The delivery of a safe and effective COVID-19 vaccine once it becomes available in South Africa will be a complex and costly logistical exercise.
Vials with vaccine are of no use unless they are administered to people using injection devices such as syringes and needles. Acquiring enough of these devices is part of crucial logistical planning to ensure rapid, equitable access to COVID-19 vaccines.
Next steps for COVID-19 vaccines in SA
South Africa, through the World Health Organization-led COVAX facility, has made a commitment to secure 5.7 million doses, to cover at least 10 percent of the population, at a cost of more than R2 billion. The Solidarity Fund, on behalf of South Africa, is scheduled to make the first down payment of more than R327 000 by 15 December. The Department of Health envisages a vaccine will become available by mid-2021.
Before it can be marketed in South Africa, a COVID-19 vaccine will have to be registered or authorised by the South African Health Products Regulatory Authority (SAHPRA). Spotlight previously reported on how SAHPRA might go about authorising COVID-19 vaccines.
The country’s immunisation programme, which is mainly geared towards children, will need to scale up to cope with the demand of rolling out a COVID-19 vaccine to include adults. It is not yet clear what the plans are for this scale-up.
The WHO has outlined distribution steps countries will have to plan for before vaccines become available. These include training healthcare workers, identification and up-scaling of immunisation sites such as clinics, hospitals and pharmacies. Refrigeration to keep the vaccine at optimal temperatures is also essential so that vaccines can be stored and transported to centres including rural areas without breaking the cold chain and degrading the efficacy of the vaccine. Security will also need to be beefed up to prevent theft of the products for sale on the illegal market.
Competition for injection devices
Ian Wakefield, the Africa general manager for Becton Dickinson (BD), a global medical technology company, predicts a surge in demand for injection devices. “As we saw in the early days of the pandemic with tests and Personal Protective Equipment such as masks, South Africa is likely to be caught up in a worldwide competition for essential vaccination equipment,” he says.
BD, a producer of vaccine injection devices, claims they manufacture 12-billion syringe units annually. Of these, three billion are for vaccines. “In light of the COVID-19 pandemic, we [are] in the process of ramping up supply with an additional one billion units, which equates to manufacturing 2 000 injection devices every minute,” says Wakefield.
About 800 million injection units have already been committed to Canada, the United Kingdom and the United States and Saudi Arabia are finalising their order, he says.
The South African Department of Health has not yet entered into formal talks with BD on injection device procurement, says Wakefield. The medical technology company currently supplies syringes for the BCG vaccine (a childhood TB vaccine) in all the provinces at a tender price of around R1.55 a unit.
Wakefield understands that access to a COVID-19 vaccine is currently at the top of the health department’s list of priorities for the pandemic. However, he says planning for delivery cannot be ignored.
“We would like discussions with health ministries in Africa because globally, the first movers, US and UK, have bought ahead of time. There is going to be a limited supply of syringes to deliver on all these vaccines. We want to raise awareness that vaccine delivery includes delivery (from the vial to the person being vaccinated). It’s key that governments look at this now before it’s too late. Because when the actual vaccine is here and there is no planning we are going to be behind the curve.”
The quantity of devices that will be needed for South Africa, he says, is not yet clear and will depend on the vaccine chosen for delivery. Some vaccines, including the Moderna and Pfizer vaccine, which have been approved for use in the United Kingdom and Canada and are scheduled to be approved in the United States soon, require two doses. “An amount of 10 million doses will be needed for 5 million people, which means millions of injection devices will be needed to meet the threshold for herd immunity.”
Wakefield cannot say much about exact costs of a BD injection device. “Since pricing is of a competitive nature we are not able to provide exact pricing for our vaccine delivery devices in South Africa and other markets. However, BD supplies vaccine delivery devices to UNICEF for low- and middle-income countries at market access prices,” he says.
‘Hundreds of suppliers’
Professor Greg Hussey, a member of the Ministerial Advisory Committee on vaccines and the Director of Vaccines for Africa, agrees millions of injection devices will be needed by mid-2021. “It is an issue, but it’s not a tool that needs to be specialised for a COVID-19 vaccine and there are hundreds of suppliers globally. The main concern is the distribution and storage of the vaccine and the monitoring and evaluation system of the vaccine’s effectiveness once it is rolled out,” he says.
“Delivery of a vaccine is a challenge, and it virtually doubles the cost of acquiring a vaccine. Apart from devices, we are going to have to ensure that enough masks are available for healthcare workers as well as people who come for the vaccine,” says Hussey.
*Adele Baleta is an independent science Writer, WHO vaccine safety communications advisor and Internews pandemic advisor.