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COVID-19 Vaccines in South Africa: Progress Report January-April 2021

By: Neala Hayratiyan, Nicole Sguigna, Debbie Ogilvie and Sachindeep Purewal

HR 300: Dr. S. Wilson-Forsberg

Wilfrid Laurier University Brantford

Executive Summary

The global vaccine development program has become the most critical component of the worldwide effort to eliminate the COVID-19 virus. It has produced collaborative networks between nations and pharmaceutical companies as they try to coordinate the production and distribution of vaccines to achieve herd immunity. With that said, the global vaccine rollout has emphasized deep inequities between lower-income and higher-income countries. The most significant of which has resulted in a global north monopoly of the vaccination distribution program. This has left many in the global south without access to available and affordable vaccines, with many countries in this region seeing the arrival delays extending into 2023 (Mthethwa 2021).

South Africa is one such country in the global south that suffers from the unequal distribution of vaccines. To date, the nation has faced the highest numbers of COVID cases across the African continent (WHO Africa Region 2021). This situation has spurred significant socio-economic and political issues such as: (1) violence against women and girls; (2) education inequities; (3) increasing rates of unemployment and food insecurity; and (4) concerns regarding government accountability. These issues have been compounded by the widespread unequal distribution of vaccines. Despite these disparities, South Africa has introduced their own vaccination program through partnerships with other countries, COVAX, pharmaceutical companies, and independent vaccine research relevant to the South African context.

Though this national program demonstrates some success in vaccine procurement, South Africa remains in a precarious situation. The vaccines purchased are slow to arrive and the country is struggling to compete against richer nations in vaccination bids. This has resulted in their low vaccine status (LOWY Institute 2021). The country is further handicapped by pushback from pharmaceutical and wealthier nation against South Africa’s joint action with India to remove Trade-Related Aspects of Intellectual Property Rights (TRIPS) on vaccines. The removal of which would allow lower-income countries to develop vaccines locally and in turn, ensure greater vaccine access (Karrim 2021). What has emerged is a vaccine apartheid wherein the global vaccine rollout has moved away from actual need and into a measure of profit for pharmaceutical companies and global north supremacy. This has left many global south countries, like South Africa, hindered in their pursuit to procure vaccines and heavily reliant on donations from richer nations.

It is necessary to ensure greater access to vaccines to help alleviate the current situation in South Africa. To achieve this goal, it is imperative that the global vaccine rollout prioritizes making the COVID vaccine a global good. Initiatives that support international aid and collaboration via vaccine sharing, removal of the TRIPS waiver and increased funding to programs like COVAX will offer countries greater opportunities to develop and procure their own vaccines. In doing so, widespread accessibility to the COVID vaccine could be guaranteed. For there to be a true global vaccine rollout, more equitable access to vaccines is imperative. This will require the countries hardest hit by COVID, like South Africa, have access to readily available and affordable vaccines. Then, and only then, will we be able to end the COVID pandemic.

Introduction

In December 2019, the Municipal Health Commission in Wuhan, China, reported a cluster of cases later identified to be SARS-CoV-2, an airborne respiratory illness more commonly referred to as COVID-19 (COVID) (John Hopkins 2021). As of writing this report, there are over 128 million cumulative cases and over 2.8 million reported COVID-related deaths worldwide (John Hopkins 2021). The safest way to bring an end to the COVID pandemic is by vaccinating a majority of the population. The unprecedented drive by international actors to develop safe and effective COVID vaccines is an incredible scientific achievement that ushers hope for the dawn of a post-pandemic future. While richer countries like Israel are fast approaching herd immunity, African countries like South Africa are still left scrambling to establish bilateral agreements for vaccines of their own (Bloomberg 2021). This report questions how the unequal distribution of COVID vaccines has impacted the country worst affected by COVID in Africa, South Africa. This report argues that there needs to be increased access to vaccines in South Africa.

The paper begins by noting the impact the unequal distribution of vaccines has on human rights. Then, it outlines the current situation in South Africa. Next, it presents a range of developments introduced over the past several months that positively impact South Africa’s access to vaccines. After, the paper points to a variety of hindrances to South Africa’s pursuit of vaccines. In the following section, the paper notes the need for further advancements. Then, it lists significant developments that took place since the start of 2021. Finally, the paper ends with several recommendations to ensure equitable access to affordable and effective vaccines in South Africa.

Global Distribution and Human Rights 

(United Nations Human Rights Office of the High Commissioner 2020).
(United Nations Human Rights Office of the High Commissioner 2020).

“The availability of vaccines, medicines, health technologies and health therapies is an essential dimension of the right to health, the right to development and the right to enjoy the benefits of scientific progress and its applications”

(United Nations Human Rights Office of the High Commissioner 2020).

