MDC Alliance Weekly Health Alert (5th Edition)

COVID-19 Vaccination – Whither to?

This weekly publication is meant to inform fellow citizens on various matters concerning the deadly covid-19 pandemic, and to facilitate informed decisions by every single one of us. Today we continue to examine the issue of the covid-19 vaccine to see if we could do better as a nation than what we have done so far.

Now that 200 000 doses of Sinopharm vaccine are here, have we arrived? Are we going to continue to procure more Sinopharm vaccines? How should Zimbabwe proceed to maximize benefit from the availability of vaccines against Covid-19 from various manufacturers and diverse technologies? What is the way forward? These are some of the questions that urgently beg an answer.

The arrival of the Sinopharm vaccine is only but the beginning. Whether we started well or not, and whether or not the processes leading to the arrival of the Sinopharm vaccine were correct, can no longer be undone. We now need to focus on the way forward, and this is what we are going to dwell on today.

Moving forward, there is need for government to carry the people with it. Transparency is key in all processes for the vaccination program to work. The government cannot just say, “If you don’t want to take the vaccine, you are free to opt out”, NO! Hear the people out and address their fears and concerns, and address all the conspiracy theories scientifically, as best we know how to. Zimbabweans deserve better, and information is key. In this process, we must immunize against corruption, wrong executive decisions propelled by greed and avarice, and the devaluation of the lives of the people of Zimbabwe through intransigence and autocracy.

Let me lay out upfront the concerns of the people of Zimbabwe before we move on. Firstly, the government in Harare is notorious for corruption, ranking 157 out of 180 countries in a recent Corruption Perceptions Index (CPI) report. We are in the top of the league. We therefore demand transparency from government on how they chose the vaccine, and how much they are paying for it. This irregular vaccine procurement can be used for looting the already moribund treasury. Our comment has nothing to do with the vaccine being Chinese per se, but we are just demanding accountability from the government, which is our due.

History tends to repeat itself. A considerable portion of the public health community in Zimbabwe is worried that government is not paying attention to the recommendations of the *“National Immunization Technical Advisory Group”* (ZimNITAG). Sadly this confirms that our decisions are not science driven and do not have the nation at heart.

Next, we demand information. How are the field trials going to be conducted? What information is going to be collected? When do we expect results of the field trials, which will inform us as individuals on whether to take the vaccine or not. We need transparency on why government is collecting samples as they vaccinate. What are we studying?

We need transparency on what other vaccines are coming, when and how much? We need transparency on the cost of all the vaccines. We need to raise awareness and educate the people about these vaccines. The World Health Organisation (WHO) is still assessing data submitted by Sinopharm and has not yet issued emergency use authorization (EUA) for this vaccine. It looks like such approval may only come in March at the earliest as it remains unclear why we rushed to get a vaccine that WHO has not yet okayed. We are however aware that countries like the UAE have done their own Phase 3 trials on this vaccine and have issued their own EUA. We must likewise be diligent to do our own field trials and keep the nation adequately informed as it is important to examine all options on the market.

What role is Parliament playing in terms of oversight in all these corruption prone processes, including choice of vaccine, procurement, logistics and distribution? Does the government not perceive a need to do extensive stakeholder consultations to distil the wisdom of the population and to get buy-in?

Now let us look at what government should be looking for as they choose vaccines to use in Zimbabwe. If we are going to spend money, let us spend it on something that works for our people.

1. SAFETY: The golden rule here is, first do no harm. We continue to emphasise the importance of properly conducted clinical trials in the field, to detect adverse events. Thereafter continued post-marketing surveillance is important to detect rare adverse events. A thorough risk-benefit analysis must be done for every vaccine candidate.

2.EFFICACY: This is a measure of the ability of the vaccine to prevent disease in the target population. The gold standard for measuring this is Randomized Controlled Trials in healthy populations. With the South African variant firmly established in Zimbabwe, it is important to document the efficacy of the Sinopharm vaccine before we spend any more money on it, and this applies to any other vaccine that we may consider to bring in. We aver that the 200 000 doses donation is adequate to conduct conclusive trials on the efficacy of the Sinopharm vaccine before we buy anymore.

3.EFFECTIVENESS: This is a measure of the total protection that we get through programmatic implementation, and depends not only on the efficacy of the vaccine, but on other parameters like the actual vaccine storage (do Zimbabwe fridges work?), transportation, preparation and administration of the vaccine, fairness of the roll out plan, and completeness of coverage. Indirect effects like herd immunity will amplify effectiveness of the vaccine to protect even those who have not been vaccinated. We are generally worried about the state of our cold chain infrastructure and equipment, staff morale and training, and vehicles & staff for mobile outreach services. The reported statement by the Zimbabwe Nurses Association does not inspire confidence, and government should take the requests of health workers seriously. This will negatively affect the effectiveness of our vaccination program.

4.VACCINE PRODUCT CHARACTERISTICS: Storage and transportation requirements differ among vaccines. In Zimbabwe, we are better off taking only those vaccines that are stored and transported at normal refrigerator temperatures (2oC – 8oC). Pfizer seems to be reviewing the low temperature requirement for their vaccine, and it seems this was done out of an abundance of caution. We need to keep our ears to the ground, as this is a developing story.

Having to reconstitute a vaccine before administration increases the workload for health workers and vaccines that come in solution are easier and quicker to administer. There are many other vaccine characteristics to consider (e.g. wastage rate, demand for syringes and needles, presentation and packaging, etc) and these are well explained on the WHO website. The Technical Advisory Group (NITAG) mentioned earlier is the one best placed to advise government on vaccine choice, and government must pay attention. Of note is the number of doses required to fully immunize an individual. The Johnson and Johnson (J & J) vaccine requires only one dose for full immunization, and this is a great advantage when we look at the issue of completing an immunization schedule. South Africa has started rolling out the J & J single dose vaccine and there could be something for us to emulate right there. Remember 61% of our virus is the South African variant.

5.COST: This is extremely important. Information we have is that the Sinopharm vaccine is more expensive than most other vaccines on the market, including the single dose of the  J & J vaccine mentioned earlier. One BBC report said “It’s not clear how much it might cost, but earlier this year, a BBC team in the Chinese city of Yiwu saw that nurses were administering the injections for a fee of around 400 Yuan ($60; £45)”

this be true, then we would like to know why Zimbabwe government chose this one, compared to the Astra-Zeneca @ $4 per dose, or Johnson and Johnson at $10 per dose. Furthermore, there is the COVAX and the African Union facilities for pooled procurement, which will make vaccines a lot cheaper and more available. It boggles the mind why our government was dithering on the issue of subscribing to these facilities when the benefits are clear. That brings the suspicion of intent to defraud the people by forming cartels, which no one can audit.

6. Finally, AVAILABILITY of the vaccine is critical and self-explanatory.

In conclusion, we want to thank The People’s Republic of China for their generous donation. We further want to implore the government to do the due diligent studies on the Sinopharm vaccine safety and efficacy before purchasing any, and to consider other suitable alternatives like the single dose Johnson and Johnson vaccine. This we mention specifically because it is already in use in RSA, we have the same viral strains (61%), and we are really one people on one land mass. We need to coordinate our efforts because inefficacy in RSA means inefficacy in Zimbabwe, since our people travel a lot. We further implore the executive to take advice from the ZimNITAG, and submit to the oversight function of parliament particularly in procurement decisions. Government must engage us the people and give feedback continuously. With covid-19, no one is safe until we are all safe.

Dr Henry Madzorera
Secretary for Heath and Child Welfare
MDC Alliance