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To suppress the Covid-19 pandemic, tens of millions of South Africans would have to be vaccinated. Nothing on that scale has been done here. (Photo: Armin Kübelbeck (CC-BY-SA via Wikimedia Commons)
Three advances in the vaccine have raised hopes that the end of the Covid-19 pandemic is near. But vaccinating tens of millions of South Africans will be difficult. It would require a massive logistical effort in 2021 for life to go back to the way it was before Covid-19. By JAMES STENT and NATHAN GEFFEN.
First Posted by GroundUp
We now have effective Covid vaccines from Pfizer / BioNTech, Moderna and Oxford / AstraZeneca. None have yet been approved by medical authorities and the study results have yet to be published in peer-reviewed journals, but this is imminent.
If we want life to go back to the way it was in February 2020, we will have to vaccinate tens of millions of South Africans next year to end the epidemic. This is a very difficult task. Never in South Africa has a vaccine been given to so many people in such a short time.
It may be more realistic to protect those most at risk: healthcare workers, the elderly, and people with diabetes.
That would not suppress the epidemic, nor would it return life to pre-Covid levels. Masks, disinfectants and physical distancing would continue to be necessary. But it would reduce the number of deaths and make the healthcare system more manageable.
Does our healthcare system do something on a similar scale?
South Africa has good vaccination programs. We vaccinate about a million children each year. 86% of children were vaccinated against measles according to a Statistics 2016SA report.
in a national campaign in 2014, more than 350,000 girls received the vaccine against human papilloma (HPV) in one month in 16,000 public schools.
This is impressive, but nowhere near the scale of the tens of millions of vaccine doses needed to suppress the Covid-19 epidemic in the country.
Our vaccine programs are struggling too.
In an analysis of the 2014 HPV campaign, thousands of doses were reported to be damaged or broken, and keeping vaccines cold and properly stored was a major challenge. It is worrying that a large-scale disinformation campaign against the HPV campaign was also launched, particularly in Mpumalanga.
The HPV vaccine in 2014 was delivered in two doses. Also, the three Covid vaccines require two injections (a few weeks apart). If we want to end the epidemic, tens of millions of people will have to go to their second appointment.
There are some even bigger health programs in the country that offer hope.
Millions of South African women regularly obtain contraception from the public health system. About five million people with HIV receive their antiretrovirals every few months; It is probably the largest public sector chronic medication program in the world.
Many of those five million also have a viral load test once a year, which means drawing blood with a needle and retrieving the result. But while this is huge, it is still not comparable to the scale of the vaccine program needed to eradicate Covid-19.
It is not impossible to implement immunization on a large scale, as polio eradication programs in India can attest. Since 1995, India has celebrated two National Immunization Days (NID) every year. About him first two NIDsOn December 9, 1995 and January 20, 1996, 87 million children up to the age of three were treated. The following year, 125 million children as young as five were vaccinated.
Can the flu vaccine provide a model for how to do this?
In South Africa normally vaccinate about a million people a year against the flu, and apparently it’s targeting two million this year; that’s not bad, but far from what is needed for Covid immunity. It is also just a jab.
(The UK has been trying vaccinate 30 million people against the flu this year, which will be an impressive feat if accomplished.)
Could we at least aspire to vaccinate tens of millions of people for two, three or four years against Covid? Maybe, but we still don’t know if any of the vaccines remain effective for that long.
Keeping it cold
Two of the three Covid-19 vaccines have very difficult storage requirements.
Pfizer vaccine must be stored at extremely low temperatures – it is stable for six months when stored at -80 ° C. You need special freezers for that. The vaccine should be shipped in boxes filled with dry ice that only need to be opened twice a day. It expires two hours after defrosting.
Ideally, Moderna’s vaccine should be kept at around -20 ° C (still much lower than a standard freezer) and will remain stable at that temperature for six months. Press release of November 16 Announced that the new results indicated that this vaccine can be stored in a refrigerator for up to 30 days, and at room temperature for up to 12 hours.
The Oxford vaccine, which is also the lowest priced, has the most manageable cold storage requirements. This vaccine only requires refrigerator storage (2-8 ° C) and will be stable at these temperatures for at least six months.
How effective are vaccines?
All three are very effective, if the results have been properly reported and the studies have been done well. Moderna reported that 95% of the people who received the vaccine had an immune response that protects them from acquiring the virus. Pfizer reported 90% and Oxford 70%.
The results do not mean that Moderna’s vaccine is more effective than Pfizer’s or that Pfizer’s is more effective than Oxford’s. They were tested in different trials in different populations and at different doses even within the same trial. We will need more data before we can compare vaccines.
Competing for the vaccine against the rest of the world
Pfizer He says 50 million doses will be available by the end of 2020, and 1.3 billion doses will be produced by the end of 2021.
AstraZeneca claim (is that it will be able to produce three billion doses (of the Oxford vaccine) by the end of 2021.
Modern He says It can produce 20 million doses in 2020 and between 500 million and 1 billion doses in 2021.
There are about eight billion people on the planet and there will be a lot of competition for those doses.
SA has the capacity to manufacture vaccines
Aspen Pharmacare has reached an agreement with Johnson & Johnson to produce its candidate vaccine, pending the results. It can produce 300 million doses a year at its Port Elizabeth plant.
Biovac, in which the state owns a minority stake, claim (is it is currently capable of producing between 20 and 30 million doses of a vaccine per year. He is currently in talks with vaccine companies.
Also, the fact that South Africa was a test site for the Pfizer vaccine may mean that we have some influence there.
According to reports, the UK government has ordered 100 million doses of the Oxford vaccine and 40 million doses of the Pfizer (for both vaccines, a patient requires two doses). Australia ordered 33.8 million doses of the Oxford vaccine.
the The European Union has ordered 400 million doses of the Oxford vaccine.
Developing world access To the Oxford vaccine it seems, at present, a total of 500 million doses, administered through the COVAX association.
South Africa has not formally joined COVAX at present, according to reports in Daily maverick. Bhekisisa posted a COVAX overview, and what it means.
The cost of each vaccine varies greatly. According to the Financial Times, Oxford vaccine is the cheapest at $ 3- $ 4 (R45-R61) per dose. The cost of a dose of The Moderna vaccine is reported at $ 37 (R565), while a Pfizer dose is $ 20 (R305).
Vaccinating tens of millions of people will cost several billion rand for the doses alone.
November 24 Finance Minister Tito Mboweni announced the allocation of R500 million to “participate in the vaccine production process”, and that the state is willing to spend R5 billion to access the vaccines.
This may seem like a lot of money, but it will almost certainly be offset by the savings in health care costs, let alone the many benefits of a more open economy.
Who gets the vaccine first?
Who should be prioritized for the vaccine is still being debated worldwide. In South Africa, the three hundred to four hundred thousand health workers should be first in line. There are between three and four million people over the age of 65, and maybe they could be next.
Even reaching this most vulnerable part of the population next year would be a considerable undertaking. The implementation of this must be planned now.
In the meantime, most of us will have to continue taking steps to avoid infection. Don’t plan to throw your masks into the fire anytime soon. DM
