A new study found that the AstraZeneca vaccine is significantly less effective against the new Covid-19 strain that emerged in South Africa. This is a major setback and expectations of an immunisation drive will have to be adjusted.
When the first vaccines against Covid-19 cleared phase three clinical trials late last year, there was palpable optimism that there might soon be an end to the pandemic that has gripped the world.
Some of the more expensive and innovative vaccines were reported to be 95% effective. Others, like the Oxford/ChAdOx1 nCoV-19 vaccine made by AstraZeneca, came in at 70% effectiveness.
The AstraZeneca vaccine was also the least expensive vaccine on the market by far, being sold at cost. In the EU, it sold for as little as $2.19, while in the US the price was $4.
That safe vaccines were developed so quickly and promised to be so effective could spell the end of the catastrophic lockdowns that authoritarian governments foisted upon their hapless citizens worldwide. This offered a rare ray of hope in an otherwise dismal 2020.
The South African government had to be slapped into action at the start of this year by public outrage that nothing had been done to acquire vaccines or plan for their roll-out, except for ordering an insufficient shipment from the World Health Organisation’s Covax facility that was only due to arrive by winter.
President Cyril Ramaphosa blatantly lied to the nation on 11 January when he said: ‘The South African government has also been engaging directly with several vaccine manufacturers for over six months.’
No, it hasn’t. It hadn’t engaged with vaccine manufacturers at all.
The Department of Health (DoH) had sought a deviation from normal procurement practices in November 2020 in order to order vaccines from the Covax facility. Before that, nothing at all had been done.
Request for a deviation
The DoH’s first request for a deviation to negotiate with vaccine manufacturers themselves – including the Serum Institute of India (SII), Pfizer, Johnson & Johnson, and Moderna – was made on 6 January 2021, a week after the media and healthcare experts laid into the government for having done nothing to secure an adequate vaccine supply.
Plans for the roll-out, such as training healthcare professionals on the handling and storage of Covid-19 vaccines and how to address public concerns about the jabs, only began in mid-January.
(I’d like to suggest an election slogan for the Democratic Alliance: ‘Rampahosa lied. People died’.)
Belatedly, the DoH cut a deal with the SII, which produces the AstraZeneca vaccine under licence. Someone’s cousin brokered a deal by which South Africa would pay only twice what it would cost to buy the vaccines directly from AstraZeneca.
A million-odd doses, destined for healthcare workers, duly arrived in the country last Monday, 1 February, to huge fanfare. Images of the crate of vaccines being unloaded from an aeroplane were plastered all over television screens. It was surrounded by a crowd of top government officials inspecting the manifest, with a massive cavalcade of black BMWs in the background to transport them all onto and off the airport apron.
Rarely has a nondescript freight container landed with more pomp and circumstance. The president took to his bully pulpit to announce the good news, forgetting to thank the Indian government, which was duly outraged.
Not a week later, a bombshell landed, which promises to throw a month’s worth of hasty planning into disarray.
On Sunday night, the Department of Health aired a webinar in which it announced the results of a small clinical trial conducted at Wits University under the leadership of Dr Shabir Madhi.
It found that although the AstraZeneca vaccine had high efficacy against the original coronavirus strain, it offered minimal protection against mild-to-moderate disease caused by the new South African strain. (The strain was once known as 501Y.V2, but just as we memorised that cryptic name, they renamed it to the equally cryptic B.1.351).
The study was too small, and its participant profile too young and low-risk, to determine effectiveness against moderate-to-severe disease, hospitalisation or death. However, a study of a very similar vaccine, made by Johnson & Johnson (J&J) subsidiary Janssen, did assess effectiveness against moderate-to-severe disease, and found efficacy was maintained for the new virus strain.
Nothing wrong with the vaccine
It should be noted – before anti-vaxxers cry wolf – that the findings did not undermine any of the safety data from the larger clinical trials conducted by AstraZeneca. There’s nothing wrong with the vaccine. It just isn’t as effective against the new strain as it was against the original virus.
This is not entirely unexpected, either. Viruses are known to mutate and new strains are often less responsive to vaccines designed with older strains in mind. This is why, for example, we need a new influenza vaccine every season.
Dr Madhi still holds out hope that the AstraZeneca vaccine will have a role to play in South Africa’s vaccination campaign and will still prove to be protective against severe disease, but in light of the new findings, the DoH has put its roll-out on hold for now.
Instead, it will fast-track the procurement of vaccines from Janssen to begin inoculating healthcare workers. J&J recently applied for emergency authorisation to use the Janssen vaccine in South Africa.
The suspension of plans to roll out the AstraZeneca vaccine comes as a body blow to healthcare workers, who for nearly a year have been risking their own lives and those of their families to test and treat Covid-19 patients. Several hundred have died in the line of duty. Most pinned their hopes on the early availability of a vaccine to protect them from the dangers of the job.
There is a silver lining to the dark cloud, however. The Janssen vaccine is the only one that comes close to competing with the AstraZeneca vaccine on price, at $10 per dose.
More importantly, unlike any other existing Covid-19 vaccine, it has a single-dose formulation, which makes it much easier and quicker to administer. We would not need to make sure that every vaccine recipient returns for their second shot at the right time. In a country as badly run as ours, that will make a huge difference.
In global trials, the Janssen vaccine has proved to be 66% effective against contracting Covid-19 and 85% effective in preventing severe disease and death. In its South African trial, led by Dr Glenda Gray, it appeared to be 57% effective against contracting the disease. It could be better, but it’s not nothing, either.
‘Protection of all at-risk individuals’
According to Madhi, the setback for the AstraZeneca vaccine and the likelihood of future strains of the virus that causes Covid-19 being able to evade other existing vaccines, “force us to recalibrate thinking about how to approach the pandemic virus and shift the focus from the aspirational goal of herd immunity against transmission to the protection of all at-risk individuals in the population against severe disease”.
Herd immunity would have been first prize, since it also protects those who do not take the vaccine, for whatever reason, and holds out hope that the virus can be eradicated altogether.
Now it seems more likely that Covid-19 will be with us for a long time, mutating into new variants that can re-infect previously immune populations. The goal then is to adapt vaccines to target the new strains and use them to reduce the risk of severe disease in at-risk individuals, much like we do today with seasonal influenza.
Efforts are already underway to develop a new generation of vaccines that protect against emerging strains by means of booster jabs, according to Wits.
How exactly this will shake out remains to be seen. It is too early to abandon the goal of vaccinating at least 67% of South Africans. After all, even in young, healthy individuals, Covid-19 can cause death or severe and lasting damage to the lungs and other organs.
However, this development does caution us to temper our expectations that a simple vaccination drive will be enough to eradicate Covid-19.
To prevent further destructive lockdowns, it remains of the utmost importance to take sensible precautions against spreading the virus. Don’t party like it’s 2019. Practise social distancing. Avoid crowded places, especially indoors. Wear masks when near other people (and anywhere in public if you don’t want to be jailed). Don’t touch your face. Regularly wash your hands.
These measures cause minimal inconvenience and economic harm, unlike the government’s much harsher lockdown rules that will surely be reimposed if new waves of infection strike in future.
Instead of hoping that Covid-19 can be wiped out, we will probably need to learn to live with it for a long time to come.
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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