God, AIDS, Africa & HOPE

Reflections / Gedanken

03/04/2021 • 8:49 am Comments Off on A window of opportunity

A window of opportunity

We all welcomed the relief of bringing back South Africa from Covid-19 alert level 3 to 1 in the last days. But having said this it is also noticeable that more and more voices are raising concern about the possibility of a 3rd wave as early as the second half of May, when winter is knocking onto the door – especially the Western Cape with cold temperatures and rain will be exposed to more indoor activities raising the bar.

So the next 8 weeks are a window of opportunity to get things right and especially to see to our tools available preventing another peak of death and hospitalization figures. Vaccinations are new in our tool box – but the way they were introduced have clouded for many the willingness to receive them. Instead of using 1.5 million jabs already in the country of a clearly death and hospitalization avoiding vaccine the countries leaders decided to give away 1.5 million protection and opting for a trial run with another vaccination provider needing volunteers to conclude phase 3.

I got quite some flak for criticising Linda-Gail Bekker for wearing two heads as the co-principal of the J&J study and at the same time being part of the running of the country’s vaccine drive. In a tweet reply she assured me that there were no financial implications for her and that several ethic committees have given the green light for this conflict of interest to overcome. I have no reason to not believe her – but I am still of the opinion that this is not really the point:

Looking around and listening to various virologists there is a clear line: vaccinate with what you can get your hands on – the WHO has approved AstraZeneca also for the mutant discovered in South Africa – and I would expect from anybody running the show in this arena to stand up against any government decision to miss the opportunity vaccinating to at least avoid dead and hospitalisation in the 3rd wave. Vaccinate your health workers with the J&J trial as it most likely produces a higher protection rate, but there are millions of South Africans who are not in the health sector – they are working in schools and crèches, in retail, in hospitality, yearning for that extra protection they can get.

While many African countries started a vaccination drive – with AstraZeneca – South Africa stands lonely with a marginal vaccination trial programme having rejected what was already in the country. Judge for yourself whether this decision costing lives in the third wave was right. There will be many who are already dead when in the third and fourth quarter the promised vaccine drive starts in this country. To get a sense of where we are the vaccinations done by now:

And there is more: the writing is already very clearly on the walls: no vaccination no freedom of travel internationally; what this means for business travel you might be able to imagine. We are in the process of missing the boat and we all know, South Africa cannot afford it.

Lastly another question mark: The whole drama about AstraZeneca was triggered by a small – not even peer-to-peer reviewed study – and knowing how the battle is on between pharmaceutical companies to get their product on the market and to cash in – it is understandable that there remain questions how convenient this study was put into the public domain. The amount of studies being published for a greater audience without the filter of academic review and academic knowledge is a danger in itself.

As lives are in danger on different levels: health, economy, social we have to ask the hard questions and to scrutinize what is done and how it is done on the level of decision-making.

We have now a window of opportunity before the virus hits us anew in another wave – and we have to expect from government more than just warm words and promises…. Lives are at stake!

Filed under: Africa, Medical and Research, Politics and Society, Reflection, Society and living environment, South Africa, Uncategorized, , , , , , , , ,

02/18/2021 • 7:41 am Comments Off on A decision costing lives

A decision costing lives

While parts of South Africa celebrating the first jabs and at the same time wonder, how a president and a minister of health jump the queue and have become overnight honorary frontline health care worker, there are more questions than answers.

There are indeed questions regarding the AstraZeneca vaccinations – 1.5 million jabs arrived with great fanfare in South Africa, received and checked by the President of the country himself – only to be overnight discarded as not effective enough via a small study without peer-to-peer review and even more questions than answers, when you listen to health care professionals behind closed doors. While the headline of a news outlet in South Africa reads: “WHO gives AstraZeneca Covid-19 vaccine emergency approval, says it works against variant first found in SA” the national Minister of Health is quick to say, that the vaccine – which was paid almost double the price as European buyers – will go the African Union for distribution in other African countries.

This will cost lives – as AstraZeneca clearly prevents severe disease and death – consequently would free up hospital beds and oxygen use in the third wave which will come without doubt in the winter months. 3/4 of a million people could be spared by using the vaccine to end up in hospital or even in a crematory.

But the story does not end here. One of the national vaccine protocol chairs is also – according to newspaper reports – wearing the hat of co-principal for a stage III study. Now the gap is filled with 80 000 vaccines to complete the trial, needed by the pharmaceutical company to acquire the emergency permission and the product consequently being added to the bouquet of vaccines available around the world. Obviously there is also the promise of more vaccines for South Africa from the same company.

