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More than a third of all Covid-19 cases in Africa have been in South Africa and there are growing concerns about the impact of a new variant of the virus.
The country has received its first batch of vaccines, but has halted its rollout because of uncertainty about its effectiveness against the new strain.
What vaccines has South Africa got?
One million doses of the Oxford-AstraZeneca vaccine, produced in India, arrived in South Africa in early February, and another half million are expected by the end of the month.
The first batch needed to undergo various checks before being distributed for use, a process which was expected to take at least two weeks.
However, South Africa has put the rollout of this vaccine on hold, following a study that showed “disappointing” results against the country’s new Covid-19 strain.
The country is now considering administering doses of the vaccine to 100,000 people to monitor its impact before deciding on wider rollout.
But it will now focus more on the Johnson & Johnson vaccine for which clinical trials have shown is effective against the South African variant.
Health Minister Zweli Mkhize says a batch of doses of this vaccine is expected to arrive in South Africa mid-February.
South Africa has so far secured a total of twenty million doses, due to be delivered in the first half of 2021, according to President Cyril Ramaphosa.
However, it appears that the bulk of these vaccines won’t be available for several months and there has been criticism that the government has been too slow to act.
Apart from bilateral deals with manufacturers, South Africa is sourcing vaccines from the World Health Organization-backed Covax scheme, as well as through an African Union programme.
Covax is a global initiative in which countries pool their resources to support the development of vaccines with a view to ensure that all countries receive a fair supply of effective vaccines.
South Africa expects to acquire doses for around 10% of the population through Covax and has been told it will receive them from April through to June.
The African Union established the African vaccine acquisition task team last year to source vaccine doses for the continent.
Could South Africa have got vaccines sooner?
There’s been concern that many poorer, less-developed countries are being left behind in the global competition to secure vaccine supplies.
However, critics suggest that South Africa – as the richest country in Africa – should not be in this position.
“The stunning reality is that [South Africa] has neither a secured vaccine supply nor a plan for mass inoculation in the foreseeable future that can withstand scrutiny,” says the Progressive Health Forum, a group of leading medical experts in the country.
The opposition Democratic Alliance has called on the government to give full details of its negotiations with vaccine suppliers, accusing the government of “dropping the ball”.
It claims the government only started to talk to vaccine suppliers in early January.
And it’s also emerged that South Africa will pay more than twice the price for AstraZeneca vaccines than countries in Europe.
What does the government say?
Dr Anban Pillay, deputy director-general at the Ministry of Health, says the country was in touch with manufacturers as far back as last September.
“There have been various conversations through the better part of last year,” says Dr Pillay.
“The vaccines that most of the other countries have procured are vaccines that may not be ideal for South Africa from various perspectives,” he has said.
He says the Pfizer/BioNTech vaccine wouldn’t be appropriate for mass vaccination, often in remote rural areas, due to its storage requirements of -70C.
And he points out that the ministerial advisory committee advised against using this vaccine.
“We were waiting for the other vaccines that we can use as a mass rollout campaign, and those vaccines had not come through the production line yet,” he said.
He also says some countries have gone ahead with some vaccines without completed clinical trial data, which wouldn’t be allowed by the regulator in South Africa.
The government says it couldn’t have signed deals early without knowing whether the vaccines were safe and effective, as this would have been in contravention of national financial laws.
“In terms of our public funds, we’re required to invest in a product once we understand that the product works,” Dr Pillay says.
What did other countries do?
Wealthy countries, such as the UK and others, signed deals for prospective vaccines as early as July last year while they were still in development and undergoing trials.
And countries who can afford to pay most at the earliest stage of development and production can often secure an advantage, according to experts.
South Africa did take part in a trial for the Oxford-AstraZeneca vaccine starting in July last year, and involving some 2,000 people.
It’s unclear whether or not the authorities used this to begin negotiating for supplies from the manufacturer.
Research by Duke University in the US tracking advance vaccine commitments by country shows that the majority of doses purchased so far have been for high income countries.
Of the 19 countries which currently have more than a million confirmed coronavirus cases, there are others in addition to South Africa which are yet to start vaccinating, such as Colombia, Peru, Ukraine and Iran.
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