If this claim appears harsh, then it is important to start with the obligations imposed by the Constitution on the government, Section 27 of the Constitution provides the right for everyone to have access to health care. To implement this right, the State is required to take reasonable legislative and other measures within its available resources to achieve the progressive realisation of the right. In the Treatment Action Campaign (TAC) case, which dealt with the government’s failure to provide nevirapine to prevent mother-to-child transmission of HIV, the Constitutional Court found that the government plan was not reasonable, albeit that it was not required to do more than simply have a plan that would, within its available resources, progressively ensure coverage.
Within this context, the content of the press conference can be evaluated. At best, we now know that the government will be able to access some vaccine as a result of it being part of the COVAX arrangement at some point, whether it be February or March 2021, thereafter frontline health care workers will receive the vaccine. Whether South Africa’s entire cohort of health care workers will be inoculated is not clear. The implementation thereafter was described in only general terms. This was almost a year since the outbreak of the pandemic and months after it was clear to the whole world that vaccines would be produced that would prove efficacious. Yet, our government still has no clear plan that could be implemented tomorrow in the unlikely event that a quantity of vaccine would be available.
In short, there is no reasonable plan to progressively vaccinate the population.
Save for the severely limited COVAX-sourced supply, there is no concrete, and visible, plan to access adequate supply or distribute it. We are told that by year-end, the objective is to ensure that some 40-million people will be vaccinated to ensure herd immunity but, in the absence of a clear line of access to 40-million vaccines (80-million, if two doses are required), this is not a plan but rather an aspiration.
We were told in the vaguest of terms that the government is in negotiations with pharmaceutical companies to access the necessary supply. In his op-ed attempt in the Daily Maverick to explain the government plan, Prof Barry Schoub, the chair of the vaccine advisory committee, relies on the argument that the country did not have the resources to pre-purchase vaccines.
Leaving aside the debate about whether a country would lose its deposit in the event that the vaccine would not be successful following a pre-purchase agreement, he leaves out essential details – when did government begin its attempt to access 40-million (or 80-million) doses? Why have countries like Colombia been able to access significant vaccines including from AstraZeneca when it is a middle-income country? How will 40-million vaccine doses be acquired and this cohort be vaccinated by year-end?
Mkhize and his team sought to hide behind non-disclosure agreements. It may be that the public cannot know about the exact price to be paid or even precise terms of delivery but, at the very least, a reasonable plan would inform the public as to timelines for further supply and why the end of 2021 is a viable date.
In addition, the game was given away when Dr Anban Pillay, deputy director-general in the Department of Health, informed the country that of the five viable vaccines at this point, Moderna was not interested in supplying the country, while the Pfizer vaccine is problematic in that its refrigeration requirements render it less useful for widespread distribution in South Africa. The Chinese vaccine has not provided its phase 3 trial results, which leaves only two companies with whom the country could be seeking widespread supplies – AstraZeneca and Johnson & Johnson. Both conducted trials in South Africa so the question remains: why are other countries already obtaining AstraZeneca vaccines, including middle-income countries, and not us? And what happened to the previous announcement that Johnson & Johnson would be manufacturing in South Africa?
In summary, save for a relatively small quantity from COVAX there is no ready supply as we enter 2021. The statement at the press conference that all acquisition of vaccines had to be done by government is deeply problematic — why in law should medical aid firms not be able to access vaccines if they are prepared to ensure that the distribution extends beyond their members or it can be shown that some private-public partnership will access supply quicker for the whole country?
In addition, there was no mention of employing the private sector, such as Coca Cola, SAB, PnP or the supermarket chains to assist in the distribution of a vaccine. After all, if we are to vaccinate 40-million people by year-end, the plan should now be in place to ensure that we rise to this unprecedented challenge. In addition, an escalating surcharge on the vaccine for those who can afford it is a far superior way of funding than begging the private sector for a handout.
And if that was not enough to worry about, it was disturbing that but a few hours after Prof Schoub’s article appeared, the narrative had changed. In his article, he punted the line that the vaccine may be dangerously threatening to the public motivation to continue with non-pharmaceutical interventions. Well, that canard lasted only until the press conference, when mercifully the minister made clear how essential the vaccine is in the fight to curb the effect of the pandemic. There is more than enough material to infer that. Sadly, instead of constitutional compliance, this is a case of belatedly making up the plan in the wake of understandable public outrage. DM
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