This week marks a critical point in SA's glacially slow Covid-19 vaccination programme.
With enough vaccines in hand for now, plans to expand the number of sites and the opening up of inoculations to over-50s, the target of 250,000 a day by the end of July is within reach.
But the delays in getting doses into arms for the past six weeks, since the national rollout launched on May 17, have left the country exposed to a surging third wave.
Proof that vaccinations save lives emerged in new data from the Sisonke implementation study, which inoculated 479,771 health-care workers from February to May. A number acquired "breakthrough infections" 28 days after their shots and more than 90% of them were protected from severe Covid.
"We have found that the 93% are asymptomatic or mild - not requiring hospital admission. We are encouraged by these results, of the cases we have validated," said Sisonke co-principal investigators Glenda Gray and Linda Gail-Bekker.
The failure to urgently roll out vaccines has resulted in preventable deaths among elderly people, according to professor Jeremy Seekings, director of the University of Cape Town Centre for Social Science Research, and UCT economics professor Nicoli Nattrass.
She said: "The slowing down of vaccinations [by rationing doses given to the provinces] is killing people."
Describing the programme as a "real shape-shifter", Seekings said: "There has been a big gap between the doses of vaccines in the country and those going into people's arms."
That widening gap is expected to narrow from next week, however, after an announcement on Friday that SA will accelerate its rollout and that it has a stable vaccine supply pipeline for July.
Dr Nicholas Crisp, deputy director-general of health, said: "The good news is, for now, we are not in a vaccine-constrained environment any more."
Daily vaccinations topped 100,000 this week for the first time, with the launch of teachers' inoculations. Daily targets are 150,000 by next week, 200,000 by mid-July and 250,000 by the end of July, said Crisp.
But Wits University professor of medicine Francois Venter said the programme is in trouble. "Gauteng announced this week that they had achieved 28% of vaccinations in those over 60 years old, and the MEC immediately blamed 'vaccine hesitancy'. But 28% after six weeks of rollout is not hesitancy. It is a programme that is not being delivered properly."
Seekings echoed this: "Given that only just over one half of the elderly are currently registered, this means that only just over one half of the elderly will have been reached by the end of July. That is a lot less than the government's target of reaching at least 70% of the elderly by the end of June."
Crisp said the programme anticipates making "much better gains on targets in the weeks ahead" by targeting three streams: over-50s, teachers and essential workers.
From July 1, vaccination registration will open to over-50s and their inoculations will begin on July 15.
Acting health minister Mmamoloko Kubayisaid Pfizer has committed to deliver 15.5-million vaccine doses in July, on top of 2.1-million expected soon and nearly 4.5-million in the second quarter.
Crisp said: "Now we are able to open a large number of sites with a better geographical spread."
But Seekings said that it is misleading to suggest vaccinations are no longer constrained by supplies.
"The supplies coming in remain insufficient for all of the three pipelines, so rationing happens through the process of allocating vaccines within the country," he said.
Of the 6.6-million Pfizer doses either delivered or imminently available, he said 4-million are accounted for: 2-million have been administered, more than 1-million over-60s are registered and waiting, 1-million doses could be lost through wastage, and 1.5-million or more doses are required for second doses.
"This leaves practically no Pfizer doses for currently unregistered elderly people or for the over-50s," said Seekings.
SA is "waiting for confirmation of another 500,000 doses" of the J&J vaccine, on top of 1.2-million which landed on Thursday.
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