It wasn’t rocket science when we predicted in early 2021 that South Africa The biggest challenge this year would be getting COVID-19 vaccines in as many arms as possible. But how it played out with multiple setbacks and tough problem-solving isn’t something one could have predicted.
Now it seems like light years ago a shipment of a million doses of AstraZeneca The COVID-19 vaccine landed in OR Tambo on February 1. A few days later, evidence emerged casting doubt on the effectiveness 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 for Johnson & johnson (J&J), with half a million healthcare workers receiving this vaccine as part of the Sisonke study.
The country’s mass immunization program finally kicked off on May 17 with people aged 60 and over. Vaccine supply was limited during the first few months of the deployment, particularly after it became apparent that batches of J&J vaccine were contaminated at a plant in United States. Over time, the provision of J&J and Pfizer vaccines would improve, so much so that towards 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 vaccinated (the initial 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 government officials and health workers are to be commended. government has taken a stronger stance on immunization mandates.
the Medical Research Council estimates that there have been over 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 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 decreased immunity over time. Towards the end of the year, Pfizer shared results (not yet published in a reputable medical journal) suggesting that their antiviral pill paxlovid is very effective in preventing serious illness and death when taken soon after 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 in screening and screening for tuberculosis. The importance of such early detection was underscored in February when the long-awaited results of South Africa first national survey on the prevalence of tuberculosis indicated that many more people in South Africa get sick 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 South Africa Minister of Health, Dr Zweli Mkhize was forced to resign after a report from the Special Investigation Unit (SIU) implicated him in the Digital Vibes corruption scandal. We have previously argued that while Mkhize should never be given public office again, there is nonetheless an important nuance to consider when evaluating his two years as Minister of Health. Mkhize has been replaced by Dr Joe Phaahla, who has generally provided a firm hand, but has yet to show a real appetite to tackle the deeper dysfunctions of national and provincial health departments.
In 2021, this dysfunction and the accompanying lack of decisive leadership remained clearer than ever. While South Africa now has a good human resources for health policy, there is no sign of its implementation. In fact, there is every reason to believe that nursing shortages will worsen in the years to come, recurring community service placement issues continued into 2021 and when Dr David Motau was appointed CEO of the Health Professions Council, he was quickly suspended after appearing in court for alleged breaches of the Financial Administration Act. In the meantime, most of the recommendations of the Competition Commission Healthcare market survey – released over two years ago – continues to gather dust and health department allowed South Africa the mental health policy framework expires.
An excellent series of provincial reports this year from the Ritshidze community watch group pointed out, once again, that the health system is collapsing in much of the country. Widespread staff shortages, long wait times, and the inability to implement easy wins like distributing ARVs over several months all paint a grim picture. That this fits in the context of the Office of Health Standards Compliance wavering because of budget cuts does not bode well.
Across all health services, there is generally a serious shortage of managerial capacity. Blurring of the lines between politics and the state continues to frustrate reforms – though cuts in budgets are also to blame. Either way, with little change in the underlying policy, the dream of a capable state continues to recede into the future.
Meanwhile, like a broken down car, Bill NHI continued to weave its way through Parliament, pushed by most ANC deputies. The ANC remains attached to a conception of INSA which confers power on the Minister of Health and relies mainly on existing anti-corruption measures. Many details, such as how NHI might be funded and how provincial health authorities might be affected, remain opaque.
Finally, on a more positive note, it must be recognized that there are many people involved in South Africa who has 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 most importantly, the many dedicated healthcare workers and public servants who continue to care and do the right thing.
* You can read the similar (less than 1,000 word) review of Spotlight from 2020 here.
* Low is the editor of Spotlight.
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