Subject: IBEXIM

Buddy Group 1
Chaitya Sanghvi C013
Charanjit Lamba C014

Topic: 3. Covid Vaccine rollout in South Africa and specific

challenges faced by the government during the rollout.
South Africa planned early for its covid vaccination programme. Yet ongoing procurement
problems and new variant fuelled waves have left its population vulnerable
Only a small fraction of the population is fully vaccinated as the country grapples with a third
wave dominated by the Delta variant of covid-19. This forced the country into a one month
“level 4” lockdown (ended 25 July) that included a ban on all gatherings and alcohol sales,
limitations on inter-provincial travel, and restaurant services limited to takeaways.

The number of hospitalisations is higher than the previous two waves, and more deaths are
being reported. Nationwide there’s an average of 13 000 new daily cases, primarily driven by
Gauteng province, the country’s economic hub encompassing Johannesburg and Pretoria. In
early July, hospitals in Gauteng ran out of beds, and private patients in intensive care units
were airlifted to other provinces.

The rapid rise in cases is in stark contrast to the sluggish pace of South Africa’s vaccination
rollout, which has been plagued by numerous setbacks.

In January, the Department of Health announced it had secured 12 million doses of vaccine
from the global Covax facility, on top of the purchase of 1.5 million doses of the AstraZeneca
vaccine earlier the same month. This made South Africa one of the few African countries
with the supplies to conduct an extensive rollout.

But the vaccines have been slow to arrive. The much-awaited Covax delivery due in March
arrived only in the last week of June and contained just 1.4 million doses. And just as the
AstraZeneca vaccine was about to be rolled out to healthcare workers in mid-February,
concerns emerged that the vaccine may not be efficacious against the emerging Beta
(B.1.351) variant identified in the country.

Challenges faced by the government

1. Supply crunch
African countries, particularly the approximately 40 nations  relying on doses
from COVAX and the Serum Institute of India, are being left behind as vaccines made in
India are diverted for domestic use. Just 1% of the 1.3 billion COVID-19 vaccines given
globally have been administered in Africa so far and that’s down from 2% a few weeks
ago.WHO recommends that countries prioritize getting the first dose to as many high-risk
people as possible, given the short expiry date of some vaccines.Modelling suggests that
vaccinating more people in the highest priority groups with one dose as opposed to
vaccinating half that number with two doses will substantially reduce death rates.“We
understand the urgent challenges in India – and WHO is helping however we can – but we
hope that second doses will arrive in Africa quickly to give people full immunity,” says Dr
Mihigo.
2. Slow rollout
COVID-19 vaccine rollouts have been exemplary in some African countries and eight
African nations have already used all of their COVAX doses. Yet nine countries have given
less than a quarter of their doses and 15 countries have used less than half.“It may be that
some of the reporting from African countries to WHO is incomplete,” explains Dr Ephrem
Lemango, an expert on essential immunization and primary health care with WHO, “but it
seems that many countries need to step up efforts to use their vaccines.”Factors leading to
delays include a lack of funds, trained professionals and hesitancy among the population to
get the vaccine. In some countries, insufficient planning, including targeting priority groups
and remote populations, are holding back the rollout.
3. Insufficient funds
Most African countries allocated funds to cover the cost of rolling out the first batch of
vaccines, and some to reach all health workers, but funding shortfalls pose a growing threat
as the number of people to be reached rises and areas to be covered located further away from
major cities. In some African countries, a lack of funds is already causing delays in addition
to a lack of vaccinators, sub-optimal training, weaker communications to boost the uptake of
vaccines and an inability to capture crucial data or to print and distribute immunization cards.
COVAX partners are committed to providing up to 30% of Africa’s vaccine doses for free,
but African countries must fund the vaccines to cover the rest of the people they aim to
vaccinate, while investing in the systems they need to roll out the vaccine. The World Bank
estimates that Africa still needs around 12 billion US Dollars to reach enough people to
ensure adequate protection from COVID-19.
4. Vaccine safety and hesitancy
Several African countries paused or stopped their vaccine rollouts due to safety concerns.
Much of this was driven by fears of adverse side effects that were reported in Europe and the
United States of America. The suspension of the use of the AstraZeneca vaccine among
younger adults in Europe has also affected the uptake of the vaccine in younger health
workers in some African countries. Concerns regarding the safety and efficacy of COVID-19
vaccines, as well as myths and misinformation, are spreading fast on social media. This has
added to vaccine hesitancy. Many African countries have only a limited ability to track and
report adverse effects following vaccination, as well as investigate serious adverse events and
share fact-based information on the benefits and risks among their populations.
5. Targeting the most at risk
Health workers are easy to find in hospitals and clinics, yet older people and those with
conditions that put them at higher risk of COVID-19, are not always easy to identify,
particularly in remote areas. Some African countries registered their priority groups before
vaccines arrived, with countries like Angola, Ghana and Nigeria making use of community
mobilizers going door-to-door to list people in advance. Yet authorities in many African
countries did not have full and correct documentation of people’s locations, ages and up to
date information on which people had existing conditions, or the resources to list them all in
advance. For these reasons and to avoid wasting vaccines, a proportion of the doses have
been used to vaccinate people not in the highest priority groups in a number of African
countries.
 6. Using different vaccines
Botswana, Rwanda and several other African countries are rolling out more than three
different types of COVID-19 vaccine. If handled well, this can lead to more people quickly
getting protected, but it can also create challenges, including around keeping track of who
gets what type of vaccine, differing logistics and storage requirements and training
vaccinators to give different vaccines. With different data on safety and effectiveness for each
vaccine, it can also make it harder for governments to promote the importance of getting the
vaccine to their populations. WHO recommends that countries stick with the same vaccine
for both doses, yet with supplies dwindling, countries may be forced to mix second doses, or
risk long delays between doses?
7. Disruptions to essential health services
Over one third of African countries have reported disruptions to essential health and
immunization services throughout the pandemic and the onset of COVID-19 vaccinations.
Two-thirds of these countries reported the reallocation of staff to provide COVID-19 relief as
the main driver for the disruptions, but fear of contracting COVID-19 has also led to lower
numbers of patients seeking care for other conditions. While disruptions to other
immunization drives appear to be decreasing, they still pose a threat. The rollout of COVID-
19 vaccines will at least double the burden on essential immunization providers in Africa and
requires more cold chain capacity and financing.