The South African government has attempted to end its contract with Johnson & Johnson to avoid receiving — and paying for — 11.4 million doses of the pharmaceutical company’s COVID-19 vaccine. The move follows late initial deliveries of jabs and current lower-than-expected demand.
South Africa signed a contract with J&J in February 2021 for 11 million doses of its COVID-19 vaccine. By April that year, the company had agreed to add 20 million more doses to this order. Still, shipments only arrived in South Africa in June 2021, partly because contamination at a U.S. manufacturing plant forced J&J to dispose of about 60 million vaccine doses. So far, South Africa has received 19.6 million of the 31 million doses it originally ordered, according to Nicholas Crisp, South Africa’s health department deputy director general.
“For a long period of time, we were unable to get any Johnson & Johnson vaccine,” Crisp said speaking to the country’s Parliament recently. “We had to change the vaccination program and rely more on the Pfizer vaccine in the first months.”
South Africa ultimately purchased 30 million Pfizer vaccine doses, and a United States government donation contributed nearly 7 million more doses to this stock, according to Crisp.
When J&J finally diverted 1.5 million doses originally intended for the U.S. market to South Africa in June 2022, the immunizations arrived thawed, Crisp explained, not frozen as is usually the case to preserve the jabs’ shelf life. These initial doses consequently had a shorter expiry date.
Today, just over half of South African adults have been vaccinated against COVID-19 — a far cry from the 70% target the country set for itself in 2021 and again in 2022. Still, the country’s advanced purchase agreement with J&J includes payment for a final delivery of 11.4 million vaccines which the country now cannot use given low public demand for the jabs, Crisp explained to the parliament.
J&J is now pushing South Africa to accept this delivery and pay the outstanding fee for the vaccines. The government, meanwhile, has unsuccessfully tried to terminate its contract with J&J to avoid paying for shots it no longer needs. The country is exploring whether it can donate the shots to other countries — but either way, South Africa may be stuck footing the bill for vaccines that came too late, Crisp told parliament.
Time to pay up
South Africa has paid the down and advanced payments in full prior to each vaccine shipment required by both Pfizer and J&J.
“Due to [Johnson & Johnson’s] operational and approval issues in the initial phase of the vaccination programme and the subsequent waning vaccine demand for COVID-19 vaccines, the need for these additional 11.4 million doses no longer exists,” Crisp told parliament. “We’ve been looking at all plausible options to mitigate this delivery for months now by delaying deliveries or trying to [donate doses] but nobody in the world is really buying vaccine[s] at the moment.”
J&J told Devex that the company is in discussions with the South African government regarding the status of its COVID-19 vaccine agreement.
“It’s important that all parties adhere to the terms of this agreement, which is a collaborative effort between our company and the government to make our vaccine available, support the country’s response to the pandemic and protect the health of people in South Africa,” Johnson & Johnson spokesperson Ronan Collins said.
Collins added that the company also supported efforts to increase local vaccine production in South Africa. Additionally, J&J had provided South Africa with 500,000 doses of vaccine — largely for the country’s health care workers — early on in the pandemic when the country had no other supplies, he noted.
These vaccines were administered as part of the Sisonke clinical research trial. Sisonke provided the world with the first evidence of the shot’s real-world effectiveness in health care workers.
The company is committed to addressing “the highly complex challenge of vaccine absorption,” Collins said, adding that “Overcoming these challenges requires close collaboration across stakeholders, and for vaccine procurement bodies to deploy every vaccine dose ordered to help protect people from COVID-19.”
Donating excess jabs is no easy way out
Crips said that the South African Parliament is looking at possibly donating unused doses to the World Health Organization, COVAX — the global vaccine sharing initiative — or the African Vaccine Acquisition Trust, the African Union’s own pooled vaccine procurement initiative.
South Africa may look to use a potential donation, in part, to cover the roughly$4 million it still owes COVAX — as it has previously done with more than 7 million doses donated through the U.S. government, according to Crisp.
Crisp said that bilateral donations to low-income countries are unlikely. Many low- and middle-income countries do not have national no-fault compensation schemes typically required by both J&J and Pfizer as a condition for receiving vaccines.
Still, even if South Africa is able to donate its surplus COVID-19 vaccines, it will still owe J&J the money for orders the firm has refused to cancel.
“Technically, we must pay the balance whether we donate then, use them or destroy them” Crisp told Devex.
As of April 2021, South Africa paid $10 per dose for the J&J vaccine, according to the national health department. This is $2.50 more per dose than the prices paid by UNICEF for the jab.
Struggle to reach vaccination target
Currently, about 7 out of 10 people in South Africa above the age of 50 are vaccinated against COVID-19, only 33% of men aged 18 to 34 can say the same, reveals the government’s vaccine dashboard.
“The reasons are pretty similar to the rest of the world,” Crisp explained to parliamentarians. “We all have COVID fatigue — people are trying to get on with their lives after a very disruptive period, and they may believe that protection is no longer important.”
COVID-19 testing and diagnoses are extremely low in the country at the moment — and
it may also be harder for people to find a vaccination site, Crisp said.
“There are now practical barriers to accessing vaccines as the number of sites has reduced, particularly in the private sector where it's no longer viable to keep vaccination sites open in the way that they were during the mass uptake,” he said. As opposed to blanket messaging, the strategy has now shifted to using routine health services to focus on low-coverage districts, he added.
While South Africa grapples with traditional forms of vaccine hesitancy in the form of misinformation and disinformation, many health care workers and experts say a lack of demand for vaccination can be more nuanced than just bad information.
David Harrison, CEO of the nonprofit DG Murray Trust, who led national vaccine demand creation efforts in 2021, told Devex that the government likely waited too long to begin creating demand for vaccines in communities.
Still, in a country with 44% unemployment and high rates of hunger, Harrison believed that — for many — COVID-19 wasn’t the biggest threat in their lives.
“Countering factual inaccuracy is absolutely essential, [but] we need to put COVID-19 into the context of people's lives into day-to-day realities,” he said.
"The challenge is that we have such an unequal society … that any future benefit [from getting vaccinated] is heavily discounted in people's minds compared to the reality of just making [life] work today,” Harrison said.