 

 

The unfair distribution and hoarding of vaccines by richer nations have complicated actions to ensure an equitable global vaccine rollout and compromise international goals and human rights norms [see Appendix] (HRW 2020b). Of the 574 million COVID vaccines deployed, 78% were in only ten countries (The Lancet 2021). Of these countries, the majority are within the wealthier global north who have had the opportunity to make early purchases of vaccines in pre-production and post-production, giving them a monopoly on the global vaccine distribution program (Felter 2021). Middle-income to low-income countries have fared much worse in the race to access vaccines, often lacking the political and financial prowess to compete against wealthier nations for vaccines [see Figure 1] (Felter 2021). Consequently, estimates suggest that these countries are unlikely to begin initial immunizations until late 2021 and will not see herd immunity until 2023, despite having some of the highest numbers of COVID cases worldwide (Felter 2021). The impact of which has led many countries to struggle to contain COVID and implement robust vaccination programs. This imbalance has produced considerable disparities in the global crusade against COVID and intensified existing socio-economic inequalities in middle-income to low-income countries, like South Africa.

Note: Map illustrates the current number of vaccines administered and the population coverage in each country. Israel is leading in the global race to herd immunity (Bloomberg 2021).

Over the course of the pandemic, South Africa has experienced the highest numbers of COVID in Africa. Currently, the country accounts for one-half of all African cases [see Figure 2] (WHO Africa Region 2021). In the preceding months, variants have become a main concern especially in terms of its impact on the efficacy of current vaccines. Currently, 90% of South African COVID cases are the variant (Reuters Staff 2020a). Despite these high numbers, South Africa is currently coming out of their second wave. It is important to note that the second wave was worse than their first [see Figure 3]. This is primarily due to their lack of vaccines paired with the growing emergence of COVID variants (AfricaNews 2021). A third wave is expected, and the government has warned it will be difficult to handle if more vaccines are not made available (Norbrook 2021).  

Map of Africa showing the spread of COVID-19 with red (WHO 2021)

 The pandemic, and more specifically, the lack of access to vaccines and sparse international support is exposing innate social, political, and economic disparities in South Africa. According to Amnesty International (2021b), COVID and the lack of access to vaccines is highlighting the ways in which many South African communities are continuing to live “with the consequences of political and economic decisions made during the apartheid era” and this is creating a grievous human rights situation in the country. The following subheadings note several socio-economic issues that have developed due to COVID.

Graph showing number of confirmed cases and deaths in South Africa (WHO 2021)

 

(1) Increased Violence Against Women and Girls

Widespread lockdowns and stay-at-home orders have made it difficult for women to leave violent situations with many unable to find help due to country-wide closures of women’s organizations after being deemed unessential (Amnesty International 2021a). Deprose Muchena, Amnesty International’s Director for East and Southern Africa, stated, “It is shocking that for many in Southern Africa, the most dangerous place to be a woman or a girl during the COVID-19 pandemic is at home” (Amnesty International 2021a). Amnesty International (2021a) has condemned South Africa in their failure to consider women’s needs when planning COVID safety measures.

(2) Education Inequities  

In South Africa, only 22% of homes have a computer and only 10 % of these homes have access to the internet (Amnesty International 2021b). The appearance of virtual learning strategies resulting from school closures have left many children unable to participate in at-home learning (Amnesty International 2021b). In addition, the closure of schools has impacted over 9 million children who rely on the National School Nutrition Program for their daily meals resulting in increased levels of childhood food insecurity (Amnesty International 2021b). Moreover, the government has struggled to provide safe classrooms in schools as long-standing issues with overcrowding and running water are hindering their efforts in implementing proper COVID sanitation and safety protocols (Amnesty International 2021b). These problems have unduly impacted schools in poorer communities as they are unable to afford the resources necessary to provide adequate learning environments for the children in these areas (Amnesty International 2021b).

(3) Unemployment and Food Insecurity

COVID-19 has resulted in thousands of South Africans becoming unemployed with the current rate standing at 42% (Stats SA 2021). Those aged 15-34 are disproportionately represented in this rate (Stats SA 2021). This loss of work and income has caused widespread food insecurity (Amnesty International 2020). To offset the pressures of this economic hardship, the government has implemented food aid programs that target poorer communities and those most affected by the pandemic (Amnesty International 2020). Unfortunately, reports state that party leaders, especially those from African National Congress Party, are stealing from the food supply (Amnesty International 2020).

(4) Government Corruption

The South African government faces significant backlash in its COVID-19 approach. Most of the criticism claims that the government exhibits slow progress in obtaining vaccines (Madhi 2021). A community of South African scientists are critical of the government, suggesting that as Africa’s richest nation, they should not be in a position where they are reliant on agencies like COVAX, or have trouble negotiating vaccine agreements (Mwai 2021). This sentiment is echoed by both the South African people and opposing government groups, like the Democratic Alliance, who are pressing for greater government accountability when it comes to vaccine negotiations and government COVID relief funds (Sullivan 2021). Also, the government is being questioned for their frivolous spending after it used an empty flight to pick up available Johnson & Johnson vaccines in Brussels when other passenger flights were available and could have been used to save money (McCain 2021). The result of which has spurred major distrust between the people and the government. Amidst this growing tension, the South African Auditor General’s Office investigated the country’s approach to managing COVID and the vaccination program (Gerber 2021). The office discovered widespread corruption and mismanagement (Gerber 2021). Traditional leaders are calling for their inclusion in the country’s vaccination program to help dispel this government corruption and to build healthier relations between the government and its citizens (Dayimani 2021). As the vaccination rollout matures in South Africa, it will be vital for the government to rebuild its rapport with its citizens to help legitimize its actions. It will be critical for the South African government to target these issues through robust strategies in their vaccination programming. As more vaccines become available, the country should prioritize issues impacting these groups.

