CFOs hear what business needs to know about the Covid-19 vaccine in South Africa

Dr Stavros Nicolaou clears some of the uncertainty around the Covid-19 vaccines in South Africa.

The Covid-19 vaccine has brought hope of a medical and economic recovery to South Africa. But with the hope came many questions around the vaccination’s roll-out and safety. In a CFO Community Conversation on 10 March, Aspen Pharmacare group senior executive of strategic trade Dr Stavros Nicolaou cleared up some of the uncertainty around the vaccine.

Stavros said that Covid-19 has had a significant economic impact on the world, and the best economic recovery plan is to vaccinate as many people as quickly as possible. “This should be our singular focus for the next 12 months.”

Currently, there are more than 23 million active Covid-19 cases globally, and around 2.5 million people have perished because of it. In South Africa, there have been around 1.5 million reported cases. “However, it’s hypothesized that closer to 35 percent of our population has been infected,” Stavros said. “Most of our population are asymptomatic or show mild symptoms and don’t go to hospitals to treat the virus when they get it. Many people have it and don’t even know.”

Learnings for treating Covid-19
Stavros explained that, in the past year, pharmacies and hospitals have learned how to use old drugs, such as dexamethasone, to help better therapeutically manage the virus,

“Part of what this virus does is that it triggers microclotting in various organs, especially your lungs, and patients go into respiratory distress really quickly. At this stage, they need to go onto ventilators,” he explained. Hospitals have improved their use of ventilators and, as a result, the mortality rate when using them has decreased by 20 percent.

Hospitals have also learned to pronate patients. “Instead of them lying on their backs, they lean over the bed, which expands their lung capacity and slightly improves the respiratory distress for patients,” Stavros explained.

He added that there are a number of investigational drugs that are in their late stages or preclinical phases.

The science behind Covid-19
Like most viruses, Covid-19 attacks the body because it is parasitic in nature. “Think of it as a ball. On the ball are spikes that latch onto the host cells and start transmitting the genetic code of the virus into them. This changes the genetic makeup of the host cell and is where the problems come in,” Stavros said.

He explained that this relationship between the virus and host cell causes mutations, and you end up with various strains of the virus. “All viruses, by nature, try to outwit the host cell by mutating.”

As the virus changes, so does the treatments and vaccines need to change. “You can’t produce one flu vaccine that endures all the different seasons. There is a different one for each season,” Stavros said.

He explained that a lot of viruses become seasonal and that we would see the same thing happening with Covid-19. “This virus is going to stay with us for a time. It will become a seasonal virus like the flu.”

Today, there are at least 4,000 variants of Covid-19. “The virus up-mutates rather than down-mutates, which means that it becomes more contagious as it mutates,” Stavros said. This is what South Africa, Brazil and the UK are currently experiencing, and why the caseload almost doubled during the second wave.

Are vaccines safe?
Stavros explained that the most effective measures available against the virus until now have been non-pharmaceutical interventions, like masks, sanitising and social distancing. But “the most effective tool we will have going forward is the vaccine options.”

He said that, over the centuries, vaccines have been demonstrated to be the most effective tool to prevent diseases. “The first vaccine was introduced in the 1800s. It’s surprising that people are suddenly questioning them. The side effects of vaccines are lower than your normal pharmaceutical medicines.”

People are also asking whether pharmaceutical companies have taken shortcuts in making the vaccine, because what normally took seven to 10 years to do, was done in 301 days. “We’re using existing technology in many cases and only tweaking the platforms for Covid-19,” Stavros points out. “This means that you take an inactive form of the virus and introduce it into the body. Then, when you get the active virus, your body’s defense mechanism recognises it and is able to fight against it,” Stavros explained.

There have also been some concerns about regulatory approval in such a short space of time. “Instead of waiting for all the data we need and only submitting our findings at the end of our research, we are doing it on a rolling basis,” Stavros said. “For this reason, we are able to introduce the vaccine into the market a lot earlier.”

He added that all of these drugs and vaccines are also being regulated by independent and objective entities across the world. In South Africa, the South African Health Products Regulatory Authority (SAHPRA) reviews the data.

Types of vaccines
Over 100 million doses of the vaccines have been distributed globally and the side effects have been extremely low. Stavros said that, with the Pfizer product, there are only two patients for every 1,000 that experience side effects, like anaphylaxis, which are usually immediate and can be treated by medical staff at the vaccination site.

He explained that, of the over 300 vaccines that are in clinical trials at the moment, there are eight forerunner options:

  1. Johnson & Johnson
  2. Pfizer
  3. AstraZeneca
  4. Sputnik
  5. Sinovac
  6. Sinopharm
  7. Moderna
  8. Novavax

Stavros said that the options for South Africa that make the most sense are the Johnson & Johnson and Pfizer vaccines. “Initially, we tried to use the AstraZeneca vaccine, but the study design didn’t cover the South African variant and scientists urged to err on the side of caution.”

He added that the Sputnik option might not be effective on HIV patients, and South Africa has the largest prevalence of HIV cases in the world.

The rest of the options simply don’t have enough data for the South African market.

“The favorite vaccine is the Johnson & Johnson, because it’s a single dose whereas the Pfizer vaccine is two doses. This halves the logistics and costs,” Stavros said. “The Pfizer vaccine also has to be stored at temperatures lower than -70 degrees celsius when it’s being moved around, whereas the Johnson & Johnson vaccine is more transport-friendly.”

Rollout plans
In order to achieve herd immunity, South Africa needs to vaccinate 40 million people. “If you give sufficient immunity to the population, they will only have a flu-type experience going forward without the catastrophic consequences.”

The government launched and developed a plan earlier this year, which would see them vaccinating people over three phases. Phase one would be the healthcare workers, phase two the essential and high-risk segments, and during phase three they would vaccinate the rest of the population. However, the first phase will only start in May, and scientists are anticipating a third wave around June.

“Trying to find vaccines in the world today is a bit like the Hunger Games,” Stavros said.

At the moment, the government wants to carry out all the procurement of the vaccines because if they allow the private and public sectors to buy the vaccines independently, the private sector will be vaccinated before the public sector, which makes up most of the country’s healthcare and essential workers.

One of the CFOs that attended the afternoon said that it would make sense for the private sector to vaccinate their own employees and families during the third phase of the rollout, to make sure that it happens quickly and takes some of the strain off the state.