ANALYSIS | Health in 2021: Another tumultuous year in under 1000 words

It wasn’t rocket science when we predicted at the start of 2021 that SA’s biggest challenge this year would be to get Covid-19 shots into as many arms as possible. But the way it has played out with multiple setbacks and scrambling problem-solving is not something anyone could have predicted.

It now seems light years ago that a consignment of one million doses of AstraZeneca’s Covid-19 vaccine touched down at OR Tambo on February 1. Mere days later, evidence emerged, casting doubt over that vaccine’s efficacy 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 to Johnson & Johnson (J&J), with half a million healthcare workers receiving that vaccine as part of the Sisonke study.

The country’s mass vaccination programme eventually kicked off on May 17 with people aged 60 and older. Vaccine supply was constrained in the early months of the rollout, particularly after it emerged that batches of the J&J vaccine were contaminated at a plant in the US.

In time, supply of both the 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 primary bottleneck.

By mid-December, over 15-million people in SA have been fully vaccinated (the initial target of 40-million is still far off).

On the one hand, vaccinating over 15-million people is a remarkable achievement that many officials and healthcare workers deserve credit for — on the other, many lives lost in the country’s catastrophic third wave may have been saved had the mass vaccination programme started earlier and had the government taken a firmer stance on vaccine mandates.

The Medical Research Council estimates there has been over 190,000 excess natural deaths in SA in 2021 — most of which will be Covid-19 deaths. As the year comes to an end, SA has entered a fourth wave of infections — this time driven by the Omicron variant.

Study after study this year confirmed the excellent efficacy and safety profiles of the key Covid-19 vaccines — though there has also been some disappointing evidence of immunity waning over time. Towards the end of the year, Pfizer shared findings (not yet published in a reputable medical journal) suggesting that their antiviral pill paxlovid is highly effective in preventing severe illness and death when taken soon after infection.

Though sluggish compared to Covid-19, there have also been important advances in tuberculosis (TB) science this year. Encouraging findings relating to early detection using blood markers and the increasing use of computer-assisted X-ray analysis suggest we may be entering a new era in TB testing and screening.

The importance of such early detection was underlined in February when long-overdue findings from SA’s first national TB prevalence survey indicated that many more people in SA fall sick with TB than previously thought. A related highlight was findings from a study showing that a targeted universal testing approach can help diagnose more people quicker.

Away from the science, 2021 was the year in which SA’s health minister, Dr Zweli Mkhize, was forced to resign after a Special Investigating Unit (SIU) report implicated him in the Digital Vibes corruption scandal. We previously argued that while Mkhize should never again be trusted with public office, there is nevertheless important nuance to take into account when assessing his two years as health minister.

Mkhize was replaced by Dr Joe Phaahla, who has generally provided a steady hand, but who hasn’t yet shown any real appetite for taking on the deeper dysfunction in the national and provincial departments of health.

In 2021, that dysfunction and the accompanying lack of decisive leadership remained as clear as ever. While SA now has good human resources for health policy, there are no signs of it being implemented. In fact, indications are that shortages of nurses will become more acute in the coming years, perennial problems with community service placements continued in 2021, and when Dr David Motau was appointed CEO of the Health Professions Council, he was soon suspended after appearing in court relating to alleged contraventions of the Public Finance Management Act.

Meanwhile, most of the recommendations from the Competition Commission’s health market inquiry — released more than two years ago — are still gathering dust and the Department of Health has allowed SA’s mental health policy framework to lapse.

An excellent series of provincial reports this year from community monitoring group Ritshidze underlined, once again, that the healthcare system is buckling in much of the country. Widespread staff shortages, long waiting times, and a failure to implement easy wins like multi-month dispensing of ARVs all paint a bleak picture.

That this comes against the backdrop of the Office of Health Standards Compliance faltering due to budget cuts doesn’t bode well.

Across health departments, there generally remains a severe shortage of management capacity. The blurring of the lines between politics and the state continues to scupper reforms — though shrinking budgets are also to blame. Either way, with little change in the underlying politics, the dream of a capable state continues to recede into the future.

Meanwhile, like a broken-down car, the NHI Bill has continued to clunk its way through parliament, pushed along by mostly ANC MPs. The ANC remains wedded to an NHI design that vests power in the minister of health and relies mostly on existing anti-corruption measures. Many details, such as how NHI might be funded and how provincial powers over health might be impacted, remain opaque.

Finally, on a more positive note, it is worth acknowledging that there are many committed people in SA who kept fighting the good fight this year. We owe a collective debt of gratitude to the office of the auditor-general, the SIU, and above all, the many committed healthcare workers and officials who keep caring and doing the right thing.

* Low is editor of Spotlight.

This article was first published by Spotlight.