Vaccine Achievements

Despite these obstacles and the disparities within the global vaccine rollout, South Africa is making significant strides forward in their battle against COVID and in their plight to procure vaccines. The following subheadings list the most prominent their most prominent achievements since the start of 2021.

National Rollout Plan

Beginning early in the year, South Africa began to implement its national vaccine program [see Figure 4]. The country has been able to make notable achievements as the national program has progressed.

Partnerships

Critical to South Africa’s national vaccine rollout has been the formation of partnerships with countries and international agencies. The country’s middle-income status has been said to be impeding their ability to invest early in the global vaccine development program and thus, restricting their access to available and affordable vaccines (Sullivan 2021). South Africa has become a beneficiary of COVAX, the WHO-backed vaccine procurement agency for lower-income countries (Mwai 2021). The country will receive enough vaccines to inoculate 10 percent of its population from the agency (Mwai 2021). They will also receive a portion of the 520 million syringes UNICEF has stockpiled for national vaccine programs (Sawlani 2020). India has also emerged as a benefactor for the country, helping the country procure 1.5 million AstraZeneca vaccines (Mwai 2021). This partnership prompted a joint venture between the two countries to make the COVID vaccine a public good (Mwai 2021). President Cyril Ramaphosa has commended the Indian government for their actions in helping the country gain access to vaccines (Du Plessis 2021). To date, South Africa has begun negotiations with China to procure their Sinopharm and Sinovac vaccines (Business Insider SA 2021b).

Timeline of key events that took place during South Africa's vaccine rollout plant from February-May 2021

 

Infrastructure

South Africa’s vaccine rollout plan has faced logistical challenges in the secure transfer and storage of COVID-19 vaccines. For example, the country has struggled to find ways to properly store the 117,000 doses of Pfizer it has received as it must be kept at –70 degrees (De Wet 2021). To help mitigate this issue, both COVAX and the World Bank have provided funding to the country to purchase ultra-cold freezers to store the vaccines (Jerving 2021). The country is also working to commission private facilities and universities to utilize their freezer space (Felix 2021a). South Africa is seeking to repurpose dry-ice methods used previously to transport HIV vaccines as it has reported to keep vaccines cold for up to 3 days in travel (Felix 2021a). In response to fears over vaccine security, the country has increased police presence around vaccine facilities and begun transporting vaccines in unmarked vans equipped with trackers and temperature controls (Evans 2021a). To help alleviate these logistical issues, South Africa is in talks with Johnson & Johnson to locally produce 300 million of their vaccines which would allow for greater access to vaccines and increase their storage capabilities (Business Insider SA 2021a). Both the South African drug maker Aspen and manufacturing company Biovac Institute are being included in the negotiations for the formulation, packaging and distribution of the vaccine (Business Insider SA 2021a).

New Vaccine Findings and Studies

As a means of offsetting the country’s difficulties in accessing vaccines, South Africa’s Department of Science and Innovation is funding studies to determine the efficacy of traditional, plant and herbal-based medicine on COVID and its variants which have shown previous success in treating HIV (Ebrahim 2021). The emergence of the South Africa variant is also pushing forward government support of pharmaceutical studies to increase the efficacy of current vaccines against this mutation. The government has backed Moderna who is working to produce a booster shot to protect against the South African variant (Walsh 2021). The University of Oxford is also working towards formulating a second-generation AstraZeneca vaccine that is more effective against the variant (Smout & Kelland 2021). South Africa has begun a promotional campaign on the efficacy of the Johnson & Johnson vaccine after a study determined it to be 82% effective against severe cases of COVID, 57-85% effective against mild to moderate variant cases and 100 % effective against hospitalization which is promising amidst rising concerns over the variant (Business Insider SA 2021a). The Johnson & Johnson vaccine has also been praised for its cost-effectiveness both as a one-shot vaccine and only requiring regular pharmaceutical freezers which is better suited for the current situation in South Africa (Business Insider SA 2021a).

New information specific to the South African context is also emerging. A recent study has found that persons with or who have had the South African variant have a better immunity against other variants (AfricaNews 2021). Blood analysis studies have also found that Black Africans have a higher immunity against COVID, though little is known about whether this will help to better protect this community until they are immunized (Evans 2021b). These new studies have been influential in the global vaccine rollout, especially in terms of treating mutations of the virus, and are critical in understanding COVID’s impact outside the global north but they are limited. It will be important to continue this research to fully achieve a global end to the pandemic.

