South Africa broadens its Covid-19 vaccine program in the face of a potential third wave

A healthcare worker tends to a patient at a temporary ward set up for Covid-19 at the Steve Biko Academic Hospital in Pretoria.
A healthcare worker tends to a patient at a temporary ward set up for Covid-19 at the Steve Biko Academic Hospital in Pretoria.
Image: Reuters/Phill Magakoe
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South Africa is set to expand its nationwide rollout of Covid-19 vaccinations as the country braces for a potential third wave of the coronavirus pandemic that officials fear could materialize in the coming weeks.

Beginning Monday, South Africans aged 60 and older will be able to receive the vaccine as part of the second phase of a rollout that began in February. To date, roughly 455,000 healthcare workers in the country have received the Covid-19 shot created by the pharma giant Johnson & Johnson, which the country was the world’s first to administer. A broadening of the program for vaccinating healthcare workers sent hundreds of such workers and others to vaccine sites this week in search of shots.

The jabs slated to start Monday will be administered with a dose of urgency. Cases of Covid-19 have increased in South Africa recently after remaining relatively flat since a second wave of the pandemic ended in February. Over the past seven days, the country has recorded a 46% uptick in cases nationwide, though the rise comes off a low base. South Africa now has roughly 23 cases of infection for every 100,000 people, compared with 90 cases per 100,000 in the U.S. and about 200 cases per 100,000 in India.

Most cases of Covid-19 in the country are now caused by a variant known as B.1.351, which first emerged in South Africa in December and has since spread to at least 68 countries.  But highly infectious variants first discovered in England (B.1.17) and India (B.1.617) have been detected in the country as well.

Officials say they are tracking the variants closely. “We have not as a country reached a resurgence threshold, though some districts in the country are fast approaching the threshold,” the national health department said on Wednesday. “We want to assure South Africans that we have not yet hit the third wave, however we are at risk, and we hence need to be on heightened vigilance as a country.”

Some experts have reportedly urged the government to tighten lockdown restrictions, which since the start of the pandemic have taken a significant toll on South Africa’s already struggling economy. The country experienced the biggest drop in economic activity last year than it has in any year since 1946.

For its part, the health department urged continued adherence to social distancing and other public-health protections. “If you offer the virus an opportunity, it spreads,” notes Dr. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, who says he has “no doubt that South Africa will do the right thing to put in place appropriate measures to contain the virus” while the rollout gets going.

South Africa has seen the highest number of Covid-19 cases in Africa, with more than 1.6 million positive cases, including nearly 55,000 deaths, since the start of the pandemic. Estimates of so-called excess deaths in South Africa over that period suggest the total could be nearly three times as high.

Recovering from vaccine stumbles

The broadening of South Africa’s vaccine rollout follows several setbacks in the program so far. In February, South Africa shelved plans to administer the Covid-19 vaccine developed by AstraZeneca and the University of Oxford after studies suggested it provided only minimal protection against the B.1.351 variant.

Health officials later paused vaccinations with the J&J vaccine when the US Food and Drug Administration temporarily suspended its use after six women who had received the vaccine in the US experienced unusual blood clots. Vaccinations with the J&J jab have since resumed in both countries.

South Africa will draw for this next phase of the rollout from supplies of both the J&J vaccine and the vaccine developed by Pfizer and BioNTech. The government has purchased 31.2 million doses of the J&J jab and 30 million doses of the two-shot Pfizer/BioNTech vaccine; enough doses in total to reach the country’s target of vaccinating 45 million people—roughly two-thirds of South Africa’s population—by February 2022.

Besides older adults, vaccinations in the second phase will cover essential workers, residents of congregate-living settings, and adults with health conditions that put them at risk of serious illness from the coronavirus, before broadening to include people over 40. A third phase of the rollout, slated to start later this year, would open Covid-19 vaccinations to everyone 18 and older.

The rollout in South Africa, which to date has vaccinated less than 1% of its population, roughly parallels the pace in neighboring Botswana and Namibia, but lags the rollout in Zimbabwe, which has vaccinated about 2.4% of its population, and Morocco, which leads the continent with nearly 15% of its population vaccinated.

Experts emphasize that widespread vaccination points the way out of the pandemic. “The problem with public health measures is that you cannot use that in winning a pandemic,” says Dr. Nkengasong. “You have to bring in vaccines aggressively to bring it down.”

Carlos Mureithi contributed reporting. 

This post has been updated with the number of healthcare workers vaccinated in South Africa so far.

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