The government’s advisers on coronavirus vaccines have recommended that it sign up to the international financing vehicle Covax under a “committed purchase agreement” that could result in SA initially receiving only enough shots to immunise frontline health-care workers and people in care facilities.

SA has recorded more Covid-19 cases and deaths than any other African nation, but lags countries such as Botswana and Libya that have already signed up to Covax, which aims to use pooled purchasing to equitably distribute 2bn doses of vaccine by the end of 2021.

It also trails countries such as the UK and US that have entered into advance purchase agreements with pharmaceutical companies developing coronavirus vaccines, which could provide faster access than Covax.

The international race to acquire vaccines gained fresh momentum earlier this month, after first Pfizer and its development partner BioNtech, and then Moderna announced interim results showing their shots were more than 90% effective at preventing Covid-19.

Final results from Pfizer, announced on Wednesday, confirmed its interim analysis, and showed it prevented both mild and severe disease.

SA missed the October deadline for committing to Covax, and is still trying to negotiate an agreement.

The government is in a tight spot, as it does not meet Covax criteria for subsidised vaccines, yet has limited funds at its disposal since the coronavirus crisis has caused a sharp contraction in the economy and precipitated a decline in tax revenue. It is also concerned about some of the conditions of the Covax agreements, such as a requirement that countries assume liability for the vaccines they procure.

Under the committed purchase agreement, countries commit to buying a specific number of shots of whichever future vaccine is allocated by Covax, at a yet to be determined price. They must pay upfront, and may only pull out if the price breaches $21.10 a dose. The alternative is a more expensive “optional purchase” agreement, which allows a country to refuse a specific vaccine.

“Informally, we have already signalled our areas of concern to them. Talking to some other countries, these concerns are shared,” said the health department’s director for affordable medicines Khadija Jamooldien.

The government is planning a phased approach to implementing a vaccine. The initial volume available via Covax could be as low as 3% of the population, because the facility will equitably distribute the first shots it procures to ensure front-line health-care workers from participating countries are covered. Only after that will countries receive their next tranche, capped at 20% of their populations, until all participating countries reach this threshold, she said.

The government had been approached by several pharmaceutical companies developing Covid-19 vaccines, but discussions had not moved beyond the exploratory stage, she said.

Barry Schoub, who chairs the ministerial advisory committee on Covid-19 vaccines, said two advisories on Covax had been submitted to health minister Zweli Mkhize. He declined to discuss the contents, saying they were for the minister to release. The minister’s spokesperson, Lwazi Manzi, had not responded to Business Day’s request for the advisories at the time of publication.

Schoub said administering vaccines to frontline health-care workers would be relatively straightforward, but a plan has yet to be devised for distributing shots on a wider scale.

A vaccine offers the best hope of safely breaking away from the restrictions on trade, travel and movement that the government has imposed to try to manage the coronavirus pandemic, said Business for SA chair Martin Kingston.

“We would certainly encourage the government, and the private sector, to see to what extent we can put in place appropriate arrangements and agreements to access the vaccine, recognising that we are very significantly fiscally constrained in the country,” he said.

It was unlikely that the government could afford to vaccinate everyone, he said.



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