At first we were champing at the bit to register. South Africa was behind in terms of the rollout and we were eager to roll up our sleeves, get jabbed and get on with our lives.
But things have changed: it isn’t vaccine doses that’s the problem now – we have plenty of those. It’s getting the Covid-19 vaccine into arms that’s the issue.
To reach the government’s target of vaccinating 67% of the population, South Africa needs to vaccinate 140 000 people a day, seven days a week.
And it’s just not happening.
On 1 September, shortly after vaccination opened for over 18s, 273 012 people received their shot. By 9 September the daily rate had dropped to 116 854. On Sunday,12 September, just over 20 000 people were jabbed.
In his latest address to the nation, President Cyril Ramaphosa said 14,6 million doses had been administered – a long way off the government’s target of 40 million.
“Government has secured sufficient vaccines to vaccinate the entire adult population,” he said. “The supply is no longer a constraint. However, we need to do much more. We’re increasing the pace of vaccination and ensuring we reach those most vulnerable to serious illness.”
Ramaphosa also quoted overwhelming evidence from the Western Cape Department of Health that vaccines work. The department compiled figures of people older than 60 who were admitted to hospital with Covid between 14 and 20 August. Only 30 of the 729 people had been vaccinated. Of the 292 people who died from Covid that week, 287 weren’t vaccinated.
“In other words,” Ramaphosa said, “96% of the people over 60 who were hospitalised and more than 98% of the people who died were not vaccinated.”
And yet even in the face of such irrefutable evidence, vaccine hesitancy persists as people choose to believe fake news and internet conspiracy theories above hard facts produced by the world’s top scientists.
According to a survey by the Human Sciences Research Council and the University of Johannesburg, close to half of South Africans aged 18-24 say they are hesitant.
“We’re trying to understand what we should do about getting to people who don’t want to be vaccinated, or the larger group that’s sitting on the fence and not quite sure what to do,” says Dr Nicholas Crisp, who’s in charge of the vaccine rollout. “We need vaccine demand.”
Facts need to override fear and experts are only too happy to spell it all out.
THE FEAR: I DON’T KNOW WHAT’S IN IT
The facts: The list of all the ingredients in vaccines is available for anyone to see, including doctors and scientists who’d be able to tell if there was any funny business going on.
There are many different types of vaccines, all designed to mimic the organism or germ being vaccinated against, says Professor Susan Goldstein, public health specialist and deputy director at the SA Medical Research Council’s Centre for Health Economics and Decision Science.
Vaccines contain an active ingredient. In the Pfizer vaccine it’s the mRNA (messenger RNA, the molecule that basically puts DNA instructions into action; in the case of the Covid-19 vaccine it carries the code for making the SARS-CoV-2 spike protein) and in the J&J jab it’s the adenovirus that carries the code for the SARS-CoV-2 spike protein. Vaccines also contain what’s referred to as excipients, such as stabilisers, lipids, sugars, salts and emulsifiers.
“These excipients are added to enhance the response of the immune system and balance the pH of the vaccine to match that of the body,” explains Professor Hannelie Meyer, head of the South African Vaccination and Immunisation Centre (Savic) at Sefako Makgatho Health Sciences University and Chair of the National Immunisation Safety Expert Committee.
“They also prevent the adenovirus (in the J&J) from breaking down, protect the fragile mRNA (in the Pfizer), prevent the mixture from separating and keep it in a liquid form.”
THE FEAR: IT WAS DEVELOPED SO FAST
The facts: Vaccines have been in development for many years against other SARS viruses. This meant they didn’t need to be started from scratch, Professor Susan Goldstein says, which made the development process much quicker.
The speed of development – also referred to as pandemic speed – was done to meet the urgent need and the threat to public health and is largely attributed to technological advances, Professor Rose Burnett explains.
“The two vaccines we use in South Africa were already in development to address other diseases. Researchers have spent decades studying vaccines related to the broader family of coronaviruses. Hence, the research wasn’t started from scratch.”
