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Daily Maverick 168

The storage, delivery and distribution challenges around Covid-19 vaccines in SA

South African Health Products Regulatory Authority (SAHPRA) are ready to commence reviewing applications from Covid-19 vaccine candidates.(Photo: biopharma-reporter.com/Wikipedia)

The delivery of a safe and effective Covid-19 vaccine once it becomes available in South Africa will be complex and costly. Vials of vaccines are of no use unless they are given to people and acquiring enough injection devices is part of the crucial planning to ensure rapid, equitable access to Covid-19 vaccines.

First published by Daily Maverick 168 weekly newspaper

South Africa, through the World Health Organisation-led (WHO) COVAX facility, has committed to securing 5.7 million doses to cover at least 10% of the population at a cost of more than R2-billion. The Department of Health (DoH) envisages that a vaccine will be available by mid-2021.

Once secured, a Covid-19 vaccine will have to be approved by the South African Health Products Regulatory Authority. The country’s immunisation programme, which is mainly geared towards children, will need to scale up to cope with the demand of rolling out a Covid-19 vaccine to include adults.

The WHO has outlined steps countries will have to plan for before vaccines become available. These include training healthcare workers and identification of immunisation sites. Refrigeration is essential so that the vaccine can be stored and transported to centres without breaking the cold chain. Security will also need to be beefed up to prevent theft for sale on the illegal market.

Ian Wakefield, the Africa general manager for Becton Dickinson (BD), a global medical technology company, says Covid-19 vaccine doses and injection devices – syringes and needles – go hand in hand. “As we saw in the early days of the pandemic with tests and personal protective equipment … SA is likely to be caught up in a worldwide competition for … vaccination equipment,” he says.

BD manufactures 12 billion syringe units annually. Of these, three billion are targeted for vaccines. “In light of the … pandemic, we are in the process of ramping up supply with one billion [more] units,” says Wakefield.

About 800 million units have been committed to Canada, the UK and the US, and Saudi Arabia is finalising its order, he says.

The DoH has not yet entered into formal talks with BD on injection device procurement, says Wakefield. The company currently supplies syringes for the BCG vaccine in all the provinces. Wakefield understands that access to a Covid-19 vaccine is top of the health department’s list of priorities for the pandemic. However, he says planning for delivery cannot be ignored.

“We would like discussions with health ministries in Africa because globally, the first movers, the US and UK, have bought ahead of time. There is going to be a limited supply of syringes… We want to raise awareness that vaccine delivery includes delivery that is from the vial to the person being vaccinated. It’s key that governments look at this now before it’s too late…”

The quantity of devices that will be needed for South Africa, he says, is not yet clear and will depend on the vaccine chosen. Asked what a BD injection device would cost, Wakefield says: “We are not able to provide exact pricing for our vaccine delivery devices in SA… However, BD supplies vaccine delivery devices to UNICEF for low- and middle-income countries at market access prices.”

Professor Greg Hussey, a member of the Ministerial Advisory Committee on vaccines and the Director of Vaccines for Africa, agrees millions of injection devices will be needed by mid-2021. “It is an issue but … there are hundreds of suppliers globally. The main concern is the distribution and storage of the vaccine and the monitoring and evaluation system of the vaccine’s effectiveness… Delivery of a vaccine is a challenge and it virtually doubles the cost… Apart from devices, we are going to have to ensure that enough masks are available for healthcare workers as well as people who come for the vaccine.”

Wakefield says BD is not changing the design of its devices for a Covid-19 vaccine. The company manufactures a calibrated auto-disabled syringe which is designed to prevent the reuse of non-sterile syringes.

He says the company was the first of its kind to make auto-disposable syringes for the polio vaccine. “When the HIV pandemic happened in the ’80s we made the first large-scale CD4 diagnostics tests. For a long time we were the largest provider of these tests in … markets like Africa and India. So from a healthcare point of view, vaccination and healthcare needs in terms of price [are] … in line with our focus as a company.” DM168

Adele Baleta is an independent science writer and WHO vaccine safety communications adviser.

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick ‘n Pay Smartshoppers at these Pick ‘n Pay stores.

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