SA vaccine rollout: A supply boost and ambitious new plans

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South Africa's fumbling vaccine rollout was boosted this week with a commitment of 30m Johnson & Johnson doses with deliveries starting by end April, while hHealth Minister Zweli Mkhize set ambitious new targets: 250,000 health workers vaccinated by the end of next week and 200,000 daily vaccinations by mid-May.

President Cyril Ramaphosa has said that Johnson & Johnson (J&J) will make 30m vaccines available to South Africa, reports BusinessLIVE. During a visit on Monday to Aspen’s manufacturing facility in Gqeberha, formerly Port Elizabeth, Ramaphosa said the US pharmaceutical company had agreed to make 250m vaccines available for the continent, with South Africa getting 30m.

It is likely 2.8m vaccines could be available in April, many from Aspen’s local facility, with up to 20m ready in the third quarter, Aspen Pharmacare senior executive Stavros Nicolaou said.

BusinessLIVE reports that the announcement could be a game changer for a country that has been on the back foot since vaccines started becoming available late last year. The government came under intense criticism when it emerged that it had not concluded agreements with producers, leaving it at the back of the queue.

It also suffered a blow when vaccines it acquired from AstraZeneca were shown in a study to be ineffective against a new variant that was identified in South Africa.

SA Health Products Regulatory Authority (SAHPRA) CEO Boitumelo Semete-Makokotlela said during a webinar on Monday that a decision on licensing the J&J vaccine could come in days.

 

The government has finally unveiled details of its vaccine rollout plan, which sets an ambitious target of inoculating up to 200,000 people a day, reports The Times. More than 2,000 vaccination sites – including stadiums, shopping centres, churches and hospitals – have been identified. The rollout is due to kick off in mid-May, following the expected arrival of the first batch of 2.8m Johnson & Johnson vaccine doses at the end of April.

Registration for phase two of the rollout is due to start next month.

The Times reports that Health Minister Zweli Mkhize briefed top ANC members on the plan at the party's national executive committee meeting. Shortly before this, he is quoted in the report as saying that both phase one and phase two would get under way simultaneously.

Phase one involves finalising the vaccination of South Africa's 1.5m health-care workers. By the end of next week, 250,000 health-care workers are expected to have been vaccinated under the Sisonke programme, part of an ongoing J&J trial that is due to finish at the end of April.

The phase one rollout will pick up where the trial ends, alongside phase two, which includes people over 60, those with comorbidities and essential workers.

The Times reports that phase three – all other adults not falling into the phase one and two categories – is set to begin in mid-November, unless vaccines arrive sooner. This means that herd immunity – which the government hopes to achieve by inoculating 67% of the adult population – may only be achieved in early 2022, as opposed to the end of this year as initially planned.

"During the mass vaccination phases we will need to be targeting about 200,000 (people) per day nationally, with variations across provinces because of the differing concentrations of populations. We will be grouping and defining vaccination sites as small, medium and large," said Mkhize.

The Times reports that he announced earlier that between April and June, 7m doses of the Pfizer vaccine would have been delivered, as well as 2.8m from Johnson & Johnson.

Mkhize said infrastructure was already in place to ensure the process runs smoothly.

 

The government has pushed out the timeframes for reaching COVID-19 population immunity to 28 February 2022, reports Daily Maverick. It’s the latest change in South Africa’s vaccine roll-out debacle of missed deadlines – initially the end of 2021 was set as the deadline to inoculate 67% of adults for population immunity – amid uncertainties around the procurement of sufficient jabs. But the government has been moving to limit further critique, and to move beyond words into action.

The new vaccination roll-out timelines have Phase One reaching 608,295 healthcare workers by 17 May, or about half the initially announced 1.25m healthcare workers over an additional six weeks after the first deadline of the end of March.

Phase Two runs in two stages. First, from mid-May to end-July 2021 to reach 5,449,980 people, including the over-60s, people in congregate settings like old age and care homes and workers with access to occupational health programmes. The second stage, from August to the end of October, aims to reach 12,900,160 people, including the over-40s and workers in high-risk settings.

The final inoculation phase is scheduled from November 2021 to 28 February 2022 for “all other residents”, or a total of 22,600,640 people.

“We are committed to rolling out vaccines. We are still on track with regards to the time-frame, although there have been delays, Mkhize told MPs. “Negotiations on vaccine procurement are complete and signing will take place in the next 48 hours.”

DM reports that vaccination sites will expand from public health facilities to include the private sector is another significant development as it indicates a more inclusionary approach to inoculation.

Phase Two and Phase Three include temporary vaccination centres such as “pop-up, drive-through” venues, the majority of which will be linked to existing infrastructure like schools and community halls.