Hindrances to South Africa

Lack of Vaccines

Despite South Africa participating in the African vaccine trials, they have been unable to access the final product and are expected to pay 2.5 more for vaccines than the global north (Mwai 2020). President Cyril Ramaphosa has noted the current climate to access vaccines in South Africa as a “painful irony” (Phillip 2021a). Those critical of the government have been quick to accuse the country that its slow approach to vaccine procurement is the reason they have been unable to access vaccines suggesting that South Africa’s position as the richest African country should have provided them greater opportunity within the global vaccine program (Mwai 2021). The government contends that they have been in negotiations since late last year but many of the available vaccines are not well-suited to the environment in South Africa and they were not comfortable purchasing vaccines before clinical trials had concluded (Mwai 2021). However, richer global north countries began entering into vaccine agreements while vaccines were in development which has afforded them an advantage in the global vaccine program in terms of cost and access (Mwai 2021). The purchase of vaccines in pre-production has resulted in a delay for the vaccines that South Africa has been able to purchase (Felter 2021). For example, the 12 million doses of vaccines from COVAX are not expected to arrive until at least April or May (Mwai 2021). As of late March, the country has also only received 80,000 of the 11 million vaccines it has procured from Johnson & Johnson (Mwai 2021). These issues have contributed to South Africa’s low vaccine status (LOWY Institute 2021). At its current rate, 9 out of 10 South Africans will not be immunized this year (Mthethwa 2021). The lack of availability and accessibility to vaccines has raised concerns that the government will be ill-prepared to handle successive waves of COVID, especially as the variant continues to be an issue for the country (Norbrook 2021).

Fake Vaccines and PCR Testing

Underground markets for fake vaccines have begun to emerge because of growing inequities in the global distribution of vaccines (BBC News 2021). Interpol has reported that police in South Africa have seized 3,000 doses of fake vaccines and have arrested upwards of 80 suspects (BBC News 2021). Though Interpol has stated that counterfeit vaccines have not yet appeared on the black market, they are closely monitoring the situation (BBC News 2021). The South African government has increased policing and security to help put an end to these networks (BBC News 2021). Complicating the situation further has been the high prevalence of fake PCR testing coming out of South Africa (Daniel 2021). The testing, which is necessary for international travel, has led many countries to further restrict South African travelers and has raised international suspicion of South Africa’s approach to COVID validation programs (Daniel 2021). This has cultivated concern over South Africa’s position in the global vaccine market, and as the possibility of vaccination passports as a means for future travel looms, whether those claiming to be vaccinated can be trusted coming out of South Africa (Daniel 2021).

Vaccine Hesitancy and Misinformation

Vaccine apprehension is a source of concern for authorities, especially in rural communities with deeply rooted traditional values (Dayimani 2021). Many people are reluctant to get the Johnson & Johnson vaccine because they do not know how safe it is after the government halted the AstraZeneca rollout (BBC News Africa 2021). To avoid more apprehension in the community, President Cyril Ramaphosa received the Johnson & Johnson vaccine (BBC News Africa 2021). Vaccine hesitancy has been particularly prevalent among the younger generation and it has become a challenge for the country to persuade them to inoculate (BBC News Africa 2021). Fueled by conspiracy theories about the link between COVID-19 and 5G technology, anti-immunization protests have also become prevalent (Chabalala 2021).

This misinformation reflects the scarcity of studies on Africa (Galey 2021). Despite containing a fifth of the world’s population, only 4% of COVID scientific research is relevant to Africa (Galey 2021). The issue of which leaves the information that is available to be applied and interpreted onto the South African context even if it is suited. Scientific research that is written for Africa could help dispel vaccine hesitancy in the country and help create stronger vaccination programming with viable vaccines that are reflective of the South African environment and people (Galey 2021).

The Need for Further Advancements

International Aid and Cooperation

To battle the COVID pandemic, it is imperative that South Africa receives increased international aid and global cooperation to help them reach their vaccine goals. Of top priority in these efforts are funding and vaccine sharing. President Cyril Ramaphosa has called on richer nations to donate 5% of their vaccines to countries in need, especially those within Africa (China Daily Global 2021). The Archbishop Makgoba of South Africa shared President Ramaphosa’s testament and urged pharmaceutical companies and rich governments to donate vaccines to other countries to allow them to reach herd immunity (Mthethwa 2021). UNICEF has encouraged richer countries to increase funding to COVAX who is in need of 10 billion dollars to procure more vaccines for participating middle- and lower-income countries (Reuters 2021). Medecins Sans Frontieres (MSF) (2021), an organization that has been on the frontlines in South Africa providing COVID medical assistance, has echoed these recommendations stating that the global north countries that have inoculated health care workers and high-risk persons should share vaccines and increase funding (Medecins Sans Frontieres 2021). MSF has also called for greater transparency from the global north and pharmaceutical companies on vaccine supply schedules so that countries like South Africa are aware of delivery dates, amounts and costs of the vaccines they will be receiving which will help them to better maintain their vaccine rollout (MSF 2021). Increasing international aid and cooperation through funding and vaccine sharing will help ensure that South Africa is not just able to “acquire […] vaccines but the right vaccines- adapted to the presence of new variants and to contextual factors- at the right time and at the right price” (Medecins Sans Frontieres 2021).

