What happens when Covid-19 vaccines become available in South Africa?

The rollout of the Pfizer/BioNTech Covid-19 vaccine is well underway in the UK, US and Canada.

In South Africa, Johnson & Johnson is the first to apply for Covid-19 vaccine registration in the country, while at least four coronavirus vaccine candidates are being evaluated.

While developing countries may only begin to receive large-scale vaccine delivery in the second half of 2021, Clicks and Dis-Chem are uniquely positioned to support the Covid-19 vaccine rollout in South Africa, from distribution to vaccine administering, says Jeremy Gorven, senior analyst at Stonehage Fleming Equity Management South Africa.

Over the last 12 months, these two pharmacy groups collectively held 1.5 million patient consultations through their clinic infrastructure, dispensed close to 50% of the country’s medicine, while Clicks alone administered 273,000 flu vaccines.

For vaccine manufacturers to supply South Africa, they are required to apply for approval from the South African Health Products Regulatory Authority (SAHPRA).

In anticipation of applications, SAHPRA has undertaken a readiness programme. The decision on how vaccines are distributed lies with the National Department of Health.

Usually, licenced pharmacies, hospitals and dispensing doctors can order SAHPRA approved vaccines, Gorven said.

As confirmed by president Ramaphosa in his latest national address, South Africa has completed all necessary processes to be part of COVAX, the World Health Organisation’s equitable vaccine distribution scheme, which aims to provide 2 billion doses by the end of 2021 to low and middle-income countries at a maximum cost of $3 a dose.

South Africa expects to receive vaccines from COVAX sufficient for 10% of its population in early 2021, Gorven said.

He said that South Africa is not well set up for the Pfizer/BioNTech vaccine given its extreme cold chain requirements but is most likely to access vaccines from Novavax, Johnson & Johnson and Oxford AstraZeneca.

The vaccines being tested by these pharmaceuticals are stored at fridge temperature, are cheaper than Pfizer and Moderna, and manufacturing capacity of 6 billion doses per annum is being established between them, Gorven said.

Aspen Pharmaceuticals has been contracted by Johnson & Johnson to produce 300 million vaccines in South Africa. Production may begin in the second quarter of 2021. “It remains unclear what portion of these vaccines may be made available to South Africans,” Gorven said.

Bill Gates, whose foundation has been funding the development of vaccines, expects Johnson & Johnson and Novavax’s Covid-19 vaccines to complete phase III drug trials by February 2021. Gates has further stated that he expects these vaccines to prove ‘very efficacious and safe’.

From factory gate to vaccine administering

Clicks Group and Dis-Chem Pharmacies, the analyst said, have the infrastructure, skills and know-how on a national scale to support the vaccination of the South African public.

“At this stage, it is unclear when a vaccine might arrive and how access will be determined.”

Clicks’ bulk distributor UPD is the market leader in the distribution of drugs from manufacturing facilities to wholesale facilities. UPD currently services Aspen, and it is possible that UPD may distribute a portion of the Johnson & Johnson vaccines, which Aspen is producing.

With a footprint of 772 pharmacies, and a 45% dispensary market share, Clicks and Dis-Chem are within close range of the majority of South Africa’s population, Gorven pointed out.

Both groups have played an active role in Covid-19 testing and antibody testing including the rollout of mobile clinics and drive-through stations by Dis-Chem. These services can be adapted to include vaccination efforts.

“Between them, the two groups operate 479 clinics equipped with vaccine fridges, employ 450 full time nurses and over the last 12 months have held over 1.5 million patient consultations including immunisations.

“Both pharmacists and nurses administer annual flu vaccines. In 2020, Clicks pharmacists administered 273,000 flu vaccines, 29% of South Africa’s total in the private healthcare market.”

Once Covid-19 vaccine candidates have been approved, the national Health Department will determine their access and distribution.

SAHPRA meanwhile, controls the rollout of all health products in the country, including monitoring, evaluating and registration.

Read: South Africa gets first Covid-19 vaccine application

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What happens when Covid-19 vaccines become available in South Africa?