“We really want to push. We have targeted over 2,000 sites,” said Mkhize, talking about vaccinating 200,000 people a day.

The changing vaccination time-frames have been blamed on supply shortages and just plain fudging the issues.

 

Meanwhile, Professor Alex van den Heever, chair of social security systems administration and management studies at Wits University’s School of Governance said that South Africa’s “dismally slow” vaccine acquisition and roll-out means the country will effectively have to rely on natural infection to reach herd immunity, with an estimated 150,000 lives lost to COVID-19 already.

Daily Maverick reports that speaking as a guest in a Medztalk webinar late last week van den Heever said the government’s inefficient response to COVID-19 via a hard lockdown in March 2020 was hugely destructive to South Africa’s social and economic fabric – and failed to prevent transmission. This accelerated the country’s economic decline, halting production lines, choking incomes and forcing people to draw on their savings – with a catastrophic effect on government functions and finances in just two months – March and April.

“This was probably the worst effect you could have on an economy outside of a war,” he says.

Van den Heever said the latest data show that each level of lockdown bore little relation to the subsequent infection peaks. “I don’t think we fully understood it – it’s driven by super-spreader events. In the first surge the government didn’t accept that it’s an airborne epidemic, for example not warning against recycling air-conditioned air or even enforcing mask-wearing in closed spaces. Taxis were not limited in numbers or advised to open windows – all this drove the surge,” he is quoted in DM as saying.

When the second, (variant), surge arrived from 27 December, new non-economy-harming restrictions were introduced, such as those on gatherings and curfews and the closing of liquor outlets and bars. From one data sounding made between 11 and 13 January, this showed an infection decline in every province at about the same time. “This suggests there is a configuration of non-pharmaceutical responses that will work and not completely destroy the economy,” he explained.

He said that in South Africa, the immunity derived from the two infection waves might affect the severity of third or fourth waves, particularly in the most heavily affected regions.

DM reports that he was sceptical about whether phase two of the vaccination roll-out, scheduled for early May, would be completed by the end of the year. (The Pfizer vaccines are due in mid-April and together with any Johnson & Johnson supplies, will be targeted at essential workers, people in congregate settings, those older than 60, and those with comorbidities).

Van den Heever added: “Natural infection will outstrip vaccinations in 2021 if the infection fatality rate of 0,8% is a correct indicator of true infection levels.”

Meanwhile, DM reports, Professor Shaheen Mehtar, infection control adviser on the Ministerial Advisory Committee, issued a strong warning to all healthcare facilities to increase their basic infection-control measures (non-pharmaceutical), to complement vaccination, which she emphasised was never 100% protective.

Top basic measures included sanitising and/or washing hands to protect all mucous membranes (eyes, nose and mouth) and ensuring good ventilation with at least 12 total air changes per hour in high COVID-19 risk wards and six-hourly air changes in general wards – all exhausting air outside the building.

DM reports that Mehtar helped draw up infection-control guidelines for the World Health Organisation and the Africa Centres for Disease Control and Prevention.

 

News24 had reported earlier that South Africa's dithering COVID-19 vaccine plan has gone further off the tracks. Government now plans to vaccinate 22m citizens between November 2021 and February 2022. The report says this is a clear admission that it will miss its previously set target to vaccinate 67% of the population by the end of the year, as promised by Mkhize.

Phase 3 of government's vaccination plan will be implemented over three months, between November 2021 and February 2022. It will cover the remainder of all citizens, including those who were not vaccinated in Phase 2. It is hoped at least 22,600,640 will be reached.

News24 reports that this is according to a statement on a Cabinet meeting, delivered by acting Minister in the Presidency Khumbudzo Ntshavheni. "Cabinet remains confident of the remarkable progress being made by the SAHPRA in authorising the J&J vaccine for mass vaccination. The recent approval by the SAHPRA of the Pfizer/BioNTech COVID-19 vaccine should give the country access to more lifesaving vaccines.

"Cabinet would like to reassure South Africans of the capacity of the Health Department, in partnership with the private sector, to undertake a mass vaccine rollout when Phase 2 gets under way," Ntshavheni said.

While Phase 1 was expected to be completed by the end of March with health workers targeted to receive the first round of vaccines, Ntshavheni said the government was expected to reach its goal by 17 May, reports IoL. “I do not recall Minister Mkhize saying that 1.1m health workers would be vaccinated by the end of March. What I do know is that Phase 1 is expected to conclude by 17 May with Minister Mkhize committing to 1.5m health workers vaccinated.

“The Health Department is on track to vaccinate all healthcare workers by the end of Phase 1,” she said.