Education

Many nations will not be able to reach herd immunity if people are not willing to take the COVID vaccine. The citizens of South Africa are hesitant to receive the vaccine since they are unaware of the side effects and how effective the vaccine is against the virus (Ngutjinazo 2021). This can create a risk for South Africa insomuch that it can delay meeting herd immunity goals necessary to end the pandemic (Wiysonge et al. 2021). The government of South Africa needs to prioritize information-sharing and education campaigns for vaccines to ensure that people can make informed decisions to vaccinate. The state should use promotional events to communicate with the public and provide targeted information regarding the misconceptions of the vaccine (Dzinamarira et al. 2021). Such actions are needed because of the complex nature of vaccine hesitancy and the impact it can have on the community (Wiysonge et al. 2021). Through vaccine education, the government can more effectively build trust with the public about the efficacy of vaccines. The state will have to ensure that they have a transparent approach to COVID and vaccination distribution to alleviate public skepticism regarding the government’s intentions within the vaccine rollout plan.   

Major Developments and Trends

Finding Effective Vaccines

The AstraZeneca vaccine was distributed to South Africa early in the year but following a 2000-person study that found it ineffective against the South African mutation, South Africa has paused its distribution (Mwai 2021). Similar trials for the Novavax vaccine showed comparable results finding lower vaccine efficacy where the variant is dominant (Rubin 2021). In South Africa where the variant has become the dominant strain, the efficacy of current vaccines and their applicability to the South African context is a major concern (Rubin 2021). At its current state, there is a clear need for the manufacturing and development of vaccines that account for this context. The process of which has started with vaccine manufacturers beginning work on producing booster shots and second-generation vaccines that specifically target the South African mutation (Walsh 2021). Thus far, Johnson & Johnson shows positive results in reducing hospitalizations which could help decrease severe cases of COVID-19 that are produced by the South African variant (Rubin 2021). The promise of such vaccines necessitates the need for South Africa to receive the 11 million doses it has procured from Johnson & Johnson promptly (Mwai 2021). It will be important to increase access to vaccines that work well in South Africa to protect its citizens from the variant, quell issues that have arisen from the pandemic and support their vaccine rollout.

Quote from Wfinnie Byanyima, UNAIDS Executive Director (Byanyima 2021)
Quote from Wfinnie Byanyima, UNAIDS Executive Director (Byanyima 2021)

“Today we are witness to a vaccine apartheid that is only serving the interests of powerful and profitable pharmaceutical corporations while costing each one of us the quickest and least harmful exist route from this crisis.”

Wfinnie Byanyima, UNAIDS Executive Director (Byanyima 2021)

 

 

Vaccine Apartheid 

President Cyril Ramaphosa has recently come forward to condemn the global north monopoly on vaccines urging that the “vaccine apartheid must come to an end” (AFP 2021). The definition of which recognizes the transformation of the global vaccine rollout away from human need and into a system that protects the pharmaceutical profits and ensures global north control (Byanyima 2021). It has been reported that many countries in the global north plan to be at least 60 % immunized against COVID-19 by the end of 2021 (China Daily Global 2021). The same cannot be said for countries like South Africa who are currently facing significant delays in mass inoculation (NPR 2020). This has created deep inequities between the global north and south wherein many lower- and middle-income countries will be unable to vaccinate their high-risk populations before wealthier countries immunize their entire population (NPR 2020). Archbishop Makgoba of South Africa has appealed to pharmaceutical companies and wealthy nations to increase vaccine production and access for African countries, including South Africa encouraging "[…] those companies and governments that are hoarding vaccines in high-income countries to please look into your hearts and make the vaccines available [...] You can’t equate human life to dollars, euros and profit” (Mthethwa 2021). His announcement comes in the wake of widespread vaccine advocacy protests seeking universal vaccine coverage, increased vaccine access in South Africa, and condemning Big Pharma control of vaccines (Mthethwa 2021).

Vaccines as a Public Good

Pivotal to creating a system that assures equitable access to readily available, applicable, and affordable vaccines is to make the COVID vaccine a public good. A key component of this system has been India and South Africa’s collaborative effort to remove the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver that would temporarily interrupt patent protections on COVID knowledge until mass inoculation can be achieved (Karrim 2021). The World Health Organization has joined this call to action by putting pressure onto the global north and pharmaceutical companies to share technology and create voluntary licensing through the WHO-owned COVID-19 Technology Access Pool initiative (Ghebreyesus 2021).  China has joined the action by making both their Sinovac and Sinopharm vaccines available to all nations, including South Africa (Opali 2021). Some vaccine manufacturers have been open to supporting this endeavour with AstraZeneca, Pfizer and Sanofi allowing for the transfer of their COVID technology to help with the development of more vaccines (Ghebreyesus 2021). As of March 1st, the list of supporters includes 100 World Trade Organization members, 400 organizations in the United States, and 115 members of the European Commission (Pietromarchi 2021).

