The world is in the grip of a massive resurgence of the Covid-19 pandemic thanks to a coronavirus variant suspected of such great transmissibility that even the most stringent nonpharmaceutical interventions are failing to contain the spread.
More chillingly, the increased spread of the virus is generating a corresponding acceleration in the numbers of people getting infected and, by extension, is exposing health systems in even the best-resourced countries to an overwhelming burden.
Humanity is now facing the full force of the greatest public health emergency in modern history, with no sign that the pandemic will abate in the short term. The only instruments able to contain the pandemic, effective vaccines, are becoming available through an uneven and desperate race among nations.
Even this hopeful intervention will not bring solace any time soon. It will take many months and huge resources to inoculate sufficient numbers of people for the pandemic to be suppressed.
And that is the outlook if countries begin mass inoculation right now, as some 40 countries have. Many more are preparing to receive vaccine supply in the next several weeks.
For the rest, mainly the poorest nations, the global Covax facility offers the only hope of receiving an adequate vaccine supply in the next 6-9 months, and only after that can the months-long vaccination programmes begin.
It beggars belief that SA, against all reasonable expectations, finds itself in this group, since it is not a poor country. The stunning reality is that it has neither a secured vaccine supply nor a plan for mass inoculation in the foreseeable future that can withstand scrutiny. This portends the worst ravages of Covid-19 for this country in the year ahead.
This lack of foresight will visit upon us the consequences of the greatest man-made failure to protect the population since the Aids pandemic, when we refused to provide life-saving medicines and directly caused the deaths of hundreds of thousands of people. A high probability of a reprise of this is a monumental and unforgivable failing.
Astonishingly, even now, in the full knowledge of what we face and with dozens of countries worldwide embarking on mass vaccination programmes, it is distressing to hear senior officials increasingly talking down the prospects for the availability and usefulness of vaccines in SA.
The unconvincing and defensive exposition of the health department's efforts, or lack thereof, perhaps even confirms the absence of a coherent and composite vaccine acquisition strategy. This communication strategy bears the hallmarks of a frantic cover-up and evasion of culpability.
South African society has a fully justified expectation that, as a member of the G20 group of leading nations, most of whom are in the process of implementing vaccination, this country will also imminently embark on its own vaccination programme. There appears to be a public narrative to deliberately diminish these expectations.
Public acknowledgement by officials that they didn't think it prudent to begin bilateral negotiations with vaccine suppliers, because they could not "take the risk" of ordering vaccines in the event that they would not work, is shockingly disingenuous. An advance market commitment does not require upfront payment and commits the buyer to purchase a vaccine only when it becomes available, at an agreed price and quantity.
It is a dangerous misconception to presuppose a populace will willingly believe any deliberate fiction put to them. However, it will be even more worrying if these officials' comments were made in ignorance of an elementary advance purchase mechanism.
The posture of the ministerial advisory committee on vaccines appointed last September suggests it has been dragooned into the specious approach of the department. The comments of the committee chair align closely with those of the deputy director-general and other officials who are supposed to lead the vaccine acquisition programme. Their admonishments that vaccines are "not a silver bullet" or that they "do not end epidemics" are astounding.
Several advisories of the vaccine committee have been issued, but none has been published. The committee's silence has been deafening, suggesting it either concurs with this lack of transparency and condones a wholly inadequate vaccine acquisition policy - or does not, but has been muzzled.
This can only mean the responsible officials have indeed missed the vaccine boat and a huge damage limitation exercise is under way. It is to the discredit of the advisory committee that it appears to have been enlisted in this exercise.
Its members have the expertise to produce a transparent and accelerated vaccine acquisition strategy, measured in weeks, not months. That such a strategy is lacking puts them in the invidious position of having to reaffirm their scholarly credibility and ethical composure.
This dissonance deepens the suspicion that the committee is not free to do its work. In a moment of existential threat, this incoherence in lead institutions is simply intolerable.
The lack of any visible sense of urgency to inoculate health-care personnel is particularly worrying because they are at the highest risk of contracting Covid-19 and are the public's ultimate resort in the frightening eventuality of infection. If such a critical sector has been neglected, what chance is there of the rest of the population being vaccinated in good time?
South Africans have the right to demand the immediate disclosure of the vaccine committee's advisories and a full account of the response to any recommendations it has made. There must be no further cover-up of the failure to secure vaccine supply sufficient for SA's needs.
Getting beyond the pandemic is more important than preserving political fortunes, bureaucratic careers or ministerial appointments. The wellbeing of the people must come first.
The president of the republic will have to dispense with his otherwise admirable political consensus management and wield the axe against those in his administration who are responsible for this perilous fiasco, and immediately set about correcting the course upon which we have been placed.
Covid-19 leaves him no other choice, because, as it has so viciously demonstrated, it has no respect for the banal affairs of state or government.
• Progressive Health Forum members who wrote this article in their personal capacities, with the support of colleagues, are: Dr Aslam Dasoo, convenor; professor Glenda Gray, president, SA Medical Research Council; professor Guy Richards, emeritus professor in critical care, Wits University; professor Marc Mendelson, head of infectious diseases and HIV, University of Cape Town; Dr Fareed Abdullah, Aids and TB Research, MRC; professor Francois Venter, CEO, Ezintsha, Wits; professor James McIntyre, school of public health, UCT; Dr Adrienne Wulfsohn, specialist in emergency medicine, Inkosi Albert Luthuli Hospital; and professor Alex van den Heever, Wits school of governance
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