 

IoL quotes Ntshavheni as saying that the roll-out programme had been extended to five vaccine sites across the country. The programme, to date, has seen more than 207,808 people vaccinated.

Phase 2 would cover more than 13.3m people in vulnerable groups, essential workers and the occupational health and safety stream, including workers in sectors that were critical to the recovery of the country’s economy. These, Ntshavheni said, included workers in the mines, hospitality industry, taxi industry, retail and spaza shops, fruit and vegetable vendors, media and other applicable beneficiaries.

Ntshavheni said the National Coronavirus Command Council (NCCC) would also determine who would be part of the other applicable beneficiaries, such as teachers and police officers.

 

Medical Research Council president, Professor Glenda Gray said in a presentation to Parliament that the current COVID-19 vaccination strategy for healthcare workers in South Africa forms part of a study – and is not part of the government’s phase 1 rollout plan, which has been on hold since February.

Business Tech reports that the study – called the 3B open-label Sisonke study – was launched after government’s official rollout of the AstraZeneca vaccines was paused on 9 February, over efficacy concerns. Gray said that following the pause of the official rollout, something needed to be done to ensure that healthcare workers were inoculated.

“To transition to the Johnson & Johnson study was almost a ‘no-brainer’ because its a single-dose vaccine that can protect against severe disease.”

Business Tech reports that government has faced criticism or the slow rolling out of vaccines, with just over 200,000 healthcare workers inoculated 36 days after the Sisonke study began – averaging 5,700 doses daily. At this rate, it would take over 16 years to vaccinate 67% of the population.

However, Gray said that the country has only received approximately 80,000 doses every two weeks – as part of the study. An additional 80,000 doses are expected next week, while a shipment of around 200,000 vaccines is expected within two weeks.

Business Tech reports that the initial target for South Africa was for 1.5m people to be inoculated by the end of March (Phase 1), when AstraZeneca was still part of government’s plan. The broader goal was for 40m South Africans to receive the jab by year-end (Phase 3).

However, with the official rollout paused and a shift to the Sisonke study, progress as stalled. According to Gray, it is anticipated that the study will be completed by the end of April, with 500,000 healthcare workers vaccinated.

Business Tech reports that medical experts and government advisors have also tempered expectations around initial targets, saying they will likely be missed. Ministerial Advisory Committee chair Barry Schoub said that the target of vaccinating most of the population by the end of the year is “ambitious” and an enormous challenge.

Mkhize, meanwhile, said that the targets are constantly being reviewed based on the available information and available vaccines.

 

News24 reports that millions of Johnson & Johnson COVID-19 vaccine doses expected to arrive in the country from April may be delayed by weeks because of a failure by the government to timeously meet a key contract clause in its agreement with the US-based drug maker. The clause calls for the government to set up a no-fault compensation (NFC) mechanism to cover damage claims arising from unlikely but potential adverse effects in people who get the jabs – but this system is yet to be set up, and News24 reports it was learned that the government was aware, since at least early February, that it would have to be put in place.

The NFC fund required by J&J is meant to allow people, who are vaccinated and experience serious negative side-effects, to easily claim for compensation, without having to go through lengthy court processes.

According to News24, the government should have established the NFC system within a reasonable time period after the agreement was signed on 26 February. And authorities have seemingly already made payment to J&J for the 11m-dose deal, an estimated R1.5bn.

The reports says J&J is now, according to key insiders, who cannot be identified as they are not authorised to speak to the media, refusing to hand over detailed delivery schedules until the mechanism is in place and conforms with guidelines set out in the agreement – despite being tailor-made for South Africa and agreed upon weeks ago with the health department.

Insiders say Mkhize's special adviser, Sibusisiwe Ngubane-Zulu, was to blame for recent delays after she allegedly took the NFC matter into her own hands.

News24 reports that the department has denied the NFC clause was holding up deliveries, saying conditions in the agreement with J&J had been met and the first deliveries of the 2.8m doses expected in the second quarter will commence in mid-April.

 

Full BusinessLIVE report (Restricted access)

Full report in The Times (Open access)

Full Daily Maverick report (Open access)

Full Daily Maverick report (Open access)

Full News24 report (Open access)

Full IoL report (Open access)

Full Business Tech report (Open access)

Full News24 report (Open access)

 

See also MedicalBrief archives:

Government briefs Parliament on SA’s COVID-19 vaccine rollout plans

SA’s COVID-19 failures: ‘It’s ideology as much as customary incompetence’

Growing anger over SA government’s vaccine ‘fiasco’

SA’s opposition parties demand greater oversight on vaccine rollout


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