A Johnson & Johnson vaccine against the COVID-19 at the Klerksdorp Hospital, as South Africa proceeds with its inoculation campaign on February 18, 2021. Photo: Phill Magakoe/AFP
On Tuesday 13 April, Health Minister Dr Zwelini Mkhize announced the suspension of the Johnson & Johnson (J&J) vaccine roll-out to healthcare workers over fears of blood clotting. The decision comes after the Food and Drug Administration (FDA) in the United States suspended its use of the vaccine and J&J’s delay in further shipments. Over 1.5 million South Africans have been infected with COVID-19 and the variant B1.351, causing the loss of over 53 000 lives. After an incredibly difficult year for South Africans, the arrival of the COVID-19 vaccine roll-out brings new hope for life returning to some degree of normality. The pandemic has highlighted the socio-economic and healthcare inequalities found across South African communities. Effectively administering the COVID-19 vaccines will be vital in the quest to halt further socio-economic decline and give South Africans a brighter outlook for 2021.
Despite facing serious challenges in Personal Protective Equipment (PPE) and oxygen availability, and overwhelming hospital admissions, South African healthcare workers must be commended for their efforts in combatting the virus thus far. Their efforts have translated to a recovery rate of about 95% among COVID-19 patients. It is hoped that the vaccine roll-out will begin easing pressure on our healthcare system, because there are many other important healthcare crises that need our healthcare workers’ attention.
Progress for Phase 1
Source: Department of Health, 15 April 2021. *Announced on 24 March 2021
South Africa was the first country on the African continent to receive the AstraZenca COVID-19 vaccine in February. Since then, Minister Mkhize presented a three-phase plan to inoculate healthcare workers, essential workers, vulnerable groups, and the public. The first phase of the vaccine roll-out runs in conjunction with the Sisonke Study, which is a clinical trial of the single-dose J&J COVID-19 vaccine. The clinical trial allows the government to make the J&J vaccine available to healthcare workers while it processes the licensing of the vaccine. The target set for the Sisonke trail is to vaccinate 500,000 healthcare workers.
Since vaccinations began in February, about 292,623 healthcare workers have received their dose. This slow rate of inoculation has raised concerns. The daily vaccination rate is too low to meet the proposed target of 1.25 million healthcare workers by 17 May. However, at the current rate we will only vaccinate just over 500,000 healthcare workers. When President Cyril Ramaphosa addressed the nation before the Easter weekend, he indicated that the government were on track to complete healthcare worker vaccinations within three months. However, there is confusion as to whether he is referring to the Sisonke trial or the 1.25 million targets. In Minister Mkhize’s cabinet statement, he refers to 1.5 million healthcare workers, whereas on the National Institute for Communicable Diseases (NICD) website, the number is 1.2 million healthcare workers. That would leave around 650,000 healthcare workers remaining, to be carried over to Phase 2, placing an additional burden on the roll-out process. Strengthening our primary healthcare infrastructure is vital if we are to vaccinate 67% (~41 million people) of South Africa’s population.
Source: Department of Health, Government Communications 2021
Reflections from healthcare workers
In an attempt to ascertain the vaccine roll-out’s progress, we interviewed some healthcare workers – doctors, administrative staff and biokineticists. Experiences varied and were mostly positive. The electronic vaccination data system (EVDS) was complimented for its ease of use in both registering and booking their vaccine appointments. In some cases, doctors were turned away if doses had run out before the end of the day, requiring them to reschedule for another day. When queuing for their vaccination, social distancing protocols were not strictly followed, which were a concern for those we spoke to. They all described having the expected post-vaccination symptoms for 48-72 hours.
A repeated concern raised was the hesitancy among some healthcare workers to register for vaccination. There are myths and misinformation circulating amongst communities about the safety of the vaccine. If healthcare workers are hesitant, rallying citizens to register could be a challenge. The government has released a ‘myths and facts’ page addressing some of this misinformation. The government implemented mask-wearing campaign is a good example of a positive initiative adopted by the public and private sector. Continued communication from government and civil society to remote communities is equally important to build positive vaccine sentiment.
