South Africa Vaccine Rollout: Health Worker Jabs Inch Forward – But With Insufficient Doses For Everyone
Vaccinated: Sister Amanda Swartz believes the vaccinations will give South Africa a fighting chance against COVID.

South Africa’s vaccination programme for health workers is inching forward, fuelled by small deliveries of the Johnson & Johnson vaccine every two weeks.  However, overall supplies remain far short of the needs – even for the health sector. 

The country has an estimated 1.25 million health workers in public and private health to serve its population of 60 million – but by 15 March, slightly fewer than 148,000 had been vaccinated due to a dearth of vaccines.

A looming third wave of COVID infections, predicted in June when the country’s winter forces people indoors, and the more infectious B.1.351 variant now dominant in the country, are two big anxieties facing health workers.  There is also hesitancy with some health workers believing that there is insufficient safety and efficacy data for most vaccines so far approved.

But Sister Amanda Swartz did not hesitate when offered a vaccine in late February. At the very front of the ‘frontline’ against the pandemic, Swartz works at Brackengate Intermediate Care Facility,  a 300-bed facility set up specifically for COVID-19 patients in Cape Town. A nurse for 30 years who has worked with HIV and tuberculosis patients, Swartz says she has never experienced anything like the second wave of the pandemic, which hit the country in December and January. 

At its zenith, South Africa was recording 22,000 new cases per day, and Swartz says the Brackengate facility was overwhelmed with patients: “We lost 20 patients in one day. Young people with no comorbidities were coming in scared because they have never been sick in their lives but they couldn’t breathe,” says Swartz. 

Swartz felt sickly on Christmas eve and spent the next 10 days in isolation. Sick with COVID-19, she had to self-isolate from her three children.

Covid is a Lonely Disease
Health workers in the Western Cape province of South Africa getting their Covid vaccination.

Describing COVID-19 as a “lonely disease”, Swartz said the nights she spent alone and struggling to breathe were the worst – but hearing her family in the house kept her going.

“It made me think about my patients differently. How they were all alone in the hospital and scared, and we are the only people that can motivate them and keep them in touch with their families.”

Returning to work was “scary”, admitted Swartz. She was still tired, suffered shortness of breath and feared being reinfected. 

When she was offered the vaccine, she grabbed the opportunity and was one of the first to be vaccinated at her facility on 24 February.

“I couldn’t actually wait for us to start with vaccinations in the country because this gives us a fighting chance against the disease,” said Swartz. “I didn’t only do it for myself. As I’m working with COVID patients, I also put the people that I love at risk. So by protecting myself, I’m also protecting my family.”

While there is still “negativity” about the vaccine on Facebook and other social media platforms, most of Swartz’s colleagues who were afraid to be vaccinated have come around:

“They see that those who have taken the vaccine didn’t have side-effects or, if we did, they were very mild like a headache or fatigue – just like if you have Hepatitis B vaccine. So most of them say they are prepared to take the vaccine now.”

Swartz believes that a third wave is inevitable in the country as people have become lax about wearing masks and physically distancing.

The Western Cape government on Thursday said that to date 27 570 healthcare workers in the province had been vaccinated,  urging others to register and get the jab to “shield each other”.

“The vaccine is currently being rolled out to healthcare workers, but not enough of us have been vaccinated at this stage to stop the spread of the virus,” the province said in a statement.

Relaxed Lockdown Regulation Could See Spike in New Cases 
On 1 March, most pandemic-related restrictions were relaxed in South Africa in the face of falling caseloads and the devastating economic impact of lock-downs. 

But with the curfew eased, alcohol on sale again over weekends, bars and restaurants open and people allowed to mingle, health experts warn that new cases are soon going to rise again –  although, for now, new infections remain under the bar of 700 a day in a country of 60 million people.

In the face of another wave of infections, Swartz said: “What I would really like to see is that each and everyone in our country takes the vaccine if the world will give it to us. We had too many losses in the second wave. If we can prevent that by taking the vaccine, I think that will help a lot.”

South Africa’s vaccine procurement, like that of other African countries, is slow and uncertain. 

Shortly after securing 1.5 million doses of the AstraZeneca/ Oxford vaccine in a bilateral deal with the Serum Institute of India for health workers in early February, a small study, just now published in the New England Journal of Medicine, showed that the AstraZeneca vaccine was not effective in preventing mild and moderate infection against the B.1.351 variant prevalent in the country.

The government decided instead to offer the Johnson & Johnson vaccine to health workers. Although the vaccine is not yet registered for use in the country, a clinical trial on efficacy had just been completed – so scientists expanded the terms of the trial to encompass an implementation study for health workers.  Since then, the J&J vaccine has been approved both by the US Food and Drug Administration and the European Medicines Agency. 

South Africa Sells AstraZeneca Vaccine Doses Despite Calls for Roll-Out

The government, however, generated a controversy when it resolved to sell its 1.5 million AstraZeneca doses to the African Union. A number of leading scientists condemned this decision, particularly Professor Schabir Madhi, dean of the Faculty of Health Sciences at the University of the Witwatersrand and Director of the SA Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit.

Madhi was the principal investigator on an AstraZeneca efficacy trial being run in South Africa.

Writing in Business Day earlier this month, Madhi argued that “there remains a strong biologically plausible reason to expect the AstraZeneca vaccine will protect against severe disease due to the B.1351 variant, likely to a similar magnitude as the J&J vaccine”.

The World Health Organization also recommended in mid-February that the AstraZeneca vaccine should still be rolled out, even in countries where the B.1.351 variant was circulating, said Madhi.

He and other health professionals, including infectious diseases expert Professor Francois Venter, believe that the AstraZeneca vaccine should have been rolled out to high-risk South Africans who have no other protection against severe illness and death.

“Every additional day of procrastination lends itself to much of the R75m [75 million Rand/$US 4.87 million] used to procure the vaccine going to waste, while the elderly and other high-risk individuals would certainly remain unprotected as opposed to being offered a fighting chance of being protected against Covid-19 severe disease and death,” wrote Madhi.

The AstraZeneca vaccine is the backbone of the global COVAX vaccine platform’s vaccination programme and it also makes up a large portion of the African Union’s vaccine procurement.

Unlike many other African countries, South Africa has yet to receive a COVAX vaccine delivery. According to the COVAX allocation plans published on 2 March,  South Africa is still due to get over 2.4 million doses of the AstraZeneca vaccine and 117 000 Pfizer doses.

However, given the government’s decision to return its own AstraZeneca purchases and a global shortage of vaccines, it is going to take a while before the country’s citizens get the jab.

Image Credits: Kerry Cullinan , Western Cape Provincial Government, South Africa .

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