An interview with Alex van den Heever: Show us the vaccine roll-out plan – the people deserve to know

A tangible vaccine roll-out plan is nowhere to be found and the public is owed as much, according to Professor Alex van den Heever during a conversation with Judge Dennis Davis on the latest episode of Judgment Date. Davis challenged the government to explain this plan and offered it the chance to do so on his platform.



Van den Heever has been monitoring the way new infection and Covid-19 mortality data have been collected, analysed and published by the government. 

He is the chair in the field of Social Security Systems Administration and Management Studies at the Wits School of Governance. He has worked in health economics and finance, public finance and social security for more than two decades. 

He argued that the government’s numbers should “come with a big health warning” because the data are compromised by the way they are collected. “It’s not that people are attempting to provide distorted information, but they are subject to certain caveats that are important to point out,” he added.

Van den Heever explained that mortality information is collected by a system that runs parallel to Home Affairs’ usual death registration system. The Covid-19 death data are from facility-based reports compiled by healthcare facilities. There is a huge difference in the number of deaths reported by each system. This indicates underreporting, he said.

The high number of excess deaths confirmed this. This meant the number of deaths reported deviated from the prediction, which was based on historical trends. “The projection provides a baseline and if there is a deviation then it must be because of a change which wasn’t in the data in 2018 and 2019.”

This trend correlated very closely – about 98% – with the reported number of new infections, implying that the excess deaths were caused by Covid-19. “If there’s a sudden rise in deaths and in Covid-19 infections, then we assume there’s a relationship between the two”.

However, the reported number of new infections was also not totally accurate. Van den Heever said that because the excess deaths are so high, there must be many more infections that caused those deaths.

“When you look at those two together, then the excess-death info suggests substantial excess of deaths and we must have a number of infections which is way larger than the reported number of infections. 

“When we put that together it presents a different picture of the local epidemic we’re facing. It is substantially larger. We’re potentially looking at 140,000 deaths as opposed to the 50,000 that have been reported. Infections could be in excess of nine million, or higher depending on the infection mortality rate that you apply.”

However, he explained that these data can still show the movements and trends of the epidemic, and when the disease is on the rise and in decline. The reporting systems of other countries are just as compromised, he said. He gave the example of the UK – it has a good parallel reporting system, but for a long time it excluded deaths in nursing homes from its reporting. 

An improved notifications system should be in place, he argued. It was evident from the data, he said, that restrictions worked to curtail the second wave – but the public data do not show where new infections are coming from. If they did, then regulations could be more targeted – they could be more effective in protecting lives while keeping the economy open. 

It could also be more accurately shown when another surge might be coming. At present, the excess death numbers precede the new infection information by about a week. “Our deaths are being reported before our infections. Our infections are reported not on the day of the test, but on the date they receive the result. 

“This means the picture is, at a minimum, three weeks old. We are always getting information three weeks late, which is enough time for a surge to take off. If that’s our signal to take action then we’re probably six weeks into a massive surge, which is effectively what happened now.”

The country’s vaccine acquisition and distribution plan was difficult to understand “because a number of different statements are being made”, said Davis. He asked Van der Heever if it is correct that by 31 December 2020 there was “no acquisition strategy at all”.

Van den Heever confirmed this is true – the country had only signed up to the COVAX facility. “COVAX was the lazy way out – you join an agreement, pay in some money and then wait until June. I think that was quite literally what the Department and Ministry of Health had done. They had sat on their hands, thinking: ‘Well, that’s the only game in town and we just wait.’ The vaccine strategy is our only way out.”

By then, other countries had already begun looking at acquisition and roll-out. “It was clear by 31 December that we had neither. Government had not engaged in any bilateral negotiation at any level until January, so what we’re seeing now is the outcome of trying to pick up the ball late and do what we can with where we are.”

South Africa now has to appeal to manufacturers and other countries to deviate from their agreements to give the country “some leeway”, said Van den Heever.

Davis mentioned that Discovery chief executive Adrian Gore had voiced support for the government’s centralised strategy. 

Van der Heever responded by saying that “large parts of the private sector have to collaborate with the government because they have such regulatory power over them. They have to collaborate and be nice and polite.

“Gore doesn’t represent us, Discovery Health medical scheme members or even industry. The important point here is that the centralised approach is what the government wants and not actually what any of the private sector thinks is sensible at this point. If the government fails in the procurement process then South Africa is left hanging because all our eggs are in this one basket and in a procurement process we have very little understanding of. It’s not clear what’s going on and very little transparency around it.”

It was “problematic” to assume a centralised approach would result in an equitable roll-out. “If everybody agrees to abide by a roll-out strategy which is fair and equitable, then that doesn’t require a centralised procurement process… For instance, if you allow the Western Cape to acquire its own vaccine, then they could and should still abide by a national roll-out strategy. Allowing actors to move forward might help us to end up with more vaccines than if one player just went on its own. The centralised procurement is not about equity, it’s meant to be about expeditious procurement.”

Davis estimated that if the country started vaccinating about 50,000 people a day soon, then the programme would only end in 2021. Van den Heever said this could be done in less time if health facilities such as pharmacies, general practitioner centres, hospitals and clinics were brought on board. Then the country could vaccinate 250,000 a day. 

“It does require a roll-out strategy. We don’t appear to have it. You’ve got a whole health system watching, and that’s part of the problem with centralisation. The plan is not apparent and not happening on the ground,” he said. He wished aloud that the government could refute him on this point and explain to the public exactly how the roll-out will work.

Davis challenged the government to prove Van den Heever wrong and to explain a concrete national distribution plan. “Would be more than happy to host them and would be delighted, because it would calm me and the listeners who are concerned.” 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]