Covax South Africa
(Photo by Mahmoud Hjaj/Anadolu Agency via Getty Images)
  • South Africa paid R283 million to the Covid-19 Vaccines Global Access, or Covax, programme in December 2020.
  • Due to supply constraints, and abandoned AstraZeneca shots, the country has not received a single dose yet.
  • Covax hopes to deliver almost 1.4 million Pfizer shots to South Africa by the end of June, but had only achieved 35% of its targeted vaccine deliveries by mid-May.
  • And that was before the Covid-19 crisis in India cut its supply in half.
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South Africa's first official procurement deal was struck with the Covid-19 Vaccines Global Access (Covax) programme nearly half a year ago, in December 2020. But unexpected vaccine trade-offs and crippling supply constraints have left South Africa with nothing to show for it so far, and Covax under pressure to meet its new June deadline.

South Africa's vaccine rollout has been anything but smooth. The first batch of vaccines secured, produced by the Serum Institute of India (SII), arrived in the country on 1 February. Those AstraZeneca doses were due to underpin Phase 1 of South Africa's rollout but were abandoned a week later after a study determined that the jab was less effective in combatting the locally-prevalent 501Y.V2 variant of the coronavirus.

The one million doses already received were sold onto the African Union (AU). The SII refunded South Africa for the vials paid for, but not yet delivered.

The health department swiftly pivoted to the Johnson & Johnson (J&J) jab, which was used to vaccinate almost 480,000 healthcare workers until its use was also halted due to health concerns raised by various international drug regulators.

The two-dose Pfizer vaccine is now being used in Phase 2 of the rollout, which targets people over the age of 60.

And while these recent hurdles have typified the stop-start nature of South Africa's rollout, initial red flags regarding government's readiness were raised in early December 2020 – when it infamously missed the deadline to join Covax.

Vaccines delivered through Covax, an initiative led by the Vaccine Alliance (Gavi) and World Health Organisation (WHO) to supply vaccines to poorer nations, were expected to kickstart South Africa’s rollout.

Despite missing the first deadline, South Africa's health department and Solidarity Fund confirmed, on 22 December 2020, that a down payment of $19.2 million – approximately R283 million at the time – had been made to secure doses through Covax. This payment represented 15% of the total cost of securing access to vaccines for 10% of the population.

South Africa trades AstraZeneca doses for Pfizer

South Africa was allocated almost 2.5 million doses of the AstraZeneca vaccine, which were due to be shipped at the end of February, according to Covax's Interim Distribution Forecast. This date was later revised to May. But South Africa's decision to abandon the use of AstraZeneca doses severely delayed things.

Allocated AstraZeneca doses were recycled into the Covax programme, with some having already made their way to Jamaica.

"South Africa was allocated 2,426,400 doses of the AstraZeneca vaccine… it has requested to be allocated another vaccine in place of AZ, and will receive allocations of alternative vaccines instead," Gavi spokesperson Evan O’Connell confirmed to Business Insider South Africa.

"It has already been allocated, at this stage, 1,392,300 doses of the Pfizer vaccine, allocated for Q2 2021."

Covax is expected to deliver 14.1 million doses of the Pfizer vaccine to at least 47 participating countries before the end of June as part of the third-round allocation. South Africa was due to receive 117,000 Pfizer doses before April, according to Covax’s first-round schedule.

But Covax is lagging on its scheduled deliveries, fuelling concern about the initiative's ability to meet its third-round deadline by the end of the second quarter.

"The Covax facility – the global Covid vaccine equity scheme – will deliver its 65 millionth dose in the coming days," announced the United Nations Children's Emergency Fund's (UNICEF) Executive Director, Henrietta Fore, on 17 May. "It should have been at least its 170 million."

"By the time G7 leaders gather in the UK next month, and as a deadly second wave of Covid-19 will likely continue to sweep across India and many of its South Asian neighbours, the shortfall will near 190 million doses."

Covax at only 35% of its intended target

Covax South Africa
Countries which have recieved vaccines through COVAX (in green) as at 25 May 2021. Image: Unicef Covid-19 Vaccine Market Dashboard

The Covid-19 crisis in India which has piled even more pressure on Covax which was due to deliver 237 million doses of the AstraZeneca vaccine in the first half of 2021. With India recording more Covid-19 infections and deaths than any other country since April, the SII, tasked with producing the AstraZeneca doses for Covax, announced that its foreign supply would be halted until at least December.

"We continue to scale up manufacturing and prioritise India," said SII CEO Adar Poonawalla on 18 May.

"We also hope to start delivering to Covax and other countries by the end of the year."

Having only achieved 35% of its targeted vaccine deliveries, Covax is calling for renewed funding and donations from first world nations which have been accused of hoarding vaccines. Ten countries are responsible for accumulating 75% of the world's vaccine supply, according to WHO director-general Tedros Adhanom Ghebreyesus, who criticised wealthy nations for perpetuating a "scandalous inequity" on Monday.

"We need countries to donate tens of millions of doses of vaccines immediately through Covax, which is the agreed global mechanism for distributing vaccines," explained Ghebreyesus.

"We need companies to help make donations happen fast, and to give Covax the first right of refusal on all uncommitted doses now, in 2021."

Faced with a sudden AstraZeneca shortage, Covax’s delivery pipeline is currently under review. And while South Africa is not reliant on AstraZeneca doses, it's unclear whether the SII's decision to halt its supply will result in reallocations of the Pfizer doses. This reallocation process could see South Africa waiting even longer for its share of Covax-supplied doses.

Gavi confirmed to Business Insider SA that it was in "regular communication" with the South African government regarding ongoing supply constraints, but referred questions about the Covax purchase agreement – which includes the allocation of Pfizer vaccines – to the department of health.

The department of health was approached for comment but has refused to offer any updates regarding South Africa's reliance on Covax.

South Africa remains the only country in Africa which has not finalised an order with Covax despite being allocated some 3.8 million doses since first signing onto the programme according to the UNICEF vaccine tracker.

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