Covid-19 vaccine doses destined to be binned next month are 'a shocking indictment' and questions need to be asked about how effective the country’s vaccination drive has been, some public health experts say. Ufrieda Ho reports.
The government plans to destroy 8.5 million doses of the Covid-19 vaccine produced by pharmaceutical company Pfizer at the end of October.
This, some experts said, casted a damning spotlight on how South Africa's Covid-19 vaccination campaign had missed the mark.
The situation also raises questions about the fate of a further 10.1 million stockpiled doses of the Johnson & Johnson vaccine that will expire between June and September 2023.
South Africa's rate of vaccine doses administered per day has dropped to a fraction of its peak last year - even though a large segment of the population has still not been vaccinated.
South Africa's fully vaccinated population, according to Our World in Data, stood at 33% as of September 2022.
It is far off the initial 70% target set at the start of the vaccination drive early in 2021. By comparison, Rwanda reports an 83% fully vaccinated population, Botswana's vaccinated population is reported to stand at 66%, and Mozambique's at 42%.
Some public health researchers and specialists in South Africa are pinning the failure to get shots into arms not on people's deepening complacency or vaccine hesitancy but on what they say is the Department of Health's missteps and mistakes in managing the national vaccination drive since vaccines arrived in the country in the first quarter of 2021.
"That these vaccines are going to be destroyed is a shocking indictment of a vaccination programme that has been badly run from inception.
"What is incomprehensible is why there was no expertise in mass public health programmes from the beginning," said Professor Francois Venter, the divisional director of Wits University's health platform, Ezintsha.
Venter was also a member of the Ministerial Advisory Committee early in the pandemic.
"From the start, there was no proper budget for advertising the vaccination services, there was no real strategy around what the key messaging was going to be, and the Department of Health just expected people to arrive at a local facility and get vaccinated."
Venter said demand-creation combined creativity, accurate and consistent messaging, and urgency to get widespread buy-in.
He added the first misstep was the halt in the rollout of Astra Zeneca vaccines in February 2021.
Then, Venter said, the EVDS (Electronic Verification Data System) failed to have substantial population penetration and now the "wheels have fallen off" of the campaign.
According to the SA Coronavirus portal data, by 11 September, 37 535 745 vaccine doses had been administered.
However, the number of daily doses administered nationwide has recently dipped below 1 000 on weekends and below 10 000 on weekdays.
Waning vaccine demand comes against the backdrop of the SA Medical Research Council's (SAMRC) sobering estimates of excess natural deaths.
It estimated the country had seen around 330 000 excess natural deaths since 3 May 2020 - with likely more than 270 000 of those directly due to Covid-19.
In 2022, the SAMRC estimated, there have been just over 42 000 excess natural deaths.
'Dedicated resources not possible'
The Department of Health, however, insisted the vaccination programme was on track.
"There is no problem with the national vaccination campaign. Vaccines are available, the vaccination programme has been integrated into the primary healthcare delivery system, and communication continues in all national media," said department spokesperson Foster Mohale.
"The challenge is that the public is complacent that there is no or low perceived risk. This is a complex challenge in a society that is easily influenced by inaccuracies and misinformation spread on social media."
Mohale added the vaccination programme continued with an eye on the possibility of another Covid-19 wave, but admitted they faced competing priorities.
"The health system has to care for millions of people with other health conditions and needs and dedicated resources are not possible for Covid-19."
Destroying the vaccines in October may well be classified as wasted resources, but the financial value of the potential waste is hard to quantify.
The government will not disclose the cost of procuring the vaccines, citing "contractual agreements".
Mohale said it had to be factored in that 7.9 million doses of the Pfizer vaccine, out of the 39 million doses received by South Africa, were a donation from the US government.
In April 2021, then-health minister Zweli Mkhize told Parliament both Johnson & Johnson and Pfizer were selling their vaccines to the country at US$10 per dose with no refunds or cancellations permitted.
At that pricing, the cost in wasted vaccine doses come end October will run into the tens of millions of dollars.
