Roll out of J&J Covid-19 vaccine in SA is cause for celebration
Dr Sheri Fanaroff
It seemed like this day was far away, but I am thrilled to announce that I was given a date and time this past weekend to receive my Covid-19 vaccination.
Are celebrations in order? Definitely, yes!
It’s a good starting point and most doctors are relieved and excited by the opportunity to be among the first South Africans to receive the vaccine.
Healthcare workers (including hospital-based doctors in the public and private sector, as well as general practitioners) have been invited to participate in the Sisonke Phase 3b open label clinical trial to receive a single-dose Johnson and Johnson vaccine. The reason this is being done as a trial is that it is the quickest way to get the vaccine to frontline workers without the delays of full SAHPRA approval. The vaccine has been registered for emergency use for healthcare workers, and trial participants will be monitored to see the efficacy of the single dose Johnson and Johnson vaccine.
There will be no placebos administered, as the vaccine has already been fully tested in Phase 1, Phase 2 and Phase 3a trials and found to be safe. Participation in this trial is voluntary, but most doctors are grabbing the opportunity to get an early vaccine.
THE JOHNSON AND JOHNSON (J & J) VACCINE
This is called the Ad26.COV2.S vaccine and is made from a type of common cold virus called Adenovirus. The adenovirus used to make this vaccine is harmless to people because it has been weakened, so it cannot replicate and cause a cold. This type of adenovirus vaccine has previously been used in Ebola, RSV, Zika and HIV vaccine trials.
The vaccine includes genetic material from the SARS-COV-2 virus: when the vaccine is injected into your body, this genetic material gets translated to produce “spike proteins” which are specific to SARS-CoV-2. Our bodies then make an immune response against these spike proteins.
It is given as a single dose and can be stored at 2 to 8 degrees Celsius for 3 months (can be stored for 2 years at -20 degrees Celsius).
Possible side effects include redness and tenderness at the injection site, headache, chills, joint pain and fever (usually last 1 to 3 days and can be treated with Panado). Serious allergic reactions are extremely rare, but happen in a few minutes and can be treated at the time of the vaccine.
The Ad26 vector has been given to more than 200 000 people and has so far caused no anaphylaxis and no serious adverse effects. Common reactogenicity events as described above were observed.
The Janssen/ Johnson & Johnson study (also known as the ENSEMBLE study) was done on 43,783 participants in the USA (44%), Brazil and South America (41%) and South Africa (15%). These trials included many high risk, older people and others with comorbidities. This is important because these are the people who are more likely to get severe disease.
The trials showed 100% protection against death; 85% protection against severe Covid; 57% protection against moderate-severe Covid; 57% protection against 501Y.V2 variant (B.1.351) – this is the variant first described in South Africa.
Preliminary data suggest a beneficial effect against asymptomatic infection and protection starts 14 days after the vaccine is given, and the protection against severe disease increases over time.
The first 80 000 doses arrived in the country last week and President Cyril Ramaphosa and Health Minister Zweli Mkhize received their vaccines publicly. Some of the hospital sites, including Baragwanath and Steve Biko Academic started vaccinating staff. Other healthcare workers will be vaccinated over the next few weeks at 16 hospitals around the country.
After the first 500 000 J&J vaccines, which should be here by the end of March, South Africa has allegedly procured 9-million further doses from Johnson & Johnson, which are expected to arrive in the second quarter. There are also 117 000 doses of the Pfizer vaccine expected by the end of the first quarter. In addition, in the second quarter, we expect 20 million more doses of the Pfizer vaccine, 300 000 doses of Moderna and possibly 20 million more doses of J & J in the third quarter. The Covax facility through WHO also promises another 2 to 3 million doses of vaccine and possibly another 12 million through the African Union.
Even if some of these vaccine deliveries do not materialise, we should get enough vaccines to immunise two thirds of the adult population, over the course of the next 12 months.
Even though we remain some time away from achieving our vaccination goal, it feels as though we have finally seen the proverbial light at the end of the tunnel. Although new challenges, including new virus strains, will almost certainly mean that the path ahead will be bumpy, I believe that we are now closer to reaching the end of the pandemic and our diligence over the next year will almost certainly be rewarded.
* Dr Sheri Fanaroff is a Johannesburg-based GP.
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