The Covid-19 vaccine rollout has been painfully slow thus far, with the government missing its own inoculation goals within the first month. Commentators have pointed out that the Government’s desire to control every aspect of the vaccination programme has severely hobbled its progress. According to the health working group B4SA‘s latest update, this situation will soon change. As phase 2 of the programme commences in May, private sector staff and facilities will be used to administer vaccines. The private sector has the capacity to vaccinate approximately 163,000 people per day writes Stavros Nicolaou, head of B4SA. – Melani Nathan
B4SA update on Covid-19 vaccine roll-out in South Africa
By Stavros Nicolaou*
Covid-19 has had a seismic impact on South Africa. We have lost loved ones, colleagues and friends, it has exacerbated our already devastating unemployment figures, worsened inequality and disrupted everyday life, health and the economy. Vaccines and the national vaccination programme represent a defining intervention to take us out of the grip of the pandemic.
B4SA has mobilised all of the business’s capabilities and resources, including those of the private healthcare and employer sectors to assist in the efficient rollout of the national Covid-19 vaccination programme. We are working in close collaboration with Government, which leads the national vaccination programme, to deliver the country’s goal of vaccinating 40 million people by February 2022. We believe that together, we are stronger. We will move faster, further and more equitably if we move together as a nation to reach herd immunity.
Late last week, Government announced the rollout of Phase 2 of the national vaccination programme, to deliver and administer vaccines to 16.6 million people, will commence on 17 May, and continue until October this year. The proposed breakdown of Phase 2 recipients is as follows:
- Over 60 years old (5m)
- Under 60 with co-morbidities (8m)
- Essential workers (2,5m)
- Persons living in congregate settings (1,1m)
The risk of severe illness and death is most strongly associated with the elderly and those living with multiple co-morbidities (diabetes and HIV). These groups have a 2-3 fold higher risk of mortality and hospitalisation than others, so it is critical that they are prioritised for vaccination during Phase 2. B4SA is in full alignment with Government in this regard.
Government also announced that the Electronic Vaccination Data System (EVDS) booking system will go live for registration for these groups on Friday 16 April. Our understanding is that this is for registration only, and not yet for the scheduling of appointments. The EVDS is an online self-enrollment portal that will schedule appointments for vaccinations. While the EVDS will be open to Phase 2 candidates only for now, ultimately, everyone over 18 years of age, whether insured through a medical scheme or not, will need to register on the EVDS in order to be scheduled for vaccination.
Phase 2 will run concurrently with Phase 1, which prioritises the vaccination of approximately 1.2 million healthcare workers (HCW) in both the public and private healthcare sectors. To date, almost 300 000 healthcare workers have been vaccinated under Phase 1A of the programme, conducted through the Sisonke implementation study which targets 500 000 HCWs for vaccination. The balance of HCWs will be vaccinated with commercially procured vaccines outside of study conditions. This rollout will be faster, as it will not require the extensive reporting conditions of the Sisonke study, and will be available at significantly more vaccination sites.
Phase 3 will commence in November 2021 and is expected to continue for three months, ending in February 2022 and aims to cover 22.6 million people, the remainder of the target population.
As B4SA we recognise that the success of the country’s vaccination programme will rely on three key elements:
- The timeous availability of efficacious vaccines
- The capacitation and delivery of an efficient vaccination rollout plan
- Willingness of the public to receive vaccines.
On Tuesday, 13 April, the Minister of Health announced that Government has secured an additional 10 million doses (5m lives) of the Pfizer vaccine.
This means that Government has successfully secured 62.39 million vaccine doses to date. This includes 31 million Johnson & Johnson (J&J) single-dose vaccines, and 30 million Pfizer-BioNTech double-dose vaccines which will arrive in the country over the course of the year and 1.39 million vaccines via the Covid-19 Vaccines Global Access programme, otherwise known as COVAX.
According to NDoH, the known timing for delivery of vaccines currently stands as follows:
| Quarter 2
April to June |
Quarter 3
July to Sept |
Quarter 4
October to December |
|
| Pfizer | 4 484 610 | 8 519 940 | 6 996 600 |
| Pfizer (COVAX) | 1 392 300 | ||
| J&J | 3 000 000 | 9 100 000 | 19 100 000 |
| J&J (AU) | 5 379 769 |
* NOTE: the timing of the delivery of the additional 10 million doses of Pfizer vaccines announced by Minister Mkhize on 13 April will be announced shortly.
