EXPLAINED: Why do we not have a Covid vaccine yet in SA?

South Africa’s daily new case statistics continue to break records as the world edges closer to mass vaccine rollouts against Covid-19. 

On Wednesday, the Department of Health confirmed that 17 710 new cases were recorded. 

The country recently hit the one million mark, with positive cases at 1 039 161 as of Wednesday evening.

#COVID19 Statistics in SA as at 30 December.

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— Department of Health: COVID-19 (@COVID_19_ZA) December 30, 2020

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With rapid increases in cases, due to a number of factors, uncertainty and frustration among members of the public regarding vaccines continue to mount. 

As such, SABC’s Morning Live hosted a panel discussion on Thursday morning, with experts Dr Anban Pillay, Safura Abdool Karim, and Professor Barry Schoub. 

Pilllay is the deputy director general of the health department, Karim is a senior researcher at the South African Medical Research Council, and Schoub is the chairperson on the ministerial advisory committee on Covid-19 vaccine developments. 

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The discussion laid out what plans are currently in place for South Africans to receive the vaccine, estimated to take place in the second quarter of 2021. The panel also took questions from ordinary citizens, and sought to distance themselves from rumours and popular misconceptions. 

When will SA receive the vaccine?

Countries such as China, Britain, Argentina, and Russia have recently begun widespread approval for the Sinopharm, AstraZeneca and Sputnik V vaccines respectively. Vaccines such as the Pfizer-BioNTech, and Moderna, are also on the table, with the former being the only vaccine to be registered globally. 

South Africa does not yet have a delivery date for the first batch of vaccines, to be delivered by the Covax programme next year. 

Pillay quashed rumours of the first delivery date being in June next year, saying a firm date will be established in early January. 

He explained that the Pfizer vaccine would not work in countries where keeping the medication under minus 70 degrees celsius would be a struggle. South Africa finds itself in that boat, with only two storage facilities that would be able to store the vaccine adequately. 

The country is therefore “holding out” for vaccines which can be stored at fridge temperature, such as AstraZeneca, which is also a more affordable option, Pillay continued. 

AstraZeneca is preparing to file for registration in South Africa soon. Pfizer has to yet filed, and does therefore have no stock to supply. It is also expected to file soon. Johnson & Johnson’s clinical trial date information is not yet known. 

But within the next month, the world will see a significant uptick in vaccine activity, Pillay said. 

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Schoub explained that no vaccines are being made in South Africa. The Aspen facility in Nelson Mandela Bay is simply going to fill vaccine vials, but will not be manufacturing it. 

However, if vaccine trials are to be done in South Africa, Schoub assured that this would mean some offshoot benefits hitting our shores, with the added benefit of having a Covid-19 vaccine evaluated under our unique conditions. 

Why do we not have a vaccine yet?

Many South Africans’ woes have been compounded by corruption related to the pandemic. As such, government is routinely accused of non-compliance and poor planning. 

Karim explained that South Africa cannot readily access vaccines in the same way that the US and Britain have been able to do, due to financial constraints. 

“Poorer countries are always left behind with new health interventions,” she said, with the system historically “prioritising profit over lives”. 

This is why many developing nations have been able to rely on the Covax system. South Africa is in a good position, Karim said, because we are part of Covax, but are also negotiating with other vaccine providers. 

Pillay elaborated by explaining that South Africa has not funded any trials, unlike wealthier nations, but has only participated in them. 

School said this too was advantageous, because once a vaccine is registered, and post-marketing surveillance completed, more information would be available on how the vaccine behaves in the field. 

“Vaccine trials started in June. No one knew which vaccine would pass or fail. If we put our cash into a particular vaccine that had to be prepaid, and it fails, we would have spend billions for no vaccine,” Pillay said. 

Schoub added that Covid-19 vaccines are brand new, and many have not been used on humans. There is currently a scramble worldwide, but richer countries have disposable monies they can afford to invest in vaccines. South Africa is not as privileged. 

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Despite this, the country is taking a cautious approach, unlike nations such as Costa Rica and Morocco, who opted to roll out vaccines before completing the third phase of trials to confirm effectiveness, Karim explained. 

“We have not taken that approach because it is the better and safer option.” 

The same applies for vaccines developed by China and Russia and other nations who have opted not to wait for more data before doing mass rollouts. 

Pillar said South Africa’s approach aimed at taking a cautious approach to prevent the vaccine from causing harm, and ensuring the efficacy of the shot. He said there was no point in rolling out an ineffective vaccine where people would still be infected.

Who will get it first?

Being part of Covax means being able to receive the vaccines from multiple suppliers, which lessons any delays in procurement processes, Pillay explained. 

At least 198 countries will be receiving vaccines through Covax, which for South Africa, is the safest and most logical approach. 

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But ordinary South Africans, even those with co-morbidities, will have to wait before being able to receive the vaccine. 

Schoub confirmed that the first batch of vaccine will go straight to healthcare and frontline workers, which he anticipates will not be received by the rest of the population yet. 

Also included in the first set of vaccines are the elderly, especially those in care homes, and institutionalised citizens, such as prisoners, due to the risk of the virus spreading faster in these circumstances remain. 

The second tier would include those with co-morbidities, which Schoub said was difficult to ring fence. Ordinary citizens will begin to receive the vaccine during this time as well. 

Not the silver bullet

Even if a vaccine arrived in South Africa today, the country would probably still experience a third and fourth wave of Covid-19 infections, Pillay said. 

In addition, the tiered approach to administering the vaccine means it could take a while before herd immunity is achieved.

Karim warned that the vaccine is not a silver bullet that will end the pandemic. She emphasised the need to continue practicing non-pharmaceutical interventions, such as washing one’s hands, wearing a mask and practicing social distancing. 

The responsibility still rests squarely on the shoulders of South African citizens that are responsible for helping control the pandemic, she said. 

The virus will also not disappear after a vaccine is administered, Schoub continued. The only virus able to disappear from the globe is smallpox, and this is due to decades of vaccine administration. 

It is not yet clear how durable our immunity is against Covid-19. The frequency required to combat the virus is also not yet clear – it could be an annual jab like a flu shot, or an injection administered every few years.

As more time passes and the variety of vaccines available to the global market increase, Schoub said this was a positive result of not rushing to roll out mass vaccinations.

There will be more choices,  and within that, more options that are suitable to South Africa’s conditions, taking into account challenges such as storage and distribution. 

He assured that all efforts are being made to get the vaccine to South Africans as soon as possible.