Uncertainty over local roll-out of Covid-19 vaccine

AS THE first Covid-19 vaccinations are rolled out in the US and UK, and new infections skyrocket in South Africa, the burning question for many is: when will we have access to vaccines?

For now, all we have is educated guesses in a sea of uncertainty.

Dr Anban Pillay from the national Health Department said that as a member of the Covax initiative to ensure equitable vaccine access for low and middle income countries, South Africa should be part of the first vaccine allocation internationally next year.

Pillay was speaking at a virtual conference on vaccine progress hosted by the AfroCentric Group. Also speaking at the conference was Professor Gregory Hussey of the Vaccines for Africa Initiative at the Institute of Infectious Diseases and Molecular Medicine, UCT.

“In the first and second quarter, Covax will be getting doses but the doses will be fairly low. The idea is that we will build up to 2 billion doses by the end of 2021 and the bulk of that will happen in quarters 3 and 4. They will then allocate that across countries, making sure that everyone gets an appropriate proportion,” Pillay said.

“In terms of roll-out, we’re awaiting details of exactly how much will be allocated to SA from Covax - we were told it will be about 3% of the population but that is still to be confirmed. We will certainly be part of the initial allocation in Q2, but this stage we don’t know in Q2 exactly when.”

The uncertainty hinges on many factors, including the results of the vaccine trials which are currently under way internationally, how soon the different vaccines are approved, and which are chosen to be distributed by Covax based on the supply, cost, and many other variables.

“As for the price of the vaccine, Covax has quoted us $10.55 but it could be as much as $20.10,” Pillay said. “Serum on the other hand is targeting $3-5 per dose. We hope we will be able to access that.”

The vaccine will hopefully be made a Prescribed Minimum Benefit (PMB) so that members of medical schemes can access it without extra cost, relieving some of the financial burden from the public sector.

However, Pillay said government would be guarding against wealthier South Africans or corporations accessing the vaccine faster or in greater quantities than the rest of the population.

“The idea is to make sure that while we’re achieving global equity with Covax, we also want to achieve equity internally in SA and make sure that simply because somebody was able to access it much easier, that they don’t necessarily skip the queue,” he said.

Hussey said cost and ease of use are two major considerations for which vaccine will be most suited to the South African context.

“Ideally everybody in SA should get the vaccine, but given the scarcity, we will have to prioritise who is first in line. The big issue is availability and cost of vaccines. Government on its own cannot fund vaccines for all South Africans.”

The Pfizer/BionTech and Moderna vaccines have shown the greatest efficacy so far, but cost $20 and $30 respectively per dose. The Oxford-AstraZeneca vaccine, which uses an older vaccine technology, is around 20% less effective but only costs $3 per dose.

Hussey said that it isn’t likely that we will need to get a new Covid vaccine each year like the flu vaccine, because the Covid-19 virus doesn’t change it’s genetic make-up enough to need a completely new vaccine the way that influenza does.

“The big question is how long immunity will last. If immunity only lasts for a year or two, we would have to provide booster vaccination.”

Hussey said another point still under consideration was whether people who have already had Covid would need to be vaccinated.

“There is virtually no public health programme that tests for immunity before vaccination.

Do we test for antibodies and if you’ve got antibodies we don’t vaccinate? It’s something that is currently under discussion.”