The goal of the TRIPS waiver is to provide countries that are having difficulty purchasing vaccines the opportunity to locally develop and manufacture their own vaccines. The benefit of which would allow for greater access to vaccines for countries who have been shut out of the global vaccine program either via vaccine hoarding, lack of funds or high vaccine costs (Mthethwa 2021). Global north countries like Canada, the United Kingdom and the United States have been quick to suggest that South Africa has a lack of sufficient infrastructure and resources to sustain local vaccine production in their pursuit to block the TRIPS Waiver (Green 2021). South Africa, however, has been reported as one of five African countries that have the necessary capacity to produce vaccines (Green 2021). The South African vaccine manufacturing company Biovac Institute, for example, has a local facility that has the capacity to manufacture 1 billion doses of the vaccine, but it requires $201-336 million in additional funding to reach its full vaccination development status (Phillip 2021b). Further opposition to the TRIPS waiver has also cited that removing TRIPS would challenge scientific invention, and that the existing policies are loose enough to support increased rates of local vaccine production (Pietromarchi 2021). In line with this pushback, 31 pharmaceutical companies have penned a letter to the United States President Joe Biden encouraging him to remain steadfast in his opposition to the TRIPS waiver (Karrim 2021). They argue that South Africa and India have “argued without evidence” that TRIPS is in fact impeding the global COVID response and have failed to prove without a doubt that the removal of TRIPS would rectify this issue (Karrim 2021). It is important to note that many of those opposing the TRIPS waiver have been able to begin mass inoculation programs (Medecins Sans Frontiers 2021).

The World Health Organization has stated for there to be equitable distribution of vaccines, governments and manufacturers need to speed up the production of vaccines (Ghebreyesus 2021). The removal of the TRIPS waiver could provide the ability to increase global production of vaccines insomuch that it would expand the number of available manufacturers, initiate local distribution networks, and increase production capacity worldwide (Pietromarchi 2021). It would, according to President Cyril Ramaphosa, increase information sharing, and allow South Africa and other countries “to harness its own continental capabilities” (AFP 2021). This would not only help build the global supply of vaccines and speed up herd immunity, but it would also decentralize the global north monopoly of the global vaccine program by generating global collaboration (Pietromarchi 2021).

Recommendations

To deal with the global pandemic, South Africa will need to obtain as many vaccines as possible to reach herd immunity. Due to South Africa’s challenges in procuring vaccines, they are dependent on the actions of the international community and as such, should look to build beneficial collaborative partnerships with other countries. These relationships must be underpinned by the importance of making vaccines a public good which recognizes that access to vaccines is a fundamental human right as it directly impacts the public’s right to health (OHCHR 2020). By positioning the vaccine as a public good, richer nations will be compelled to provide increased funding, and share COVID vaccines and supplies to the global vaccination campaign to ensure greater access to vaccines and in turn, protect intrinsic human rights.

To further support equitable access to vaccines, the World Health Organization has recommended that pharmaceutical companies regulate the cost of vaccines (Ghebreyesus 2021). The purpose of which will help to prevent vaccine hoarding and ensure that South Africa has access to available and affordable vaccines (Ghebreyesus 2021). The government is encouraged to work with pharmaceutical companies to enter into bilateral agreements that are attuned to South Africa’s budget. Though the government has added $688 million for vaccines to its 2021 budget, the country could still spend up to $1.33 billion over the next three years to inoculate its entire population (Khumalo 2021). Therefore, the government must focus on allocating more funding to put towards the purchase of vaccines. It is recommended that South Africa revisits their COVID budget to support their vaccination rollout plan.

For South Africa to increase their vaccination rates, it should begin to locally develop vaccines. This will not only allow greater access to vaccines, but could help to quell skepticism of foreign vaccines. The government needs to put more pressure on the international community to remove the TRIPS waiver to enable them the ability to produce their own vaccines. Critical to the removal of the TRIPS waiver is international support. To engage such support, South Africa should initiate discourse with the international community that emphasizes that public health and safety are much more important than private profit when in times of crisis (OHCHR 2020). These efforts will be pivotal in South Africa being able to produce their own vaccine.

In the long term, South Africa must focus on ensuring that they have the capacity to create their own vaccine within the country. The government must work on establish the facilities and infrastructure needed for the development of injections in the future. This will limit South Africa’s dependance on other states to provide them with medical technologies and supplies. South Africa should also focus on participating in vaccine trials and doing further research on the relationship between Africa and COVID injections (Galey 2021). The Human Rights Watch has recommended that states make their research accessible to all to create better and more effective vaccines (HRW 2020a). This will benefit states like South Africa when trying to develop their vaccines to ensure that they create applicable vaccines suitable for the South African context.

Conclusion

South Africa’s ability to continue their vaccine rollout, achieve herd immunity and mitigate the pressures of COVID is heavily reliant on their capacity to access affordable, effective, and available vaccines. To date, the country has been stunted in their ability to do so by way of various logistical, economic and political challenges that have rendered it unable to compete in the arms race for vaccines. Despite these challenges, they have been able to make significant vaccines achievements via partnerships with countries and international agencies, enabling the country to begin the early stages of its national vaccine rollout. However, the future of South Africa’s vaccine success remains uncertain. Global north vaccine hoarding, resistance against efforts to open local vaccine development networks, and the emergence of a global vaccine program that prioritizes profit over human need threaten to continue global vaccine instability. As a result, this further endangers the equitable access to vaccines. Moreover, for the countries hardest-hit by COVID like South Africa, this poses a significant threat to the achievement of herd immunity and ending the pandemic. It is necessary that all nations work collaboratively to help control the spread of COVID which should come in the form of increasing access to affordable and available vaccines. Richer global north countries must support efforts to make the vaccine into a public good in order to give rise to a global vaccine program that is equitable for lower- and middle-income global south countries. Only when there is true global collaboration that sees vaccine development and distribution as a human right will a truly equitable global vaccine program be achieved. This must be prioritized as it is the right of every country to have equitable access to COVID vaccines.