Minister Mkhize has also proposed a post market surveillance system study to ensure medical authorities closely monitor the deployment of both J&J and Pfizer.
Three phase roll-out strategy – the devil is in the detail
Phase 1 roll-out facts and challenges
The first phase of the government’s roll-out plan proposed 18 centralised sites which have now expanded to 58. During the expansion there was confusion around certain sites being listed as open but were in fact closed and vice versa. For a venue to be utilised as a vaccination site, the South African Medical Research Council (SAMRC), the Department of Health (DoH), Desmond Tutu Health Foundation, Centre for Aids Programme of Research (CAPRISA) and Janssen Pharmaceuticals must be consulted. This makes the coordination of opening a vaccination site somewhat complex. The process of approving venues creates a bottleneck. The sites need constant updating on the EVDS where registration occurs. There is little information yet on how the government plans to overcome this process when Phase 2 begins next month, which could add to the already strained roll-out process.
Phase 2 roll-out plans
The government plans on increasing the number of vaccination sites to 1,750 and they will range between small, medium and large sites. Small sites will likely be community clinics or pharmacies and general practitioner offices. Medium sites include hospitals, medical centres and retail locations that may be fixed or temporary. Large sites are venues such as stadiums and conference centres.
A massive scale-up effort is needed for site approval if they are to reach this target and vaccinate up to 300,000 people a day. To reach that number per day we will need to mobilise at least 6,250 vaccinators (per day) and they’ll need to do 48 inoculations a day. If South Africa enters a third wave it could mean that some sites would have to de-escalate vaccination efforts to open facilities for COVID-19 testing, slowing down the roll-out further.
Source: Department of Health 2021
Before the end of April, an additional one million doses of J&J are expected to arrive, after which two tranches of 900,000 doses will arrive in May and June. 31 million J&J (single dose) and 30 million Pfizer (two dose) vaccines have been secured by the DoH. Just under two million Pfizer doses are expected to arrive in May. In total South Africa is expected to have 46 million full vaccine doses, which should be sufficient to cover the necessary 40 million needed to obtain herd immunity.
The J&J vaccine will be particularly important for the roll-out in rural areas and remote communities. The J&J vaccine is easier to store, with only a single dose and can be frozen and kept for up two years (refer to the table below). Its efficacy against the B1.351 variant is 95% and is very effective in preventing severe disease or death associated with COVID-19. Unopened vials can be kept for up to three months at fridge temperatures of between 2˚C and 8˚C. If they are drawn into syringes, they will need to be administered within six hours.
Source: Department of Health, National Institute of Communicable Diseases 2021
The Pfizer vaccine on the other hand requires colder storage -20˚C for up to 14 days, and 2-8˚C up to 5 days, with two doses required and can be frozen for up to 6 months (refer to table below). The second dose should be administered between 21-42 days after the first dose. As yet there is no substantial clinical evidence that the Pfizer vaccine protects against the B1.351 variant. A recent study concluded that the B1.351 variant was, to some degree, able to break through’s the Pfizer vaccine’s protection. The government will need to confirm veracity of this study before administering the vaccine. Coordination amongst pharmacists, vaccinators, researchers, and medical administration staff is vital to ensure jabs are not wasted, so as to avoid any impediments to the roll-out process.
Supply chain governance
Proposals for storage and distribution of the vaccine will be done on an open-tender basis. The Biologicals and Vaccines Institute of Southern Africa (Biovac) and the SAMRC have helped distribute the J&J vaccine but the government is yet to announce who will distribute the Pfizer vaccine. Minister Mkhize has said the department have identified storage capacity across the country but no further details on where these facilities are located.
When vaccines reach their destination, they will need to be signed off by a pharmacist on delivery. The World Health Organization (WHO) recommends at least one pharmacist for every 2,300 people, in South Africa we have one for every 3,837 people. The distribution of pharmacists across provinces is not equal and may pose a problem when delivery is made to areas without these specialists. Measures should be implemented to ensure the adequate placement of pharmacists across provinces is finalised so as to mitigate challenges that may arise.
