In mid-January 2021, I wrote a post entitled “Successful Healthcare Delivery … a missing link could be logistics” and at that time I referred to the then stated target of vaccinating 67% of the South African population by at the latest the end of 2021. It has now been admitted that the country will be unable to achieve this target and at best achieve a target of 40% by February 2022, as implementation has “lost a little time”, far removed from the “herd immunity” referred to by the Minister of Health earlier. While the inability of South Africa to procure vaccines due to “richer countries hogging vaccine supplies” and the “disappointment” with regard to the AstraZeneca COVID-19 vaccine’s poor performance when measured against the South African variant 501.V2 are advanced as reasons for the slow start to the vaccine program, are these the only reasons?
While mass COVID-19 vaccination programs have been slow to gain momentum across the world with a reported 7.4 per 100 people having received at least one dose of the vaccine worldwide, it is instructive to look more closely at those countries that are on top of the “leader board”. Israel leads the world with over 100 people out of a possible 100 having been vaccinated and with a total of 9.8 million doses administered as of 30th March 2021. South Africa on the other hand languishes very low on the list with a paltry 0.4 people out of a potential 100 having received the vaccine and with a total of 239,655 doses administered mostly to health workers as of 30th March 2021. An interesting country is Chile with an impressive 53 of every 100 people having received a dosage of vaccine with a total of 9.9 million doses administered. This is a marginally greater percentage than the United Kingdom although the United Kingdom has administered a far greater total of vaccines to its larger population. By any measure South Africa has lagged behind countries that appear to have a less well developed health infrastructure.
Chile is not a wealthy country and although advantaged by a relatively small population of 19 million people is an interesting case study. It was not able to negotiate lower prices for vaccines but appears to have made some key decisions concluding contracts early during the epidemic. The country finalised early deals with several vaccine manufacturers and according to reports has ordered enough vaccine to vaccinate its population twice! Like South Africa, the country hosted vaccine trials which reportedly gave political leaders leverage during negotiations to conclude the vaccine deals. This raises questions regarding the argument put forward by the South African Government that it could not finalise contracts to provide the country with adequate and timeous delivery of vaccines due to a lack of funding. Could it be that the massive fraud and corruption related to personal protective equipment (PPE) in the earlier stages of the epidemic in South Africa drained the national coffers to such a degree that funding was not available to secure the vaccines or that it was the result of bureaucratic ineptitude and vacillation in decision making. Whatever the reason it raises serious questions about the culpability of government for the situation the country now finds itself.
It is too easy to blame a hegemony of the North on vaccine supply as it appears that companies manufacturing vaccines have been willing to supply South Africa but could have been limited in doing so by the tardiness of government’s response. Ironically a private sector company located in South Africa, Aspen Pharmacare, will process the Johnson and Johnson COVID-19 vaccine under licence from June 2021, which is due to be exported elsewhere. An agreement has only been recently reached, although apparently not yet fully finalised, to supply this country with a significant portion of these vaccines to meet the quantities of COVID-19 vaccines that South Africa so desperately needs. The consequence of this failure to aggressively ramp up the rate of vaccination is the spectre of a “third wave” of COVID-19 infections with the potential imposition of various harsher “lockdown” restrictions on the country and the impact of these on the lives and livelihoods of South Africans.
Government has determined that all COVID-19 vaccine procurement must be done solely by government as has been the case in some other countries effectively excluding the involvement of the private sector from procurement leaving government officials scrambling to meet the contractual, storage and logistical issues for which they are to an extent often ill equipped. The stated rationale for this decision is to ensure “equity” of supply and distribution and in addition prevent the fraud and corruption that dogged the procurement of personal protective equipment (PPE) in the earlier stages of the epidemic in South Africa. The consequence appears to have been that the vaccine supply to South Africa to date, apart from the ill-fated but much heralded arrival of the AstraZeneca vaccine, has been a very limited supply of the Johnson and Johnson vaccine supplied through an agreement to allow the utilisation of surplus vaccines from the Sisonke “open label” research trial. This has only been available to “front-line” health workers and certain highly placed political luminaries. This, although heralded as such, can hardly be regarded as a national COVID-19 vaccination program and to date (30th March 2021) accounts for the around 230,000 doses administered in South Africa even failing to meet the need to protect all the health workers who may be required to deal with the threatened “third wave”.
Surely faced with a national crisis of the magnitude of the consequences of the COVID-19 pandemic all available resources should be focused on making the COVID-19 vaccine available to as many South Africans as possible in the shortest possible time. It should be a priority beyond all others in dealing with the epidemic certainly above the introduction of at times non sensible restrictions on the citizens of this country. The current state of healthcare in South Africa points to a systemic inability to address even the most basic health and other needs of many in the population. How the COVID-19 pandemic has been managed in South Africa, while positive in some aspects, has left many doubtful of both the logic and capacity of Government alone to ensure that what is needed will be indeed be done. Under these circumstances is it not far fetched to expect that Government alone can achieve what is required with regard to the COVID-19 vaccine program. It has correctly been stated that the vaccination of the entire South African population is a project, the magnitude of which has never been undertaken in this country before. As I indicated in my January 2021 post, the Seven R’s of Logistics will be crucial to the success of this endeavour. The “Seven R’s” are not the strongest suit of government bureaucracy and the current state of many South African government entities and departments does not engender confidence that this crucial program will be able meet its targets.
It is useful to revisit this graphic related to the COVID-19 vaccination program which can be interpreted on various levels. The Right product (1) at the Right cost (7) in this context is the available COVID-19 vaccine suitably registered and procured for widespread distribution and administration. The Right customer (2) is the person to be vaccinated initially according to the priority determined by that risk of infection, severity of infection, hospitalisation and death but ultimately every person residing in the country. The Right time (3), Right place (4) and Right condition (5) in this context refer to the transport, storage and ability to administer the vaccine as required while the Right quantity (6) refers both to global quantities but also to the availability of the correct quantities of vaccine at each storage depot and administration site. It is seemingly simple when reflected in this manner but logistics to be effective is a complex task requiring capacity, expertise and skill. In reviewing the current situation it is not difficult to identify possible deficiencies in the South African COVID-19 vaccine scenario.
In my opinion for the sake of the health, lives and livelihood of all South Africans it behoves those in positions of power and authority to acknowledge that government alone cannot succeed in ensuring the successful vaccination of the South African population within the required timeframe. An alternative is a social compact that engages all sectors of society, public and private, bringing to bear every available resource both within and outside government on the COVID-19 vaccination campaign seeking viable alternative avenues and exploiting logistic strengths where they exist. As with a shipboard emergency the cry must be “All hands on deck!” engaging all segments of South African society to get the job done!
