The African country with the worst confirmed coronavirus outbreak is yet to provide clarity on how it plans to order vaccines, even as the global race to secure inoculations accelerates.

South Africa is hosting three trials, including for Johnson & Johnson and a partnership between AstraZeneca Plc and the University of Oxford, yet hasn’t announced a firm strategy to immunize a population that’s bracing for a potential resurgence of the pandemic. Almost 22,000 people have died of Covid-19 in the nation, the 14th-highest worldwide.

South Africa’s Finance Minister Mboweni’s Tough South African Budget TaskTito Mboweni

South Africa did confirm last week that it plans to sign up to Covax, a global initiative that strives to ensure that poorer countries have access to shots. The National Treasury paid 500 million rand ($33 million) toward the program and will need to find a further 4.5 billion rand to move to “the front of the queue,” Finance Minister Tito Mboweni said in an interview.

Yet that proposal will initially provide doses for just 3% of South Africa’s population of about 59 million, according to Anban Pillay, deputy director general of the Department of Health, or 10% over the longer term. The government has said that front-line health-care workers and the elderly will be given priority, meaning advance-purchase agreements with pharmaceutical companies will be needed to protect the wider community.

“What worries me about government is the clear lack of communication,” Francois Venter, a professor of medicine at the University of the Witwatersrand in Johannesburg and a former member of the ministerial advisory council on the virus, said in an interview. “We’re all sitting here terrified, not knowing if we get the vaccine.”

Behind Brazil

The lack of progress comes at a critical time for South Africa, which is seeing a new surge in coronavirus cases in some provinces just as millions of people prepare to travel to home towns and holiday destinations. A protracted lockdown starting in March hobbled the economy and caused millions of job losses, and a need for further restrictions is likely to undermine President Cyril Ramaphosa’s focus on revival.

While Pillay said the government has been talking to “a number of manufacturers” about bilateral deals, other countries have already put pen to paper. The U.K. has secured access to 357 million doses from seven different developers. Brazil has agreed to buy a total of 186 million from a combination of AstraZeneca and Covax.

In Africa, Botswana and Namibia agreed in November to procure sufficient vaccines from Covax for 20% of their populations of about 2 million people each. Rwanda plans to raise $15 million for its first batch of shots, Finance Minister Uzziel Ndagijimana said last week.

Lwazi Manzi, a spokeswoman for Health Minister Zweli Mkhize, said the minister will make an announcement “in due course.” Barry Schoub, the chairman of the ministerial advisory council, said he can’t comment on plans to pre-order vaccines.

Pfizer Inc., co-maker of the vaccine approved by the U.K. this week, said it has started engagements with the South African government, without giving further detail.

Manufacturing Deal

Aspen Pharmacare Holdings Ltd., Africa’s biggest drugmaker, signed a deal last month to manufacture about a third of the one billion doses J&J hopes to produce next year in a South African factory. Half of the total will be destined for emerging markets under the Covax program, according to Stavros Nicolaou, Aspen’s senior executive for trade.

J&J has offered the shots to South Africa at not-for-profit prices, according to Glenda Gray, chief executive officer of the South African Medical Research Council and co-chair of the local arm of the company’s trial.

South Africa should be “in a favorable position to start negotiations with manufacturers,” Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand and lead researcher on the country’s leg of the Oxford trial, said by text message. “However, government needs to engage with the manufacturers. I’ve no idea where government is with such negotiations.”