How a week of violence and looting has affected South Africa’s Covid-19 vaccine roll-out

The violent protests and looting in South Africa have led to the closing down of several Covid vaccination sites in KwaZulu-Natal and Gauteng. As a result, KwaZulu-Natal this week only administered a 10th of the daily doses it did last week. Gauteng’s doses have also gone down.

Pharmacies, some of which were also vaccination sites, have also been looted and Cipla, a major manufacturer of generic medicine, had its factory in Durban looted. Many KwaZulu-Natal patients are now without chronic medication for conditions such as diabetes, HIV and hypertension, which make them more likely to fall severely ill with Covid and end up in hospital.

Bhekisisa asked the man in charge of the country’s vaccine roll-out programme, deputy director-general at the health department Dr Nicholas Crisp, about the impact of the unrest on vaccinations and what the road ahead looks like.

1. The South African Pharmacy Council says more than 90 pharmacies in KwaZulu-Natal and Gauteng have been destroyed and looted and that Covid-19 vaccines and other medicines were stolen in the process. How many vaccines have been stolen? 

Some Covid vaccines did get stolen, but it’s a small amount. We first have to get pharmacies to do their tallies before we’d know exactly how many — and we won’t necessarily release the number. Pharmacies don’t keep a lot of stock on the premises, most of the stock is kept at warehouses.

But the biggest disaster with the looting of medicine isn’t vaccines; it’s the looting of chronic medicine. For close to half of patients in KwaZulu-Natal, it’s gone. So much of the insulin for diabetes patients, the morphine, the antiretroviral drugs for HIV patients, are gone.

(Several warehouses and distributors, such as Clicks’s United Pharmaceutical Distributors have been looted. On Wednesday night, the pharmaceutical company Cipla’s factory in Durban was burnt down. Cipla is a major manufacturer of generic medicine).

Our other problem is getting oxygen to Covid patients on roads that are blocked and getting food supplies to hospitals — some patients are without food.

If we catch the people who did this, we’re going to charge them with murder for those patients who died. What they’ve done is steal much of the chronic medicine for the private and part of the public sector — medicine that keeps people alive.

2. Most vaccination sites in KwaZulu-Natal have closed down. Which ones are open?  

Mostly, only sites in the rural, peripheral parts of the province are open, so are sites in small towns. Urban sites are closed because health workers can’t get to work because roads are blocked. Now people are also running out of fuel. There’s no point in trying to continue with the vaccination programme in the affected areas and putting people’s lives at risk.

We’re not releasing a list with the names of the open sites because we’re concerned those sites become targets for looters if we make it easy for them to know where the open centres are — that’s why we’re advising people to, rather, phone sites to find out if they’re open.

3. Do you have an adjusted vaccination roll-out plan going forward — what about your target of vaccinating 250,000 people per day by the end of this week (the week of July 12)? 

For KwaZulu-Natal, the programme is obviously on hold, temporarily. We have to put people’s safety first. But in the rest of the country, we’re going flat out — we’re still managing to reach about 140,000 people per day.

KwaZulu-Natal made up a large chunk of our national vaccination numbers, about 40,000 daily doses — we will therefore be short of that number for our target. We’re diverting some of KwaZulu-Natal’s current supplies to other provinces. If we reach 200,000 vaccinations per day within the next couple of days, I’d be over the moon; 250,000 is, under the current circumstances, unlikely to happen.

4. For people who get the Pfizer vaccine, the health department recommends a 42-day gap between the first and second dose. What should people who have been scheduled for a second dose, but at a site that has now closed down, do? 

They can get their second dose at a later date, the EVDS will automatically reschedule them — it won’t make the vaccine less effective.

There are several reasons why we don’t want people to get a second dose before 42 days. Firstly, it’s to create enough space to allow as many people as possible to get a first dose, which already provides partial protection. Secondly, the chances of getting reactions (side-effects) are higher if you get the two jabs closer together than if they’re a little bit further apart.

The science that we have now shows that your immune response at 42 days (as opposed to the original 21 days that was used in Pfizer’s efficacy trial) is excellent. In fact, some studies now show that a longer waiting period can be even better.

People who miss their second dose appointments because of closed sites can therefore defer their appointments until the sites open up again. Alternatively, they can do walk-ins at open sites. All sites have been instructed to accommodate walk-in appointments and to have one line for booked, and one line for unscheduled appointments. But do bear in mind that we can’t have everyone coming for walk-ins, because we wouldn’t want to create sites with so many walk-ins that they become risks for superspreader events.

5. People of 35 years and older could start to register for vaccination on Thursday. They’re scheduled to get vaccinated from 1 August. Will that still happen, given the current circumstances? 