THE FEAR: THEY’RE UNSAFE
The facts: They are safe, Goldstein says. “We know this because literally billions of people have been given the vaccines.”
Dr Angelique Coetzee, chairperson of the South African Medical Association (Sama), says even if there are a few vaccine side effects, they’re small compared to the devastating effects of Covid-19.
Vaccine side effects include pain or redness in your arm, headaches, joint aches, muscle aches, tiredness, chills ?and fever. Taking paracetamol can help to ease these side effects.
Covid-19, on the other hand, can cause fever, a dry cough, body aches, difficulty breathing or shortness of breath, chest pain or pressure and loss of speech or movement. It can also turn into Covid pneumonia, and lead to death.
Pfizer examined vaccine safety for people with comorbidities such as obesity, diabetes and pulmonary disease and a study showed the jab was “exceedingly safe”.
When the J&J vaccine was rolled out in the Sisonke trial, 6 000 of the participants had comorbidities, Meyer says.
“The data showed the vaccine worked well on this group and that it’s safe to use."
According to the global Covid-19 tracker, more than 5,63 billion vaccine shots have been given to people around the world.
Of the 40, 34 were found to be coincidental (meaning the vaccine had nothing to do with their death), and of these 34, 13 had Covid-19, one of which was a breakthrough infection. Six cases were unclassifiable, which means there wasn’t sufficient information available.
“Of the 34 cases found to be coincidental, the majority were elderly people with multiple comorbidities,” Meyer said. “They didn’t die from the vaccine. They died of their comorbidity.”
THE FEAR: IT WILL MAKE ME SICK
The facts: Vaccines can make you temporarily feel fluish, which is a side effect and shows your body is developing immunity.
In addition, in extremely rare cases it is possible to have an allergic reaction to the vaccine called anaphylaxis, where blood pressure drops and the airways narrow. A rash could also develop, along with nausea or vomiting. This happens within a couple of minutes and you need to be treated immediately, hence the 15-minute waiting period after your vaccination,” Goldstein adds.
It’s so rare it’s happened in a ratio of two-and-a-half people to one million people.
Meyer says there’s a minute risk of very rare serious events developing, such as Guillain-Barré syndrome (GBS) and thrombosis with thrombocytopenia syndrome (TTS) after the J&J vaccine, and myocarditis (mild heart inflammation) after the Pfizer vaccine.
“The likelihood of being diagnosed with GBS after receiving the vaccine is extremely small – about 0.0008%,” says US neurologist Dr Kevin Levin, adding the milder cases of GBS may go undiagnosed, never causing enough concern to warrant a doctor’s visit.
“You have a very tiny risk of developing one of these events,” Meyer says. “But if you look at people who get Covid-19, they have a much bigger risk of also developing one of those outcomes.”
THE FEAR: THE VACCINE WILL GIVE ME COVID-19
The facts: Neither of the two vaccines used in South Africa contains the virus that causes Covid-19, Professor Hannelie Meyer says, thus it cannot give you the disease.
“Both vaccines deliver a synthesised piece of genetic code that contains the necessary information for the body’s cells to produce the SARS-CoV-2 spike protein,” she adds.
Vaccines create an immune response without injecting the virus or any part of the virus into your body. This makes vaccines very safe.
THE FEAR: IT’S PAINFUL
The facts: Covid jabs feel similar to any other vaccine or injection given intra-muscularly. In other words, it’s just a little prick.
“The actual pain experience depends on the individual receiving the vaccine, as people have different perceptions of pain and thresholds for tolerating pain,” Professor Hannelie Meyer says.
“It’s estimated that approximately 10% of the population fear needles. Needle fear can worsen the experience of pain and can also lead to an immunisation stress-related response such as fainting.”
THE FEAR: I CAN STILL GET COVID AFTER THE JAB
The facts: Yes, after being vaccinated you may still get the infection but your symptoms will be far less severe and it’s unlikely you’ll need hospitalisation.
