How South Africa navigates the AstraZeneca Covid vaccine will have ‘global repercussions’

10 Feb 2021

With the WHO concluding that there is still a major role for the Oxford/AstraZeneca vaccine, the principal investigator in the SA trial said on Tuesday that the vaccine will probably protect against severe Covid-19, hospitalisation and death caused by the 501Y.V2 mutation of the virus first identified in South Africa.

Given that it is the cheapest and the most readily available Covid-19 vaccine available globally at present, South Africa is likely to be faced with having no vaccine or one that will probably protect against death and hospitalisation, the principal investigator in the Oxford/AstraZeneca trial, Professor Shabir Madhi, said on Tuesday, 9 February.

Madhi and Professor Glenda Gray, the president of the South African Medical Research Council and the principal investigator in the Johnson & Johnson emergency vaccine trial, were the panellists at a webinar hosted by Maverick Citizen editor Mark Heywood. The webinar was sponsored by the Konrad Adenauer Stiftung.

“There is still a major role for the AstraZeneca vaccine, the World Health Organisation said. There is a reason for that,” Madhi said.

“If South Africa becomes reckless in dealing with the AstraZeneca vaccine it will have global repercussions. This vaccine will be the cheapest and the most readily available. The toss-up might be between no vaccine and a vaccine that likely will protect against death and hospitalisation.”

Gray agreed, saying if it can stop deaths and stop health facilities from being overrun, the vaccine should be given to high-risk patients.

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On Sunday Madhi said the trial to test if the vaccine protected against mild and moderate disease caused by the coronavirus found that it only offered 22% protection for infections caused by the 501Y.V2 strain of the virus that was first identified in South Africa and currently is the dominant strain in the country. He said the goal of the study was to see if it would offer 60% protection, and it did not. The trial participants were relatively young, with a median age of 31.

Madhi, however, stressed that the efficacy of the vaccine in preventing severe Covid-19, hospitalisation and death caused by the 501Y.V2 strain had not been evaluated.

He said South Africa was heading towards the first anniversary of the first confirmed case of coronavirus infection in the country.

“I was sceptical that we would have a vaccine in a year. It usually takes 10 years. But we have seven vaccines that have been approved. Most are highly efficacious against the original virus. Even the lowest had more than 50% efficacy. Many of the others are up t0 95% efficacious. This first generation of vaccines were a phenomenal success. They are highly efficacious in preventing disease.

“Until recently we were in the honeymoon period. Nothing was going wrong. All of the ducks were lining up in a row.”

He said all the vaccines that are currently available globally have been declared safe and work against the original virus. He said all of them also trigger an immune response that prevents severe disease and possible hospitalisation and death.

Madhi said at this stage there are 35 other vaccines in late-stage human trials.

Explaining why it was possible for the world to produce vaccines against the coronavirus so quickly, he said much of the scientific community had diverted their attention to develop Covid-19 vaccines and understanding the virus.

“The vaccines we see today are piggybacking on other vaccines technology and technology to treat cancer.”

He added that clinical trials usually take place in series with pauses between the different phases, but because of the funding that was made available and the effort dedicated to it, companies were able to run parallel streams of studies.

“This doesn’t mean that there were short cuts,” Madhi said.

Gray also emphasised that a huge injection of public money had accelerated vaccine development.

She said where the world finds itself at the moment, as mutations of the virus emerge, was an important phase.

“With the emergence of the variants we must look at the impact on the vaccines already developed against ‘vanilla’ Covid. We are starting to see an impact on vaccine efficacy,” she said.

I don’t think we must halt the programme, but we can’t take it to health workers and say we must vaccinate. Seventy-five percent of healthcare workers won’t benefit from it. It doesn’t protect against mild infection.

“We are now looking at a second generation of vaccines… but that doesn’t mean that current vaccines should not be rolled out.”

She said that in evaluating the role of a vaccine it is important to remember that it has a personal health benefit as well as economic and public health benefits.

She said the vaccines currently available do protect against severe Covid-19, hospitalisation and death. They have an economic benefit as they would allow teachers to return to the classroom, workers to return to the workplace and will keep the economy going and protect the health system.

