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Growing anger over SA government's vaccine 'fiasco'

South African medical scientists, joined by activist groups, health workers and opposition parties, have slammed the government and its Medical Advisory Committee (MAC) over the “perilous fiasco” of the vaccine roll-out, reports MedicalBrief. It's a mobilisation reminiscent of the activist wave that the government faced over HIV/Aids in the late 1990s and early 2000s.

A statement released at the weekend and signed by some of the country's leading medical figures under the auspices of the Progressive Health Forum, says that it “beggars belief” that middle-income country South Africa has left itself dependent on the COVAX initiative set up to assist poor countries, and criticises the government's playing down of the importance of vaccines in relation to non-pharmaceutical interventions.

Business Day reports that following the scientists' statement and as SA cases of COVID-19 rise to the highest daily levels, the “lack of a coherent vaccine strategy is leading to a growing outcry from doctors and nurses and from opposition political parties”.

SA's official opposition, the Democratic Alliance (DA) has written to the Speaker of the National Assembly to again request an urgent debate of national importance regarding the government's vaccination-plan. Accusing the Health minister of raising more questions than answers in his briefings on vaccinations, the DA Shadow Minister for Health, Siviwe Gwarube, has also submitted a Promotion of Access to Information Act (PAIA) application to obtain information on the procurement process and the distribution mechanisms and methods of the vaccines.

More than 7,500 health professionals have signed an online petition demanding a detailed vaccine plan from the government. Agri SA has expressed concern at the government's perceived lack of urgency by the government in securing enough vaccines, rather than the initial 10% announced by President Cyril Ramaphosa, who said only 10% of South Africans would get the vaccine, with health workers taking priority.

The Congress of SA Trade Unions (Cosatu), a key government ally, said in a statement: “It is clear that we are dealing with colossal mismanagement of the vaccine procurement process”. It described Mkhize's briefing as publicity stunt: “What the minister presented is bunk and the country should not accept it. South Africans are familiar with the egregious policy failures with deadly consequences as we saw with the mismanagement of the Aids pandemic.”

“It is clear that we are dealing with colossal mismanagement of the vaccine procurement process and frontline workers, the elderly and those with comorbidities will pay with their lives. This is hiding the fact that there are 40 countries that have already begun immunising their people, some since December and some are South Africa's peers in the middle-income bracket.”

Solidarity union was especially critical of the government’s strategy of controlling procurement but expecting private sector resources. Said the union: ‘The state cannot be in control while the private sector provides the finances. The state has a poor management record. During the pandemic, the government has repeatedly proven that it is not competent to take the lead. It is this incompetence that has led to the delay in obtaining the vaccine, and the government should be kept as far away from this process as possible.’

The Institute of Race Relations (IRR) said in a statement it was considering a legal challenge on “compelling action to ensure that South Africans have access to a vaccine”. The IRR CEO, Dr Frans Cronje, said: “It is not good enough to say there is a plan to procure vaccines. South Africans need to know what has been procured and when it will be available”. Cronje added that the IRR believed that the government, with support from the private sector, could ‘easily and rapidly finance vaccine procurement’.

Content of PHF statement

The PHF statement, published in a variety of newspapers, notes that the “stunning reality” is that the SA government has failed to secure vaccine supply, nor does it have a plan for mass inoculation in the foreseeable future “that can withstand scrutiny”. “This lack of foresight,” they write, “will visit on us the consequences of the greatest man-made failure to protect the population since the Aids pandemic… A high probability of a reprise of this is a monumental and unforgivable failing.”

They signatories, a number of who were dropped from Health Minister Dr Zweli Mkhize's MAC – speculatively because they were too outspoken – called for the advice given by the MAC on vaccines to the government to be made public. They have harsh words for their medical peers serving on the MAC, whom they accuse of either condoning the government's strategy or else participating in a “cover-up”.

“The posture of the Ministerial Advisory Committee on Vaccines appointed last September, suggests that it has been dragooned into the specious approach of the department. The comments of the chairman of the vaccine committee align closely with the comments of the Deputy Director-General and other officials of the department who are supposed to lead the vaccine acquisition programme of the government. Their admonishment that vaccines are not a silver bullet”, or that they “do not end epidemics” are frankly astounding.

“Several advisories of the vaccine committee have been issued, but none have been published. The committee’s silence on the matter has been deafening. This suggests that the committee either concurs with this lack of transparency and condones a wholly inadequate vaccine acquisition policy, or it does not, but has been officially muzzled.