Securing the pipeline of scheduled and delivered vaccines remains a priority. The supply of vaccines globally is constrained due to the demand from all countries, including South Africa. If we have learned anything over the last year, it is that some uncertainty will remain with us, and will require us to be patient, resilient and flexible in protecting our people against this century’s most profound challenge.
The second critical element to a successful vaccination programme is to ensure the systems and vaccination sites are capacitated to deliver efficiently. This includes ensuring that the EVDS system is fully functional, secure and scalable for registration and scheduling. Government has stress-tested the EVDS to ensure that it is fit for purpose. Government will be sharing more information about the EVDS registration process in due course. As soon as this information becomes known, B4SA will share this with you.
Both Government and B4SA private sector vaccination sites are currently being configured and capacitated, accredited and certified, and vaccinators are being allocated and trained. Government’s programme includes the capacitation of vaccination sites in every district across the country, which will include small, medium, large and mass vaccination sites across both the public and private sector.
Government’s calculation is that the country – across both public and private vaccination sites – will need to vaccinate between 250 000 and 300 000 people per day in Phase 2 to meet the 16.6 million target.
B4SA has created a specific operationalisation work stream that includes three service delivery teams responsible for the rollout of private-sector sites which will feed into the overall national sites programme. The private sector can vaccinate approximately 163 000 people per day across corporate and independent pharmacies, employer occupational health sites, large scale sites developed by medical schemes, GPs, private hospitals, and mass vaccination sites.
The country’s leading private sector medical and business experts, have volunteered to manage and run B4SA’s programme and are working 24/7 to contribute to a successful, overall national vaccination rollout.
The third element required for success is the nation’s willingness to be vaccinated. We know that there is a certain level of hesitancy towards vaccines, for a range of different reasons. The most widespread concern relates to potential side effects of the vaccines. The best antidote to vaccine hesitancy remains the dissemination of accurate, fact-checked information and B4SA is working closely with Government, labour, civil society, faith-based organisations, NGOs and the Solidarity Fund, on the roll-out of ongoing communications campaigns in this regard.
We know that vaccines, which protect against serious illness, hospitalisation and death, are the best way to protect lives and livelihoods. This is the intention behind the country’s Covid-19 vaccination programme. They offer the quickest and most effective way to reach herd immunity. Both vaccines earmarked for South Africa (Pfizer and J&J) have been registered and approved for use by the SA Health Products Regulatory Authority (SAHPRA) and are efficacious against the variant prevalent in South Africa.
On Tuesday, the Food and Drug Administration (FDA) in the United States announced that it was pausing the rollout of the J&J vaccine on a precautionary basis after 6 vaccine recipients out of 6.8 million in the US developed a rare blood clot condition. In response, on Tuesday evening, the Minister of Health, Dr Zweli Mkhize announced that South Africa will voluntarily pause the rollout of J&J vaccines, to allow SAHPRA to assess the situation. Minister Mkhize stressed that this was a precautionary and temporary measure and that no blood clotting disorders had occurred in almost 300 000 vaccine recipients who received the vaccine in SA. He assured citizens that these kinds of reports are expected to emerge as part of a robust post-market surveillance system (pharmacovigilance), and should provide comfort that medical authorities keep a vigilant watch on all new products that are deployed into the market to ensure they remain safe and effective for human consumption.
With over 53 000 deaths caused by Covid-19 in South Africa since the onset of the pandemic, B4SA believes that vaccines remain the safest, and most effective way to combat the virus.
South Africa is no stranger to vaccines. We already dispense over 14 million vaccinations per year, most of them paediatric vaccines. Pre-Covid-19, the private sector also rolled out 1.3m flu vaccines on an annual basis.
With winter and the annual flu season around the corner, as well as a likely third wave of the pandemic, it is critical that we do everything in our power to protect ourselves so that we don’t overwhelm our healthcare system. In addition to adhering to the non-pharmaceutical interventions (wearing masks, washing and sanitising hands, and social distancing), we would like to encourage you all to get the flu vaccine as soon as possible as these are readily available now.
A successful rollout requires close and ongoing collaboration between Government and its social partners, including business, and the participation and commitment to social solidarity from every one of us. As B4SA, we are wholly committed to doing our part.
- Stavros Nicolaou is the head of health working group B4SA
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