind of public health service is ‘demand-creation’ and the people who know how to do this are those working with programmes like male circumcision, HIV testing and ARV access – not the Department of Health or the private sector,” he adds.
“From the start, there was no proper budget for advertising the vaccination services, no real strategy around what the key messaging would be: the Health Department just expected people to arrive at a facility and get vaccinated.”
Venter says demand-creation combines creativity, accurate and consistent messaging, and urgency to get widespread buy-in, and the first misstep was halting the roll-out of AstraZeneca vaccines in February 2021. Then, he says, the EVDS (Electronic Verification Data System) failed to have substantial population penetration and now the “wheels have fallen off” the campaign.
The SA Coronavirus portal data records that by 11 September, 37 535 745 vaccine doses had been administered. However, the number of daily doses nationwide has dipped below 1 000 on weekends and under 10 000 on weekdays.
Waning demand comes against the backdrop of the South African Medical Research Council’s (SAMRC) sobering estimates of excess natural deaths – numbering around 330 000 since 3 May 2020, with possibly more than 270 000 of those directly due to COVID-19. In 2022, the SAMRC estimates there have so far been more than 42 000 excess natural deaths.
‘Dedicated resources not possible’
The Health Department, however, insists the vaccination programme is on track.
“There is no problem with the campaign. Vaccines are available, the programme has been integrated into the primary healthcare delivery system, and communication continues in national media,” says Foster Mohale, department spokesperson.
“The challenge is that the public is complacent that there is no or low perceived risk, a complex challenge in a society easily influenced by inaccuracies and misinformation spread in social media.”
Mohale says the vaccination programme continues with an eye on the possibility of another COVID-19 wave, but he admits they face competing priorities.
“The health system has to care for millions of people with other health conditions and needs and dedicated resources are not possible for COVID-19.”
Wasted resources?
Destroying the vaccines in October may well be classified as wasted resources, but the financial value of the potential waste is hard to quantify. Government won’t disclose the cost of procuring the vaccines, citing “contractual agreements”.
Mohale says it has to be factored in that 7.9m doses of the Pfizer vaccine, out of the 39m doses received by South Africa, were a donation from the US.
In April 2021, then Health Minister Zweli Mkhize told Parliament that both J&J and Pfizer were selling their vaccines to SA at $10 a dose with no refunds or cancellations permitted. At that pricing, the cost of wasted vaccine doses come end October will run into the tens of millions of dollars.
Mohale confirms that the “environmentally approved” disposal will come with its own price tag. Estimates are “R18 and R25 per kilogram of waste disposed and a tray of 1 170 doses weighs approximately 1.2kg”.
Other options
The department says it is trying to extend the October expiry date by three months but is awaiting South African Health Products Regulatory Authority (SAHPRA) approval. It has also tried to offload the 8.5m near-expiry doses to other countries. The government has approached the African Union and the COVAX facility. The problem, says Mohale, is that any recipient country has to agree to the “no-fault compensation scheme”, which indemnifies manufacturers in the event of any adverse events from the vaccine.
Government has no plans to use up the vaccines by making them generally available to children under 12. Mohale says the Vaccine Ministerial Advisory Committee has advised against mass vaccination of “small children” though vaccination for immune-compromised children between five and 11 is encouraged. He says the EVDS is being adapted to accommodate this population cohort.
Government will also not shorten the recommended intervals between booster shots in a bid to use up the doses either. However, he says “further boosters over time to accommodate waning immunity are under evaluation”.
‘Everything has been so slow’
Public health specialist Lynne Wilkinson says allowing the vaccines to be dumped waste without alternative campaigns to ensure they are used is a travesty, especially as jab rates are so low and the unknowns around long COVID still pose potential health burdens for sufferers.
“Government needs to think out of the box by making an additional vaccine accessible for whoever wants one or running vaccination blitz days or working with religious leaders to vaccinate at gatherings, for instance.”
Wilkinson says at more than a year down the line into vaccination, there should have been lessons learnt to inform a better vaccination strategy. She says the exit of corruption-tainted Mkhize should also have been a moment for stronger leadership and revived confidence in vaccination rather than vagueness that has now allowed people to self-assess COVID risk.
“Everything has been so slow and has just dribbled on instead of mobilising community-based organisations and making it easy for people to get a vaccine,” she says.
Wilkinson spearheaded a vaccination drive at the Bulungula Incubator based in the Eastern Cape village of Nqileni in 2021. Within weeks she says they achieved a more than 95% vaccination rate for over 60s as soon as vaccinations became available for this age cohort – even in a deep rural setting.
“We activated all community resources – meeting elders, going door to door and using community radio and making information clear and available.”
‘Inequality, not hesitancy’
Professor Kate Alexander of the University of Johannesburg’s Centre for Social Change, says low vaccination rates come down to inequality, not vaccine hesitancy. She says it’s not a question of money either, with significant overseas donor money having been pumped into the country via the likes of USAID to accelerate the vaccination rollout.
“Government just doesn’t have a clue about how to deal with issues of inequality, so hesitancy becomes an argument by which it blames ordinary people for the vaccine uptake instead of working on simple interventions to eliminate barriers. Government also doesn’t know how to relate to community-based organisations, and focuses on existing leadership rather than younger activists. Big NGOs have a similar problem,” she says.
Interventions, she says, could be better access to information about vaccine sites, flexible operating hours, addressing transport problems to get to sites, and mobilising community groups, like young people, to get the message across. Failure to change direction puts the remaining 10m stockpiled vaccine doses in similar jeopardy of expiring before being used up.
“It’s scandalous and a shambles,” she says of the inaction, and prompted her to join the growing call for an inquiry into SA’s handling of the pandemic and vaccination campaign.
“An inquiry should be accessible to the public, with the right to subpoena evidence. The low vaccine level is primarily a question for social science whose practitioners would also have something valuable to say… if the relevant data were made publicly available.”
See more from MedicalBrief archives:
Millions of unused, expired COVID vaccines to be destroyed, says Phaahla
Vaccine rollout: SA government has made three mistakes
Sale of AstraZeneca vaccines ‘resulted in up to 22,000 deaths’ of SA elderly
Debate continues over SA’s ditching of the AstraZeneca vaccine
With 7m doses set to expire, DOH tries to boost sluggish vaccination campaign