“This can only mean that the responsible officials have indeed missed the vaccine boat and a huge damage limitation exercise is underway to escape scrutiny and likely censure for this unforgivable failure, which will be measured in lives lost in their thousands, sickness for tens of thousands, a broken healthcare system and profound and ongoing economic damage.

“It is unconscionable that this has been allowed to occur and it is to the discredit of the advisory committee that it appears to have been enlisted in this exercise. Its members have the ability and expertise to produce a transparent and accelerated vaccine acquisition strategy, measured in weeks, not months. That such a strategy is lacking puts them in the invidious position of having to reaffirm their scholarly credibility and ethical composure. This dissonance deepens the suspicion that the committee is not free to do its work.

“In a moment of existential threat, this incoherence in lead institutions is simply intolerable.”

“South Africans, pummelled mercilessly by the pandemic, have an untrammelled right to demand the immediate public disclosure of the advisories of the vaccine MAC and a full account of the disposal of any of its recommendations. There must be no further cover-up…”

The signatories — “writing in their personal capacities and with the support of colleagues here and abroad” — are Dr Aslam Dasoo (Convenor of the Progressive Health Forum), Prof Glenda Gray (President of the SA Medical Research Council), Prof Guy Richards (Emeritus Professor in Critical Care at Wits University), Prof Marc Mendelson (Head of Infectious Diseases and HIV at the University of Cape Town), Dr Fareed Abdullah (AIDS and TB Research at the SAMRC), Prof Francois Venter (CEO of Ezintsha at Wits), Prof James McIntyre (School of Public Health at UCT), Dr Adrienne Wulfsohn, (Specialist in Emergency Medicine at Inkosi Albert Luthuli Hospital) and Prof Alex van den Heever (School of Governance at Wits).

Government and the MAC's position

The government's position on the vaccine rollout has been maddeningly vague, its critics claim. In his New Year’s address, President Cyril Ramaphosa said the “vaccine will come”, while the Deputy Director-General of Health, Anban Pillay, suggested this would only happen in the second quarter of 2021.

In Mkhize's briefing on Sunday, 3 January 2021, he announced that at least 67% of the South African population will need to be vaccinated against Covid-19 to ensure herd immunity. The vaccine would be rolled out in three phases, with the 1.25-million healthcare workers in the country having first access.

The second phase would see essential workers and those living in congregate spaces, such as care centres and prisons, offered the vaccine. Those classed as essential workers include miners, teachers and police officers. The second phase, which will require roughly 16-million doses, will also include those aged 60 and older as well as those with comorbidities.

The third phase would see the vaccine being made available to an additional 40-million people.

Mkhize said the COVAX agreement would see enough vaccines to cover 10% of the population delivered by the second quarter of 2021. He added that enough doses to cover the remaining 57% of the population would have to be sourced through bilateral agreements.

The government hoped to conclude negotiations with coronavirus vaccine suppliers and begin vaccinating frontline healthcare workers in February. Mkhize said government departments were working urgently to secure vaccines through bilateral deals with manufacturers. He said the target date was “really more our wish” and no deals had been reached to deliver vaccines by February, but the government was “fighting” to secure supplies before the second quarter of the year.

Prof Barry Schoub, Chair of the MAC on COVID-19 vaccines, responded in Daily Maverick to the criticisms, “to address an urgent and earnest appeal to civil society groups – please stop insinuating false hopes and expectations to the public for immediate solutions to the COVID-19 crisis”. The availability of a vaccine would not be a “magic wand and any suggestion that it may be is dangerously threatening the public motivation to continue with the non-pharmaceutical interventions”.

“There is a growing groundswell of impatience, and sometimes even a demanding anger, resulting from the delay in having COVID-19 vaccines in the country … Undoubtedly the issue is becoming more and more emotional and a hot political weapon. Activist groups, such as the C19 People’s Initiative, have also sprung into action, alluding to the laudable and effective HIV treatment campaign. However, while the intent is commendable, it must be balanced against raising false expectations which could imperil the crucial non-vaccine Covid infection prevention precautions which will still be critically needed for some time to come.

“The delay has simply come about as a result of the grotesque selfishness of high-income countries.
middle-income countries, like South Africa, would be roundly condemned should they have considered gambling with their much more limited taxpayers’ money for vaccines still undergoing investigative trials, when it was unknown whether they would be safe and effective.

