South Africa cost of vaccines
(Photo by: Rafayat Khan/Majority World/Universal Images Group via Getty Images)
  • South Africa paid roughly R150 per dose of the now-abandoned AstraZeneca vaccine.
  • This is more than double what the European Union paid and 25% higher than the average cost to high-income countries.
  • Higher vaccine costs imposed on poorer nations, coupled with a lack of transparency regarding purchase agreements, is a cause for concern according to anti-corruption group Transparency International.
  • The price of the Pfizer and Johnson & Johnson vaccines are, however, better aligned with South Africa’s curve.
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South Africa overpaid for 1.5 million doses of the AstraZeneca vaccine produced by the Serum Institute of India (SII). The two-dose course cost $10.05 – roughly R150 at the time of purchase agreement – which is 25% more than higher-income countries paid.

The issue of vaccine inequality, which has stunted rollouts in the developing world, is laid bare in the latest report published by Transparency International (TI) on Tuesday. The global anti-corruption watchdog has drawn attention to the lack of transparency among governments and vaccine manufacturers with regards to contracts and clinical trials.

Of the 182 vaccine purchase agreements identified by TI, only 6% of these contracts have been published through formal channels by developers and buyers. Less than 1% of all contracts published by buyers did not include redactions. These redactions hide vital information of public interest pertaining to prices per dose and delivery timetables.

"Even in published contracts there are significant redactions which hide key details of public interest and may play a part in explaining why many countries lost out in the initial race for vaccines," notes the TI report.

READ | SA paid Covax R280 million 5 months ago – and hasn't received a single vaccine dose yet

Just ten countries have accumulated 75% of the world's Covid-19 vaccine supply. The World Health Organisation (WHO) has described this uneven spread – which has resulted in less than 2% of Africa's population being vaccinated – as a "scandalous inequity".

And while poorer nations are struggling to foot the bill for millions of vaccines to reach heard immunity, TI has found that lower income economies are being forced to pay more for doses compared to their high-income counterparts. This is especially true for AstraZeneca's Covishield vaccine.

High income countries, like the United States (US) and members of the European Union (EU), paid an average of $6.26 (less than R100 at the time purchase agreements were finalised) for two doses of the AstraZeneca vaccine. Lower-middle income economies, like Nepal, Bangladesh, the Philippines, and the African Union (AU) paid, on average, 7% more.

Upper-middle income countries, like South Africa, Brazil, and nations in Latin America, paid the most for AstraZeneca doses at an average of $7.81 (R117) for a full course.

Only one other country, Saudi Arabia, paid as much as South Africa did for its AstraZeneca supply.

South Africa vaccine
(Transparency International Global Health)

South Africa, which abandoned the use of AstraZeneca jabs just a week after the first shipment arrived from India in early February, managed to secure a refund from the SII for doses which had been ordered but not yet delivered. The 1 million doses which South Africa had already received were resold to the AU.

And although the South African government claims to have been fully reimbursed through the AU sale and SII refund, concerns surrounding the inverse relationship between a country's GDP and cost-per-dose persist.

South Africa's costly purchase agreement with the SII was explained by the health department's deputy director-general Anban Pillay, who told Reuters that wealthy countries had paid less because they had invested in the vaccine's research and development. This, despite South Africa hosting clinical trials of the AstraZeneca vaccine in partnership with Oxford University.

Data drawn from the United Nations Children's Emergency Fund's (UNICEF) Covid-19 vaccine market dashboard – used by TI to compile its latest report – includes prices paid for Johnson & Johnson (J&J) and Pfizer doses which now underpin South Africa's rollout.

Health Minister Zweli Mkhize recently confirmed that government had paid $10 (R145 at the time of the announcement) per dose of the J&J and Pfizer vaccine. The two-dose Pfizer vaccine has a full course cost of $20 (R290).

These prices are better aligned with the GDP curve between poor and wealthy nations. The US and EU are paying almost double what South Africa is for a single dose of the Pfizer vaccine, while its costing the AU just $6.75 (currently less than R100).

South Africa is paying the same as the US for its doses of the J&J vaccine, but the same jabs are costing the EU 15% less.

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