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Research gaps identified for Covid-19 vaccine rollout


Priorities include countering vaccine hesitancy and identifying South African risk factors

Research is needed to fill knowledge gaps that might otherwise hamper the rollout of Covid-19 vaccines in South Africa, scientists have told the government. 

Gaps include how to access priority populations and overcome vaccine hesitancy, the safety and efficacy of vaccines in individuals co-infected with tuberculosis or HIV, and the local risk factors of severe Covid-19 disease.

These and other research questions that need answering are outlined in an internal memo to health minister Zweli Mkhize from Barry Schoub, who chairs the minister’s advisory committee on Covid-19 vaccines. 

The memo, dated 15 December but published this month, says that six considerations will be “key” in the selection of which vaccines to roll out in the country. They are: safety and efficacy, ease of use, stability during storage and distribution, supply, cost, and approval by the local medicines regulator.

“The evidence required to formulate more concrete recommendations are not available as yet,” the memo adds, before listing the research gaps (full list at the bottom of this article). 

The gaps highlight some of the challenges facing the government as it scrambles to secure vaccines. When countries like the United States and the United Kingdom started vaccinating people late last year, it emerged that South Africa’s government had made little progress in accessing and approving the jabs for local use. 

Over the holidays there have been growing calls for the government to step up its efforts. Earlier this month Mkhize announced that the government had secured 1.5 million doses of the vaccine developed by AstraZeneca and the University of Oxford from the Serum Institute of India, which would be delivered by the end of January and rolled out to health workers. 

Last weekend, South African president Cyril Ramaphosa announced that 20 million Covid-19 vaccines had been secured, but provided no other details. His government is adamant it will be able to vaccinate 67 per cent of the population by the end of 2021.

However, many observers think the government’s targets are unrealistic, not least because a large proportion of South Africans may choose not to accept the jab. According to a survey by market research company Ipsos and the World Economic Forum published late last year, only 53 per cent of South Africans said they would take the shot, if offered. 

Vaccine hesitancy was identified as a possible major stumbling block for vaccine rollout, in a Covid vaccine framework, also dated 15 December, prepared by the ministerial advisory committee chaired by Schoub and put forward to the health ministry.

There is an “urgent need” to put in place a communications strategy to “ensure that the investment made into Covid-19 related scientific research including vaccine research and the eventual rollout is not jeopardised,” it reads. 

“The strategy should take into account global research, whilst articulating where appropriate the need for South African research to explore the national context,” it adds.

R&D gaps for vaccine rollout in South Africa

  • Implementation science studies to assess: accessing selected target populations; communication strategy to create demand, address vaccine safety perceptions and anti-vax messaging; sustaining non-pharmaceutical interventions (masking, distancing, hand washing) after vaccine introduction.  

  • Local correlates of protection or risk.  

  • Durability of protection following vaccination and any requirement for booster doses.  

  • Vaccine protection against transmission and acquisition.  

  • Safety and immunogenicity of vaccination in Covid-19 seropositive individuals and individuals with HIV, TB, cancers, diabetes and other immune deficiency conditions.  

  • Safety in pregnant and lactating women and paediatric populations.  

  • Effect of pre-existing immunity to other alpha and beta Coronaviruses.  

  • Effect of viral drift/evolution on vaccine efficacy.