“We cannot afford to create false hopes and false expectations which, unfortunately, vaccine activism may be in danger of doing. Vaccines will not immediately allow us all to go back to our pre-Covid lives. Sustaining human behavioural dedication to fight an unseen enemy is challenging, uncomfortable and even irritating. But it depends critically on the support of all sections of the community. It is fragile and can be easily fractured by the seduction of a magic vaccine. It is equally easy to look for a scapegoat.

“Arguably, there may well seem to be a lacuna in communicating adequate assurance to the public. But let me state that there are indeed very extensive behind-the-scenes efforts to acquire safe and effective vaccines as soon as possible, and also to develop a comprehensive vaccine strategy.”

Schoub said that South Africa could not afford to buy vaccines in advance like many rich countries have done because it would have meant purchasing vaccines on risk. In other words the government would have had to pay for vaccines that were still being tested even if they failed to work.

Other reaction

In an interview with GroundUp, Shabir Madhi, professor of vaccinology at Wits University, said this was “nonsense”. He said that making an “advance market commitment” to vaccine producers would mean only paying if the vaccine was successfully brought to market. This is why countries like Canada have enough vaccines committed to it to vaccinate their entire population.

An editorial in Maverick Citizen says that the polarisation in SA “feels like the bad old days of Aids”.

“The informed anger of leading scientists is understandable. The obfuscation of government and vaccine MAC Chairperson Prof Barry Schoub is unacceptable. Accusing activists of “raising false expectations” rather than dealing with their complaints is bound to harden divisions. Health activists don’t give trust away freely anymore: COVID-19 corruption and, before that, the millions of wasted lives caused by Aids denialism are still too fresh in our memories.

“The truth is that the government did drop the ball on vaccines. There’s no point in denying it, doing so just draws out the conflict. The truth is that government did hand-pick a Ministerial Advisory Committee (MAC) on Vaccines that left out expert scientists and civil society experts who are unwilling to wear a muzzle in return for the privilege of advising government.

“Government needs civil society and it needs all the medical profession, not just those that will toe its line. Twenty years ago, when the Treatment Action Campaign (TAC) catalysed an international mobilisation to help South African and other developing countries fight Aids, it was civil society pressure, which made antiretroviral medicines affordable.

“Today, civil society still has a critical role to play in ensuring that safe and efficacious vaccine access is determined by science and medicine, not blocked by either profiteering, corruption or the geopolitics of big powers like China or Russia who might link vaccine access to economic favours and expanding spheres of influence.”

 

[link url="https://www.businesslive.co.za/bd/national/health/2021-01-02-leading-scientists-slam-government-inaction-amid-global-race-for-vaccines/"]Full BusinessLIVE report (Subscription Required)[/link]

 

[link url="https://www.dailymaverick.co.za/article/2021-01-02-vaccines-for-south-africa-now/?"]Full Progressive Health Forum statement in Daily Maverick[/link]

 

[link url="https://www.change.org/p/sa-department-of-health-we-need-a-vaccine-plan-now?recruiter=20854029&utm_source=share_petition&utm_medium=twitter&utm_campaign=psf_combo_share_initial&utm_term=psf_combo_share_initial&recruited_by_id=c07335a9-f58f-4cd1-9997-5ad49763dccc"]Health workers petition[/link]

 

[link url="https://www.da.org.za/2021/01/speaker-must-reconsider-urgent-debate-on-sas-covid-19-vaccination-plan-and-allow-an-ad-hoc-committee-to-be-formed-to-monitor-the-vaccine-rollout"]Full DA statement report[/link]

 

[link url="https://www.polity.org.za/article/mkhize-caught-sleeping-in-the-face-of-a-deadly-pandemic-says-cosatu-on-vaccine-rollout-2021-01-04"]Full Cosatu statement[/link]

 

[link url="https://dailyfriend.co.za/2021/01/05/potential-vaccine-legal-challenge-from-irr/?"]Full IRR statement[/link]

 

[link url="https://www.dailymaverick.co.za/article/2021-01-03-the-covid-19-vaccine-and-the-danger-of-creating-false-expectations/?"]Full Daily Maverick report[/link]

 

[link url="https://www.groundup.org.za/article/health-workers-demand-vaccine-rollout/
Health workers demand vaccine rollout"]Full GroundUp report[/link]

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