Professor Glenda Gray says the result of the Johnson & Johnson vaccine Phase 3 trial is welcome news for South Africans who are staring down the end of a deadly second wave of Covid-19 that has overburdened the health system. The results came out on Friday, January 28.

“It’s brilliant news and shows we are protected against severe Covid. The vaccine can avert death and hospitalisation, and it reduces the burden of the disease,” says Gray, who is the principal investigator for the South African leg of the trials.  She enrolled in the trial to build trust in vaccines.   

 Globally, the vaccine showed 66% efficacy against mild to severe Covid-19 and had an 85% hit rate against severe forms of the disease. The J&J vaccine will make up 20% of the total complement of all the jabs South Africa plans to buy. Inoculation is likely to start in the middle of February, and the first Covishield vials arrive on Monday from the Serum Institute in India. Covishield is one of the brand names for the AstraZeneca-Oxford vaccine.

In the US, the J&J vaccine offers 72% efficacy, but this dropped to 57% in South Africa, where it was tested on the variant (501Y.V2), which is so highly contagious that it has caused a second wave much higher than the first wave of Covid-19 in the country. Gray says that in a pandemic, a vaccine that can stop high excess deaths and severe suffering is “an amazing intervention; it is the most important thing”.  

The vaccine has the additional value of a single-dose jab and being easy to store in refrigerators for three months. The other most effective vaccines on the market are nearly all still two-dose injections. 

The Phase 3 trial enrolled 43,000 participants, of whom 6,350 (15%) were South African. “These are incredible results [which make] Covid-19 more benign,” says Gray.

A smaller Novavax trial result released yesterday showed greater protection against the variant first identified in Britain (90% efficacy, according to The New York Times) than the one in South Africa (49%).

But as the World Health Organisation’s executive director of health emergencies, Mike Ryan, has pointed out, vaccine success is measured by “reducing the capacity of this virus to kill, to put people in the hospital, to destroy our economy and social lives”.

Most vaccines trialled on the variants identified around the world show that booster shots will be likely or that changes to vaccine material will be required, as the coronavirus mutates. South Africa is on track to buy nine million doses of the J&J vaccine at R153/dose, according to a presentation by Health Minister Zweli Mkhize to Parliament earlier in January.  After the frontline healthcare workers are inoculated in Phase 1, jabs will be given to those older than 60, people living with comorbidities and those in congregate settings, who are most at risk of severe infection and death. 

In addition to the Novavax and J&J trials, the SA Health Products Authority also allowed the use of the drug ivermectin on compassionate grounds this week, making it a busy week for a country that has been hammered by Covid-19 in the first month of 2021. 

By January 28, the official number of Covid-19 deaths in South Africa was 43,105, while excess deaths are more than 100,000, most of which are likely to be attributable to the virus – be it through unrecorded infections and deaths or because sick people did not seek healthcare in an overburdened system.

 Dr Mathai Mammen, J&J’s global head of research, told CNN:

“We’re 85% effective at preventing severe disease, which we define as disease that makes you feel particularly sick at home, or may [force you to] go to the hospital, or worse.

“And we are right now completely protective – it would appear 100% protective – against disease that actually does make you go to the hospital, we’re 100% protective against death.

“I’m looking at that South African variant, and I’m seeing that we’re able to completely protect against concerning levels of illness, where one might go to a hospital,” he said. DM

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