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EF: Can you elaborate on the impact of COVID and how South Africa responded?

SN: We have had four COVID waves and two distinct phases in South Africa and are expecting the 5th wave of covid. We hope that this variant's trajectory is similar to omicron. Healthcare systems around the world were significantly stretched, and like any other country, South Africa's response to covid was good.  

I hosted an emergency meeting this past March with healthcare leaders. The discussion was based on setting up a solidarity fund, making the private sector capacity available, and creating an economic and labour response. The meeting was so productive and unique that I was invited to speak in other countries like Costa Rica. I attended a meeting convened by the president based on how South Africa needs to respond at an economic labour and healthcare level. This meeting was the enthusing factor for the solidarity fund.  

The first phase of COVID was the first wave manifesting in winter. During the first wave, healthcare systems were significantly tested. We worked closely with the government to increase capacity and ensure availability in finance. We set up a facility to procure PPE. It was quite difficult to get PPE because it was a global constraint. We managed to buy 100 million units of PPE by tapping into our sources and contacts in China and other countries. The second wave hit just as matric high school students wrote their finals. Many students socialized, which spread the second wave of covid. Therefore, we sequenced the beta variant during the peak of the second wave.  

EF: In your opinion, what do you think 2022 will be the year of?

SN: The history of the pandemic speaks to the challenges of the capacity in Africa and South Africa. 2020 showed us that handling pandemics alone was a challenge. We relied heavily on the Covex facility, which did not materialize. The first vaccines were administered by Pfizer globally in December of 2020. South Africa woke up to the reality that it would not get the vaccines through Covex. At this point, we entered into a bilateral with AstraZeneca for 2 million doses. These first doses were for doctors, nurses, and the people working at the covid frontline before the third wave hit us. We wanted our doctors, nurses, and other healthcare workers vaccinated because they were four to seven times more prone to get covid than the rest of the population.

As we were waiting for the first dose of vaccines, medical experts determined that AstraZeneca did not have the required efficacy for the beta variant. At this point, the government requested I get into discussions with the European Union health commissioner. Unfortunately, they had a lot to deal with at the time and could not help us. In the interim, we were the only emerging market globally that had a clinical trial for Pfizer, J&J, and AstraZeneca. We convinced J&J to give us doses if we held clinical trials for phase three of the implementation study. We were able to vaccinate 490,000 subjects by getting our hands on Pfizer. Preceding September, Aspen had signed a contract with Johnson and Johnson to manufacture the J&J vaccine.  

It was groundbreaking because we were the only country in the Southern Hemisphere to do this. We were also the quickest off the mark with the J&J contract. J&J contracted ten companies to manufacture the vaccine, and at the beginning of our contract, we were the ninth company. However, we became the number one company by producing the most vaccines among the ten companies. This speaks to Aspen's capabilities and Africa's capabilities.  

Aspen started receiving some vaccine products from a facility in Baltimore, US, with contaminated products. At that time, South Africa suffered a setback because we were waiting for those doses to vaccinate against the beta variant. After that, we received uncontaminated substances from a supplier in the Netherlands.  
We had to write off the first consignment of the completed product, which meant Aspen was in a testing situation. At the time of production, the delta variant hit and President Macron supported us in terms of keeping our vaccines. Macron believed that vaccines produced in Africa should be distributed in Africa. He had us sign an IP waiver, and there was a back and forth between us and the EU. It was President Ramaphosa who settled the deal with 90% of the vaccines to stay on the continent, and 10% were shipped off.  

In 2022 everyone talks about pandemic preparedness. It is great that in 2022 institutions are willing to set up covid capacities in under-capacitated continents. However, if institutions do not get a real orientation of the global procurement dynamics, they will not be in a position to sustain those capacities in under-capacitated continents.  
2022 should be the year of finding out how to sustain pandemic capacities for 2022 and beyond. Only 15% of Africa is fully vaccinated, and only 18% have received their first dose yet. We need to learn how to streamline healthcare systems to create demand and have an appropriate supply chain to overcome COVID. 2022 is massively around beating the pandemic and putting it to bed.  

The pandemic highlighted fault lines within our infrastructure in human capital management and work needed to be in regarding the provision of facilities. There has been significant neglect of chronic diseases. There is a rising tide of diabetes and a hangover of COVID. Chronic patients that have been in contact with COVID are more likely to contract other chronic conditions. We need to start managing neglected chronic diseases and live with the aftermath of COVID. It all needs to be done amid financial collaborations. There is an ideological difference between the public and private sectors that we hope to breach.

The pandemic has also shown that the public and private sectors can work together. Patients from public hospitals were vaccinated in private pharmacies, and private patients were vaccinated in public hospitals. We need to have a hybrid model that will help collaborations become better.

South Africa made way for Africa. President Ramaphosa and his team and the African Union set up structures for the AU covid commission. South Africa held the AU leadership at the time the pandemic broke. At the 2021 AU council meeting, the AU appointed president Ramaphosa as the AU covid champion. It is relevant as it affects the present and the future as well. Most of my time is spent in the AU and EU, trying to integrate both systems. There is a lack of capacity in the African continent, whereas South Africa has the ability and expertise, which is why we took the lead during the pandemic.  

South Africa delivered, and there are five highlights. The first is on emerging markets with clinical trials with J&J, Pfizer, and AstraZeneca. Second, we have the most intelligent genomic surveilling and sequencing from an emerging market perspective. For the omicron variant, we were the first to sequence it. The third is Aspen made 180 million doses from its collaboration with J&J as we were manufacturing for the entire southern hemisphere. The fourth is how we conducted the largest phase 3 implementation studies with 490,000 test subjects. The fifth highlight is that we did the biggest booster study, the Sisonke2.

April 2022
South Africa