SA has “squandered the opportunity to protect at least 500,000 of its most vulnerable citizens before the next resurgence” of Covid-19 infections, said top medical scientists.

In an editorial published on Thursday in the SA Medical Journal, the scientists attacked the country’s decision to resell its million doses of the AstraZeneca vaccine to the African Union (AU).

The editorial was written by:

• Wits University professor of vaccinology Shabir Madhi;
• Prof Francois Venter, divisional head of Ezintsha at Wits University, the first author;
• Dr Jeremy Nel, an infectious diseases expert at Wits;
• Prof Alex van den Heever from the Wits school of governance;
• Prof Mosa Moshabela, chief medical specialist and dean in the school of nursing and public health at the University of KwaZulu-Natal; and
• Prof Marc Mendelson, an infectious disease expert at the University of Cape Town.

Madhi was the principal investigator of an AstraZeneca vaccine trial, which found it did not have an efficacy of at least 60% against mild-moderate Covid-19 due to the B. 1.351 variant.

The scientists said at the time of writing, the country was ill-prepared for mitigating a third wave, with “only a minority of largely urban health workers vaccinated against Covid-19 and rollout to the general population yet to start”.

Although the AstraZeneca vaccine did not reduce the risk of mild Covid-19 caused by the B. 1.351 variant, they wrote: “Even if the protection against severe disease and death afforded by the AstraZeneca vaccine ends up being just half or a third of what it is with comparator vaccines (a highly unlikely scenario), it is irresponsible to pass up the opportunity to reduce the number of deaths in the absence of alternative vaccines.”

Mortality has plummeted in vaccinated populations, including in the UK, which has its own virulent variants, they pointed out.

Vaccinated animals were “fully protected against severe lower respiratory tract infection following challenge by the variants”, the editorial noted.

“The fact that ‘breakthrough’ infections by variants, causing hospitalisation and death, have not been reported in tens of millions of Europeans given the AZ vaccine is highly reassuring.”

They argued that diminished protection against mild to moderate Covid-19 caused by the variant was no reason to reject the AstraZeneca vaccine, which had a high level of efficacy against the original “wild ancestry” virus.

The AstraZeneca efficacy against severe disease caused by the variant has not been proven, but nor has Pfizer’s vaccine been proven against the variant, and SA has ordered 20 million doses of that vaccine

“SA’s muddled procurement strategy is further demonstrated by the commitment to buy 20 million doses of the Pfizer vaccine, for which there is no clinical evidence of efficacy against the B. 1.351 variant.

“We agree with the decision to purchase the Pfizer vaccine, but the national department of health must concede that it then makes a mockery of the argument that we cannot use the AstraZeneca vaccine because of a lack of data against severe disease caused by this same B. 1.351 variant.”

The Novavax vaccine, which has been proven to work against the variant, is not among  government’s choices. The Johnson & Johnson vaccine being used to vaccinate health-care workers has proved effective against the variant.

The authors wrote of the vaccine choices: “Unfortunately, none of the ministerial advisory committee on vaccines advisories, rationales or decisions have been published in the public domain since January 3 2021, and none of the debate around specific vaccine choices has therefore been open to the public or the broader scientific community.

“From media interviews, the chief reason appears to be concern about the lower efficacy against the B. 1.351 variant.

“Cost or a desire ‘not to waste money’ has been cited as a reason for delaying use and reselling of the AstraZeneca vaccine, an argument comprehensively disputed when matched against the cost of infection and lockdowns on the economy.

“SA lost 8.2% (R389bn) of its gross domestic product in 2020 as a result of the Covid-19 pandemic. The cost (depending on which vaccine we use) of vaccinating everyone who needs it is between R8.6bn and R16.4bn.”

The scientists said sending the vaccine to other African countries raised “deep ethical concerns”.

“We note with dismay the reselling of the AstraZeneca vaccines to the AU despite the B. 1.351 variant, the dominant variant during SA’s second wave, circulating in much of Africa,” read the editorial.

“The B. 1.351 variant has been detected throughout Africa and may be responsible for the devastating second wave many countries have just experienced. If the SA authorities truly believed the AstraZeneca vaccine did not work, why was it sold on to the AU, and why would they purchase it?”

Nine countries have received more than 720,000 doses of the AstraZeneca vaccine from the one million doses the Africa Vaccine Acquisition Task Team acquired from SA, and they were “extremely appreciative” of the deliveries, said Dr John Nkengasong, chief of the Africa Centres for Disease Control and Prevention.

The doses were distributed to Gambia (15,000), Ghana (165,000), Guinea-Bissau (12,000), Liberia (27,000), Mauritania (27,000), Nigeria (300,000), Senegal (90,000), Sierra Leone (42,000) and Togo (45,000), with Malawi expecting 102,000 doses by the weekend.

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