Rolling out the vaccine: Provincial plans compared
South Africa’s vaccine rollout was set to start early in February, aiming to vaccinate 1.25 million healthcare workers nationwide in its first phase. However, it hit a snag when a study indicated that the Oxford University/AstraZeneca vaccine earmarked to spearhead the effort failed to show meaningful efficacy in preventing mild or moderate disease caused by the new 501Y.V2 variant.
Health Minister Dr Zweli Mkhize assured the public in a press conference last week that the country’s rollout plans will remain the same, just with a different vaccine, most likely the Johnson & Johnson or Pfizer/BioNTech vaccines. The Johnson & Johnson vaccine has been shown to be reasonably effective in preventing mild-to-moderate disease, and highly effective in preventing severe disease or death, caused by the 501Y.V2 variant.
From 17 February, this vaccine will be provided to healthcare workers as part of a phase III(b) clinical trial. When the rollout will start outside of trial contexts is not yet known. Most of the provincial planning presented so far is understood to relate to this latter phase of the rollout where vaccinations will be provided outside of a trial setting. This phase will only begin once the South African Health Products Regulatory Authority has given the green light for use of the relevant vaccines outside of clinical trials.
Mkhize confirmed on Tuesday, that as part of the trial the first batch of 80 000 doses of the Johnson & Johnson vaccine, which arrived on the same day, will be distributed to 20 vaccination sites across the nine provinces. A team of 64 vaccinators will vaccinate 80 000 healthcare workers over the next two weeks.
“As more doses arrive, the service will be ramped up accordingly to ensure that we maintain a good rate of daily vaccines,” he said. So far, 17 sites have been confirmed. Chairperson of the South African Medical Association, Dr Angelique Coetzee, in an interview with eNCA on Tuesday, noted 17 hospitals chosen for the roll out of the first batch of doses. These are:
- Eastern Cape: Livingstone Hospital and Nelson Mandela Academic Hospital.
- Free State: Pelonomi Hospital and Universitas Hospital.
- Gauteng: Chris Hani Baragwanath Hospital and Steve Biko Academic Hospital.
- KwaZulu-Natal: Inkosi Albert Luthuli Central Hospital and Prince Mshiyeni Memorial Hospital.
- Limpopo: Pietersburg Hospital and Mankweng Hospital.
- Mpumalanga: Rob Ferreira Hospital and Witbank Hospital.
- North West: Job Shimankana Tabane Hospital and Klerksdorp-Tshepong Hospital.
- Northern Cape: Robert Sobukwe Hospital.
- Western Cape: Khayelitsha District Hospital, Groote Schuur Hospital and Tygerberg Hospital.
Meanwhile, South Africa’s nine provinces have been briefing MPs in Parliament and the public on their rollout plans since mid-January. Details of these plans may change as more information around the timing of and exact number of vaccines allocated per province are revealed.
So far, Spotlight has seen rollout plans for seven of the nine provinces, with the Free State and Mpumalanga still outstanding.
In a parliamentary briefing the acting superintendent-general for the Department of Health in the Eastern Cape, Dr Sibongile Zungu explained the province will take a phased approach, comprising three phases. The first phase will focus on health care workers, a target population of about 200 000. An estimated 60 000 of which are in the public sector and interacting directly with patients.
The province aims to vaccinate a total of 3.7 million people through the three phases. The second phase, which will include essential workers, those in congregate settings and those over 18 with comorbidities will have a target population of about 1.5 million. The third phase, which focuses on all people over 18, will be about 2 million.
The Eastern Cape faces a significant challenge in reaching all its residents, as it contains about 45% of the country’s (mostly rural) communities who have to travel more than 5km to get to a health facility, Zungu said during the parliamentary briefing. This translates to just over 2 800 communities.
Zungu said the province will set up temporary vaccination sites at key points like municipal offices, malls, taxi ranks, pharmacies, private hospitals, NGOs, and clinics. Mobile services would also be employed.
Later, in an interview with SABC, Zungu said that the vaccination sites will also include churches, schools and health science facilities at medical schools in the province.
Spotlight previously reported that the Eastern Cape Health MEC Sindisiwa Gomba said 571 vaccinators were being evaluated and trained, and 1 158 vaccination sites were being evaluated.
The Gauteng province is ready to start as soon as the National Department of Health gives them a date, acting COO for the Department of Health in Gauteng, Nomsa Mmope, confirmed in a press briefing last week. Their vaccination roll out will begin in the Charlotte Maxeke Academic Hospital and Steve Biko Academic hospital, and both are ready to start when the National Department of Health gives them a date.
Mmope said the province’s cold chain storage for the vaccine is sufficient and will be able to maintain the 2-8 degrees Celsius required for the Johnson and Johnson vaccine. The fridges they will use have an alarm that will alert them to any changes in temperature, she said.
Vaccination sites that don’t have big vaccine fridges will be provided with World Health Organization (WHO) accredited cooler boxes and ice packs. Back-up generators are also in place at the pharmacies where the vaccines will be stored. These same pharmacies, said Mmope, have alarm systems to ensure the vaccines remain secure. Only one batch of vaccines will be taken to the vaccination sites per day as an additional safety measure to ensure that no vaccines go missing.