Local vaccine manufacturing
The government has partnered with Biovac, Aspen and ImmunityBio to develop localised manufacturing of a COVID-19 vaccine that will offer long duration immunity against multiple variants of COVID-19. President Ramaphosa has called for the continent to use its existing skills and capacity to manufacture its own vaccines. Rwanda’s President Paul Kagame said that “vaccine equity” cannot be guaranteed by “goodwill alone” and that Africa should produce its own vaccines and pharmaceuticals products. The COVID-19 pandemic presents an opportunity for African countries to collaborate and promote continental (and local) innovation within the pharmaceutical industry.
- Government to continue sharing relevant information learnt from Phase 1 to grow public trust and confidence in the vaccination roll-out process.
- Finalise the sites and required number of healthcare workers to be placed to administer vaccines per site.
- Formulate measures to overcome potential internet connectivity concerns for vaccine registration.
- Finalise registration process for undocumented migrants without passports or identification documents.
- Government to continue sharing the vaccination roll-out progress.
 Current population estimate for South Africa is 59.6 million according to StatsSA data from 2020.
New posters have popped up on the streets of South Africa advertising ‘vaccination R150’. At first glance they could be referring to any vaccine, but COVID-19 is likely the disease in question. And recent incidents suggest there is cause for concern.
In November 2020, the South African Police Service raided a warehouse in Germiston east of Johannesburg and discovered a consignment of packages resembling COVID-19 vaccines. They comprised around 2 400 fake doses and large quantities of counterfeit N95 face masks that originated from China worth around R6 million (US$40 000). Days later, INTERPOL issued an orange notice warning for law enforcement agencies worldwide of organised crime networks advertising, selling and administering fake COVID-19 vaccines.
COVID-19 vaccination is intended to provide immunity against Covid-19, but fake vaccines are already entering the market in South Africa. Photo: Getty Images
In February, police in China dismantled a criminal network responsible for producing and selling water as COVID-19 vaccine shots in Kunshan, eastern China. Police had arrested the syndicate leader in December 2020. It isn’t clear if the fake vaccines seized in South Africa originated from this network, but the syndicate did ship an estimated 600 doses abroad (destination unspecified) on 12 November 2020.
South Africa isn’t the only African country threatened by criminal networks trafficking fake medicines. Counterfeit vaccines have been reported only in South Africa, but this form of organised crime will eventually reach other African countries given the rise in COVID-19 cases on the continent.
Fake medicines are pharmaceutical products sold to deceive the buyers regarding the contents. These products are misbranded, often contain the wrong active ingredient or even toxic substances, and are manufactured by unqualified personnel.
The illegal trade in counterfeit medicines presents a significant threat to Africa. In addition to the negative impact on markets, economies and livelihoods, it also severely affects the health sector. ENACT research shows that these products help spread drug-resistant illness and undermine confidence in health professionals and systems.
Experts believe fake medicines and supplies are the most lucrative sector within the counterfeit market. While the market size is difficult to measure, it’s estimated to be billions of US dollars annually. Africa bears the brunt of this.
The World Health Organization reports that between 2013 and 2017, 42% of all cases of counterfeit medication reported were in Africa. However, this figure was probably higher, considering that not all cases are reported.
Innovation: local heroes
Kenyans are used to finding local solutions to everyday challenges and COVID-19 has inspired innovators to find creative ways to cope with the pandemic
Kenyan fashion designer of “Lookslikeavido”, David Avido, 24, poses for a portrait at his studio in Kibera, Nairobi, on March 18, 2020, with a mask he made, that he creates from remnant of cloth he uses, to hand out to people for free so that they can wear it as a preventive measure against the COVID-19 coronavirus. (Photo by Gordwin ODHIAMBO / AFP)
Onyango Okoth was diagnosed with COVID-19 on 14 July after he visited a hospital in Kisumu for what he claims was a routine medical check. The father of four, who works as a fisherman in Lake Victoria in the western part of Kenya, says he had experienced shortness of breath and high fever the previous day, prompting him to look for treatment. “After receiving initial medical assistance, I was advised to go back home as the hospital facilities were packed,” says Okoth. “The doctors said I was to self-isolate for at least 14 days.” But Okoth, 45, did not know where to start; he’d never heard of self-care. “It was a long, tough and draining struggle with my meagre resources, which had to compete for food, medical equipment and sanitary products,” he told Africa in Fact. Faced with this financial pressure, he says he opted to look for alternative and affordable solutions, particularly a special bed that he had been advised to obtain. Okoth’s story mirrors the daily struggle of many Kenyans in the wake of the COVID-19 pandemic.
