SA vaccine rollout not far behind, says Mkhize

Health Minister Dr Zweli Mkhize on Thursday advised the parliamentary committee on health on the current developments regarding the Covid-19 pandemic, as well as the country’s planned vaccine rollout. 

Vaccine rollout in phases

The only major source of protection against Covid-19 is a vaccination programme, Mkhize said. 

This is especially important if the country is to reach herd immunity, which means that between 67% and 70% of the population needs to be immunised to break the cycle of infection. In South Africa, this would mean immunising at least 40 million people.

If it was possible, everyone would be given the vaccine as soon as it was delivered, but South Africa’s tiered approach will see those considered “essential” prioritised. 

Mkhize said timelines provided by Covax indicated the first group of vaccines would be rolled out in April. 

Mkhize revealed that South Africa’s healthcare workers will receive the first batch of one million AstraZeneca vaccine vials in January, with another batch of 500,000 due in February, the Serum Institute of India confirmed to the health department this week. 

Those most at risk of infection, and those most at risk of transmitting Covid-19 to others, would receive the vaccine first. 

The first phase of the vaccine rollout will see constrained supply, with limited doses available, Mkhize explained. The vaccine target for phase one is 1,250,000 people. 

The second phase includes essential workers, citizens in congregate settings such as prisoners and hospitality workers, as well as those in educational institutions. 

People who are 60 years and older, and people older than 18 years with co-morbidities such as HIV and TB, would also form part of the 16,600,000 set to receive the vaccine in phase two. 

The third phase will see all other people over 18 receiving the vaccine, estimated to be 22,500,000. 

The ministerial advisory committee is still working on ascertaining whether pregnant women and children should be vaccinated, as the safety and efficacy of Covid-19 vaccines for these population groups is not yet known.

As such, the department is not currently recommending that children or pregnant women receive the vaccine. 

Types of vaccines being eyed

There are currently five vaccines government is looking to distribute. 

The first is Pfizer/BioNTech, which a number of countries and the World Health Organisation (WHO) have approved. It is a two-dose vaccine with a 90% protection rate against the virus. 

It must be stored at minus 70°C, which is a constraint for South Africa, due to limited commercial ultra-low cold chain storage facilities. Only small volumes of this vaccine can therefore be stored and rolled out. 

The second is AstraZeneca, or the University of Oxford vaccine. It has a 70% efficacy rate, and is also a two-dose vaccine. 

The production of AstraZeneca has been outsourced to many sites around the world, but the main producer is the Serum Institute of India. 

It needs only be stored at 2°C t0 8°C, a more practical option for the country. 

The third is Johnson & Johnson, which has not yet been approved. A dossier submission is expected this month, however. 

This vaccine is a single dose jab, which would prove easier for administration and costs. It can also be manufactured at the Aspen facility in Port Elizabeth on a contract basis. 

The four is Moderna, a two-dose vaccine stored at minus 20°C It has been approved by the Food and Drug Administration (FDA) agency in the US.

And the last is Sinopharm, produced by China and approved in China and a number of United Arab Emirates countries. It has a 79% efficacy rate. 

All Covid-19 vaccine applications are being received by the South African Health Products Regulatory Authority (SAHPRA). 

While many vaccines require two doses to be effective, they are not interchangeable, which is important if citizens receive a multitude of different vaccines.

Mkhize also said that vaccines administration was voluntary, but that the public needed to understand that it was for their benefit. Any objections could be dealt with, but vaccines should be taken by all, for the common good. 

Money issues

Government will be the sole purchaser of the vaccines for the country, Mkhize said. 

He also addressed the delay in payment processes for vaccines, saying that Treasury advised there was a need to raise money so as not to tamper with the existing tabled budget framework for the next year. 

Additional support from the Solidarity Fund helped move the process along. 

But the delays were mainly due to debates between legal teams on the local and global side of the vaccine initiative, which was resolved. 

“As we speak, money is being paid and guarantees signed,” Mkhize said, adding that a solid amount for vaccines was now guaranteed in the budget. 

The country is also confident enough to speak to manufacturers and enter bilateral agreements for better prices and timeous rollouts. A task team has been appointed by President Cyril Ramaphosa to facilitate this process. 

Non-disclosure agreements were signed in September and October 2020 already, to allow manufactures to share sensitive information with government. 

Finance Minister Tito Mboweni has already informed Mkhize of looking at other ways of raising funds so that the fiscus is not overly burdened. This will come in the form of medical schemes contributing for social solidarity, as well as getting businesses to make their own contributions. 

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Over and above the financial contingency measures, Mkhize said Treasury had allocated non-fixed amounts to ensure that funding for all health requirements would be covered. 

The anxiety being felt during the second wave had created panic, but this type of response was natural, Mkhize assured. 

“The situation is being managed to the best of our abilities, and we are making sure vaccines are coming as quickly as possible.” 

He said South Africa was “on course”, and that by the time citizens begin to receive vaccines, “we won’t be too far behind other countries”.

“South Africa has focused on the best possible way to deal with Covid-19. We will start our vaccination programme soon, like other counties.” 

On Wednesday, the country breached the 20 000 mark for new cases in 24 hours for the first. A total of 21,832 new cases were recorded in the department’s last report, bringing South Africa’s current case load to 1,149,591. 

A breakdown of the new cases revealed that 30.9% came from KwaZulu-Natal. Gauteng account for 26.4% of these infections, and the Western Cape 17.2%. 

The Northern Cape currently accounts for just 1.2% of new cases. 

There were complications, however, with regards to fatality rates when comparing new case data. 

Gauteng, for example, accounted for 5923 new cases as of the last report, but only has a fatality rate of 1.9% – among the lowest in the country. 

Infections in the Eastern Cape, previously declared a Covid-19 hotspot, has already begun to plateau, Mkhize said, but the province’s fatality rate was currently the highest in the country, at 4.7%. 

New variants, complacency and the second wave

The unpredictability of the virus is further exacerbated by the new variant experienced in South Africa, the UK, Brazil and Australia.

Mkhize said research is being ramped up regarding the impact of the variants. No evidence has been found that the virus is more virulent, but the impact of vaccines is not yet known. 

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“South Africa is working with many international partners advanced on this level, and is using cutting-edge technology. We will always know as much as anyone else in the world would know about this virus,” he assured. 

Widespread complacency and the return of festive crowds was also putting pressure on the public and private healthcare sectors.

Mkhize said the reactivation of beds had been commissioned in some areas, adding that numbers of infections in the Eastern and Western Cape, KwaZulu-Natal and Gauteng, would far exceed the first surge of the virus. 

KwaZulu-Natal is at almost twice the number of patients admitted currently, compared to the first wave. 

He pointed out that frontline healthcare workers fighting Covid-19 had hardly had time to rest, with the resurgence of infections taking place before they could take a break. 

“Their levels of exhaustion is noticeable,” he reported. 

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