Shirley de Villiers FM features editor & columnist

At 7am on Monday, the UK will begin inoculating frontline workers for Covid 19, having this week approved Pfizer/BioNTech’s vaccine for emergency use.

A total 800,000 doses of the vaccine are already wending their way to that country, bound for the 50 hospitals that will serve as initial inoculation points.

That’s the first batch of 40-million doses of the vaccine the UK has preordered from Pfizer; it’s secured another 315-million from the company’s competitors, pending regulatory approval.

Over in the US, the Food & Drug Administration advisory panel will meet on Wednesday to consider Pfizer’s application for emergency regulatory approval for its vaccine; Moderna’s candidate will be considered a week later. In the event one of these gets the go-ahead, the country is reportedly primed to begin inoculations within 24 hours using prepositioned stocks.

The US has already ordered a combined 200-million doses from just these two manufacturers.

The European Union has also secured 2-billion Covid vaccine doses through six supply agreements, according to Bloomberg; Brazil has preordered 186-million. And CNN reports that, through vaccine trial agreements with China, Brazil is set to receive an additional 46-million doses, Turkey 50-million, Indonesia 40-million, and Mexico 35-million.

Canada has preordered enough vaccines to cover its population five times.

All told, according to the Duke Global Health Innovation Centre, about 9.8-billion vaccine doses were already reserved around the world by late November – before a single vaccine had come to market.

And South Africa?

Well, SA is sitting on its hands.

Deadline schmeadline

News24’s Kyle Cowan reported yesterday that SA has yet to make good on its promise to settle a R500m down-payment that would secure its place in Covax – a pooled buying scheme aimed at ensuring widespread and equitable access to Covid vaccines.

This is no small lapse. Developing countries can be shut out of the vaccine race because wealthier countries can afford to pay more, and can set up deals with drug companies to ensure they’re first in the queue to get them.

By putting in place a joint buying agreement, an initiative such as Covax speeds up rollout: upfront funding can be used to ramp up vaccine production prior to vaccine approval. It also guards against the risk of a country placing its hope in a single vaccine candidate, only to have it fail. And the scale of the project incentivises manufacturers to enter preorder agreements.

Already, by the Duke centre’s estimates, 700-million doses have been bought through Covax. (Here’s a useful explainer on the scheme by Seth Berkley, CEO of Covax’s co-ordinating partner Gavi.)

Not that Covax itself is without issues. There’s little choice, for example, on which vaccine may be rolled out in a particular country, how many doses it could access (no participating country will be allowed to buy vaccines above a 20% coverage rate until all have reached 20%), or how it disburses them.

But given that we reportedly have yet to put pen to paper in any bilateral negotiations with drug manufacturers – and given the expected pressure on global stocks – it could be our best shot at an affordable, early solution, even if just for the most at risk.

Not that our government appears taken with the urgency of the moment. As Cowan notes, the extent of our participation in Covax at this point would seem to be limited to a nonbinding letter of intent to participate.

Only, Covax required a binding commitment by September 18 and an upfront part-payment of 15% by October 9. That was a whole 19 days before the government, in its medium-term budget policy statement, noted it was “exploring options to ensure access to vaccines when they become available, including participating in the Covax facility”.

So now, almost two months after the payment deadline, the Solidarity Fund is stumping up the funds, “while government is sorting itself out in terms of its own internal processes”, National Treasury director-general Dondo Mogajane told Cowan.

Those apparently include finding an additional R4.5bn for the rest of SA’s vaccine commitment – presumably something that will only be tabled in the February budget.

The SAA slap in the face

On the bright side, talks with Covax are still going ahead, despite SA’s apparent arrogance in simply ignoring the deadline. But the situation is galling on at least three counts.

First, the Solidarity Fund is now paying the upfront Covax fee, Mogajane told Cowan, because “we had just passed the budget and obviously the framework didn’t include this thing”.

It seems astounding that, in the midst of a pandemic, the government didn’t factor some form of vaccine relief into its October budget – particularly given that Covax launched back in June already, and its deadline for a letter of intent was August 31.

Second, the government did find a way to reprioritise R10.5bn between October and end-February to keep SAA on life support without breaking a sweat. Just imagine if that money were spent on a vaccine ...

Finally, given that taxpayers will be footing the bill for SA’s R4.5bn vaccine commitment, you’d expect our vaccine strategy to be less shrouded in mystery.

Surely the government should be telling us where we are in our vaccine negotiations, what we may expect and how government plans to share out the vaccines it does secure?

These, in fact, are among the questions sent to government by the Health Justice Initiative, a public health and law NGO. It has yet to receive a response – even to acknowledge receipt of its letter.

When it comes to media queries from the likes of Cowan, departmental spokespeople are either entirely absent, or engage in an endless game of pass the accountability parcel.

And yet, our tweeting finance minister seems to think there’s no problem. “As far as I know, all systems were prepped to go,” he says of the Covax conundrum.

Would that we could all be as confident ...

*De Villiers is the features editor of the FM​

This is a roundup of the best Covid-19 news from the web, brought to you in today’s FM lockdown newsletter.

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