South Africa’s frontline healthcare workers will be the first to receive the Covid-19 vaccine. And they will not have to wait long.
Health Minister Dr Zweli Mkhize said on Thursday that the first batch of one million AstraZeneca vaccine vials would arrive in the country in January. The second batch of 500,000 would come in February.
The good news was confirmed to the Department of Health this week by the Serum Institute of India, the main vaccine producer for AstraZeneca globally.
Since March last year, frontline healthcare workers fighting Covid-19 have hardly had any time to rest, and the resurgence of infections had taken place before they could take a break.
“Their levels of exhaustion is noticeable,” Mkhize reported.
AstraZeneca is likely to be the most widely used vaccine, due to is temperature stability. The vaccine can be stored at temperatures between 2°C to 8°C, which is ideal for South Africa’s low commercial ultra-low cold chain storage capabilities.
AstraZeneca is also expected to be able to produce large amounts through their myriad of global vaccine producer partners.
But how will the vaccine be distributed, who else will get it first, and how will we ensure security?
Securing the goods
And on the advent of the country receiving expensive vaccines, concerns are high that a repeat of the corruption could impact the success of the vaccine.
The department explained that rigorous safety measures would be implemented, both for the vaccine itself, as well as the safety of citizens receiving it.
Vaccines for healthcare workers will be outsourced and distributed through a central distributor, to both the private and public health sectors.
This includes hospitals, vaccination centres, pharmacies, mobile clinics, occupational health sites, outreach teams and other public and private sector sites.
The Covax facility vaccine storage and distribution will be outsourced and distributed through central and contracted parties.
Contracted vaccine suppliers will be responsible for storing and distributing the vaccine. The distribution would involve direct delivery to identified vaccine administration sites.
All vehicles the vaccines will be traveling in must be tracked and monitored by central and/or contract distributors, the department said.
Safety and security must also be observed at vaccine administration sites, with some law enforcement or security presence.
Barcode scanning will allow for vaccines to be tracked and traced, which is also important to ensure that those who have taken vaccines that require two doses are given the correct second dosages.
All vaccine packaging and vials must be safely and securely disposed of, and all vaccine wastage monitored.
Data verification for the distributed and administered volumes must also take place.
The Covid-19 vaccine is based on new technology and has never been licensed, which means that transparency is key to ensuring the effectiveness and safety of the vaccine.
All citizens who receive the vaccine must receive some sort of confirmation. The health department said the South Africa Healthcare Products Regulatory Authority (SAHPRA) would be implementing the Yellow Vaccine Card System to include the Covid-19 vaccine.
They have also said that a “MedSafety” application would be used for electronic reporting on the vaccine and any adverse events following immunisation (AEFI) in the public and private healthcare sectors. This will also be rolled out by SAHPRA.
Reports will then be assessed by the National Immunisation Safety Expert Committee (NISEC).
How healthcare workers will receive the vaccine
Healthcare workers as a whole are prioritised, but within this prioritisation, they have been divided into four categories, based on how direct their interactions with Covid-19 patients are.
Workers in category one are those conducting aerosol-generating procedures, for example taking Covid-19 specimens, intubation and ventilation.
Category two is healthcare workers in direct contact with confirmed or suspected Covid-19 patients.
Category three is for those in contact with patients who are not known or suspected to have the virus, and category four is for workers not in contact with patients at all.
Phase one of the vaccine rollout will see healthcare workers vaccinated on a work-based programme, which means workers will be vaccinated in the hospital they work in.
This will be done either through occupational health centres or services at the hospital, or via vaccinators who will receive vials delivered directly to the hospital.
Vaccines delivered will be stored in the hospital pharmacy, and vaccination teams will provide on-site vaccination services to all healthcare workers in the hospital. Vaccinators may be fellow staff members or occupational health workers, who will be virtually trained.
Smaller health facility workers will be vaccinated according to the hub and spoke model, using outreach teams.
The idea is that vaccines be distributed to hospitals for daily collection, and mobile clinics or teams can move between facilities to vaccinate eligible workers.
Teams will be coordinated by the relevant district health services.
Health workers not working in health facilities with occupational health services can also be vaccinated through vaccination centres, which will be set up in each district.
Examples of these workers include emergency services staff, independent practitioners, workers not linked to a healthcare facility, traditional healers and administrative staff.
These centres will either be linked to a pharmacy or health facility, or stand alone.
The public and private sectors will have to “share the burden” of service delivery in this regard, the department said, adding that the centres would be a “good option for urban settings and reaching independent healthcare workers”.
Nurses on short-term contracts would also be brought in to provide vaccination.
The Department of Health plans to vaccinate 40 million people over 12 months. This would mean 316,000 vaccinations per day.
Each vaccinator is capable of vaccinating around 50 people everyday. There will be approximately 6300 full-time vaccinators dedicated to jabbing all those eligible for the shot.
Additional vaccinators may be required, such as clinical-associated, post-community service nurses and doctors, contract nurses, and final-year medical and nursing students.
For the greater good
Mkhize highlighted the importance of having citizens “buy into the idea of a vaccine”, especially because getting vaccinated was not mandatory.
He said the public needed to understand that it was for their benefit, and for the benefit of others, to get vaccinated.
He explained that any objections that may arise on a personal, religious or cultural level could be dealt with, but that the vaccine should be taken for the common good of all.
This was reiterated in the department’s presentation on the country’s vaccine rollout, where it said the “perceived vaccine safety” was an “essential component of acceptability of the vaccine”.
Confidence in the vaccine can be achieved, through transparency and effective vaccine safety surveillance, and cohesive reporting on any AEFI.