MORRISTOWN, New Jersey — In October 2020, South African scientists noticed a spike in COVID-19 cases around the country, ultimately discovering links to a new variant of the virus. By January 2021, the more easily transmittable variant contributed to more than 48,000 deaths in South Africa and had spread to more than 40 countries across the globe. While this variant does not appear to be any more deadly, scientists estimate it is 50% more infectious. The variant could have larger implications for the vaccine rollout across South Africa and across the world. Additionally, the variant’s existence and impact warn world leaders about the consequences of vaccination efforts that neglect developing countries.
The South African Vaccination Conundrum
At the beginning of 2021, the AstraZeneca vaccine was South Africa’s biggest hope for the vaccine rollout. Doses are inexpensive and require regular refrigeration temperatures as opposed to extremely low temperatures that the Pfizer and Moderna vaccines require. However, a study published in mid-March 2021 found that the AstraZeneca vaccine does not protect against the South African variant.
The study showed that the AstraZeneca vaccine was only 10.4% effective at stopping mild-to-moderate cases in adults 18-64 years old, leading South Africa to suspend the use of the vaccine. This finding upended the vaccine rollout, which should have accelerated in the early months of 2021. With South Africa’s goal of vaccinating 40 million people by the end of 2021, a setback of this size discouraged South African scientists and officials.
The South African Variant and COVAX
The Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance and the World Health Organization (WHO) implemented the COVAX initiative to ensure equitable vaccine access worldwide, with developing countries at the forefront. However, AstraZeneca is the most prominent vaccine distributed through COVAX, meaning South Africa will no longer attain vaccines through the initiative for the moment. In fact, South African Health Minister Zweli Mkhize announced that South Africa would donate doses of the AstraZeneca vaccines, which the country attained before it suspended use, to the African Union. African countries with no reported cases of the South African variant will use the AstraZeneca vaccines, ensuring no doses are wasted.
Alternatives to AstraZeneca
Other vaccines, such as those of Pfizer and Moderna, appear to be effective against the South African variant. The effectiveness of these vaccines decreases by factors of 6.7% and 4.5%, according to the New England Journal of Medicine. However, the high costs of these vaccines, extremely low storage temperatures and the fact that the vaccines require two doses means these vaccines are not optimal for a country where much of the population lives in hard-to-reach places.
However, the Johnson & Johnson vaccine tells another story. This vaccine may provide 57% protection against moderate-to-severe COVID-19 infections caused by the South African variant. The variant accounts for 90% of cases in South Africa. The Johnson & Johnson vaccines are less expensive than the Pfizer and Moderna vaccines. Furthermore, the Johnson & Johnson vaccines involve a single shot requiring only regular refrigeration. After approving the vaccine for healthcare workers in mid-February 2021, South Africa approved its use for civilians on April 1, 2021, and has already secured nine million doses.
South African Variant Lessons
When the South African variant was discovered, President Cyril Ramaphosa implemented measures to keep citizens safe, such as a curfew, limited social gathering sizes and a mask mandate. These protocols curb the spread of the virus, which slows further mutations. According to a survey of infectious disease specialists in 28 countries, if COVID-19 vaccines are not rolled out steadily worldwide throughout 2021, there could be more vaccine-resistant variants, extending the duration of the pandemic.
In March 2021, two-thirds of the experts predicted that if enough people in all countries do not receive a vaccine within roughly a year’s time, the disease will have evolved and current vaccines will no longer be effective. Regardless of the domestic vaccine rollout, experts maintain that the whole world will be safe only if wealthy nations support developing countries.
Vaccine Development Against Variants
Experts believe that companies owning vaccine rights must temporarily waive their intellectual property rights in order to strengthen the vaccine rollout in developing countries. More companies could produce vaccines in vaster quantities worldwide, speeding up manufacturing times and making vaccines cheaper to distribute.
To ensure people remain immune to COVID-19 even as it mutates, scientists from the New England Journal of Medicine argue that “second-generation vaccines” must be developed. For example, the Oxford University scientists who created the AstraZeneca vaccine are currently attempting to create a version that is effective against the South African variant.
There is a long road ahead in the vaccine effort in South Africa and around the globe. The South African variant of COVID-19 teaches the world many important lessons about the virus, vaccines and the inoculation effort, emphasizing the importance of vaccine equity, diplomacy and multilateralism.
– Elyssa Nielsen