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A Look At The Inequities Around The COVID-19 Vaccine In South Africa

ARI SHAPIRO, HOST:

The open market of the coronavirus vaccines has left countries like South Africa in a bind as they try to figure out a way to protect their citizens. NPR's Nurith Aizenman explains.

NURITH AIZENMAN, BYLINE: Salim Abdool Karim is an infectious disease researcher who co-chairs South Africa's advisory committee on COVID-19. Abdool Karim notes that almost as soon as the pandemic hit, wealthy nations like the U.S. started cutting deals with pharmaceutical companies, putting in advance orders for multiple vaccines that were still under development, vaccines that hadn't even been proven effective. But Abdool Karim says in South Africa's case...

SALIM ABDOOL KARIM: We couldn't do that. We couldn't buy it, and we don't know if the vaccines work. We just don't have the funds to be able to do that.

AIZENMAN: South Africa is not a poor country, but it's only middle-income. So South Africa's next idea was to turn to COVAX, an international effort co-led by the World Health Organization to distribute vaccines more equitably among nations. The trouble, says Abdool Karim...

ABDOOL KARIM: In principle, it's a great idea. But the way it was operationalized created several problems.

AIZENMAN: For instance, countries like South Africa, which are well-off enough to pay for the vaccines they get through COVAX, were asked to commit to a set price per dose without knowing which vaccine it would be for.

ABDOOL KARIM: If we paid $10 and the actual vaccine is only costing $4, then we were paying more than we should have.

AIZENMAN: So officials decided to buy only 10% of the vaccine supply South Africa would need through COVAX. How to get the rest - well, South Africa and the other nations of the African Union have formed a separate buying pool just for Africa. In recent weeks, the group announced deals to buy 270 million doses of three of the major vaccines. Hitesh Hurkchand is an epidemiologist, an expert on pharmaceutical supply chains who's been informally advising the team.

HITESH HURKCHAND: Africa had to step up for itself. The fact that they were able to go out and, as a unified voice, tell the world that, you know, we have a need for the continent and we are able to do this on our own - I think that in itself speaks volumes.

AIZENMAN: South Africa's government has also negotiated direct purchases for the country, obtaining commitments from Pfizer, Johnson and Johnson and AstraZeneca. But because rich countries preordered so much of the supply, actually getting these vaccines is expected to take months. So, like many countries, South Africa has pinned most of its hopes on the vaccine that will be available soonest - AstraZeneca. Last week, when the plane carrying the first batch of it landed near Johannesburg, South African television stations carried the event live.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER: I do see that the plane...

AIZENMAN: It was not a moment too soon. South Africa has already been hammered by a wave of cases fuelled by a new, more infectious variant of the virus. More than 47,000 people have already died. Now they're bracing for another surge once the winter season begins there in April.

(SOUNDBITE OF ARCHIVED RECORDING)

CYRIL RAMAPHOSA: Well, we are delighted the vaccines are here now, the 1 million.

AIZENMAN: Then this week, everything changed. A small study found that the AstraZeneca vaccine may be only minimally effective at preventing mild to moderate disease from the variant in South Africa, and there's no clear evidence yet on how well the vaccine protects against severe cases.

HURKCHAND: Oh, my God.

AIZENMAN: Hurkchand says when he heard this news...

HURKCHAND: I was devastated. You know, like, what are we going to do now? And, you know, what's going to happen?

AIZENMAN: In the short run, South African officials have paused the rollout of AstraZeneca. But another study has shown that the Johnson and Johnson vaccine does prevent severe cases from the variant that's circulating in South Africa, so officials have arranged to get enough doses of the Johnson and Johnson vaccine to inoculate about 500,000 health workers starting next week. And because the AstraZeneca vaccine is biologically similar to the Johnson and Johnson vaccine, many scientists are now hoping that even if AstraZeneca can't prevent mild disease, it, too, will ultimately prove effective at stopping the most deadly cases. Nurith Aizenman, NPR News.

(SOUNDBITE OF RATATAT SONG, "BUSTELO") Transcript provided by NPR, Copyright NPR.