Why don't we have a vaccine yet?

As of now, only two vaccines have received emergency approval worldwide: the Pfizer vaccine and the Oxford-AstraZeneca vaccine, approved a week ago

At this stage every person in the country probably knows someone who has been infected by the COVID- 19 virus. With the infection and death rates climbing fast, our only hope of curbing this disaster is via a vaccine. With many countries (most in the developed world) rolling out millions of vaccinations, South Africans are understandably getting frustrated with the delay in receiving access to vaccines.

I was also getting increasingly frustrated. However, knowing any of the people in government working on procurement, I knew that it could not just be an issue of laxness or incompetency causing the delay – as many analysts and experts would like us to believe.

So, I set out on a journey to try and understand why we don’t have a vaccine yet. I read articles, spoke with experts and government officials and here is what I discovered: 

The first issue is getting the right vaccine.

It goes without saying that any vaccine needs to be safe and effective. That requires approval by independent bodies on the basis of scientific research and carefully conducted trials. (Remember Will Smith’s character who was the only survivor in the “I Am Legend” movie after a vaccination went wrong? Well, we don’t want that!)

Apart from the Russian and Chinese vaccines - both which lack transparent testing data - only two vaccines have received emergency approval worldwide. The Pfizer vaccine received approval in early December while the Oxford-AstraZeneca one was approved a week ago.

For now, those are the only vaccines that can possibly be used in South Africa - although it seems neither has applied to our regulatory authorities for approval yet.

Assuming that they do apply, then of course the next question is which one should government use. The Pfizer vaccine (which is used most widely at this stage) requires refrigeration at minus 70 degrees. South Africa has only two facilities that can house vaccines at that temperature, so we could have small numbers of the Pfizer vaccine – for example to vaccinate health care workers - but it is not suitable for mass vaccination.

That leaves the Oxford-AstraZeneca vaccine, which seems more appropriate since it requires normal refrigeration temperatures.

The problem is that at the moment, both suppliers are – to put it bluntly – sold out.  

That brings us to the second issue: availability.

Manufacturers are supposed to make two billion vaccine doses available by the end of 2021. But according to the vaccine alliance Gavi, only one billion of those doses have been planned for the world’s 92 poorer countries.

Globally, we have seen a hoarding of the vaccines by the richest countries in the world. Canada, for example, has reserved enough vaccines to vaccinate each Canadian citizen five times. Updated data shows that rich nations representing just 14 per cent of the world’s population have bought up at least 53 per cent of all the most promising vaccines so far.

They were able to do that because they had the money to pay top dollar rates for the vaccine.

Which brings us to the third issue: affordability.

Many questions have been raised as to why the South African government did not reserve some of the vaccines as many other countries did.

Shortly after the epidemic hit, many pharmaceutical companies entered the race to develop a vaccine.  They knew that getting there first would mean big (and I mean BIG) money.

In order to have access to a vaccine once it was developed, these “nice” people demanded pre-orders which had to be paid up front and… wait for it… if they were not successful in developing a vaccine, you couldn’t get your money back. So it was a gamble involving billions of dollars.

Of course, thanks to the Zuma years, we don’t even have a couple of million (Rands) to waste, so the government decided to rather go with the COVAX initiative. 

Instead of individual nations in the developing world taking the risks with pre-orders, COVAX was designed to do it for them, whilst also negotiating vaccines at cost price. Since South Africa would not have been able to pay the rack rate for the vaccines, this seemed like the only solution. 

However, it comes as no surprise that the manufacturers are more interested in fulfilling the orders of full-paying customers first, so COVAX is running short, which explains why South Africa will initially only get enough to immunise 10 per cent of its population. (According to Anban Pillay, DDG of Health, it has nothing to do with missing payment deadlines.) 

This means that the government now has to negotiate additional bi-lateral agreements with these pharmaceutical companies, who are basically telling us to stand in line – “we will get back to you”.  

So yes, it is a mess…but it is a mess that is linked to the age-old problem of global inequality.

I have no doubt that our government has made mistakes along the way and, as so often before, their communication about this with the South African people has been appalling.

However, the COVID-19 pandemic continues to highlight not just scientific/technical/supply-chain issues, but moral questions about a world in which health care and pharmaceutical interventions are seen as a commodities sold to the highest bidder rather than  (to quote the UN Secretary-General) a “global public good” made available to all.

So as a country, we are again having to face what the majority of South Africans and people in the developing world know all too well: Access to health care depends on whether you have money or not.