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South Africa has an estimated population of nearly 60 million. To achieve herd immunity against COVID-19, the government recently set an ambitious goal of vaccinating 67% of the population – around 40 million people. According to the outline of this plan, this would be achieved by 2021.
But is this ambitious goal even achievable?
In my opinion, the proposed COVID-19 strategy is not a strategy, but rather an ambitious goal. And an unrealistic one at that.
The elephant in the room is that the government has set a target of vaccinating two-thirds of the population, but it has yet to get the 80 million doses that would require.
This is what we know. South Africa had pledged to purchase enough vaccine for around 10% of the population through the COVAX facility – around 12 million doses. The facility is a global collaboration aimed at accelerating the development, manufacture and “fair” distribution of new vaccines. These vaccines are expected to be available from February and spread over the next few months.
The health ministry also said 20 million doses of the vaccine will likely be received by the end of June or July. As such, it appears that the government has managed to procure an additional 6.5 million vaccines in addition to the COVAX facility, and has purchased around 1.5 million doses from the Serum Institute of India (SII), which produces the Astra Zeneca vaccine. The initial 1.5 million IBS vaccines were allocated to immunize health workers during the first phase of the COVID vaccine deployment.
But there are a lot of things that remain unclear. For example, how will the injections of 1.2 million workers in health establishments be covered, given that the 1.5 million doses allocated can only reach 750,000 of them. This means that the personnel to be vaccinated in health facilities should be prioritized.
So aside from the fact that the country does not yet have the 80 million doses of vaccine needed for 40 million people, there has been very little planning on how these vaccines will be deployed. This has become clear over the past four weeks as the government has come under attack for not having a plan.
It appears the government has put all its eggs in one basket and has decided to focus only on purchasing vaccines through the COVAX facility, and has only started engaging in meaningful bilateral discussions with manufacturers. than in recent weeks.
The Ministry of Health has now set up a task force to review operational issues. A good place to start for this team would be to perform a reality check to set more achievable goals and deadlines. The team must also begin to broaden its approach to harness the potential of the private sector and civil society to deploy the vaccine.
Reality check
The government is considering three phases of vaccination. The first targets health workers. The second would expand the deployment to essential workers – people involved in disaster management such as firefighters – people over 60 and people with co-morbidities who are especially at higher risk than most. A total of 16.5 million people are targeted in this phase.
In the third phase, the general population over the age of 18 would be the target – a total of 22.5 million people.
It’s easier said than done. Health workers are relatively easy to reach. But I’m not convinced that the logistics are in place to be able to reach substantially – even only to people over 65 and those with co-morbidities. Without proper planning, vaccines end up stuck in depots simply because the logistics were not handled in terms of deployment.
Even assuming the government purchases 80 million doses of vaccine for the 40 million targeted, these are unlikely to become available in substantial quantities until April. And assuming the government starts immunizing people from April 1, 150,000 people are expected to receive the vaccine every day, seven days a week, for the first month. And after that, that number is expected to climb to 300,000 people every day until the end of December 31, 2021, as most vaccines would require a two-dose schedule.
No country other than Israel has approached 150,000 shots a day, let alone 300,000. Even countries like the UK and the US have struggled to vaccinate up to 50,000 people a day.
Additionally, given that none of the COVID-19 vaccines are licensed for use in children under the age of 16, who make up around 30% of South Africa’s population, the goal of vaccinating 40 million South -Africans would require vaccination of almost 95% of all adults in South Africa. Whereas a recent Ipsos poll of South African adults indicated that only around 53% of adults would be ready to be vaccinated – and COVID-19 vaccination is unlikely to be made mandatory – aspiration to vaccinate 40 million South Africans by the end of 2021 is unlikely to materialize.
A more realistic goal is to vaccinate about a third of the population. This represents about two-thirds of the adult population, but not two-thirds of the South African population. But even for this to work, there would need to be decentralization in terms of roles and responsibilities. If the country depends solely on public sector control over the distribution of COVID-19 vaccines, it will fail miserably.
For this reason, it is essential that the private sector take a leadership role at the point of delivery. When it comes to vaccine deployment, the private sector with GPs and many pharmacies has a much better reach in terms of access to South Africans than public health clinics.
The private sector – whether large pharmacies or general practitioners – must show social solidarity. They should, for example, ensure that everyone can come in and get vaccinated without having to pay. Without it, there will be iniquity.
What did not go well
The current confusion stems from two mistakes in the past year. The first was the government’s decision to continue – exclusively – access to vaccines through the COVAX facility. COVAX was created to ensure that countries can get enough vaccines for at least 20% of the population. The pricing mechanism built into the fair access mechanism meant that larger economies would pay a premium to subsidize poor economies.
Read more: Model’s Guide to How Trade Rules Affect Access to COVID-19 Vaccines
South Africa had to pay between $ 12 and $ 13 per dose as an upper middle-income country to participate in the COVAX facility. This is more than three times the cost of purchasing the vaccine directly from AstraZeneca (or Serum Institute of India) at the list price of $ 3 per dose.
Participation in the COVAX facility expresses social solidarity with countries less endowed with resources whose unit cost is subsidized by richer countries and philanthropic organizations. But the initiative is largely independent of the realities of distress in the South African economy.
The second mistake is that the government has compounded the problem by not engaging in timely bilateral agreements directly with manufacturers through an advanced market engagement mechanism. Many other countries, including middle-income countries, did so as soon as the vaccines entered phases two and three of the trials.
It is only recently – after the public outcry – that the government seems to have been activated to engage in substantive bilateral talks. The problem is, it’s too little too late. Many of the vaccines, which have been approved for use in North America and Europe, to be produced over the next 6 months are already destined for other countries with earlier commitments.
As a result, South Africa will likely experience another one to two outbreaks of COVID-19, before a substantial proportion of the population is vaccinated.
Shabir Madhi Institution (Wits Health Consortium, a subsidiary of the University of the Witwatersrand) receives funding from the South African Medical Research Council and the Bill & Melinda Gates Foundation to conduct the study of the COVID-19 vaccine in South Africa. None of the funders are involved in the actual conduct of the study.
By Shabir A. Madhi, Professor of Vaccinology and Director of the SAMRC Vaccine and Infectious Disease Analytical Research Unit, University of the Witwatersrand
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