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The unprecedented speed at which vaccines have been manufactured, tested, and distributed to combat an ever-changing virus presents unprecedented challenges for all of us, writes Deputy Minister of Health Dr. Joe Phaahla.
Vaccines are most effective against static targets, and SARS-CoV-2 is anything but stationary. The massive scale of human infection has provided Covid-19 with abundant opportunities to generate variants. This nimble, mutant virus is outperforming and outwitting the world’s best scientists.
The Health Department’s decision to modify the launch of the AstraZeneca Covid-19 vaccine, after research suggested it offers diminished protection against the 501Y.V2 variant that is prevalent in South Africa, is disappointing. But it should come as no surprise given how quickly this virus transforms.
A dead end situation
AstraZeneca’s vaccine research began at the end of the first wave of infections in South Africa last year and continued through the second wave that occurred in late 2020. We now know that the second wave was largely driven by the 501Y variant. V2, which first emerged in the Eastern Cape and then spread rapidly across the country. It was only in late 2020 and early January 2021 that researchers began to focus on the effect of vaccines against the 501Y.V2 variant.
The results of their studies were only available on Friday, February 5, and were published publicly and transparently two days later at a press conference organized by the Minister of Health, Dr. Zweli Mkhize.
It was through this research, in which the government has invested directly, that the AstraZeneca vaccine was established to be largely ineffective at the 501Y.V2 variant. By then, a million doses of the vaccine, designed to fight the original virus and developed before the new variant was discovered, had already been delivered to South Africa.
READ | Explainer: Covid-19: Variant 501yY.V2 came from SA? We ask the experts
When launching vaccines around the world began in 2021, the government found itself in a dead end.
In early January, we were reprimanded for not having signed bilateral agreements with pharmaceutical companies to secure vaccines, although no one knew for sure whether they would be effective against the new strain.
At the time we had no idea if vaccine evasion was a feature of the 501Y.V2 variant. That information was still coming in. The only information we were able to access was from the daily tests. This made it impossible to anticipate anything, as tests were carried out on the fly while the virus mutated.
If we waited and the results showed that the vaccine was effective against the new variant, we would have missed the opportunity to acquire a possible antidote. It is understandable that South Africans would have been outraged.
The decision to purchase the AstraZeneca vaccine was based on data showing 76% efficacy after a single dose. For us, it was a relatively small, short-term, low-risk investment that we had to make to ensure the safety of our healthcare workers and front-line advocates. By the time the decision was made, it was the right thing to do.
Deadlines and expiration dates
Suggestions that the government has sold expired vaccines are absurd.
If the vaccines were appropriate for the South African Covid-19 context and we had proceeded with the launch of the AstraZeneca vaccine as planned, the Department of Health would have safely injected one million doses into frontline healthcare workers much earlier. April 30, when the vaccine expires.
The April expiration date was also not discovered by accident. Through the implementation of quality assurance and control protocols, the government was aware of when the stock expired. That the shipment expires in April is not alarming. Its drastically reduced effectiveness of 22% against the 501Y.V2 variant is the concern.
Now what?
Right now, the immediate priority is to reduce the risk of serious disease and help ease the burden on our health systems. We will continue Phase 1 of the vaccination program as planned, using Johnson & Johnson and Pfizer vaccines instead of AstraZeneca. These vaccines have been shown to be effective against the 501Y.V2 variant and the necessary approval processes for their use in South Africa are underway.
In partnership with the Medical Research Council and the National Department of Health, the vaccination rollout will begin in the form of an implementation study at vaccination sites across the country. This study will provide valuable information on emerging infections, should they occur, among vaccinated healthcare workers.
READ | The first blows from Johnson & Johnson of SA could come next week. This is what our implementation plan looks like
Such a nimble virus demands a variety of responses, which is why we are also engaging Sinopharm, Moderna, and the makers of the candidate Sputnik V. There are vaccines coming out all the time, and this is an iterative process. We always knew that first-generation vaccines would be far from perfect. Scientists have warned all along that this is a long game with gradual wins. We all must, therefore, manage our expectations.
What about AstraZeneca?
So are we burning the AstraZeneca vaccine?
Depending on the advice we receive from the experts, the vaccine will either be changed before the expiration date or it will be sold to countries where the 501Y.V2 variant is not present. At a recent World Health Organization (WHO) press conference discussing South Africa’s findings on the efficacy of AstraZeneca against the 501Y.V2 variant, scientists and public health experts emphasized that the vaccine still has an important role that play. AstraZeneca’s storage and cost make it particularly suitable for developing countries, which have been left at the bottom of the procurement queue after developed countries stockpiled billions of doses of vaccines.
READ | Covid-19: Astrazeneca vaccine provides minimal protection against 501Y.V2 variant – new study
With so much research focused on developing vaccines to combat this pandemic, there is great reason for optimism. But vaccines are just one of several responses we will need to control the pandemic.
Right now, we all need to refine non-pharmaceutical interventions: maintain social distancing; wear masks; keep out our social bubbles; and hand washing.
There are no quick fixes or magic bullets in the fight against Covid-19. This is a long battle.
– Dr. Joe Phaahla is the Vice Minister of Health.
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