The Covid-19 vaccine and the danger of creating false expectations

There is a growing groundswell of impatience, and sometimes even a demanding anger, resulting from the delay in having Covid-19 vaccines in the country. ‘Why is it taking so long to get the vaccine into the country?’ ‘Has the government dropped the ball?’ 

Undoubtedly the issue is becoming more and more emotional and a hot political weapon. Activist groups, such as the C19 People’s Initiative, have also sprung into action, alluding to the laudable and effective HIV treatment campaign. However, while the intent is commendable, it must be balanced against raising false expectations which could imperil the crucial non-vaccine Covid infection prevention precautions which will still be critically needed for some time to come. 

Let me say at the outset, that I have spent some four decades of my professional life fighting, supporting and advocating for vaccines which, together with the provision of clean water, are the most effective modalities for protecting against disease and maintaining health. However, Covid-19 vaccines are not measles vaccines and the strategies for their control are not the same.

Other than a handful of anti-vaxers, and maybe a few more nervous vaccine-hesitant folk, we all want this vaccine, and we all urgently want it as soon as possible, none more than our heroic frontline healthcare workers. The delay has simply come about as a result of the grotesque selfishness of high-income countries. 

Comprising some 13% of the world’s population, they have jumped in, even before the results of clinical trials to assess the efficacy and safety were known, and bought up 51% of the global production of vaccines – in some cases enough for 3 to 5 times their entire populations’ needs. This was done so that at least some of their vaccine purchases would be effective and safe.

However, middle-income countries, like South Africa, would be roundly condemned should they have considered gambling with their much more limited taxpayers’ money for vaccines still undergoing investigative trials, when it was unknown whether they would be safe and effective. 

The decision was then taken to secure a guaranteed tranche of vaccine for 10% of the population through the pooled procurement facility of COVAX. COVAX would be purchasing vaccine on behalf of some 189 countries to aim for equitable distribution of available vaccines globally. 

Word from COVAX is that the expectation for delivery of this allocation of vaccines to South Africa (one of the first countries in line) would be the second quarter of this year. Importantly, however, over and above this, the government and the business sector are in negotiations with vaccine manufacturers to secure supplies of vaccine as soon as possible, and also for the remainder of the population. For obvious reasons these negotiations are, at this stage, sensitive and confidential – no one with genuine interests for us speedily acquiring vaccines would now wish to jeopardise these negotiations.

The impatience, the anxiety and the dissatisfaction are understandable. The Covid-19 pandemic of 2020 has taken a tremendous toll of illness, loss of life and loss of livelihood. There has also been a very significant intrusion into people’s quality of life. Not unexpectedly, people are tired of these encumbrances, irritations and invasions into their daily living. ‘If only we had a vaccine this would all go away’; ‘If only the government had not been so inept, we would not have to continue with these restrictions’.

Regrettably, the reality is that the vaccine will not be a magic wand and any suggestion that it may be, is dangerously threatening the public motivation to continue with the non-pharmaceutical interventions, which are so critical for the control of the epidemic. 

The vaccine grab by the wealthy nations has not only harmed the middle- and lower-income world (the latter depending solely on COVAX), but it is, in fact, also short-sighted. Pandemic infections can only be controlled if they are controlled globally, and that means every country, wealthy and poor. 

The delay for South Africa is, of course, deeply regrettable and unfortunate, especially for our vulnerable and indispensable healthcare workers. However, it does offer us a short breathing space, enabling us to even better assess and evaluate those vaccines being deployed in the field in the developed world. How are these completely novel vaccines faring in the field situation? How they perform in millions of recipients may not always be identical to their behaviour in the few thousands of volunteers within the structured environment of the clinical trial. (As one example, it has now been reported that severe allergic reaction, anaphylaxis, has been seen, albeit rarely, but 10 times more commonly with the Pfizer vaccine than with other vaccines, which is now necessitating a specific warning to allergy-prone individuals).

In addition, more vaccine manufacturers are now applying for licensing, thereby widening the choice for vaccines for our local conditions, rather than simply grabbing the first available licensed vaccines, as wealthy countries have done. Our vaccine selection and strategic planning could well be influenced by observations and knowledge coming from the field behaviour of these vaccines.

In conclusion, and most important of all, the public must be made aware that the Covid-19 vaccine will not be a magic bullet. Its arrival on our shores will not miraculously and immediately spell the end of the epidemic. 

The United Kingdom, one of the first countries in the world to roll out vaccines at the beginning of December, is currently experiencing a second wave considerably greater than the first wave. It is still experiencing a daily new infection rate nearly three times that of South Africa, while it is battling the disease with one of the harshest lockdowns in the world. 

Clearly, we will still have a way to go even after the commencement of vaccination. For many months after receiving the vaccine, we will still need to depend on public buy-in to the Covid-19 infection precautions. 

We cannot afford to create false hopes and false expectations which, unfortunately, vaccine activism may be in danger of doing. Vaccines will not immediately allow us all to go back to our pre-Covid lives. Sustaining human behavioural dedication to fight an unseen enemy is challenging, uncomfortable and even irritating. But it depends critically on the support of all sections of the community. It is fragile and can be easily fractured by the seduction of a magic vaccine. It is equally easy to look for a scapegoat. 

Arguably, there may well seem to be a lacuna in communicating adequate assurance to the public. But let me state that there are indeed very extensive behind-the-scenes efforts to acquire safe and effective vaccines as soon as possible, and also to develop a comprehensive vaccine strategy.

Finally, I would like to address an urgent and earnest appeal to civil society groups – please stop insinuating false hopes and expectations to the public for immediate solutions to the Covid-19 crisis. These only serve to compromise, and even jeopardise, the critical current imperative to maintain the, maybe less palatable, but critically needed, Covid-19 prevention precautions. The challenges are unique and difficult enough to sustain, and we can only succeed with the support of all leaders who influence behaviour in the country. DM

Barry Schoub is the Chair of the Ministerial Advisory Committee on Covid-19 vaccines. He is Professor Emeritus of Virology, University of the Witwatersrand and formerly the founding Director of the National Institute for Communicable Diseases. This submission is made in his personal capacity and does not necessarily reflect the views of any organisation which he is affiliated with.