While more than 30,000 Kenyans had contracted the disease by the first week of September, and there had been 581 deaths, many people had also lost their livelihoods, which has translated to escalated poverty rates. On 1 September, the Kenya Bureau of Statistics said in its Quarterly Labour Force report that unemployment had increased to 10.4% between April and June 2020 compared to the 5.2% recorded in the first quarter of 2020. But even though the crisis has meant sweeping changes to Kenyan society, daily routines and work life, it has also acted as a powerful driver of creative thought and innovation, especially among young people. “As much as we are working around the clock to ensure Kenyans adhere to the COVID-19 protocols and guidelines to contain its spread, we are also challenging young people to come up with innovations in response to the outbreak to stimulate economic and job growth,” says Julius Korir, the Principal Secretary, State Department for Youth.
This, he adds, is being done through training, mentorship, support systems, funding and the creation of an innovation-specific regulatory framework. Acknowledging that innovation is a critical element in providing solutions to ensure better health for all, the World Health Organization (WHO) in the African region held the first in a series of virtual innovation showcases on 21 May that brought together eight innovators and entrepreneurs drawn from Ghana, South Africa, Nigeria, Guinea and Kenya, all of whom had found their own creative solutions to addressing gaps in local responses to COVID-19. Innovations showcased included interactive public transport contact tracing apps, dynamic data analytics systems, rapid diagnostic testing kits, mobile testing booths and low-cost critical care beds.
Among the eight innovators was Gordon Ogutu, 34, from Nairobi’s Githurai slums, who turned to YouTube to learn how critical care beds could be made and improvised locally to fit the demands of the market for people like Onyango Okoth. Ogutu says it was his anger that the Kenyan government was spending billions of shillings to import critical care beds that inspired him to come up with a local solution. Using the know-how he gathered from YouTube, he now makes critical care beds from locally assembled materials. Celebrating the creativity of Ogutu’s work during the event, WHO regional innovation advisor Moredreck Chibi said they aimed at continuing to integrate African innovators into the regional COVID-19 response strategy. Ogutu’s metal critical care beds are designed to provide comfort and safety to both the patient and the caregiver. The design includes a release feature that allows medical teams to flatten the bed at the push of a button or lever and IV poles with hooks to hang fluids and other medication administered via a drip.
Kenyan fashion desiner of “Lookslikeavido” David Avido, 24, creates masks from remnant of cloth he uses, to hand out to people for free so that they can wear it as a preventive measure against the COVID-19 coronavirus, in Kibera, Nairobi, on March 18, 2020. (Photo by Gordwin ODHIAMBO / AFP)
The beds also have removable heads and footboards, which lock safely into place allowing caregivers to tilt the bed and also to adjust the height. “If they (western countries) can do it, then I knew I could also, perhaps even better,” says Ogutu, who graduated from the Kenya Polytechnic in industrial chemistry in 2010. “I gained a lot of knowledge from various online platforms; it was not as complex as I had thought initially.” He told Africa in Fact that the demand for his beds had grown exponentially, with small hospitals as well individuals among his customers. “Impressed by my workmanship, customers have come from as far as 500 km away to order their beds. As a result, I have expanded my workshop labour pool to six, sometimes as many as 15 depending on the orders to be made.” Among his individual customers is Michael Ndwiga, 54, from Embu in central Kenya, who in June had two suspected COVID-19 cases in his family.
