Editorial: Government should explain plans in wake of J&J setback

COVID-19 was high on President Cyril Ramaphosa’s agenda at the just-completed G7 summit in Cornwall in the United Kingdom. This is as it should be. With a third wave of infections sweeping through a number of provinces, the country’s vaccination rates are still disturbingly low. Ensuring that more people are vaccinated quicker should arguably be the President’s top priority for at least the next six months.

South Africa is currently procuring two safe and highly effective vaccines for its COVID-19 vaccination programme – a two-dose vaccine made by Pfizer/BioNTech and a single-dose one from Johnson & Johnson. For now, though, it is only the Pfizer/BioNTech jab that is being administered.

This is not what was planned.

The envisaged scale-up of South Africa’s vaccination programme in June was premised on the expectation that we would have at least two million doses of the Johnson & Johnson vaccine ready to go into arms from early June.

Those plans were first delayed while the United States Food and Drug Administration investigated the possible contamination of these two million doses – an investigation that arguably took too long.

Those plans were then virtually torn up when over the weekend it emerged that we will not be able to use any of the two million doses because of possible contamination. The contamination occurred at a factory in the United States before the vaccines were shipped to South Africa.

Depressing as these developments are, the public can take some comfort in the fact that regulators are taking potential contamination very seriously and that they will not allow the use of vaccines that are at risk of having been contaminated. As an aside, it is worth stressing that the Johnson & Johnson vaccines used in the Sisonke Research Trial came from a different factory and were not contaminated.

Where does this leave us?

As yet the government has not provided a detailed account of its revised vaccination plans – nor any meaningful details of plans to boost supply in the short term. The most recent planning documents we’ve seen still assumed a significant supply of the Johnson & Johnson vaccine in early June.

300 000 Johnson & Johnson vaccines (that are not contaminated) have reportedly been secured for the vaccination of teachers in the coming weeks. While the government has confirmed these plans, they have provided relatively little detail and much of what we know is from circulars sent out to provinces rather than from government statements.

Johnson & Johnson will of course continue to supply new batches of vaccine for fill and finish at Aspen Pharmacare’s factory in Gqeberha in the Eastern Cape. Ramaphosa on the weekend said that Aspen is already beginning work on new batches of the Johnson & Johnson vaccine.

Aspen then said in a press release Monday that it expects to release Johnson & Johnson vaccines manufactured from drug substance that has not been impacted by the contamination issues within a week and that they should have further doses ready in July. Aspen CEO Stephen Saad told ENCA that over the next two weeks a couple of million doses plus should be available – including around a million from Aspen and another million or so directly from Johnson & Johnson. (The interview with Saad is worth watching.)

Ramaphosa also said over the weekend that United States President Joe Biden has agreed to donate doses of the Pfizer/BioNTech vaccine to South Africa – in addition to what we are already procuring from Pfizer. There are, however, as yet no details on when these doses will arrive and in what quantities.

Time for stronger more transparent leadership

South Africa’s vaccination efforts have been plagued by rotten luck – first with the AstraZeneca vaccine’s disappointing performance against the beta variant and now with the contamination of two million doses of the Johnson & Johnson vaccine.

But bad luck is something governments should plan for.

As it is, it appears the government had hardly any contingency planning. After the AstraZeneca setback, it was first and foremost researchers who scrambled to get healthcare workers vaccinated in the Sisonke study. With this second setback, it is not yet clear what the backup plan is, or, as Peter Bruce suggested in Business Day, whether there even was one until a few days ago.

Saad’s reassurance that we should have a couple of million doses ready over the next two weeks, with more to follow in July,  is great news. But to the extent that we are scrambling and coming up with a Plan B, it is notable that the details of this Plan B have so far been communicated by a private company and not by government.

Government should now step up.

The President or the Acting Minister of Health should urgently provide the public with a briefing on its updated vaccination plans given the Johnson & Johnson setback. This should include details of when we will be getting how much of which vaccine into the system as well as a detailed account of what steps government is taking to procure additional vaccines faster. And of course, we should also be told what our Plan B and C is if any of the new plans don’t work out.

If the information provided by Saad is correct, then the acceleration of our vaccination programme is back on – albeit three or so weeks behind the original schedule. That three-week delay will likely cost lives as people who might otherwise have been vaccinated fall sick with COVID-19 as South Africa’s third wave of infections takes its toll.

We simply cannot afford any more such setbacks.