It was an enormous relief that the health department secured a contract for 1.5-million Covid-19 vaccine doses last week. It was a last-minute, emergency scramble, but at least the more than 1-million people who work in health-care and related support services will be get their first shot.

But with regulatory process and logistical arrangements still at initial stages, it will be February before the first vaccine is administered. That will be too late to shield health workers from the approaching storm in Gauteng, where the coronavirus is expected to peak in January.

ToBut to break the cycle of infection, it is estimated that 40-million people must be vaccinated, many of them twice, depending on the vaccine acquired. The next firm arrangement for a secure supply is with Covax, the global vaccine initiative, which it is anticipated will deliver a sufficient amount to inoculate 10% of the population — but only by April.

We do not have the vaccine supply we need. This sets SA back compared to the rest of the world, not just on a health footing but economically, too. It will make it difficult for South Africans to travel as well as foreigners to visit SA.

It is clear that the government let the country down in this crucial leg of the battle. While 45 countries, including many of our middle-income peers, have secured vaccine stocks through prepayment other than through the Covax initiative, SA did not even enter the race. Kenya, for instance, has announced that the 24-million doses it has bought from the Serum Institute of India — the same source as SA — will begin arriving in February.

Why did SA get left behind in the vaccine race? In September, the government established an expert ministerial advisory committee on vaccines.

In its first report, the committee, chaired by Wits virologist Barry Schoub, noted that the wealthy world had already bought up to 2-billion vaccines through prepayment arrangements with pharmaceutical companies. These arrangements involved making non-refundable deposits, which the committee cautioned carried much risk as the vaccine candidate may fail or not be suitable for the country.

The committee strongly recommended that SA participate in the Covax arrangement, which included a number of vaccine candidates and therefore involved less risk.

The committee also recommended that “bilateral engagements with pharmaceutical companies continue” but, despite a global vaccine race very clearly under way, did not propose making any pre-orders for priority groups such as health workers.

In its second (published) advisory in December, a two-page affair, the committee noted that some clear leaders had emerged in the vaccine race with four companies reporting good results in phase 3 trials. But, said the committee, there were too many research gaps to make a concrete recommendation for any vaccine.

It recommended that the government adopt a set of fairly obvious criteria, including safety and efficacy, ease of use, storage requirements and cost. It also recommended a framework for allocation. It didn’t even remotely suggest that procurement should begin.

The committee’s role, said the health department at its inception, was to advise the government “on all matters pertaining to the vaccine development and rollout”. This it certainly has not done effectively.

A similar criticism must be laid at the door of top department officials, who, it must be assumed, have the necessary skills to carry out their duty to take care of the health of citizens.

But while experts and government officials are expected to be on top of the technicalities, it is only the political leadership of the country, headed by President Cyril Ramaphosa, that has the ability to set priorities, redirect resources and weigh up the spending and political trade-offs that must, as a matter of course, be made.

Here again, we have experienced a chronic failure of leadership — our ongoing and very costly Achilles heel as a country.

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