He says he purchased the locally made critical care beds from Ogutu after the government announced the plan for patients to be looked after at home due to congestion in hospitals. “Apart from being affordable, they are of good quality, and (quite) similar to those that are imported from abroad,” he said. Ogutu hopes to benefit from President Uhuru Kenyatta’s call on 15 July, which instructed the government to procure 500 hospital beds from local innovators. “The locally made critical care beds are a vital aid to public hospitals that are reeling under the pressure of COVID-19-related admissions,” President Kenyatta said then. The opportunities arising from the pandemic for young innovators have extended beyond critical care beds to locally made surgical masks, which were initially imported, at a relatively higher cost, from the United States, Europe and Asia.
David Avido, 24, a designer and proprietor of the LooksLikeAvido, a Kibrabased fashion firm that focuses on African fabrics, says he took matters into his own hands to produce masks for the people of the Kibra slums after he realised the gravity of the coronavirus. Unlike other businesses driven by return on investment, he told Africa in Fact that he makes and distributes the masks for free. Since March, Avido said, he had distributed more than 20,000 of the items. For his philanthropy, Avido has received a special commendation from President Kenyatta, listed in the 2020 Presidential Citations Order for Outstanding Professionals in Kenya’s response to the coronavirus pandemic. Also among the 68 on the list for the Presidential Order of Service – Uzalendo Award was nine-year-old Stephen Wamukota from Mukwa in Bungoma, western Kenya, who came up with a wooden hand-washing machine to help check the spread of coronavirus.
Wamukota, who came up with the idea after learning on television about ways to prevent catching the virus, says the machine allows users to tip a bucket of water using a foot pedal to avoid touching surfaces, thus reducing the chance of infections. In a bid to enhance innovation, Deputy President William Ruto, in a 24 July tweet, said the government would step up the mentoring and resourcing of micro-, small- and medium-sized businesses and startups “with an appreciation that they are the arteries of our development”. He noted that, due to the biting effects of the COVID-19 pandemic on the economy, the government would support and forge partnerships with creative entrepreneurs and businesses, big and small, to support their sustainable growth. Young people across Africa, he said, were exposed to environments that encouraged innovation.
“No doubt in the near future, given proper attention and the right environment, Africa will be the centre of global innovations and inventions, where even vaccines for stubborn pandemics like COVID-19 can be found,” he said.
Youth: Fighting COVID-19 their way
Africa’s young people are using resourcefulness and new technologies to engage and make a difference in the battle against the virus
Ndlovu Youth Choir “America’s Got Talent” Season 14 Live Show Red Carpet at Dolby Theatre on September 17, 2019 in Hollywood, California. Photo: Frazer Harrison/Getty Images/AFP
As Africa continues to battle COVID-19, the continent’s youth are not sitting idly by waiting for the worst to come. Across the continent, young people are hard at work, in partnership with governments and diverse partners, providing solutions to help reduce the spread of the virus and ways to address the socioeconomic impact of the pandemic, through engagements and innovation. In Egypt, Mohamed Elkholy, 25, is using new technologies to engage young people, fight misinformation about COVID-19 and spread the right messages about the virus. Mohamed, the leader of youth network Y-Peer Egypt, has been hosting a youth-to-youth podcast programme to create awareness among young people. In a country like Egypt, where youth constitute some 60% of the population, finding effective ways to engage young people and empower them is important in the battle against the pandemic.
Gwendolyn Myers, a 29-year-old peace activist, is co-chairing the National Youth Taskforce Against COVID-19 in Liberia. The task force was set up under the auspices of Liberia’s Ministry of Youth and Sports, bringing together five youth-led organisations. It was established to mobilise and build young people, empowering them to to lead campaigns against the pandemic in local communities. The task force, for example, uses young people at grassroots levels to ensure food is distributed to vulnerable sectors of the population, and to distribute essential sanitary material in high-risk virus hotspots such as slum communities and informal settlements with large populations and a limited supply of social services. In East Africa, Kibra Green is a youth organisation in Kenya’s largest slum, Kibera, in the capital Nairobi. The group is passionate about the localised implementation of the United Nations Sustainable Development Goals (SDGs), including SDG 3 on health and wellbeing.