Appendix lists general international vaccine goals and the human rights norms associated with COVID-19

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Amnesty International. “COVID-19 Pushes Inequality in Schools to Crippling New Level, Risks a Lost Generation of Learners.” Amnesty International. February 15, 2021b. Accessed April 2021b. https://www.amnesty.org/en/latest/news/2021/02/south-africa-covid19-pushes-inequality-in-schools-to-crippling-new-level-risks-a-lost-generation-of-learners/

Asala, Kizzi. “Children in South Africa Become Orphans Due to Coronavirus Pandemic.” Africanews. February 1, 2021. Accessed April 2021. https://www.africanews.com/2021/03/01/pandemic-sees-orphaned-south-african-children-in-port-elizabeth/.

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Gerber, Jan. “Auditor-General in Talks with Treasury to Recoup R150m Spent on Auditing COVID-19 Corruption.” News24. March 5, 2021. Accessed March 2021.        https://www.news24.com/news24/southafrica/news/auditor-general-in-talks-with.              treasury-to-recoup-r150m-spent-on-auditing-covid-19-corruption-20210305.

Ghebreyesus, Tedros Adhanom. "Waive Covid Vaccine Patents to Put World on War Footing." World Health Organization. March 07, 2021. Accessed March 2021. https://www.who.int/news-room/commentaries/detail/waive-covid-vaccine-patents-to-put-world-on-war-footing.

Green, Andrew. “In Brief: Rich Countries Block Waiver on COVID-19 Vaccine IP.” Devex. February 4, 2021. Accessed March 2021. https://www.devex.com/news/in-brief-rich-countries-block-waiver-on-covid-19-vaccine-ip-99077

Heggen, Kristin, Tony Sandset, and Eivind Engebretson. “COVID-19 and Sustainable Development Goals.” World Health Organization, October 2020. Accessed March. 2020. https://www.who.int/bulletin/volumes/98/10/20-263533/en/.

Human Rights Watch. "Whoever Finds the Vaccine Must Share It.” Human Rights Watch. November 03, 2020a. Accessed April 2021.                                                   https://www.hrw.org/report/2020/10/29/whoever-finds-vaccine-must-share-it/strengthening-human-rights-and-transparency.

Human Rights Watch. “Human Rights Dimensions of COVID-19 Response.” Human Rights Watch. March 19, 2020b. Accessed March 2020. https://www.hrw.org/news/2020/03/19/human-rights-dimensions-covid-19-response.

Human Rights Watch. “COVID-19’s Devastating Impact on Children.” Human Rights Watch. April 9, 2020c. Accessed April 2021. https://www.hrw.org/news/2020/04/09/covid-19s-devastating-impact-children.

Jerving, Sara. “Africa CDC outlines ultracold storage strategy for COVID-19 vaccines.” Devex. January 21, 2021. Accessed March 2021. https://www.devex.com/news/africa-cdc-outlines-ultracold-storage-strategy-for-covid-19-vaccines-98962.

Johns Hopkins. “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins.” Johns Hopkins. Live Reports. Accessed April 15, 202. https://coronavirus.jhu.edu/map.html

Karrim, Azarrah. “Pharmaceuticals Berate SA, India in Letter to Biden for Pushing Vaccine Property Rights Waiver.” News 24. March 10, 2021. Accessed March 2021. https://www.news24.com/news24/southafrica/news/pharmaceuticals-berate-sa-india-in-letter-to-biden-for-pushing-vaccine-property-rights-waiver-20210310.

LOWY Institute. “COVID Performance Index: Deconstructing Pandemic Response.” LOWY Institute. March 13, 2021. Accessed April 2021. https://interactives.lowyinstitute.org/features/covid-performance/#overview.

McCain, Nicole. “SAA’s ‘R5m Journey’ to Fetch Latest Vaccine Doses a ‘Vanity Flight,’ says Pilots’ Association.” News24. February 25, 2021. Accessed March 2021. https://www.news24.com/news24/southafrica/news/saas-r5m-journey-to-fetch-latest-vaccine-doses-a-vanity-flight-says-pilots-association-20210225

Madhi, Shabir. “South Africa failed to get its act together on vaccines: here’s how.” The Conversation. January 15, 2021. Accessed March 2021. https://theconversation.com/south-africa-failed-to-get-its-act-together-on-vaccines-heres-how-153384.

