Op-Ed

Vaccines for South Africa. Now

By South Africa's Eminent Scientists 2 January 2021
Caption
Photo: EPA-EFE / Wu Hong

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.

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. DM

 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

Prof Marc Mendelson, Head of Infectious Diseases and HIV, University of Cape Town 

Dr Fareed Abdullah, AIDS and TB Research, SA Medical Research Council

Prof Francois Venter, CEO, Ezintsha, Wits University 

Prof James McIntyre, School of Public Health, University of Cape Town

Dr Adrienne Wulfsohn, Specialist in Emergency Medicine, Inkosi Albert Luthuli Hospital 

Prof Alex van den Heever, School of Governance, Wits University

(writing in their personal capacities and with the support of colleagues here and abroad.)

Gallery

"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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All Comments 28

    • Why don’t you stop your corny bleats, Glyn Morgan. Just about every day in DM.

      The DA shot itself in the foot by electing John Steenhuisen, and not Mbali Ntuli. What a tonic that would have been!

      One can only wonder what the likes of Helen Suzman, Colin Eglin and Frederik van Zyl Slabbert would think about the sad state into which the DA has cast itself.

      • Please explain why we should be encouraged by anything the ANC has done?
        They are such a disappointment. Bunch of thieves, rouges and waste of opportunity

      • Hi Aitchie – We live in a DEMOCRACY. By definition it is NOT perfect. We pick the best party that we can from a bunch that we consider less perfect. Out of the entire collection of political parties in South Africa I believe that the DA IS THE BEST. John Steenhuisen is a very switched on guy. That is NOT to say Mbali Ntuli is not good, I think that she is VERY good and she will get to the top in the not too distant future. BUT we have what we have got NOW and it is the best in SA. If we do nothing nothing will happen, or maybe you want the ANC to rule till the cows come home?

  • 6 minutes ago
    In any other country I suspect heads would roll! Not on planet ZA though. No one but the soft target populace is ever held accountable.

  • Is the country’s leadership so paralysed by its members’ precarious hold onto power that they are incapable of doing what this article so clearly articulates? Will the president be reading this damning record of his executives’ wilful (or fearful) failure to act?

  • “The only instrument humanity now has to contain the pandemic, effective vaccines”
    This is ever so slightly alarmist. A vaccine works with your immune system.
    As an example, any vaccine is going to have it’s efficacy reduced when given to anyone with comordities (diabetes as an example).
    Starting in March 2020 one could have improved their chances of surviving Covid-19 by improving their immune system, ie health.
    Less alcohol, less cigarettes, less meat, and a little vitamin D. The people that are dropping like flies are the ones that are unhealthy, predominantly. No, this is not to say Covid19 will not overcome the healthiest person on the planet, but the stats are there to analyse. Noone seems to be doing this and saying “Hey, live a healthier life and you’ll improve your chances of getting through this, along with wearing a mask and washing your hands”.

    • Well actually, how healthy would you be if you were unemployed and starving? This fate befalls a large sector of our population.
      Granted their plight is brought about largely by an inept, incompetent government that has corruption running in its DNA. It’s quite possible then, that without vaccines, we may just be facing the early stages of a really widespread pandemic on a scale that even the most qualified (and healthy) modeler could never imagine.

    • I have to say I am with you on this one on the immune system; in the last year the world has done everything it can, in the name of curtailing a virus, to destroy people’s natural immune system, isolation (staying inside and away from others), endless alcohol based sanitisers and full face masks (the rebreathing of carbon dioxide cannot be good). When we were growing up we were encouraged to play outside (in the sun) in the dirt with lots of kids, we got sick and we built our immune systems. We had access to well researched and tested vaccines (Mumps, Measles etc.) and if we didn’t we went to ‘measles parties’ to get it and build our immune system. We all know people who have had this virus and suffered from no symptoms to death (our colleague died aged 73 after complete isolation for three months, this after playing golf 3 times a week and never getting even the flu, interestingly enough my father-in-law died a few years ago, he had cancer, but picked up a cold (not flu) developed pneumonia and died and on his death certificate the cold was never mentioned) what I don’t know, and want to know, because the press does not seem interested to find out and the government does not want you to know is all the death stats for this year; we normally have an average of 500,000 deaths a year so how many have we had and from what? If we still have 12,000 flu deaths and 70,000 TB deaths and all the other causes at normal numbers then we have a potential issue. We have scared the population into ‘getting tested’ or going to hospital at a mere sniffle that turns out to be cold or a hangover (7m tests and 1m positive) which is clogging up our health system amongst the poorer elements of our population. The vaccine is not the silver bullet for this especially as it is rushed to market and may not be a vaccine at all but genetic engineering (forgive me for not trusting pharmaceutical companies or politicians on this one) as even the flu changes strain every year and needs a new vaccine (I seem to remember the flu being around for a long time without a vaccine and Doctors saying there are no vaccines for viruses you just treat the symptoms).

      So, can we get all the data and stop banging on with one set of KPI’s (covid infections, day rates and deaths) and get the whole picture of deaths in SA, can we get out of the quarantining of the healthy and the killing of the economy and allow for the population to have choice; if you are worried about your health then get a vaccine (which I do not want, of a flu one either), wear a mask in public, stay at home and keep away from me. I will promise to stay at home if I feel sick (like I always did) and we can get on with living because we are not living we are in a constant state of suspension. I still have a 99.93% chance of surviving Covid in 2021.