During the province’s briefing to Parliament, chief executive officer of the Medical Supplies Depot, Dumisani Malele said that the vaccination rollout plan would also be divided into three phases, with phase one focusing on just over 215 000 health care workers.
The second phase would be divided into two sections, the first focusing on frontline workers, like essential workers, and the second would focus on the members of the population with the highest risk of developing severe disease. When added together, the target population here is just over 7.3 million people.
The third phase would focus on generating herd immunity and targets just over 2.7 million people.
The province aims to vaccinate 67% of their population, which is around 10 million people.
He added that the province currently has 808 vaccinators and 224 vaccination sites. This was confirmed by Mmope.
In a press conference several days before the parliamentary briefing, Gauteng’s acting HOD for health in Gauteng, Lesiba Malotana said that for phase two and three, over 2 000 potential vaccination sites had been identified.
KwaZulu-Natal premier Sihle Zikalala announced the province’s roll out plan on the 2 Feb.
The province will follow a phased approach, with phase one comprising two categories, those who are in direct contact with patients such as healthcare workers and support staff, and the hospital staff who are not in direct contact with patients, such as administrative staff.
These categories contain just over 163 000 eligible health personnel, with an estimated 81 000 healthcare workers in the public sector and about 49 000 in the private sector.
The province has identified 91 vaccination sites, which include all public hospitals and Community Health Centres (CHCs). According to the Premier, the hospitals and the CHCs will be responsible for the clinics and other sites in their catchment areas.
Health MEC Nomagugu Simelane-Zulu who was also present at the press briefing said that the vaccine process for COVID-19 is nothing new, as it will follow the same process that is followed for other vaccines.
In order to vaccinate the target population, an additional 2 000 additional nurses “over and above” the nurses who do routine vaccinations have been trained to administer the COVID-19 vaccine according to Simelane-Zulu. This is to prepare for the second and third phases of the vaccine roll out.
She said that phase two and three might be a challenge because of the high number of people who need to be vaccinated. She says phase two includes essential workers, those over 60, those over 18 with comorbidities, and phase three is everyone who is over 18.
During a press briefing on the province’s rollout plans, Limpopo Premier Chupu Stanley Mathabatha said that the province had 39 vaccination sites ready to begin the vaccination process.
The plan will be implemented in three phases, according to Mathabatha, with phase one focusing on frontline health workers in both the public and private sector. This phase will be divided into two further stages, Phase one A, which focuses on healthcare workers and medical staff such as ENTs and dentists, who are at high risk for contracting COVID-19 because of their exposure to patients. It will also include staff who work in the COVID-19 wards, such as nurses, cleaners and food servers.
Phase one B will focus on staff who are briefly in direct contact with patients, like security guards, administrators, clerks, or who are not in direct contact with patients at all, like staff in Human Resources and finance.
The second phase will target those people in high-risk groups like those over 60, people in congregate settings and essential workers, a population of about 1.66 million. The third phase will include an open vaccination for all the residents of Limpopo who are over 18, which is about 2.25 million.
According to the province’s MEC for Health, Dr Phophi Ramathuba, during an interview with eNCA, the province estimates that there are around 50 000 healthcare workers who need to be vaccinated in the first phase. Yet, under the original allocation of the Oxford/AstraZeneca vaccine, Ramathuba says that only around 44 000 doses would be delivered as the number of doses allocated were determined by numbers extrapolated from the National Department of Health’s Personnel System or ‘Persal’.
There are additional an estimated 6 000 staff members not accounted for in the Personnel System, according to Ramathuba. They include security guards, and community healthcare workers employed by NGOs.
The Head of the Department of Health in Mpumalanga, Dr Savera Mohangi, presented the province’s rollout plans to MPs in Parliament on 17 February.
Mohangi said the province will start its rollout plan on 18 February. Mpumalanga was allocated 3 640 doses from the first batch of Johnson and Johnson doses, which will be administered at Rob Ferreira Hospital (2000 doses) and Witbank Hospital (1 640).
Mohangi said this number suffices to vaccinate all the healthcare workers at both facilities.
Mpumalanga’s rollout plan will also follow three phases. Mohangi said Phase one will comprise healthcare workers who will be divided into four categories including those who conduct aerosol-generating procedures like intubation, ventilation and taking COVID-19 specimens; those who are in direct contact with known or suspected COVID-19 cases; those who are in contact with patients who are not known or suspected to have COVID-19; and those healthcare workers who are not in contact with patients.
Mohangi said healthcare workers in the private health sector will only join once the province receives its second batch of vaccines.
The target population for phase one is just over 69 000 and about 30 000 of those are in public hospitals and Primary Health Care (PHC) facilities.
The combined target population for all the phases, Mohangi said, is 3 157 026.
She said that under the original planning for the Oxford University/AstraZeneca vaccine, 31 hospitals had been identified as vaccination sites, and all have WHO approved fridges and back-up generators. The province is procuring continuous temperature monitors.
For now, the safety of the first batch will be the responsibility of the Medical Research Council (MRC), as they are responsible for the vaccine at this point, Mohangi told MPs.
