Gauteng health workers receive the J&J Covid-19 vaccine at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg. Picture: Freddy Mavunda
Gauteng health workers receive the J&J Covid-19 vaccine at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg. Picture: Freddy Mavunda

The department of health notes with concern the FM editorial "SA’s Bungles Cost it Badly on Vaccines" (March 25-31).

We wish to put on record that the vaccine acquisition and inoculation programme is not a bungle.

SA has signed an agreement with Johnson & Johnson (J&J) for 11-million doses (with an additional 20-million pending), a term sheet with Pfizer for 20-million doses and an agreement with Covax for 12-million doses.

Furthermore, the editorial claims that "just about every Covid-19 intervention" in SA has been "chaotic." Not only is the statement unnecessarily insulting, but it is patently untrue.

Emergency procurement of vaccines is bound to cause anxiety. So it’s appreciated that the process can seem distorted and slow to those not involved in the dealmaking. It is natural to compare it with others and draw conclusions from that metric alone. It may allay anxieties if those of us charged with the responsibility tell our side of the story.

As a middle-income country, SA didn’t have the financial muscle to make the unhedged bets of our high-income counterparts. However, SA also did not qualify for aid. This was highlighted by The New York Times, which on December 28 reported: "Countries like SA are in a singular bind because they cannot hold out on hope for charity … SA is considered too rich to qualify for cut-rate vaccines from international aid organisations."

The accusation that we started to talk to manufacturers only "this year" is totally untrue.

In vaccine acquisition, the strategy begins by getting involved in research & development. In the case of J&J, we participated in the Ensemble trials and, through our contributions, were able to extract key information.

For instance, the trial told us the vaccine is safe for people living with HIV and the elderly with co-morbidities, and that it is effective against the 501Y.V2 variant. These are critical findings specific to our population.

We surveil vaccine development closely and begin to negotiate as soon as the scientific evidence shows adequate efficacy for our unique needs. We began engagements with pharmaceutical companies as follows: Pfizer (June); J&J and Russia/Sputnik V (September); Moderna and China’s Sinopharm/Sinovac (November); and AstraZeneca (December). State-owned vaccine company Biovac has also been in contact with Cuba around the Soberana 02 vaccine.

We have established a strong working relationship between the government, J&J and local manufacturer Aspen. We have made history as the first country to roll out the one-dose J&J vaccine through the Sisonke protocol, which itself will contribute key insights into the merits of mass vaccination.

As it stands, production of J&J vaccines is under way in Gqeberha and, in April, millions of doses will be shipped from our shores, with SA being one of the first recipients of market doses.

The FM editorial raises a number of issues in relation to the "delay" in pausing the rollout of the AstraZeneca vaccine, yet argues that the decision to sell the doses was "short-sighted", citing a study that demonstrated 79% efficacy of the vaccine against severe disease and 100% efficacy against death.

However, the science of withholding the AstraZeneca vaccine remains sound. The current generation of AstraZeneca vaccine demonstrates little to no activity against the 501Y.V2 variant that is dominant in SA. The arguments that AstraZeneca should be made available despite its low efficacy are not based on science and are, frankly, ethically questionable. We believe that population immunity should be approached with precision, not risk hedging, which could damage vaccine confidence and risk lives.

Despite the challenges SA faces, our vaccination programme is still on track, and we remain committed to meeting our target of population immunity in 2021. The execution of the Sisonke protocol allowed us to start our vaccination campaign on time, despite the stumbling block we faced with the AstraZeneca vaccine.

Ultimately, the vaccination rollout does not fall squarely on the shoulders of the government. Acquisition is a government-driven exercise, but getting jabs into people’s arms will require a whole-of-society approach. We are highly encouraged by the level of preparation for phases 2 and 3 of the vaccination schedule. And we are seeing deepening ties between the government, business, labour and civil society. Despite moments of negativity, this shows an overall maturation of our society that is worth celebrating.

Dr Zweli Mkhize
Minister of health

The FM welcomes concise letters from readers. They can be sent to fmmail@fm.co.za

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