Covid-19 vaccine: where SA stands

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Vaccination drives are set to begin soon in the fight against the Coronavirus. PHOTO for illustration: Samantha lee-jacobs
Vaccination drives are set to begin soon in the fight against the Coronavirus. PHOTO for illustration: Samantha lee-jacobs

Up until last week, most South Africans playing a word-association game would have said, “social media” and not “vaccine” when shown a card with “platform” written on it. Not anymore.

The media storm that followed the national Department of Health’s public announcement on Sunday 7 February – that the AstraZeneca vaccine was no good when it came to the 501Y.V2 variant – has introduced a boatload of new terminology to the local lingo. Chief among these is “vaccine platform” which describes the mechanism, device, delivery vector or cell line employed for target vaccines.

But as South Africans try to make sense of the science behind the department’s subsequent decision to put the use of the AstraZeneca vaccine on hold, few quantified answers are being given to the question, “What happens next?”

Of the 1.5 million doses bought from the Serum Institute in India, a million doses arrived in the country just two weeks ago.

The idea was to start vaccinating healthcare workers with this vaccine last week.

However, the results of a study by Wits University, which showed the vaccine did not prevent mild to moderate disease of the new variant, put paid to this plan.

Last week, the minister of health Dr Zweli Mkhize said that the national ministerial advisory committee for vaccines was continuing with further deliberations on the AstraZeneca vaccine use in South Africa.

Depending on their advice – which he said would probably only be given in the next week or two – the vaccine would be swapped with countries that did not have the new strain (before the expiry date – April 2021).

AstraZeneca

But it seems this option is not set in stone. The government might still decide to use the AstraZeneca vaccine locally, albeit in a different way.

The Wits study, which had 2 000 participants aged between 18 and 25, found that a two-dose regimen of the AstraZeneca vaccine provides minimal protection against mild-moderate Covid-19 infection from the new strain.

What is important to note here is the age of the participants. The study did not include people who fall in the “high risk” group – people who are older than 60 years or who have health conditions like lung or heart disease, diabetes or conditions that affect their immune system.

In other words,? the study did not assess efficacy (how well it works or brings the results you hoped for) against severe Covid-19 infection from the variant. This data simply does not exist – yet.

Prof Linda-Gail Bekker, chief operating officer of the Desmond Tutu HIV Foundation and one of the national protocol chairs working on the vaccine roll-out, suggests that some of those one million doses could be used to quickly compile the missing information. She stressed, though, that this was just her personal view.

“It is conceivable that you could – within research conditions – do a roll-out of the (AstraZeneca) vaccine so that it would be voluntary in a way that you could collect that data and come up with definitive information that we are missing,” Bekker says.

Furthermore, Prof Shabir Madhi, the principal investigator of the AstraZeneca trial in South Africa, has recommended that there is potentially a use for this vaccine among the high-risk population.

Last week, the World Health Organisation (WHO) recommended the use of the AstraZeneca vaccine for all ages.

Alejandro Cravioto, chair of WHO’s strategic advisory group of experts on immunisation (Sage), said there was “significant evidence” the AstraZeneca vaccine proved effective in preventing severe disease from the South African variant.

New contenders

While the future of the AstraZeneca vaccine in South Africa hangs in the balance, two new contenders have entered the playing field: Johnson & Johnsons’ (J&J) Janssen’s vaccine and the Pfizer vaccine.

According to an Ad26.COV2.S Covid-19 vaccine Emsemble study, the Janssen’s vaccine shows 57% efficacy in South Africa (including patients with the new strain) and 85% efficacy against severe disease.

It also showed complete protection against Covid-19 related hospitalisation and death by day 28 of administering the vaccine.

The Pfizer vaccine was 95% effective in its initial trials and they have reported that recent laboratory studies have shown that while antibody production against the new strain is reduced, it is still effective against it. There are no in vivo (clinical) studies to prove its efficacy against the new strain.

Last week, Mkhize said the department would continue with the planned phase one vaccination of health workers using the Janssen’s vaccine in mid-February.

“The roll-out of vaccination will proceed in the form of an implementation study with the partnership of the Medical Research Council (MRC) and the national Department of Health vaccination sites across the country,” Mkhize said.

In addition, he announced, the country had also secured doses from Pfizer for phase one roll-out.

The Western Cape Health Department has confirmed that it is continuing with its logistical planning for the phase one vaccine roll-out and that as part of its planning, they had identified almost 150 000 health care workers in the public and private sector to receive the vaccine.

In a digital press conference held on Thursday 11 February, Dr Keith Cloete, head of the provincial health department, shared it was estimated that 300 000 to 500 000 doses of the Janssen’s vaccine would be available “shortly” to be used as part of the implementation study, or as it was referred to during the press conference: an open label Covid-19 vaccine programme, called Sisonke.

Cloete could not confirm the allocation of J&J doses to the province but he said the programme would be conducted over the coming weeks. Whether the government will have to pay for these initial doses is still unclear.

On Wednesday 10 February, Mkhize said they were in negotiations with J&J and that there had been talk that the doses to be used for the study might be provided for free by J&J, but he couldn’t confirm this as yet.

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