Yes — obviously only in areas where sites are open. And just like when we opened up the registration for people of 50 and older, some people already went to get vaccinated the day after registration, as opposed to only on 1 August when vaccinations were supposed to start. We’re not encouraging going earlier as we would first like to get as many of the older people vaccinated, because they run a higher risk of being hospitalised. We will, however, not turn people who come earlier away, as long as a site has enough vaccines in stock to help them.

6. We’ve had huge delays with the delivery of Johnson & Johnson (J&J) vaccines and have only received 1.5 million out of 31 million doses so far. When will we get our next batch? 

We haven’t yet received further delivery dates from J&J.

Why not? 

I’m not at liberty to discuss what’s going on behind the scenes.

How many of the 17-million J&J doses that President Cyril Ramaphosa announced Aspen in Gqeberha will produce over the next three months, will South Africa get? 

We don’t know yet.

7. Has the health department decided on whether South Africa will procure Sinovac’s Covid vaccine, Coronavac, that was recently approved for use by the South African Health Products Regulatory Authority (Sahpra)? 

No. Sinovac has conditional emergency use authorisation and they have to meet all those conditions before we can even contemplate buying it (the conditions require that Sinovac submits the final results of ongoing clinical studies). We don’t have formal pricing yet and formal procurement processes are not yet under way.

It isn’t one person who makes the decision to procure, there’s a chain of reporting — the decision goes through the ministerial advisory committee on Covid vaccines and then a range of administrative procedures of budgeting and so forth. So we’re not there yet with the procurement of that vaccine.

8. We’ve procured enough Pfizer and J&J doses to vaccinate all adults in South Africa. So why are we then looking at procuring other brands of vaccines?

Because there are issues about reserving and procuring. Currently, we have two types of vaccines. But look at what has happened: there were issues with contamination in the case of J&J and during that time we received no doses, which means we’re now behind schedule, so you do need to have security.

The question is: Are two vaccines from different sources sufficient to ensure a consistent supply of vaccines?

We have two vaccines, in addition to the ones (Pfizer and J&J) which have already been approved by Sahpra: AstraZeneca and Sinovac.

AstraZeneca we couldn’t use when the Beta variant was dominant, because it didn’t work well against the variant, but now the Delta variant, against which AstraZeneca does work, has become the main form of the virus circulating in South Africa.

It would be easy to get AstraZeneca back into the country, if we could buy it. So the question is, who’s selling and in what quantities can we procure it to get a third vaccine option in case something happens with the Pfizer or J&J pipelines?

These are strategic decisions we’ve got to worry about. And make no mistake, the epidemic won’t be over by the end of the financial year, viruses don’t plan on financial years. This is going to continue for a long time.

9. The cash-in-transit industry announced this week that the unrest prevents them from delivering cash at social grant payout points. That’s where the South African Medical Research Council (SAMRC) was planning to reach people of 60 and older with vaccinations at pension payout points. What will happen with that now? 

The SAMRC has redirected the mobile vaccination vans which they were going to use at payout points to communities where they take vaccinations to the people by going door-to-door to recruit vaccinees. I’ve just received photos of a mobile clinic van in Lusikisiki in the rural Eastern Cape that is now no longer parked at a South African Social Security (Sassa) payout point, but that has gone into the field to villages. They say they’re not going to let the grass grow under their feet, they’re going to use the vaccines and vaccinate as many people as possible.

10. Which essential worker groups are you currently vaccinating and is it going ahead during the unrest?  

In the areas unaffected by unrest, we’re going ahead full speed. The police, education (primary and high school staff) and correctional services programmes are running, the South African National Defence Force programme has started and the social development department’s programme is about to start.

We’re using J&J vaccines that expire on 11 August for those programmes and there are now also plans to use some of the J&J vaccines for community programmes. We’re not planning to waste any vaccine, so we’re planning to use all of the jabs before they expire.

Why are the J&J figures displayed on the health department’s dashboard for this week relatively low? 

In specifically the basic education roll-out, there have been thousands of paper vaccination records that have not yet been entered into the EVDS, so those won’t display on the dashboard yet (the dashboard draws vaccination data from the EVDS).

11. How concerned are you about the impact of the unrest on the vaccination programme?

We should be worried about KwaZulu-Natal in particular, and also some communities in Gauteng, where sites are closed and we can’t reach people with vaccines. This is going to prolong the pandemic. Obviously, it’s distressing to us that we had a programme that was gearing up nicely and now it’s been disrupted, yet again.

But in the rest of the country, the programme is going ahead, so we haven’t lost everything, we’ve got to see the silver lining. We’ve got to go flat out in all the other provinces to get as many people vaccinated with every means at our disposal. DM/MC

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.