The group has been engaged in several initiatives to mitigate and reduce the spread of COVID-19. Alfred Otieno, a leading member of Kibra Green, believes that youth have a critical role to play in the fight against the virus. In their case, the group, in partnership with UN-Habitat and Médecins Sans Frontières (Doctors without Borders), has set up hand-washing stations for residents, enabling them to sanitise. The group has also handed out masks, disseminated relevant information about COVID-19 and prevention, as well distributed food and other essential items to vulnerable families, including sanitary pads to needy girls. Kennedy Odede, the CEO and founder of Shining Hope for Communities (SHOFCO), a grassroots organisation that offers support to several hundred thousand slum residents in Nairobi, argues that youth are in the majority on the continent and yet most of the time young people find themselves marginalised. “We can’t win this COVID-19 war if the youth are not involved,” Odede says.
Mohammed Elkholy spreads the right messages about COVID-19. Photo: Raphael Obonyo
“We have a new youth in Africa who will not follow orders. This new youth want to be listened to, not told what to do. They believe they have the solutions. Now let’s tap on them to fight COVID-19.” In Democratic Republic of Congo (DRC), Christella Kiakuba, 26, an orphan of military parents and co-founder of community organisation Telema Mwana Ya Mapinga, is helping women and orphans protect themselves from the coronavirus. She is distributing face masks and showing people how to use them, and how to sanitise. She and her organisation deliver food and provide legal help to widows and orphans. In Cameroon, Achaleke Christian, the national coordinator of civil society organisation Local Youth Corner, launched a “One Person, One Sanitiser” campaign in April to prevent the spread of coronavirus, especially among the poor.
He and members of the youth group have produced homemade hand sanitisers using World Health Organization standards and distributed them for free, teaming up with a coalition of youth civil society organisations, medical doctors, pharmacists and a laboratory scientist in the process. In South Africa, young people have been at the forefront of government and community efforts to educate people about the basic preventive measures to help curb the spread of COVID-19. One example is 750Amped, a national campaign launched in May by South Africa’s National Department of Health and the Health and Welfare Sector Education and Training Authority (HWSETA). The initiative, which involved the initial training of 750 learners, was established as “a proactive intervention that leverages the power of youth to inspire changes in social behaviour through training, education, and awareness around COVID-19”, according to the 750Amped website.
Kibra Green is a youth organisation engaged in initiatives to mitigate the spread of COVID-19 in Kibera, Nairobi. Photo: Raphael Obonyo
Young South Africans have also used the power of music to encourage their communities to practise preventative measures against the virus. The Ndlovu Youth Choir, which was originally formed in 2008 by a Dutch doctor, working in South Africa’s largely rural Limpopo province to help orphans and the children of Aids patients, became a global phenomenon when they reached the finals of the TV show America’s Got Talent. They were forced to cancel an international tour when COVID-19 swept the world, but since then a video of a new song, in isiZulu with English subtitles, that demonstrates how to practise basic preventative measures, has gone viral. North of the border, in Zimbabwe, Bridget Mutsinze, 25, is among a group of youth volunteers working with development organisation Voluntary Service Overseas (VOS), using social media to fight coronavirus misinformation.
They have taken to Twitter, WhatsApp, Facebook and radio to comb through online comments, to identify and correct COVID-19 misinformation. In Côte d’Ivoire, Ibrahima Diabate and the Youth Peace and Security Network recorded a series of awareness-raising videos in different local languages to disseminate the much-needed information about coronavirus. The videos went viral on social media platforms. The use of local languages, and the cultural translation of the messages in ways that make sense to the communities they target, have enhanced their accessibility. And telling the stories of life under COVID-19, in this case among poor and marginalised communities in southern Africa, are dynamic young journalists like the team at Tazama World Media in Kenya, led by James Smart and Kizito Gamba in Kenya, who are dedicated to community-based journalism using smart phones and social media.
As South Africa’s Sport, Arts and Culture Minister Nathi Mthethwa said when he launched youth month 2020 on 2 June, recalling the role of young people in fighting the country’s apartheid regime: “The youth of 2020 have been called upon to fight a much more silent war, the coronavirus pandemic, and to help rebuild a society post COVID-19.” As Mthethwa correctly noted in his address, young people have a major role to play in the fight against the coronavirus – because youth are Africa’s greatest asset and the future of the continent depends on them.