It wasn’t rocket science when we predicted in early 2021 that South Africa’s biggest challenge this year would be getting COVID-19 vaccines into as many arms as possible. But the way it turned out with multiple setbacks and scrambled problem solving isn’t something anyone could have predicted.
It now seems light years ago that a shipment of one million doses of AstraZeneca’s COVID-19 vaccine landed at OR Tambo on February 1. A few days later, evidence emerged casting doubt on the efficacy of this vaccine against the locally circulating variant of the virus. In a decision that remains controversial, the government decided not to use the doses. What followed was a pivot to Johnson & Johnson (J&J), with half a million healthcare workers receiving this vaccine as part of the Sisonke study.
The country’s mass vaccination program finally kicked off on May 17 with people aged 60 and over. Vaccine supply was limited in the first months of the rollout, particularly after batches of J&J vaccines were found to be contaminated at a factory in the United States. Over time, the supply of J&J and Pfizer vaccines would improve, so much so that by the end of the year the government was delaying deliveries and supply was no longer the main bottleneck.
As of mid-December, more than 15 million people in South Africa have been fully immunized (the original target of 40 million is still a long way off). On the one hand, the vaccination of more than 15 million people is a remarkable achievement for which many officials and health care workers deserve credit – on the other hand, the many lives lost during the catastrophic third wave of the countries could have been saved if the mass vaccination program had started earlier and had government taken a stronger stance on vaccination mandates.
The Medical Research Council estimates that there were more than 190,000 excess natural deaths in South Africa in 2021 – most of which will be deaths from COVID-19. As the year draws to a close, South Africa has entered a fourth wave of infections, this time caused by the omicron variant.
Study after study this year has confirmed the excellent efficacy and safety profiles of major COVID-19 vaccines – although there has also been disappointing evidence of waning immunity over time. Towards the end of the year, Pfizer shared findings (not yet published in a reputable medical journal) suggesting that their antiviral pill paxlovid is highly effective in preventing serious illness and death when taken shortly after pregnancy. ‘infection.
Although slow compared to COVID-19, there have also been significant advances in the science of tuberculosis (TB) this year. Encouraging findings regarding early detection using blood markers and the increasing use of computer-assisted X-ray analysis suggest that we may be entering a new era of tuberculosis screening and screening. The importance of such early detection was underscored in February when the long-awaited results of South Africa’s first national TB prevalence survey indicated that many more people in South Africa are falling ill with tuberculosis than previously thought. A related highlight was the results of a study showing that a targeted universal testing approach can help diagnose more people faster.
Far from science, 2021 was the year in which South Africa’s Minister of Health, Dr Zweli Mkhize, was forced to resign after a report by the Special Investigations Unit (SIU) implicated him in the Digital Vibes corruption scandal. We have previously argued that while Mkhize should never again be given public office, there is nevertheless an important nuance to consider when assessing his two years as health minister. Mkhize was replaced by Dr Joe Phaahla, who has generally provided a steady hand but has yet to show any real appetite to tackle the deeper dysfunction of national and provincial health departments.
In 2021, this dysfunction and the accompanying lack of decisive leadership remained as clear as ever. While South Africa now has a good human resources for health policy, there is no evidence that it is being implemented. In fact, it looks like nursing shortages will become more acute in the coming years, persistent community service placement issues continued into 2021 and, when Dr David Motau was appointed CEO of the Professions Council of health, he was promptly suspended after appearing in court. relating to alleged breaches of the Public Financial Management Act. Meanwhile, most of the recommendations of the Competition Commission’s health market inquiry – published more than two years ago – continue to gather dust and the Department of Health has dropped the framework South African mental health policy.
An excellent series of provincial reports this year from the community watch group Ritshidze highlighted, once again, that the health system is collapsing in much of the country. Widespread staff shortages, long waiting times and failure to implement easy wins like multi-month ARV distribution all paint a grim picture. That this is happening against the backdrop of the failure of the Office of Health Standards Compliance due to budget cuts does not bode well.
In all health departments, there generally remains a severe shortage of management capacity. The blurring of lines between politics and the state continues to sabotage reforms – although shrinking budgets are also to blame. Either way, with little change in the underlying politics, the dream of a capable state continues to recede into the future.
Meanwhile, like a broken down car, the NHI Bill continued to wind its way through Parliament, pushed by most ANC MPs. The ANC remains committed to a conception of the NHI which gives power to the Minister of Health and relies mainly on existing anti-corruption measures. Many details, such as how the NHI might be funded and how provincial health powers might be affected, remain opaque.
Finally, on a more positive note, it should be recognized that there are many committed people in South Africa who have continued to fight the good fight this year. We owe a collective debt of gratitude to the Office of the Auditor General, the SIU and, above all, the many dedicated health care workers and officials who continue to care and do the right thing.
*You can read Spotlight’s similar review (less than 1,000 words) from 2020 here.
*Low is Spotlight’s editor.