Medecins Sans Frontieres. “Southern Africa Needs the Right COVID-19 Vaccines, at the Right Price-Right Now.” Medecins Sans Frontieres. February 18, 2021. Accessed April 2021. https://www.msf.org/msf-urges-rich-countries-share-appropriate-covid-19-vaccines-southern-africa.

Mitchley, Alex. “Politicians got the COVID-19 Jab Early to Show the Public that it is Safe, Health Dept says.” News24. March 3, 2021. Accessed March 2021. https://www.news24.com/news24/southafrica/news/politicians-got-the-covid-19-jab-early-to-show-the-public-that-it-is-safe-health-dept-says-20210303.

Mthethwa, Cebelihla. “‘We Can’t be Silent in the Face of Vaccine Apartheid’- Archbishop Makgoba.” News24. March 11, 2021. Accessed March 2021. https://www.news24.com/news24/southafrica/news/we-cant-be-silent-in-the-face-of-vaccine-apartheid-archbishop-makgoba-20210311.

Mwai, Peter. “Coronavirus: When Will South Africa Start Vaccinating?” BBC News: Africa, January 21, 2021. Accessed February, 2021. https://www.bbc.com/news/world-africa-55675806

Ngqakamba, Sesona. “COVID-19 vaccine: Registration for Phase 2 to Start in April, says Ramaphosa.” News24. March 31, 2021. Accessed April 2021. https://www.news24.com/news24/southafrica/news/covid-19-vaccine-registration-for-phase-2-to-start-in-april-says-ramaphosa-20210331.

Ngutjinazo, Okeri. "Why Many Africans Are Wary of COVID-19 Vaccines." DW.COM. March 04, 2021. Accessed April 02, 2021. https://www.dw.com/en/why-many-africans-are-wary-of-covid-19-vaccines/a-56774599.

Norbrook, Nicholas. “South Africa eyes post-Covid future, but ‘we are not out of the woods yet’ warns Mkhize.” The Africa Report. February 19, 2021. Accessed March 2021. https://www.theafricareport.com/67028/south-africa-eyes-post-covid-future-but-we-are-not-out-of-the-woods-yet-warns-mkhize.

NPR. “How Rich Countries are ‘Hoarding’ The World’s Vaccines, In Charts.” NPR, December 3, 2020. Accessed March 2021. https://www.npr.org/sections/goatsandsoda/2020/12/03/942303736/how-rich-countries-are-hoarding-the-worlds-vaccines-in-charts.

OHCHR. “Human Rights and Access to COVID-19 Vaccines.” OHCHR, December 17, 2020. Accessed March 2021. https://www.ohchr.org/Documents/Events/COVID-19_AccessVaccines_Guidance.pdf.

Opali, Otiato. “Africa's Rollout Gathers Pace as More Doses Arrive.” China Daily News.                       February 5, 2021. Accessed February 2021. https://www.chinadaily.com.cn/a/202102/05/WS601cad44a31024ad0baa775c.html.

Piertromarchi, Virginia. “Patently Unfair: Can Waivers Help Solve COVID Vaccine Inequality?” Aljazeera. March 1, 2021. Accessed April 2021. https://www.aljazeera.com/news/2021/3/1/can-a-waiver-on-ip-rights-solve-vaccine.

Phillip, Xolisa. “Africa: AU chair Ramaphosa calls out ‘painful irony’ of vaccine access.” The    Africa Report. January 28 2021a. Accessed March                                                              2021. https://www.theafricareport.com/62123/africa-au-chair-ramaphosa-calls-out-painful-irony-of-vaccine-access/

Phillip, Xolisa. “Africa Needs $200m Jumpstart and to Revamp Its Vaccine Models Says Biovac CEO.” The Africa Report.com. The Africa Report. February 22, 2021b.                              https://www.theafricareport.com/67320/africa-needs-200m-jumpstart-and-to-revamp-its-vaccine-models-says-biovac-ceo/.

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Reuters. “UNICEF: $R156bn More Needed for COVAX Vaccine Rollout, Says UNICEF Chief.” News24. March 10, 2021. Accessed March 2021. https://news24.com/news24/world/news/covid-19-r156bn-more-needed-for-covax-vaccine-rollout-says-unicef-chief-20210310.

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Sarajerving. “Africa CDC Outlines Ultracold Storage Strategy for COVID-19 Vaccines.” Devex. January 21, 2021. https://www.devex.com/news/africa-cdc-outlines-ultracold-storage-strategy-for-covid-19-vaccines-98962.

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Wiysonge, Charles, Ndwandwe, Duduzile, Ryan, Jill, Jaca, Anelisa, Batoure, Oumarou, Anya, Blanche-Philopmene Melanga and Sara Cooper. “Vaccine Hesitancy in the Era of COVID-19: Could Lessons from the Past Help in the Future?” Human Vaccines & Immunotherapeutics (2021): 1-3. https://doi.org.libproxy.wlu.ca/10.1080/21645515.2021.1893062.

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WHO Africa Region. “COVID-19 Cases.” World Health Organization. 2021. Accessed April 2021. https://who.maps.arcgis.com/apps/opsdashboard/index.html#/0c9b3a8b68d0437a8cf28581e9c063a9.



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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