3.3 million Pfizer doses are due to expire on 31 March 2023, and a further 26 million vaccines doses will expire at the end of April.
The most recent comprehensive report shows that South Africa currently has almost 30 million doses of the COVID-19 vaccine in stock. Roughly 8 million are Johnson & Johnson doses and the rest are Pfizer.
According to the National Department of Health (NDoH), if unused, the expired vaccines won’t be discarded. Instead, the department will apply for to the South African Health Products Regulatory Authority (SAHPRA) for an extension assessment.
COVID-19 vaccine wastage
Currently, there is no stored stock that has expired. The department periodically applies to the regulator for the extension of the expiry date based on stability testing. In this way, none of the unused vaccines is disposed of even after the expiry date, while the department awaits further applications and approvals for extensions.
According to the NDoH, the country’s total wastage so far is at 1.5% and varies from one part of the country to another, depending on the month and on the ratio of public to private usage. Currently, no province has exceeded 2% wastage.
“Unavoidable waste” is reported when not all doses in a vial can be used and when vials are exposed to field conditions and cannot be returned to fridges for use the next day. The standard is that 15% to 25% of 10-dose vials of vaccines can be expected to be wasted in this way.
South Africa has been trying to donate vaccines since last year. However, no countries in Africa are interested and many other countries are instead trying to donate to South Africa.
“We have not procured any COVID-19 vaccines for well over a year. All vaccines were procured when they became available, and we sit with those commitments,” says Foster Mohale, spokesperson for the Department of Health.
Efforts to exit vaccine procurement agreements have been largely successful with COVAX but not at all with Janssen.
With just over 38 million COVID-19 vaccines administered in the whole vaccination period, the country still sits below the target of 70% of the population being vaccinated. Only 4.2 million people have come forward for booster doses, including people that are developing severe diseases and who are most in need of input.
Professor of Vaccinology at Wits University, Shabir Madhi, says there are several reasons for the low uptake of vaccines.
“One of the major drivers is that infection with the virus has resulted in less severe disease due to extensive infection. When people get infected now, they’re less likely to develop severe disease from the virus.
The booster uptake is not growing due to the improper messaging as to what the benefits of the booster dose are, when to get it, and who specifically would benefit most from the boost. The messaging to the public doesn’t ensure that those people that will benefit the most are actually mobilised to come forward for the booster dose,” he says.
Other issues include the anti-vaccine sentiment that has gained traction, which casts doubt in terms of the value of vaccines, as well as their role in influencing the willingness of people to get vaccinated.
Children are not the target
Only 35% of adolescents between the ages of 12 and 18 have been vaccinated at least once.
Mohale says children are not a target of the department’s communication campaign. The exception is children with immunocompromised conditions and those who wish to travel to countries that require vaccination.
Young adults over 18 are a target, as this is an under-vaccinated portion of the population.
Mohale says that local vaccine targeting of communities and groups of people identified with low coverage has had varied success.
Madhi says the extremely low uptake in children will not have an impact and should not be a concern. “Firstly, the ordinary healthy child is at a very low risk of developing severe disease. To vaccinate those who don’t have any underlying medical conditions, which predisposes them to severe disease, is not a very strong case to vaccinate children.
Secondly, considering the low burden of disease children, Madhi doesn’t believe that the current generation of COVID-19 vaccines are necessary, as they work in protecting against severe disease, but they work less well in protecting against infection.
The current generation of vaccines is referred to as the first generation. The second generation of vaccines are vaccines that will be more robust in terms of increasing the immunity for protection against mild disease due to new variants.
“As the virus mutates, the vaccines become less effective in protecting against infections. We would like to have vaccines that protect against severe disease that would be sort of a different type of vaccine that targets parts of the virus that are less likely to mutate, but at the same time are able to protect against severe disease.”
Unplanned vaccine roll-out
A part of the problem in the vaccine roll-out is that the department was not very strategic in how they target who should be vaccinated, says Madhi.
“We focused on chasing after the numbers. We continued increasing the pool of people that can be vaccinated, without really reflecting whether we are efficient with the manner in which we’re using our vaccines.”
Madhi notes the department did not sort out the logistics of vaccine education and distribution, and that by the time the vaccines became available to the country, the peak in the Delta wave had already passed.
“Unfortunately, the fact that we have millions of doses that will expire is a failure on the part of the government to adequately strategise the roll-out of vaccines and to actually get it into the hands of people that require them timeously,” he says.
Data still shows that people at a higher risk of developing severe disease, require more frequent doses of boosters or more frequent booster doses. The COVID-19 vaccine still remains the safest and most efficient protection against severe illness caused by the virus.
The latest COVID-19 vaccine statistics show that the uptake of primary vaccination remains low, although January showed a marginal pickup in booster doses where the health departments have events and interventions in communities.
New vaccination sites are added across the country on a regular basis. For the latest vaccination sites visit: https://sacoronavirus.co.za/active-vaccination-sites/.