Orlando, Florida, February 9, 2021 --  

A vaccine failure in South Africa shows how leaving the continent unvaccinated will exacerbate the pandemic for the rest of us.

The halt in South Africa's vaccination program just one week after doses began arriving in the country is a troubling sign of what the future holds for a pandemic-weary world.

South Africa's ministry of health announced the suspension after early results showing the AstraZeneca vaccine giving minimal protection against strains circulating in the country. Those strains include a mutated variant known as B.1.351 that has global health authorities worried.¹

For South Africa, the initial failure of the AstraZeneca vaccine leaves it scrambling for alternatives. Johnson and Johnson's vaccine has shown a moderate 57% efficacy against strains in South Africa. and a vaccine from Novavax has shown 49% efficacy.² Both these vaccines require only refrigerated temperatures and not ultra-cold storage like vaccines from Moderna and Pfizer, To date, the country has not sourced China's Sinovac nor Russia's Sputnik-5.

South African officials have announced they are in talks with J&J to use its vaccine as a drop-in replacement for AstraZeneca's product in their vaccination of health workers.³ Those plans will first require regulatory approval of the J&J vaccine in South Africa, as well as a commitment from J&J to deliver the required doses.

Getting commitments for deliveries is often the driving problem for less wealthy countries like South Africa. Rich nations in Europe and North America have long since locked in massive orders from Moderna, Pfizer and AstraZeneca leaving few doses available for middle-income countries like South Africa, let alone poorer nations in the rest of the continent.

This "vaccine nationalism" is intended by rich nations to protect their domestic populations first, ending the pandemic early in countries that can afford to do so. But the case of South Africa shows how foolish those plans are. Unvaccinated countries serve as incubators for new mutations which will destroy the efficacy of existing vaccines and require the design, testing and manufacture of new ones. While AstraZeneca has announced plans to work with its research partners at Oxford University to "tweak" its vaccine to better target the South African strain, this process will likely take most of this year.

South Africa's vaccine program is hardly typical for Africa. The country has by far the most advanced economy and health system on the continent. Between the Cape of Good Hope and the Mediterranean Sea, there are 1.3 billion people, most living in countries with little hope of mass vaccination programs any time soon. Tanzania's anti-vaxxer president has rejected the idea of vaccinating the population.⁴ And most other African nations that do want vaccines are relying on a World Health Organization program called COVAX designed to distribute vaccines to poor and middle-income countries.

But the WHO COVAX program has been beset by delays caused by rich nations snapping up the early supply of vaccines. The American and British governments have both hedged their bets between multiple vaccines (a hedge proved wise by the AstraZeneca failure) and have bought up far more does than needed to cover their respective populations. This led Serbia's president to quip, "It’s as if they intend to vaccinate all their cats and dogs.” ⁵

Many poor African countries have little hope of getting widespread vaccinations this year. and there is hardly any international attention to this problem. Part of the lack of attention is because there have so far been few pandemic horror stories coming out of Africa's poorer nations. Part of the reason for this may be because it has a very young population that is more likely to experience asymptomatic infections vs. severe cases. Part of this may be because poorer African countries are not as globally connected as places like South Africa, leading to less contact with people where cases are widespread. And part of it may also be lack of good data. South Africa is the only country south of the Sahara that has good statistics on elevated death rates.

But even if the rates of severe disease and death are for some reason lower in poorer parts of Africa, an unvaccinated continent is still a risk to the rest of the world. Even in asymptomatic cases, the virus invades cells, replicates, and spreads to other people. Those replications will create new mutations. Sooner or later, one of those mutations will have a similar or worse effect than the B.1.351 variant that forced South Africa to abandon the AstraZeneca vaccine. A pool of 1.3 billion unvaccinated people spreading the virus around simply cannot be ignored.

The end result will be that mass vaccinations in the rich world will offer limited, if any, periods of herd immunity. This will only last until mutations originating in unvaccinated areas re-light the fire of the pandemic and unleash the disease upon the rich world yet again. If the rich world is to avoid this fate, production capacity must grow enough to distribute the vaccine to all.

Notes:

1. Business Tech, South Africa Hopes to Get Johnson & Johnson Covid-19 Vaccines This Week, February 8, 2021

2. Science, South Africa suspends Use of AstraZeneca’s COVID-19 Vaccine After it Fails to Clearly Stop Virus Variant, February 8, 2021

3. Eyewitness News, SA Turns to J&J Vaccine to Begin COVID-19 Immunization Programme, February 8, 2021

4. BBC, Coronavirus in Tanzania: The Country That's Rejecting the Vaccine, February 6, 2021

5. Voice of America, AstraZeneca Vaccine Less Effective Versus South African Variant, February 6, 2021