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The plan to ramp up South Africa’s vaccination drive

Proposals to open stadiums and community halls are just some of the plans afoot to ramp up the Covid-19 inoculation plan. However, reaching 67% herd immunity by December might not be a reality, experts confirm. 

Professor Glenda Gray, chief executive of the Medical Research Council and the driving force behind the Covid-19 vaccination roll-out, told the Mail & Guardian that stadiums and large venues like community and school halls were included in “super-inoculation” weekend events envisaged for later in the year after the less restrictive mid-April Pfizer vaccine roll-out begins. 

She was responding to Media Hack’s “vaccination calculator”, which at 16 237 vaccinations a day, puts the time it would take South Africa to reach herd immunity at six years and nine months.

Gray believes that with accelerated vaccine acquisition and inoculation ramp-up, herd immunity could be achieved within 10 months.

The average daily inoculation rate is 10 000, with some peak days reaching 16 000 shots. She says the calculator fails to account for the unique South African context. 

The highly effective but unregistered Johnson and Johnson (J&J) vaccine is being slowly rolled out to frontline healthcare workers through the Sisonke Study, which is taking place in controlled clinical-practice conditions, under strict supervision. 

This requires qualified research pharmacists, doctors and nurses who understand good clinical practice to be on hand at the 47 research sites to ensure strict protocols are observed. 

South Africa is the first country in the world to roll out the unregistered J&J vaccine, beginning on 17 February; it was followed about two weeks ago by the US. 

The Sisonke Study aims to reach up to 500 000 healthcare workers at 18 public sector hospitals across all nine provinces, with the Pfizer and J&J vaccines accounting for the remaining 750 000 healthcare workers from the end of April. 

Gray said that with the transition to Pfizer vaccines from mid-April, things should gear up beyond the intended 400 approved vaccination sites; the Covid-19 ministerial advisory council is also planning super events like vaccinations in stadiums. 

She added that when provinces were supplied, provincial departments of health would then decide how to deploy the Pfizer vaccine. 

“It’s more complicated than people might appreciate. The Pfizer vials have six doses per vial and the Johnson and Johnson two. Our vaccinators need to know how to draw it up into the syringe and ensure they’re not under- or overdosing, which requires good oversight of the whole process to ensure critical vigilance and safety,” Gray said. 

“We have to work under strict Sahpra [South African Health Products Regulatory Authority], section 21 rules — and the stricter they are, the slower the roll-out is.” 

The Pfizer vaccine requires two shots at least 21 days apart and can be stored for six months at minus -70°C. However, once opened, it must be used within five days.

Dr Jantjie Taljaard, head of infectious diseases at Tygerberg Academic Hospital, said that, except for deep rural areas, South Africa had sufficient cold storage facilities at hospitals and enough refrigerated trucks to cope. 

Gray added that the electronic vaccine data system would easily cope with automatic second-shot SMS reminders. 

Taljaard said that even if it took a few months longer than by the end of January, there was no need to stress. 

He appealed to the government to allow the private sector to import, distribute and administer vaccines, saying that would accelerate the roll-out. The country had many highly competent corporates very capable of collecting data, he said..

“I can see the roll-out going much, much faster from mid-April, but it’s not an easy task. I don’t think we’ll make it quite in the time Glenda says, but that’s okay. No country in the world has managed it in their projected times,” Taljaard said. 

“My big concern is that we’re not targeting high-risk people everywhere. Instead, we’re targeting relatively young healthcare workers for whom it’s not that appropriate. That’s a flawed approach and a big mistake. The healthcare workers are not the ones putting a strain on the whole system — it’s people like diabetics and the elderly,” he said.

Meanwhile, Professor Shaheen Mehtar, the infection control adviser on the Covid-19 ministerial advisory committee, issued a strong warning to all healthcare facilities to increase their basic non-pharmaceutical infection control measures to afford protection to complement the vaccination.

At the time of writing just more than 22% of SA’s healthcare workers had been inoculated. Since March last year, an estimated 6.3% of public sector healthcare workers have been infected, nearly double the general population infection rate — and more than 650 have died. 

Speaking to South Africa’s capacity to take on the mega-inoculation programme, Gray said that the system must be agile and flexible. 

“Luckily, with Pfizer, we do not have the same constraints,” she said.

Gray said a swift vaccination roll-out to achieve herd immunity was all about keeping hospitals, education facilities, shops and workplaces open. “That’s our job. For me, that’s the benefit,” she said. “Hopefully, we’ll start to see a dramatic drop off in mortality, like in Israel — that’s the first thing you want.”

The speed of a vaccination roll-out depended on how quickly bottlenecks were identified and cleared, for which the past month of experience had proved invaluable, she said. “You can’t speculate until you know what our true capacity is. Then you ramp things up exponentially or additively. We don’t know where all the synergies are yet.”

When asked about the ambitious December herd immunity goal, Health Minister Zweli Mkhize had projected, Gray said it was not as unrealistic as many thought. 

“I really do believe there’s a huge commitment in the country. There’s been serious political commitment to get us to where we are — we don’t have an apathetic department of health. They’re not dragging their feet — once more vaccines arrive, there’ll be a huge ramp up.”

Gray added that the last four weeks have proved highly instructive in preparing the roll-out to be scaled-up. “It’s shown where the potential roadblocks are, like the lack of 1mm syringes and needles. The syringes alone have increased in price over the last four weeks from R50 to R400 per pack. There are global shortages of them. We need time to learn how to go to scale — to manage things to scale,” she said.

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Chris Bateman
Chris Bateman is a freelance journalist

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