“We still have a lot to celebrate. We have vaccines that stop death and hospitalisation. Isn’t that what we are looking for?”

Madhi said the immediate priority of a vaccine should be to prevent hospitalisation and dying, but then also to prevent multiple waves of a pandemic and to make people less infectious.

An ideal vaccine, he said, will prevent infection and mild to severe disease.

“But our priority for the immediate future is to save lives,” he added. “It is preventing severe disease and death that we must focus on now.”

He explained that the virus had mutated after roughly 30% of South African adults were infected with it during the first wave and then developed “some sort of immunity”.

The mutation, Madhi explained, was the virus’s way of evading the human immune response and ensuring its survival.

He said the Oxford/AstraZeneca trail was started in South Africa during the first wave with the purpose of assessing the vaccine’s safety and to see if it would protect against Covid-19 with an efficacy of more than 60%.

By the time the study had accrued enough Covid-19 cases to proceed, the 60% protection goal could not be reached, but most of the cases, Madhi said, were mild or moderate.

Gray said answering the question of whether the Oxford/AstraZeneca vaccine will prevent Covid-19 deaths and severe disease is important and is currently the subject of a trial involving 30,000 people in the US.

“We can’t pronounce if the vaccine can protect against severe disease. But we do know it does not protect against mild disease.”

Madhi said while the data are not available, he believes the vaccine will protect against severe Covid-19.

“That would be the role for the Oxford/AstraZeneca vaccine.”

He said the vaccine was very similar to the one produced by Johnson & Johnson and triggered very similar immune responses.

The Johnson & Johnson study found that it does protect against severe disease, hospitalisation and death, including for illness caused by the 01Y.V2 strain of the virus.

But Madhi said he agreed with the roll-out of the vaccine being suspended as it would be of no benefit to those who are young and not at risk.

“Certainly, I won’t advocate the use of the vaccine in someone young and healthy and not at a high risk of severe disease.”

He said the Novavax vaccine, which was also evaluated in South Africa, does offer protection against mild disease and had proved to be 60% efficacious.

“I don’t think we must halt the programme, but we can’t take it to health workers and say we must vaccinate. Seventy-five percent of healthcare workers won’t benefit from it. It doesn’t protect against mild infection,” he said, adding that it would probably protect the other 25% against severe disease.

Gray said answering the question of whether the Oxford/AstraZeneca vaccine will prevent Covid-19 deaths and severe disease is important and is currently the subject of a trial involving 30,000 people in the US.

“We need more information. These results will be out very soon.”

She said data showed that the Johnson & Johnson vaccine protects against severe disease, hospitalisation and death, and is “impactful against the variant we have in South Africa.

“But we were asking, what is it that an emergency vaccine can do? We know it can stop people from dying and going to hospital. Healthcare workers have borne the brunt of the pandemic. Now we have a vaccine that can help. It shows that unequivocally and it shows this in South Africa. Our findings are 10 days old,” she said.

The Minister of Health, Dr Zweli Mkhize, announced on Sunday night that the Johnson & Johnson vaccine will be rolled out to South Africa’s health workers as part of an implementation trial – a large-scale study assessing its use in the field.

Madhi said there were also some studies under way that were investigating combining vaccines to boost the body’s immune response.

“Studies are under way in the United Kingdom. There is no reason why vaccines cannot be used together. There might be a benefit.”

He said the Sputnik vaccine, created in Russia, uses this approach by combining two different viral vectors in its two doses.

“We don’t have hard data but in theory it should work.”

He said South Africa should take another look at its phased approach.

“I agree with the Oxford/AstraZeneca suspension, but for those at high risk and without other options, they should be vaccinated [with it].”

Given the emergence of the mutated virus, Madhi said, South Africa and the world should shift their goals from obtaining herd immunity to a targeted approach to protect lives and protect health facilities from becoming overburdened. DM/MC

Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c), it is prohibited to publish information through any medium with the intention to deceive people on government measures to address Covid-19. We are, therefore, disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information we should know about, please email [email protected]

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