Vaccines prepare your immune system to clear the virus from your body before it has time to establish severe disease, but it can’t stop the virus from entering your body. It’s the same as a normal flu shot – you can still get the flu but you won’t get as sick as someone who didn’t get the flu vaccine.
“Also, it takes the body 14 days after the second dose of the Pfizer vaccine and 30 days after the J&J vaccine to mount an adequate immune response, meaning you aren’t protected during this time. Thus, if you come into contact with the virus at this early stage, you may get infected and get very sick,” Burnett explains.
You can still infect people after you’ve been vaccinated but vaxxed-up people have lower viral loads and are therefore about 50% less likely to transmit the infection.
Coetzee says you still need to follow all Covid-19 protocols, like wearing a mask and sanitising. “The vaccines won’t take that away. What sets you apart is that you’ll be asymptomatic, you won’t be as sick if you test positive for Covid-19 and your chances of spreading it are also much less,” she says.
THE FEAR: IT’S NOT WORTH IT – I’LL TAKE MY CHANCES
The facts: Experts can’t stress it enough: the vaccine will prevent you from getting severe illness and dying from Covid-19.
“It also decreases the likelihood of long Covid,” Goldstein says, referring to the state in which the effects of Covid can linger for months on end.
But it’s not just about you. Getting vaccinated not only protects you but your loved ones and others around you. Viruses mutate continually because of “uncorrected errors” that happen during replication, Burnett explains. These errors can lead to alterations in the virus.
“The replication of viruses with RNA genomes (a molecule similar to DNA) such as SARS-CoV-2, is particularly error-prone,” Burnett explains.
If you’re vaccinated, you have antibodies and immune cells that immediately start to neutralise the virus. “So you clear the virus very quickly, as opposed to people who aren’t vaccinated,” Meyer says. “If you aren’t vaccinated and you get Covid, the virus multiplies in your body for a longer period, so it has more chance to multiply and make new mutations.”
That’s how deadly new variants are formed.
The main difference between the two vaccines is the way in which the code for the spike protein is transported to the cells, Meyer says.
The Pfizer vaccine contains ready-made messenger RNA (mRNA) supported within a lipid coat, whereas the code in the J&J vaccine must still be turned into mRNA by your cells and is carried by a non-replicating harmless adenovirus.
With the Pfizer jab, the mRNA carries the message to give your cells instructions to make spike proteins, the part of the virus that attaches to your cell. Your body recognises this as a foreign object and starts making antibodies, proteins created by your immune system that help you fight off infection.
In order to protect the spike protein that is to be delivered to the cells, scientists use technology whereby a lipid coat – tiny balls of fat – covers the mRNA, and protects it from destructive enzymes, taking it to the cells where the mRNA is then unloaded.
The J&J vaccine uses a harmless adenovirus vector (common viruses that cause a range of illness) first before it is converted into mRNA. “Scientists basically remove the inside [of the vector] and put that genetic code inside that vector. Now the vector is in the vaccine and is delivered to the cell so when it enters the cell it basically releases that genetic material. When it goes into the cell the enzyme of the cell then converts that to mRNA,” she says.
So, in essence the J&J vaccine has an extra step to transporting the message to the cell as opposed to the Pfizer.
The J&J vaccine is a one-dose vaccine as research has shown it produces a lasting immune response after 30 days following vaccination. Pfizer is a two-dose vaccine because immune response is stronger and lasts much longer when a second dose is given 42 days after the first dose.
The one is not better than the other. “The goal is to protect people against hospitalisation and death and they both do that very well,” Meyer says.
EXTRA SOURCES: NEWS24.COM, WHO. INT, IMMUNOLOGY.ORG, BUSINESSTECH.CO.ZA,TIMESLIVE.CO.ZA, STATISTICA.COM, SACORONAVIRUS.CO.ZA, HEALTH.CLEVELANDCLINIC. ORG, RESEARCHPROFESSIONALNEWS.COM, NEWS24/HEALTH24.COM, STATNEWS.COM, WEBMD.COM, NICD.AC.ZA