The urgent need for vaccine parity

As the Omicron variant spreads across the world, Dr Nicholas Crisp, Acting Director-General of South Africa Ministry of Health, speaks to HW Editor Sarah Cartledge about the importance of assisting other countries to help themselves

The sudden recent emergence of the new Omicron coronavirus variant has led to the unwelcome tightening of restrictions globally. First detected by South African scientists, it appears to a ect younger people who have not been vaccinated. The instinctive reaction to ban flights from the country has finally provoked the wider conversation that has been put on hold for more than a year – the urgent need for vaccine parity.

South Africa has su ered more than most African countries from the e ects of COVID-19. With deaths in excess of 200,000 and the Beta variant identified as originating there, the health department is fighting to vaccinate the population rapidly, despite slow uptake and political obstacles.

Heading up the task is Dr Nicholas Crisp, a retired public health o icial who was originally brought back to set up the new o ice for the proposed national health insurance programme. On his arrival in June 2021 he was also asked to run the struggling vaccine programme, and he went on to stand in as Director General when the incumbent was placed on precautionary suspension.

With a wealth of national and international public health experience, he is fighting many battles and the most important is to contain the anticipated fourth wave. Each wave has been more aggressive than the previous one, but vaccination rates have been good in parts.

Around 14.5m people have received both doses, with 22m vaccines administered thus far.

Changing the distribution strategy

Much of this success has been achieved despite the cuts in the healthcare budget of more than 6 per cent. Many donors have come to their aid and the large private sector has been closely involved. The US and UK government among others have helped with vaccine supplies, while the German government has assisted with refrigeration and digital solutions.

But the wider issue lies with South Africa’s porous borders. With six neighbouring countries – Botswana, Namibia, Mozambique, Lesotho, Swaziland and Zimbabwe – and 1,740 miles of coastline with many ports, South Africa has to remain vigilant.

“We have to be able to vaccinate everybody who comes here, whether they’re legal or illegal,” says Dr Crisp. “And the more they can be vaccinated in their own countries, the less they want to come here for vaccination. We need countries to understand that it doesn’t help to keep giving us donations – it needs a di erent structure.

“Let’s create a pool that donates to neighbouring countries which South Africa will facilitate. We will help to get their vaccination programmes going as people move regionally between these borders for work and trade and so forth. It’s in all of our interests that we vaccinate everybody.”

He feels that South Africa is being held to ransom by global pharma companies as the country is too large to qualify for COVAX donations and is hampered by the healthcare budget cuts. “COVAX has been disappointingly supported by other countries and it doesn’t serve anyone’s interests to have this global apartheid,” he says. “We’re strongly in favour of pooling our resources, whether it’s patents or vaccines. We’re aiming towards getting the vaccines made here, along with other drugs and APIs so we can be more self-su icient, working together with the African Union.

Dr Nicholas Crisp Acting Director-General South Africa Ministry of Health

“Let’s create a pool that donates to neighbouring countries which South Africa will facilitate”

Rolling out the vaccine

South Africa was hit hard at the start of the pandemic. “The first wave was huge but we managed to get private and public hospitals to accept patients,” Dr Crisp says. “Now the clinicians have more experience of the virus and we have worked out who is more likely to get sick, but at the time we had lockdowns which a ected both the tourism and hospitality sectors enormously.”

A er some false starts the Pfizer vaccine has been the mainstay of the programme and, following distribution issues, the Johnson & Johnson vaccine is also in use. With 1800 primary vaccination sites, many with their own satellite sites, there are 12,000 vaccinators and more than 65 per cent of over 60s have now received at least one jab.

Surprisingly, the rural areas have been more successful in achieving a good coverage rate. Political and religious leaders have been travelling around their communities in advance of the mobile clinics, encouraging people to attend. In contrast, larger urban groups have been more di icult to reach.

“The urban vaccination sites are static and people are reluctant to spend money to travel to them,” he adds. “We also have a lot of anti-vaxxers and negative media, so we have devised a demand creation strategy which uses our government communication systems together with a full range of private providers who have come mostly voluntarily to the system, such as private radio stations and print media. This is vital as coronavirus has decimated the economy of communities and created massive mental health and education issues.”

The speed of the South African medical community in identifying a new strain shows the important work being done behind the scenes. For South Africa to face renewed economic hardship as a result of closed borders seems harsh to many. However, Dr Crisp is realistic about the situation.

“Our allies are the BRICS and not so much the West,” he says. “If the West wants to stay friends with Africa, then they have to be really interested in opening up trade and helping us grow our economies. COVID has taught us that if we don’t stand up for ourselves in Africa, we’re going to end up being the poor kid in the corner with the le over porridge. And that’s not OK.”