By Mike Burnard
On Sunday evening, 7 January, South African health minister Dr Zweli Mkhize and a panel of leading experts hosted a media briefing to outline new developments in South Africa’s Covid-19 vaccine acquisition and rollout programme.
Professor Shabir Madhi, who led the clinical trial of the Oxford/AstraZeneca vaccine candidate locally, said that while the vaccine had initially showed “tremendous potential” against the previous dominant strain, results against the new strain were ‘disappointing.’
One million doses of the AstraZeneca Covid-19 vaccine arrived at OR Tambo airport last week from India.
The results mean that the rollout out of the vaccine is being put on hold, however according to Professor Salim Abdool Karim, one of South Africa’s leading COVID-19 experts, the findings do not spell “doom and gloom”.
The news that the 1 million doses will now be rendered “ineffective” led to a public outcry in the South African media ranging from charges of corruption, allegations of deception, claims of incompetence, accusations of waste and general outcries of frustration.
In a season of uncertainty, exasperated by countless conspiracy theories and a lack of trust in government policies, it remains critical to separate the noise from the news and examine the information critically and contextually.
Is it government deception or simply a need for a different perception?
First of all, the AstraZeneca fail is not a uniquely South African crisis.
Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. More than 50 individual nations have ordered more than 2 billion doses of the AstraZeneca vaccine. These countries will all face the same challenge as South Africa to re-strategize and find the most effective way of using the vaccine with the new information available.
Secondly, it’s not a matter of incompetence from those who procured the vaccine but a lack of information at the time. When the vaccines were developed and approved, the new strain was still an unknown factor.
The trial for the AstraZeneca vaccine began towards the end of August last year before the 501Y.V2 variant was identified and widely circulating in South Africa. According to Professor Shabir Madhi , who led the clinical trial of the Oxford/AstraZeneca vaccine candidate locally, the trial was showing around 75% efficacy by the end of October.
On 27 January 2021 Helen Rees, chairwoman of the South African Health Products Authority (SAHPRA) board, announced that South Africa has approved AstraZeneca’s Covid-19 vaccine for emergency use and is reviewing applications by rival manufacturers, Johnson & Johnson, and Pfizer. “In terms of the AstraZeneca vaccine … this has been granted emergency use (approval) and there will be a press conference with the minister of health on this (later),” said Ms Rees.
This decision was taken at a time where tests indicated a 70% effective rate on average.
But when the new variant became increasingly dominant, that efficacy dropped to 10%. This is because, in many cases, people in the group receiving the vaccine had to fight COVID caused by 501Y.V2, as opposed to disease caused by the original form of the variant. Studies have shown that the new variant is not only more infectious than its predecessor, but has changed itself in such a way that it can evade the antibodies that our body’s produce in response to the original version of the virus, which is what the AstraZeneca vaccine was designed around.
Thirdly, the fact that the vaccine is less effective in “mild cases” does not imply that the vaccine is suddenly rendered useless as a vaccine.
The UK Vaccines Minister, Nadhim Zahawi, explained in an interview that it still deals “effectively with serious illness, serious disease and hospitalisation‘: “The new scientific data revealed that the AstraZeneca vaccine offered “minimal protection” against mild and moderate illness in the new COVID-19 strain, but it still is a very important part of the global response to the current pandemic, easing the strain on hospitals and healthcare systems.”
Professor Shabir Madhi , who led the South African clinical trial of the Oxford/AstraZeneca vaccine, said that it was important to protect high-risk groups against severe forms of COVID-19 and death. “I think it would be somewhat reckless of us to discard all the millions of dollars of vaccine that is available. There is a biological probability that these vaccines might still be useful in terms of protecting against severe disease.”
Minister Zahawi from the UK said AstraZeneca is ‘confident’ its jab prevents serious illness caused by the South African coronavirus variant after early data from a small study suggested the vaccine was less effective against the strain.
Fourthly, the new data does not derail the government’s efforts to find solutions to curb the spread of the virus, it simply means a new strategy needs to be adopted. The emphasis will now most probably shift from using the vaccine for healthcare workers first to those who are already seriously ill. But, at this stage, there are still many uncertainties. Bhekisisa lists the following 6 unknowns that will be researched and investigated in the weeks to come:
Whether the AstraZeneca vaccine will be included in an implementation study — and at what dosing interval (four weeks or three months) — to determine whether the jab protects against severe disease. A team of scientists is meeting every day this week to make this decision.
Whether the implementation study will include mixing of vaccines, i.e. a first shot of one jab followed by a second short of another vaccine.
How many people will be included in the study overall? It is estimated that there will be 100 000 healthcare workers receiving each vaccine, but this could change as the study is underway.
When the implementation study will start and for how long it will go on. Each vaccine candidate will have to be individually assessed based on its initial clinical trial results to see at what point the jab can move to wider roll-out or if it needs to be halted completely.
Whether other vaccines (on top of Pfizer, Johnson & Johnson and possibly AstraZeneca) will also, eventually, be included in the implementation study. At this stage, it seems scientists will look at the data of each new vaccine option before deciding whether it can just be rolled-out or whether it first needs to be part of the implementation study.
How many people South Africa aims to have vaccinated by the end of the year with its new roll-out strategy — the original goal was 40 million, which many experts argued is unrealistic.
From a Christian perspective
1Peter 1:13 gives a glorious exhortation not to be ignorant nor to be deceived, but also not to lose hope: Therefore, with minds that are alert and fully sober, set your hope on the grace to be brought to you when Jesus Christ is revealed at his coming.
We are to hope perfectly and trust without doubting to that grace which is offered to us by the gospel. Matthew Henry explains it as follows: The main work of a Christian lies in the right management of his heart and of his mind.
But not only are we beneficiaries of hope, we also need to be conduits of hope. Yes, we seek the truth and find the facts, but we present it in such a way that all will know that in Christ, life has a purpose and challenges presents opportunities. No vaccine, no strain, no pandemic and virus can separate us from the love of God (Romans 8:38)
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