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Vaccines for South Africa. Now

- Progressive Health Forum

It is distressing to hear senior officials increasingly talking down the prospects for the availability and usefulness of Covid-19 vaccines in South Africa.

The world is in the grip of a massive resurgence of the Covid-19 pandemic, in which SARSCoV-2, the coronavirus, appears to have produced a variant suspected of such great transmissibility that even the most stringent attempts at mitigation by non-pharmaceutical intervention is failing to contain the spread. 

More chillingly, the increased spread of the virus is generating a corresponding acceleration in the numbers of people getting infected and, by extension, is exposing health systems in even the best resourced countries to an overwhelming burden with which they’re increasingly unable to cope.  

Humanity is now facing the full force of the greatest public health emergency in modern history, with no sign that the force of the pandemic will abate anytime soon. The only instrument humanity now has to contain the pandemic, effective vaccines, are becoming available through an uneven and desperate race among nations. Even this hopeful intervention will not bring solace anytime soon.

It will take many months and huge resources to inoculate sufficient numbers of people for the pandemic to be suppressed. And that is the outlook if countries begin mass inoculation right now, as some 40 countries have embarked upon. 

Many more are preparing to receive vaccine supply in the next several weeks to join the vaccination drive. For the rest, mainly the poorest nations on the planet, the global COVAX facility offers the only hope of receiving an adequate vaccine supply sometime in the next six to nine months, only after which can the months-long vaccination programmes begin. 

It beggars belief that South Africa, against all reasonable expectations, finds itself in this group, since it is not a poor country, despite the best efforts of a corrupt political class to ensure that moniker. The stunning reality is that It has neither a secured vaccine supply nor a plan for mass inoculation in the foreseeable future that can withstand scrutiny. This portends for this country the worst ravages of Covid-19 in the year ahead. 

This lack of foresight will visit on us the consequences of the greatest man-made failure to protect the population since the Aids pandemic, when we refused to provide life-saving medicines out of choice and against the desperate pleas of horrified medical and humanitarian agencies here and abroad and directly caused the deaths of hundreds of thousands of people. A high probability of a reprise of this is a monumental and unforgivable failing. 

Developed and developing nations alike appear to have proceeded with early negotiations for future vaccine procurement several months ago without any qualms. South African officials appear to have eschewed such efforts, but what unique insights they may have in this regard is unknown. Assertions that SA knew better than many advanced and peer nations might have been dismissed as misplaced confidence, were the consequences not so deadly. 

Astonishingly, even now, in the full knowledge of what we face and with dozens of countries worldwide, including African nations, embarking on mass vaccination programmes against Covid-19, it is distressing to hear senior officials increasingly talking down the prospects for the availability and usefulness of Covid-19 vaccines in South Africa.

This position is, at best, inexplicable, given the depth of available knowledge about efficacy and safety among several leading vaccine candidates being clinically trialled and evaluated right here in SA. That is why the recent commentary by senior officials regarding the government’s vaccine strategy in response to pointed enquiries from the press, health experts and labour and civil society formations, has sown great disquiet. 

The unconvincing and defensive exposition of the department’s efforts, or to be precise, the lack thereof, deepens suspicions of and perhaps even confirms the absence of a coherent and composite vaccine acquisition strategy.

This communication strategy bears the hallmarks of a frantic cover-up and evasion of culpability. South African society has a fully justified expectation that, as a member of the G20 group of leading nations, most of whom are in the process of implementing vaccination, this country will also imminently embark on its own vaccination programme. There appears to be a public narrative to deliberately diminish these expectations. 

Public acknowledgement by officials that they didn’t think it prudent to begin bilateral negotiations with vaccine suppliers, because they could not ‘take the risk’ of ordering vaccines in the event that they would not work, is shockingly disingenuous. An Advanced Market Commitment does not require upfront payment for the vaccine and commits the buyer to purchase vaccine only when it becomes available, at an agreed price and quantity. 

It is a dangerous misconception, often exercised by arrogant local officialdom, to presuppose that a populace will willingly believe any deliberate fiction put to them. However, it will be even more worrying if these officials’ comments were made in ignorance of an elementary advance purchase mechanism and impels urgent enquiry into their fitness to manage such a critical portfolio. 

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 DDG 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. The lack of any visible sense of urgency to inoculate healthcare personnel is particularly worrying because they are at the highest risk of contracting Covid-19 and are the people’s ultimate resort in the frightening eventuality of infection. If such a critical sector has been neglected, what chance then of the rest of the population being vaccinated in good time? 

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 of the ongoing failure to secure vaccine supply sufficient for South Africa’s needs. Getting beyond the pandemic is far more urgent and infinitely more important than preserving political fortunes, bureaucratic careers or ministerial appointments. The well-being of the people must always come first.

The President of the Republic, through his constitutional authority, will have to dispense with his otherwise admirable political consensus management and wield the axe against the members and officials in his administration who are responsible for this perilous fiasco and immediately set about correcting the course we have been placed on. Covid-19 leaves him no other choice, because, as it has so viciously demonstrated, it has no respect for the banal affairs of state or government.

This article appeared in the Daily Maverick.

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