The province’s security plan is that the South Africa Police Service (SAPS) will assist with keeping vaccines safe during transit, and the transport vans will have trackers. Another safety precaution is using the Electronic Vaccination Data System (EVDS) to ensure “that the vaccines are given to the right person at the right time”, Mohangi said.
A press briefing by the premier of the Northern Cape Zamani Saul revealed the province seeks to vaccinate its residents in three phases, focusing on an estimated 14 000 “patient-facing healthcare workers”. This comprises an estimated 10 000 healthcare workers in the public and an estimated 4 000 healthcare workers in the private sector.
In a briefing to parliament, Dr Dion Theys, Head of the Department of Health in the Northern Cape, said that 245 vaccinators had already been trained, and 15 vaccination sites at hospitals had been identified across the province.
The province will work in a phased approach. With phase one focusing on healthcare workers and staff who have been divided into four categories.
Category one, which is divided into two sub categories, deals with health care workers and staff who are “conducting aerosol generating procedures” such as ventilating, intubating or taking COVID-19 specimens. The first sub category deals only with hospital staff and includes doctors, nurses, pharmacists, cleaners and administrative clerks who are in direct contact with patients. The second sub category deals with all clinic staff.
Category two include those healthcare staff who are in contact with known or suspected COVID-19 cases.
Category three deals with healthcare staff who are in contact with patients who are not known or suspected COVID-19 cases
Finally, category four deals with those healthcare staff who are not in direct contact with patients at all.
Theys said that phase two and three of the vaccination plan is still a “work in progress”, and they are still in discussions with the National Department of Health about these last two phases.
He added that the province still has challenges with connectivity in several “far-flung areas” in the province.
For phase three of the plan, they will use newly acquired vehicles as well as WHO accredited cooler boxes to transport the vaccines to these communities daily with teams, of which there are 80, to transport and administer the vaccines. The teams will include data capturers, nurses, doctors and so forth, according to Theys.
He added that all the vaccine sites have fridges that can adequately store the vaccines. Pharmacists were assigned, under the original planning for the Oxford University/AstraZeneca vaccine, to ensure that the cold chain is maintained.
The province’s premier Prof Tebogo Job Mokgoro briefed the media on its vaccine rollout plan on the 1 February.
He was joined by medical specialist Prof John Tumbu who said that in order for the province to achieve herd immunity, it has to vaccinate 67% of its population, which is about 2.7 million people.
Tumbu said that the province aims to vaccinate an estimated 34 000 frontline healthcare workers in Phase one of its roll out, with an estimated 23 000 in the public sector and an estimated 11 000 in the private sector. At the time of the press briefing, he revealed that the province was still collecting data on the number of traditional health practitioners, and these numbers would be added to the total.
According to Mokgoro, the vaccination of health care workers and staff at health facilities will be done in three phases based on the risk of exposure to COVID-19. The first phase will focus on high-risk units, the second phase on medium-risk units, and the third phase on low-risk units.
“For the first part of Phase 1, public and private hospitals in the provinces are targeted to be vaccination sites, as they have infrastructure sufficient to cater for this activity,” Mokgoro said.
Tumbu said that the province has identified 21 vaccination facilities that can be used for phase one, which includes two Tertiary Hospitals, two specialised hospitals and sixteen district hospitals.
In a press briefing early in February, Head of the Western Cape Department of Health, Dr Keith Cloete, outlined the province’s vaccination plans, which will also be divided into three phases. The first phase will focus on healthcare workers, in both the private and public sector, care workers, community health care workers, health science students and traditional healers. The estimated target population is 133 000.
The second phase will comprise essential workers, persons in congregate settings, those over 60 and those over 18 with comorbidities. The target population is about 2 million.
The third phase comprises the rest of the province’s population, who are over 18 and are about 2.9 million people.
In the same press conference, MEC for Health Dr Nomafrench Mbombo said to combat difficulties in keeping the vaccines at the correct temperatures during transportation to the vaccine sites, particularly in rural areas, vans with trackers and temperature meters that allows for temperature monitoring during transit will be used.
The vaccines, once received, (which at this point referred to the Oxford University/AstraZeneca vaccine), will be transported directly to the Cape Medical depot, which according to Mbombo normally houses vaccines for the province
During a press conference last week, Cloete said that 93 additional vaccine friendly fridges had arrived in the province. An assessment of the generators has also been conducted and portable generators are on standby so that cold chain can always be maintained in the facilities.
He also said that minus 70 degree storage facilities to house the Pfizer vaccine had been confirmed with Stellenbosch University.
The master list of vaccination facilities is still being finalised, but Cloete previously said that 378 vaccination sites have been identified in the public sector and 41 in the private sector.
In terms of security, Cloete added that SAPS and other law enforcement are being briefed to ensure that the vaccines are kept safe during transportation.
A total of 583 vaccinators have been trained so far, said Cloete, and they are located mainly at Groote Schuur Hospital and Tygerberg Hospital. According to the Western Cape Premier, Alan Winde a total 3 084 vaccinators had registered by 10 February.
Plans not yet shared with the public as of 16 February 2021.