Transparency looks different – insiders know how tough the fight for market shares is and how much money is at stake in the run for emergency approval and being able to sell the product. As much as it is nice to see vaccinations finally happening in South Africa, connecting the dots gives at least a picture which leads to more question than answers. And with all the cheer being produced by those pulling the strings behind the proverbial curtain the fact is that giving away the AstraZeneca vaccines will cost South African lives in the future. Experts are aware that none of the vaccine delivers a 100% protection and true is also, that one vaccination might not be enough on the long run. All companies work already on boosters, including also to cover the many variants of the virus; at the end such boosters will follow for most vaccines.

For now, it should be acted on what Christian Drosten, Chef virologist of the world-famous Charite remarked some days ago: that whatever you have on vaccine, should be used because at the end, all the vaccines help to cut down on the spread of the virus one or the other way.

And so there is only one conclusion:
competition, egos, politics or similar should be on the backbench – whatever tool is available should be made available to protect people from becoming severe ill and dying. Every prevented dead is a win! The chaos around the vaccine and the questions the story raises will not help to boost the confidence of people in South Africa for the vaccine. Looking at the social media response there is no indication that jumping the queue of politicians assists in changing minds. If we really want the buy-in of those opposing the vaccine one has to avoid any appearance of non-transparency or second guessing about motivations, reasons and decision-making. In this South Africa has still to catch up heavily.

Filed under: Medical and Research, Politics and Society, Reflection, Society and living environment, Uncategorized, , , , , , ,

02/11/2021 • 8:47 am Comments Off on The vaccine confusion

The vaccine confusion

AstraZeneca vaccine stopped – so the headlines around the world when South Africa decided to re-think the use of the vaccine it bought for a higher price without checking the expiry date – and one could think this is a typical story – or another example of the incompetence of South Africa’s national government. That may be the case, but I guess, in this time and situation government bashing should not be first priority but to look a bit deeper into this headline creating event.

The first batch of vaccines in South Africa was designated to be used for the health worker at the forefront of the fight against the pandemic; and obviously the aim is to protect those doctors, nurses and health workers against the virus. It was known that the AstraZeneca vaccine was not a 100% protection, but a small and not peer-to-peer reviewed study, which in itself poses more questions than answers was cited as the reason to stop the vaccination drive before it started.
And here the first critical thought has to be mentioned:
This discussion is way above the heads of the general population. The South African government, in its drive to be as transparent as possible, decided to bring into the public a level of medical research discourse which created more confusion than it helped to motivate people to make an informed decision on wanting to be vaccinated. It also laid bare the underlying belief of many, that a vaccine is either the miracle cure or not helping at all.
In reality, we are far from understanding the virus and the potential of vaccinations in this case. Questions about how long the vaccine will work, what possible boosters are needed, how mutations will change the course of strategy and whether vaccinated people can still be infected or pass on the virus are questions in transition of answers. Combinations of vaccines would be another question which warrants an answer.

The advent of highly expert driven expert discussions in the public and political domain is creating more havoc and uncertainty then intended by those allowing for it. And looking through publications and mini studies and opinion pieces one can’t stop thinking that some so-called or self-identified experts have their own popularity as priority number one on their agenda. Also here social media are at parts more a curse than a blessing, when it comes to relay information which are factual correct and done in a way which enlighten ordinary people.

The additional problem in South Africa is that even those, who vote for the governing party not necessarily trust anybody in government, knowing what they know via the Zondo Commission. Too much lies, too much deception, to many people in charge just looking for their own advantage and having their own hidden agendas.

As it stands at the moment, no decision is taken what happens to the amount of expensive vaccines waiting in the cold storerooms of South Africa. It would be a pity if they would be given back or expire- as they still prevent severe illness and death for those being vaccinated with them.

Generally speaking we have to learn to appreciate what medical advances can do – and to understand that all are building blocks to prevent the pandemic from raging on – none is currently the golden bullet which stops the virus in the track. And there is something else to learn: that health experts should only cover parts of the political decision-making process in pandemic times for complex societies. There is more to balance and if one part is dominant, it will derail the process of taking with them the people governed.

Filed under: Africa, Politics and Society, Reflection, Society and living environment, South Africa, Uncategorized, , , , , , , ,

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