Editorial

Government assurances of credible action on Covid-19 vaccines sound disturbingly hollow

By Daily Maverick 4 January 2021
Caption
South African Health Minister Dr Zweli Mkhize. (Photo: Gallo Images/Darren Stewart)

The moment the Minister of Health Dr Zweli Mkhize forgot to switch on his screen at the commencement of a press conference, which was designed to inform the country of the vaccine rollout, was a foreshadow of the disorganised state of the so-called rollout of vaccines. The entire 90 minutes were characterised by generality and little detail.

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

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 18

  • The vaccine certainly is essential in the fight against Covid, but there are doctors overseas also expressing a concern that people may start ignoring the non-pharmaceutical interventions too soon.

    • Show me the money !
      Have not even made an application to treasury yet !
      Where did the ‘late deposit’ come from , missed 2 deadlines already .
      If and when it does arrive , will be steeped in corruption and fail to deliver.
      If you cannot eliminate pit toilets in 24 years , vaccinate 40 m in 6-9 months !
      What is essential in the fight is not the vaccine , which should be reserved for those front line health workers and in care homes .
      Yeah great,the vaccine , so I do not have to worry about personal hygiene !
      Actually , thats a long way away .
      Not up for a CCP jab when the locals are not signing up in numbers !
      Avoiding their virus is not rocket science !
      Sure in crowded places it spreads easily . Poverty does not help.
      Nor does the mentality of the populace .
      Follow the rules , and the virus will die out .
      This one anyway .
      12 hours outside a host, dead !
      We have known that for 12 months , yes the WHO , failed so many times ! Masks on or off and why !
      We all have choices , I choose not to have unprotected sex with someone who has aids /hiv , I also choose not to expose myself to possible infection from others .
      What really irks me is that with all the PPE corruption , there has been no sign of a ‘social’ mask distribution .
      Even here the poor must pay !
      Easier to blame the booze or the zoll , or richer nations .
      The numbers will continue to climb as long as the people ignore the rules , not about curfew or drinking .
      Reality check here ….can that person I passed infect me and how ?
      Was he wearing a mask when he /she coughed or sneezed ?
      Leave the area !
      That is it , touch nothing , even if you sanitised on entry .
      Simple rules , ignore at your peril .

    • All that is required is a very clear plan, going forward, as to how the population of this country will be vaccinated. In such a way as to include, primarily, the efficacy, quantity etc of the drug to ensure the herd immunity proposition is met. At the same time looking at funding required, whom, when, where, how etc logistics as to receipt and roll out of the vaccine to all.
      Good grief this is not rocket science!! Bring in capable people to ensure this is done.

  • Absolutely. It horrifies me that healthcare workers, already exhausted, ill, and in danger, are expected to continue to work, and are not being cared for by this government. They should receive vaccination immediately. What kind of people are we?

    • In addition to clear plans for vaccine acquisition and roll out, the government must have a sound communication strategy. It appears that at present communications are ad hoc and reactive. In a time of crisis, clear information is essential if the population is to be properly informed and reassured that the authorities are competently addressing the situation. Without this, speculative claims and disinformation will abound and be likely to undermine trust in government and their efforts. The Department of Health should immediately inform the public of their detailed plans and timeframes for procurement and rollout of the vaccine. Progress should be reported at appropriate intervals (every 14 days is suggested) so that the public can remain informed and hold government to account.
      The Minister of Health is reminded that under Article 32 of the South African Constitution (Access to information), “Everyone has the right of access to any information held by the state.” We have the right to know the government’s plans for procurement and roll out and we have the right to regular progress updates.

  • Another utterly disappointing fact is that miners (and other workers like teachers and the police) deemed essential in terms of keeping the economy alive in the beginning of lockdown, are now mysteriously “as vulnerable” as the elderly and people with co-morbidities. Meaning, that some very healthy 30 year old miner will be vaccinated, either with or ahead of people who are significantly more at risk of dying from Covid. Surely all the elderly and people with co-morbidities must be vaccinated before we start vaccinating healthy, younger workers. Being essential does not mean your life has more worth…Who keeps on making these bad decisions? Prioritize vaccination based on individual risk profiles, not on whether you are deemed essential to the economy.

    • Do not hold your breath , I look after myself , not waiting for a vaccine .
      I do care about my Mom , in a care home where the staff brought in the virus .
      was a miner of sorts back on the 70’s .
      An Aunt and Uncle in the UK have had their 2 jabs already , did not apply , chosen because of their age .
      I am 66 , not having any jab !
      Protocols will stay the same , for a long time !
      Until we get to Taiwan status !
      Last of 7 deaths in APRIL !
      While China is still having outbreaks , Taiwan is not .
      With respect , you talk about vaccinations based on risk profiles , fair enough , let us make a new ministry to oversee it , get some cadres in . Get some tenders approved , fast tracked . Avoid oversight !
      Seriously , forget the vaccine for yourself , you will wait too long .

  • The headline of this article is the understatement of the year. Off course its hollow. Everything this government says is hollow. Everything the lame duck of a president says is hollow. When a president is scared of his sub-ordinates, the whole government (or is it the ANC NEC, the real cabinet in this sick country) becomes hollow. This Mkizi guy, a few months ago a hero, now nothing but a pawn in the claws of a sick governing party

  • If it’s true we have been offered vaccine at $10 a dose, how come we can find R10,5B for SAA, but not R18B to inoculate the whole country?

  • The NewYorkTimes had a widget where you filled in your age, sex, comorbidities, whether a frontline worker and it kicked out where you are in a Q if the US were 100 people. I was nr87 and no I am not 9y old. So I will assume that as a 55y old white male with no comorbidities and not being a health worker : I will be 97 in SA.

    Already there is talk of annual boosters. I might get my vaccination by the time the first candidates have had their third booster unless I organize my own solution? My government will declare it illegal to organize your own vaccine – pretty certain of that.

  • Constitutionally everyone should have access to health care. If the government cannot provide, surely it is unconstitutional to prevent me obtaining my own?! Or my private medical aid scheme which I co-fund through being a “member” should be able to find me a vaccine outside the government orbit?
    Next step, all the countries that are actually caring for their citizens and timeously obtained vaccinations will prevent entry of unvaccinated foreigners. What will that do to our economy if businessmen cannot access foreign countries??
    It is clear that the Sunday evening briefing was hastily put together to counter public outrage. It was a case of BS baffles brains”.
    If this fiasco is a forerunner of the National Health Insurance (NHI), God help us.

  • Because of the lack of trust I have in our government, the “non-disclosure undertaking” immediately makes me think that the ANC’s commercial arm, Chancellor House, will be used as a middle-man for the purchase of any vaccines. A small handling fee on 40 million vaccines is a tidy sum for them to use for contesting the next election.

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