The ANC has dropped the ball on vaccine procurement and rollout in a spectacular manner.  By the day the signs have been mounting that our government dawdled and failed to do its homework. There is little evidence that a rollout on a massive scale can begin in the next few weeks. 

The economic case for mass vaccination against Covid-19 is a no-brainer. A vaccine programme would help cut short the pandemic and yield immense direct savings on medical resources. It would also help end the lockdown sooner rather than later and allow a full return to work, an economic recovery and with that a rise in tax revenue.  With our economy under dire stress, rolling out vaccines as soon as possible should have been the big priority. 

South Africa’s vaccine rollout will be months behind that in more than 30 countries, some a lot poorer than us. Israel, which is not a fabulously wealthy country, has so far immunised about a quarter of its population.  South Africa has little chance of meeting the declared goal of vaccinating two thirds of the population or about 40 million people by the end of the year. 

Alarm signals have sounded, but there has been a collective failure to push for proper accountability. There was no allocation to buy a sufficient number of vaccine doses to cover two thirds of the population in October’s Medium-Term Budget Policy Statement. This is even though Covid-19 vaccine development by a number of companies was advanced. A sign of government’s grossly misplaced priorities, the Medium-Term Budget contained a R10bn splurge to support SAA – the government glamour project. As it turns out, this amount is slightly above the approximate cost of R8.6bn for a vaccine programme. 

Later the failure by government to meet the deadline for its first down payment to the COVAX facility to acquire doses for ten percent of the population set off an alarm, but the sleep button was soon pressed by all of us as it was soon paid.  Finally, earlier this month, under pressure from a public letter from scientists to President Cyril Ramaphosa pointing to the absence of a plan, government responded. But even then its claims that it will vaccinate two thirds of the population by the end of the year do not hold up to scrutiny. 

Lack of accountability and poor management in government resulted in a pitiful failure to conduct proper due diligence. 

 Professor Shabir Madhi, Professor of Vaccinology at Wits writes that what went so wrong was the government’s over-reliance on COVAX. As an upper middle income country South Africa found itself having to pay $12-$13 per dose to participate in the COVAX facility. Madhi writes that this is more than three times the cost of procuring the vaccine directly from AstraZeneca at the prevailing price of $3 per dose. COVAX will supply 12 million doses in coming months that will cover ten percent of the SA population, as well as an additional 6.5 million doses at a later stage. 

That is a bad deal. We would have been better off buying from the pharmaceutical companies and making a reasonable direct donation to some of our neighbours, rather than an untargeted donation to the world’s poor. 

The failure to sound the alarm early and often over government’s dawdling and lack of due diligence also shows up the opposition parties, the media, and the medical community. Why did they not ask questions in public at the time of the release last year of the R500bn Covid-19 emergency support package and scrutinise the Medium-Term Budget Policy Statement for a line item on vaccines. The big missed question to ask was what sort of deal we were getting from COVAX?

In countries that have higher standards of accountability, the ministers responsible for this failure would have been forced to resign some time ago. Yet against this shambolic background government has declared that it will centralise the programme on the spurious grounds that this is to cut corruption. Decentralised procurement and rollout under the private sector would probably permit far less corruption and delay. South Africa’s poor performance on child immunisation probably does not indicate that the public health system would perform well on Covid-19 vaccination. 

 A speedy rollout has become vital to prevent the virus from further mutating and perhaps ultimately developing features that render the present vaccines ineffective. The effectiveness of the current Covid-19 vaccines against the recent mutations is still under investigation. But a slow rollout will delay building herd immunity and may require another round of vaccine development, and further prolong the pandemic and lockdowns. 

There is no sign of an imminent arrival of a sufficient supply of vaccines in SA to allow for rapid immunisation of the population.  Democratic Alliance (DA) Leader John Steenhuisen has pointed out that the promised supply of vaccines is so far uncertain. There is no signed deal yet for 1.5 million doses from the Serum Institute of India, a million of which we have been told will be delivered this month. The 1.5 million doses from India are meant to cover around 750,000 health workers. 

A Health Department official told Rapport that negotiations are still underway for the purchase of 20 million doses which we were told would hopefully arrive in the first half of the year.  President Cyril Ramaphosa has pointed to a supply of 270 million doses secured by the African Union, but there has been no information on what South Africa’s share will be and when it will be delivered. 

Earlier this week the DA threatened to take the government to court to compel it to release a full and detailed plan on where the vaccines are coming from, how much is being paid, and what happens when they get here. 

How do we quickly get out of the debacle?

First, the private sector needs to be able to purchase vaccines without government interference. 

The UK has appointed a Cabinet Minister to deal with its vaccine rollout. South Africa needs to up its game and appoint an individual from the private sector who has the sort of business experience that can ensure a quick rollout. 

The Vaccine Tsar should be independent to ensure that government does not hamstring the rollout. Ideally, the Tsar should be selected by the private sector bodies upon whom government is likely to heavily rely for a rollout – the pharmaceutical chains, health insurers, occupational health clinics and others. If government insists that the private health sector subsidise the process, let the private sector take charge. 

Putting the private sector in charge would ensure that public sector work restrictions would not kill the process. Jack Bloom, the DA’s Gauteng Shadow MEC for Health points out that great flexibility is required to ensure an efficient process. In Israel, rather than discarding unused vaccine, the government offers inoculations to those who might not be in the priority demographic. 

Will the public health system offer vaccines after normal hours and over weekends?

Thus far, our Covid-19 saga makes a strong case for libertarianism. 

The views of the writer are not necessarily the views of the Daily Friend or the IRR.

Correction: Monday’s article Is the WHO fit for purpose? (Part III) referred to Nigerian former finance minister, Ngozi Okonjo-Iweala, as “He”. Okonjo-Iweala is a woman.

Jonathan Katzenellenbogen is a Johannesburg-based freelance journalist. His articles have appeared on DefenceWeb, Politicsweb, as well as in a number of overseas publications. Katzenellenbogen has also worked on Business Day and as a TV and radio reporter and newsreader. He has a Master's degree in International Relations from the Fletcher School of Law and Diplomacy at Tufts University and an MBA from the MIT Sloan School of Management.