Why is the government in such a muddle over vaccination?

Illustration: Lisa Nelson

Jeremy Seekings and Nicoli Nattrass argue that President Ramaphosa’s pronouncements about vaccine supply are muddled. Apparent incoherence and a lack of transparency may be the symptoms of a vaccine strategy that is coming to be driven by political not scientific considerations.

On Tuesday 15 June, speaking on television, President Ramaphosa told the nation that there had been ‘delays’ and ‘setbacks’ with the vaccination rollout, but that it was back on track.

But what track is this?

The President’s report on the vaccination programme was muddled, apparently reflecting the lack of any clear and coherent strategy on the part of the government.

The government’s original Vaccine Rollout Strategy (published on 3rd January) set out a very general roadmap for both securing vaccine supplies (primarily through the COVAX facility and domestic manufacturers) and then administering them to the priority groups (health care workers, then the elderly, adults with co-morbidities, people in “congregant settings” such as prisons, and essential workers).

Actual government policy soon deviated from this strategy. It soon became clear that most of the required vaccine doses would have to be obtained directly from the foreign pharmaceutical companies. Then, as is well known, there were multiple problems with these supplies. Meanwhile, the actual rollout was organised around the Electronic Vaccine Data System (EVDS): People would register and then be told when and where they should go for their vaccination. This meant that vaccinations would proceed by age cohort alone, because this was the only criterion that could be easily verified.

From 17 May, when vaccinations through the government programme began, the rollout has been amended repeatedly. Many vaccination sites showed admirable flexibility in vaccinating “walk-ins” without appointments and even assisting people to register on site. EVDS procedures for scheduling appointments were changed. The system of vaccine allocation was changed: doses were allocated directly by the national government to the private sector and allocations to the provincial health departments were reduced. The ranking of priority groups seems to have been abandoned. Asked directly by eNCA (on 10 June) about prioritisation, the government official in charge of the rollout (Dr Nicholas Crisp) avoided answering the question, explaining that there were “conflicting demands”.

Many of these modifications were very sensible. As the Western Cape Department of Health put it: “It is important to plan as best you can, but learn from the experience as it unfolds … [W]e must be prepared to learn from what works and change what doesn’t.”

Other modifications were questionable, especially given diminishing transparency over who precisely is getting what, when and why. Rather than listening to scientists, the government appears to be making decisions on an ad hoc and political basis.

This probably explains why the president’s comments on the rollout on Tuesday were so muddled.

First, consider his comments on the supply of vaccines. The president said that the country had “to date received nearly 2.4 million Pfizer vaccine doses” and “by the end of June, we expect to have received a total of 3.1 million Pfizer doses”.

This does not square with our data on actual deliveries of Pfizer vaccines. Unfortunately the government has stopped announcing when deliveries arrive in the country. Multiple sources suggest, however, that 2.6 million doses of Pfizer had been flown into the country as of 7 June and deliveries totalling a further 3.3 million doses were scheduled by the end of June, bringing the anticipated total to 5.9 million Pfizer doses.

Perhaps what the President meant to say was that an additional 3.1 million doses were expected in June, bringing the total to 5.5 million doses (close to our figure of 5.9 million doses). We asked the Ministry of Health to clarify, but our queries are no longer being answered. Without more transparency there is no way of seeing through the muddle of presidential announcements.

Who will get these vaccines? The president assured us on Tuesday that “our immediate task is to complete the vaccination of all those over 60 years of age without delay”. But he also told us that “the initial doses we receive from Johnson & Johnson will be used to vaccinate educators in our schools and thereafter security personnel on the frontline”. Will the vaccination of elderly people be delayed because teachers, police and soldiers are being prioritised over them?

How fast will vaccines be rolled out? The President told us on Tuesday night that we have the capacity to administer 150,000 vaccines per day. Yet Dr Crisp told eNCA last week that the programme was “pretty much operating at capacity”: “We just don’t have a vaccine pipeline that can sustain more vaccines than they are administering at the moment”. Last week, the rollout averaged 83,000 vaccinations per weekday, i.e. barely half of the figure provided by the president on Tuesday night (and significantly less than the number of vaccines arriving in the country, according to Crisp’s own figures).

Some provinces are crying out for larger supplies. The Western Cape Health Department, for example, says that it can handle about 25,000 vaccinations per weekday – and is soon to open a site at the CTICC that will be open seven days per week, for 12 hours per day. But the national Department of Health is currently only allocating 10,000 vaccines per weekday to the province.

We have argued repeatedly that available vaccines can be used quicker than at present. Are vaccines being stockpiled for distribution through alternative channels? Already a share of each delivery is being set aside for distribution through the “private sector”. There is no transparency about how much, who decides this, or who gets these vaccines and when. It has proved impossible to get data from the public sector on this. Without transparency over the allocation of vaccines, there is no way of holding the government to account for the pace of vaccinations using available supplies.

When the president and others say that various categories of public sector workers are to be prioritised, without explanation, we are surely right to be concerned that reprioritization might be driven by political considerations.

Both Peter Bruce and Marcus Low have castigated the government for the absence of any contingency planning in the event that expected supplies were delayed. Low rightly calls on the President or the acting health minister to provide urgently a full briefing on precisely what quantities of vaccine are expected and when, with a Plan B in case of further setbacks.

The government must do more than this. We need a clear explanation of not only the supply of vaccines – including with contingency planning – but also of how existing supplies are being used and how future supplies will be used.

Put simply, we need a transparent and coherent rollout strategy.

The authors are both professors at UCT.

Views expressed are not necessarily GroundUp’s.

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