      One more thing: observing the broader population of this country they seem to have spoken, but the government is not listening, they have weighed up their experience of this disease over the course of 2020 and are prepared to take their chances so have had parties, gatherings, walking in the street, seeing neighbours and friends and general living without masks and social distancing and we have seen a small spike in infections in some areas where people have gathered (in the past they would have transmitted, strep throat, colds, flus, TB, STD’s and we would not have shut down the world and gone into a flat spin about it. The people have spoken and want to get on with living so let’s take a lead and get on with it. Covid is high infection and low deaths just what Dr Erikson predicted back in May and was shut down for!

  • Colleagues, thank you for your courage to publish your very worrying assessment of the state of affairs regarding the lacking vaccine acquisition and vaccination planning! I am deeply alarmed to read your letter and can only hope that either matters are better than they appear to you, or that your raising of the alarms will jolt the responsible officials into action!
    Prof. Harro von Blottnitz

    • Unfortunately, Prof, even in the unlikely event of officials being jolted awake, the horse has now bolted and is way over the horizon out of sight already!

  • First premise : let us not forget Thalidomide!
    Second premise: if you follow the rules, cleanliness, masks if you neccesarily go out, stay isolated as much as possible; you are going to stay infection free.
    Third premise : those that break the rules are of low intelligence and a waste of oxygen.
    Stay safe, and watch. Only when the vaccines are proven to work, with no (serious) side effects, then is the time to get vaccinated.

    • Remember that the vaccines have been extensively tested. Also, there are many who don’t have the option of remaining isolated. Do the maths on the infection rate and try to factor in the increased transmission of the new strain. Working off excess deaths to date plus confirmed covid fatalities gives a current mortality of about 90K. Taking 60 million as a rough figure for South Africa’s population, and a ballpark 2% fatality rate this implies that up to 4.5 million may have already have been infected with covid, very roughly 7% of the population. It is impossible to predict what those figures might be in a year’s time, but if 30% of the population becomes infected that will mean that approximately 1 in every 167 people may die. These are nightmare figures. The need to vaccinate can not be taken lightly.

  • The American vaccine seems dodgy at best. Let them test on themselves first. Funny that nobody is talking about the Chinese or Russian vaccines. Also no SA vaccine a candidate? Seeing that we have a facility that can produce vaccines in large quantities according to Moderna…

    • You mean the Pfizer/Biontech one? Odd that there’s so little mention of Biontech being a German company (with founders about as globally diverse as the German football team). Not that this particularly matters; it is the quality of their innovative science and speed of development that should maybe get a bit more attention.

  • The tone of the article is formal and polite, as befits eminent scientists. But how long will it take for this debacle to become an issue on social media? Once they become aware, I don’t think the mass of of South Africans are going to take it lying down. Certainly, in months to come, the DA will get on board, and I can’t imagine Malema passing up an opportunity like this.
    But when, oh when, are we actually going to see incompetent and criminal officials pay the price for their misdeeds? (That is, instead of SA’s people paying the price.)

    • “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”. I am sure some of the authors are part of the advisory committee, but are trying to separate themselves from their own inability to act.

  • It now seems uncertain that the vaccine will provide long lasting protection. Talk is of an annual booster. SA has no chance of vaccinating ¼ of the population by January 2022. So by then the ¼ will need a booster.

    I will assume we will need to sort ourselves out. Again

    • Three thoughts as to the delay.
      1. Concern over choosing the best and safest vaccine.
      2. How does the ANC profit from the vaccine?
      3. With the municipal elections coming up in the next few months when is the best political timing for the roll out?

        • You may as well have a loudhailer. How do you propose to get rid of the ANC *right now* and get mass vaccination going? Shush with the electioneering, it just muddies the already murky waters.

  • One of the excuses for not using the Pfizer vaccine – which is already available and is being used – is that they only have 2 facilities capable of bulk storage at between -60 °C and -80 °C. So? Build some more! Is that seriously beyond the conceptual abilities of our politicians and civil servants?

    With the greatly increased production of Oxygen for medical purposes over the last nine months, the same plant can be used to produce increased amounts of liquid Nitrogen (-196 °C) which can easily be used to chill such facilities, as one possible solution. There are of course many others.

  • This letter from our country’s top disease scientists is deeply disturbing. The goverment under Zuma was a disaster. But, now, under Ramaphosa. it is frightening. This goverment is prepared for thousands more citizens to die, due to their selfish, criminal, self-interest. A incredible weak president, an incredible weak country

  • This is like a kick-boxer who has a lethal right foot or left hook . You still need both your feet and hands to fight effectively and hopefully a good head in the between. If your hands and one leg get tied up you will loose the fight despite having a lethal right foot like we are doing now with all the preventive measures and 9pm-6am restrictions on movements in place. The vaccine is that lethal left hook or foot missing. This virus is like the multi headed hydra from Greek mythology.

  • The ANC is nothing more than the mafia who ran different states in both the US and italy in the 70’s and 80’s. The only difference is the volume of people who are affected by their corruption, greed, and downright incompetence. If you think you are getting a vaccine anytime soon here, you are delusional. For those who can afford it, they will look to other countries, for those who can’t, the uplifters of the poor, and the down trodden will look after you… dont worry.

  • OP-ED

    Gauteng SOS: We are overwhelmed with calls for oxygen – Gift of the Givers

    By Imtiaz Sooliman

    "Whatever the cost of our libraries the price is cheap compared to that of an ignorant nation." ~ Walter Cronkite