Cape Town - South Africa will embark on an ambitious Covid-19 vaccine roll-out plan that will cost in excess of R20 billion with up to 31 000 vaccinations taking place each day.

With just over a week to go until the end of January, and the awaited arrival of the first batch of one million Covid-19 vaccines, South Africans are anticipating a more detailed vaccine roll-out plan.

President Cyril Ramaphosa has called the vaccine drive “the largest and most complex logistical undertaking in our country’s history”.

While there remains many unanswered questions, there are a few things we know about the government’s grand plan and how the vaccine roll-out will kick off:

What is the plan?

• Vaccines will not be available for everyone immediately, and a prioritisation system will have to be applied. The country plans to vaccinate 67% of the population, roughly 40 million people in order to achieve population immunity.
• There will be a three-phased approach based on the availability of vaccines.

– Phase one: target a population of 1.25 million; front-line healthcare workers (HCW) would be first in line.

– Phase two: target population of 2 500 000: this would include police officers, miners and workers in the security, retail food, funeral, teachers, banking, essential municipal workers and home affairs, border control and port health services.

– Phase two: target population of 1 100 000: this includes people in care homes, 60 years and older, people older than 18 years with co-morbidities, detention centres, shelters and prisons. In addition, people working in the hospitality and tourism industry, and educational institutions.

– Phase three: target population of 22 500 000 – from the rest of the population.

Who are the vaccine suppliers?

The Department of Health and the Ministerial Advisory Committee have been in discussions with five potential vaccine suppliers, including: Pfizer, AstraZeneca, Johnson and Johnson, Moderna, and Cipla.

South Africa is part of the COVAX vaccine programme, the global initiative aimed at working with vaccine manufacturers to provide countries worldwide with equitable access to safe and effective vaccines.

In the presentation given by Health Minister Zweli Mkhize to Parliament this month, the following “assumptions” were made about the vaccines South Africa will be receiving:

• 5% from Moderna;
• 5% from Pfizer;
• 70% from AstraZeneca; and
• 20% from Johnson & Johnson.

The Department of Health’s spokesperson Popo Maja said negotiations with vaccine suppliers remained ongoing.

“We are aiming at securing vaccines from multiple countries so as to minimize the risk of short supply,” he said.

How many vaccines have been secured?

South Africa has reportedly secured around 34.5 million doses of Covid-19 vaccines.

About 1 million doses are expected to arrive in the country before the end of January from the Serum Institute of India. This biotech company is producing the vaccine developed by AstraZeneca and the University of Oxford. A further 500 000 doses are due to arrive in February.

Around 12 million doses are expected from the COVAX facility, plus a further 12 million doses out of the AU's allocation.

There was also the possibility of 9 million doses of Johnson & Johnson’s candidate vaccine being allocated to SA. The Johnson & Johnson's vaccine is undergoing its third-phase clinical trials, with data due to be published in early February.

The three vaccine makers which are closest to widespread distribution, namely AstraZeneca, Pfizer and Moderna, require two doses of the vaccine to work. Which means, if 40 million people are to be vaccinated by year end, South Africa would need to acquire 80 million doses.

Who will roll out?

Cape Town-based Biovac, part-owned by the government, has been appointed for three months to provide storage and distribution services for vaccines to inoculate frontline healthcare workers.

How much will it cost?

According to the Department of Health the purchase of enough doses for 67% of South Africa’s population would cost R20.6 billion

“The government will be the sole buyer, before allocating vaccines to regional authorities and the private sector. The majority will come from AstraZeneca, which has set a price of R54, compared with Moderna’s R536,” said Mkhize.

The National Treasury will put up the majority of the cost, though the government will also look to raise funds and ask medical insurance providers to contribute.

However, some have questioned where this figure comes from, as it seems too high. DA Finance spokesperson Geordin Hill-Lewis said cost estimates vary from around R7bn, if all vaccines were produced by AstraZeneca, which is the cheapest and R15bn if we were to go with the more expensive ones.

“Lives are at stake. We need access to the vaccine as quickly as possible, or more people will die and the country cannot end the cycle of endless lockdowns. We have no confirmation of when the vaccine will arrive, how many will come, and how much they will cost. This is a tragedy, and a scandal,” said Lewis.

Additional costs

An estimated R1.2bn is needed to hire 8 851 nurses for the Covid-19 vaccinations.

R2.2bn for the international distribution initiative COVAX facility. The Solidarity Fund has already made a deposit of R327m.

Will my medical aid pay for my shots?

All South African medical aids will be covering the cost of the vaccines to its members, said managing director of the Board of Healthcare Funders (BHF) Dr Katlego Mothudi.

“It is now legislated as part of the prescribed minimum benefits for members. Those who qualify as per the government prioritisation process, for example the healthcare workers and the elderly, medical aids will pay for the vaccines, and they will be prioritised,” he said.

Around 17% of the country’s population is covered by medical insurance, according to Stats SA. Mothudi said that the adult population will be prioritised for the vaccines.

One of the country’s largest medical aid schemes, Discovery Health, revealed at least R7bn has been set aside to ensure its members received the vaccine as soon as it was made available in South Africa.

Can I refuse a vaccine?

Vaccination is not compulsory in the country and people are entitled to refuse the jab, said Maja.

“What needs to be communicated clearly is that the vaccination is important for any health system. It prevents outbreaks of diseases that could be catastrophic to societies,” he said.

Conspiracy theories about the Covid-19 vaccine have been running rife from the time the vaccine was developed. Claims have circulated worldwide among anti-vaxxer groups which include theories that the vaccine will alter a person’s DNA and that microchips will be implanted after a person receives the jab.

Maja said only vaccines that have been licensed or authorised for use by the South African Health Products Regulatory Authority (SAHPRA) will be used.

“We will need to ensure citizens are informed clearly about the safety and all the safety monitoring that is in place for vaccines right from the trials through to the licensing and monitoring even after that,” he said.

Security

SANDF and the police will be deployed to different sites where the vaccine is set to be administered across the country.

Speaking during a webinar organised by the ANC Progressive Business Forum, member of the Covid-19 Partnership Task Team, Dr Aquina Thulare, said “to make sure that we secure the vaccine the South African National Defence Force (SANDF) members will be deployed at the administration sites.”

“The police and military will also be tasked to look over the vaccine as they are administered. This will ensure we are able to account for every dose of the Covid-19 vaccines. It also helps us to manage those who have to come back a second time,” she said.

Where will people be vaccinated?

In South Africa, the vaccine will be delivered using three methods during phase one:

Work-based programmes: This is ideal for hospital staff, especially at district level private and public hospitals.

Outreach-based programmes using mobile teams moving between facilities: Ideal for primary health-care providers, community health workers, and private medical centres.

Vaccination centres, particularly in remote areas: Ideal for independent health-care workers.

 

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