Trisha shakes her head when asked if she's vaccinated. The Cape Town student heard stories that people died afterwards. "So I was scared. I don't want to risk my life." Only half of her family members are vaccinated, the 19-year-old says. That's slightly more than the national average.
About 40% of adult South Africans are fully vaccinated. On the whole continent, just 15%. The World Health Organization has set a target of 70% coverage for all countries by June 2022. So far, only Mauritius and Seychelles reached that number in Africa. Most countries will likely miss it.
About 40% of South Africa's adult population are fully vaccinated against COVID
From 'historic agreement' to historic failure?
"We have to fight complacency," says Stavros Nicolaou, a Senior Executive at Aspen Pharmacare Group. About one year ago the company started manufacturing COVID-19 vaccines in the city of Gqeberha.
The production line received a €600 million ($634 million) long-term financing package from development agencies, also from Germany. South Africa's president Cyril Ramaphosa called it a "historic agreement." Aspen said it could manufacture more than 200 million doses per year for Johnson & Johnson. That number was never reached.
President Ramaphosa received the Johnson & Johnson COVID vaccine in early 2021
Later, Aspen went into a licensing arrangement with Johnson & Johnson and acquired rights to manufacture their own vaccine Aspenovax.
So far they haven't received a single order — and are now at risk to shut down the production lines. "Everybody has supported building local capacities on the continent," Nicolaou told DW. "But that policy decision has not been practically expressed in orders."
Aspen has counted on orders by multinational procurement agencies – but never received any. About 60% of COVID-19 vaccines used in Africa went through the UN-backed COVAX (COVID-19 Vaccines Global Access) facility. In the past, several industrialized countries donated their surplus doses to COVAX and poorer nations. Often with approaching expiry dates.
At the outset of the pandemic, Johnson & Johnson ran clinical COVID vaccine trials in South Africa
'A massive setback for Africa's plans'
In the absence of orders or commitments, Aspen is considering the repurposing of two COVID-19 production lines for the manufacture of other products. "The continent would lose its only existing COVID vaccine manufacturing capacity," Nicolaou says. "It would be a massive setback for Africa's plans to localize and reduce its dependency on imported vaccines."
About one percent of vaccines used in Africa are currently manufactured on the continent. At the beginning of the pandemic, several African leaders said they want 60% of all vaccines produced locally by 2040. Africa's major public health body, the Africa Centers for Disease Control and Prevention (Africa CDC), urged all buyers of COVID-19 vaccines for the continent to place orders with Aspen.
Wolfgang Preiser, a virologist at Stellenbosch University, says the risk of production closure is alarming news. He is worried that in future pandemics, pharmaceutical companies might be more reluctant to ramp up investments under pressure. However, he says it is not unexpected: As global production capacity was stepped up globally, it was clear that at some stage vaccine supply would exceed demand.
Repurposed for other types of vaccines
While Aspen runs the only commercial COVID-19 vaccine production plant on the continent, at least six African countries are currently setting mRNA vaccine production capacity. Preiser believes they could be repurposed to produce other types of vaccines. "This field has really accelerated enormously during the pandemic. Many people expect that in the future we will have mRNA vaccines against a number of other diseases, possibly also cancer."
The reputation of the Johnson & Johnson vaccine could be another reason for the lacking orders, Preiser says. "It had a bit of a rough start," according to the virologist. Last week regulators in the United States announced strict limits on who can receive the Johnson & Johnson vaccine amid ongoing concerns about a rare but serious side effect that could cause life-threatening blood clots in patients who receive the shot.
Despite previous challenges, Africa CDC has been recommending the Johnson & Johnson vaccine on the continent. Unlike mRNA vaccines it is easier to store and distribute, especially in rural areas.
Preiser emphasizes that all approved vaccines are safe and effective. Numbers of new COVID-19 infections in South Africa are currently increasing, driven by omicron sub-lineages BA.4 and BA.5.
Preiser says he is sometimes tired of arguing with those refusing the vaccine. "It reminds me of 25 years ago, when we had similar scenarios for HIV."
At the outset of the HIV/AIDS epidemic, many South Africans denied the existence of the virus
"But we need to improve our way to communicate with the public to convince people to get vaccinated," the virologist says. The excess death rate during the COVID-19 pandemic suggests 300,000 related deaths in South Africa.
Edited by: Benita van Eyssen