Mohale said the "environmentally approved" disposal would come with its own price tag, adding estimates were "R18 and R25 per kilogram of waste disposed and a tray of 1 170 doses weighs approximately 1.2 kilograms".
The department said it was trying to extend the October expiry date by three months but was awaiting SA Health Products Regulatory Authority (SAHPRA) approval.
It has also tried to offload the 8.5 million near-expiry vaccine doses to other countries.
Mohale said the government had approached the African Union and COVAX facility.
The challenge though, he added, was any recipient country had to agree to the "no-fault compensation scheme", which indemnified manufacturers in the event of any adverse events due to the vaccine.
The government has no plans to use up the vaccines by making them generally available to children under the age of 12.
Mohale said the Vaccine Ministerial Advisory Committee had advised against mass vaccination of "small children", though vaccination for immune-compromised children between five and 11 was encouraged.
He added the EVDS was being adapted to accommodate this population cohort.
The government will also not shorten the recommended intervals between booster shots to use up the vaccine doses either.
However, Mohale said "further boosters over time to accommodate waning immunity are under evaluation".
'Everything has been so slow'
Public health specialist Lynne Wilkinson said allowing the vaccines to go to waste without alternative campaigns to make sure they were used was a travesty.
This especially as vaccination rates in the country were so low and the unknowns around long Covid still posed potential health burdens for sufferers, she added.
"Government needs to think out of the box now by making an additional vaccine accessible and available for whoever wants one or running vaccination blitz days or working with religious leaders to vaccinate at gatherings, for instance."
Wilkinson said more than a year down the line into vaccination, there should have been lessons learnt to inform a better vaccination strategy going forward.
She added the exit of corruption tainted Mkhize should also have been a moment for stronger leadership and revived confidence in vaccination rather than vagueness that had now allowed people to self-assess the Covid risk.
She spearheaded a vaccination drive at the Bulungula Incubator based in the Eastern Cape village of Nqileni in 2021.
Within weeks, she said, they achieved more than 95% vaccination rates for over 60s as soon as vaccinations became available for this age cohort – even in a deep rural setting.
"We activated all our community resources - meeting elders, going door to door and using community radio and making information clear and available," Wilkinson added.
'Inequality, not hesitancy'
But many more villages and places that fall off the radar easily still need to be reached for vaccination.
Professor Kate Alexander of the University of Johannesburg's Centre for Social Change said low vaccination rates came down to inequality, not vaccine hesitancy.
Alexander pointed out it was not a question of money either, with significant overseas donor money having been pumped into the country via the likes of USAID to accelerate the vaccination rollout in the country.
"Government just doesn't have a clue about how to deal with issues of inequality, so hesitancy becomes an argument by which the government blames ordinary people for the vaccine uptake instead of working on simple interventions to get rid of barriers.
"Government also doesn't know how to relate to community-based organisations and focuses on existing 'leadership' rather than younger activists. Big NGOs have a similar problem," she said.
Interventions, Alexander added, could be better accessed to information about vaccination sites, flexible operating hours for vaccination sites, addressing transport problems to get to sites, and mobilising community groups, like young people, to get the message across.
She warned failure to change direction would put the remaining 10 million vaccine doses in stockpile in similar jeopardy of expiring before being used up.
"It's scandalous and a shambles," she said of the inaction.
This has prompted her to join the growing call for an inquiry into South Africa's handling of the pandemic and vaccination campaign.
"An inquiry should be accessible to the public and have the right to subpoena evidence. The low level of vaccination is primarily a question for social science whose practitioners would also have something valuable to say … if the relevant data was made publicly available," Alexander said.
NOTE: Professor Francois Venter is quoted in this article. Venter is a member of Spotlight's Editorial Advisory Panel. The panel provides the Spotlight editors with advice and feedback on the quality and relevance of Spotlight's public interest health journalism. The Spotlight editors, however, remain editorially independent and solely responsible for all editorial decisions. Read more on the role and purpose of the panel here.
*This article was published by Spotlight - health journalism in the public interest.