- President Cyril Ramaphosa’s administration has come under heavy criticism this week for its lack of a convincing Covid-19 vaccination strategy.
- While the government hopes to begin vaccinating healthcare workers by February, vaccine supplies lined up to date only cover a fraction of the population.
- The details and timeframes for a broader vaccination drive are still uncertain as the government has been slow to negotiate with vaccine manufacturers.
- A slow vaccine rollout would add another downside risk to South Africa’s economic recovery prospects.
On 6 January, daily new Covid-19 cases surged to 21,832 cases amid concerns that the recently identified Covid-19 strain 501Y.V2 is much more easily transmissible. By comparison, during last July’s ‘first wave’ peak, daily new cases averaged around 12,000 daily cases. Of a total of about 1.1mn cumulative cases, around 100,000 have been registered in the past seven days. The daily death toll also rose to 844 cases on 6 January, bringing total pandemic-related deaths to 31,368. Yet the year-end return to lockdown ‘Level 3’ still appears comparatively light and additional measures might still be required.
The intensity of the Covid-19 resurgence redoubles pressure for a clear and speedy vaccine strategy. Yet Health Minister Zweli Mkhize’s 3 January announcement of South Africa’s vaccination strategy was widely criticized for lacking critical details. At least for now, the government seems to be trailing in the global vaccine race, which could further delay the badly needed economic recovery. An additional wrinkle are concerns over whether or how effective current available vaccines will be in relation to strain 501Y.V2. The daunting vaccination challenge facing the government could thus emerge as a third serious downside factor to South Africa’s economic recovery prospects, alongside electricity constraints and reform delays.
While Mkhize’s stated goal is to vaccinate 40mn people this year, vaccine procurement remains unclear. Under the COVID-19 Vaccine Global Access (COVAX) initiative, South Africa is expected to receive about 6mn vaccine doses. The delivery timeframes are expected to be confirmed this month, but the first shipments are only anticipated in Q2. A small ray of light came today, 7 January, when Mkhize announced that South Africa had struck a deal with the Serum Institute of India, manufacturers of the Oxford University-Astra Zeneca vaccine, for 1mn doses to be delivered and another 500,000 in February.
Although regulatory approvals still need to happen, the SA Health Products Regulatory Authority (Sahpra) is unlikely to be a significant hurdle given ‘reliance agreements’ that allow data sharing with regulatory authorities elsewhere. One regulatory challenge could be, however, that unlike some emerging markets, South Africa has not yet made plans for procurement of Chinese or Russian vaccines, which Sahpra would be unlikely to approve without the necessary data.
With the Serum Institute deal and Covax allocations only expected to cover a fraction of South Africa’s vaccine needs, the Ramaphosa government, unlike some other emerging markets, appears to have been slow out of the starting block where deal-making with vaccine manufacturers is concerned. It has also insisted on centralized vaccine procurement, though private medical schemes are expected to strike a cross-subsidy deal with the government to fund Covid-19 vaccines for 7.1mn of their own members, plus an equal number of non-members.
Distribution plans are also still in the early stages. So far, the government’s vaccination plan provides for 6,300 full-time vaccinators in the public sector to vaccinate most of the targeted 40mn South Africans by the end of the year.
With vaccine progress slow, leading local scientists have publicly accused the government of an unconscionable failure to procure vaccines, which they have likened to another Thabo Mbeki-era ARV disaster in the making. This comparison is probably overblown. Unlike former president Mbeki at the time, Ramaphosa and Mkhize are no denialists. Rather than their intent, capacity to deliver will probably prove the crucial challenge.
The reasons for the vaccine delays are likely attributable to a combination of factors. The recent official narrative that vaccination would not amount to a substitute for public health measures like mask wearing or lockdowns is disingenuous as this is hardly a binary choice. More likely the delay is attributable to a combination of South Africa’s severe fiscal crunch, lack of administrative competence, and perhaps an expectation on the part of the DoH that global pressure would force down vaccine prices for Africa (an argument officials feel is buoyed by disastrous past experiences with HIV/AIDS). Keen to protect its already catastrophic budget metrics, the Treasury has been slow to confirm that, with private sector help, it will cover the necessary costs of vaccine acquisition, which is estimated to cost ZAR 12bn-20bn.
While South Africa’s main struggle in the vaccine game will likely be the question of access and financing, public perception could also impact the roll-out, particularly if the chief justice’s recent controversial remarks reflect broader public skepticism regarding vaccinations. Indeed, a recent Ipsos survey recorded only 53% of South African respondents saying that they intend to get the Covid-19 vaccine – a smaller proportion than in other emerging markets such as Brazil (78%) or Mexico (77%).