Health-care workers have finally begun dispensing coronavirus shots to their peers in the first phase of the government’s long-awaited rollout plan. The process has begun slowly, with just shy of 83,600 people vaccinated in the first fortnight, but it is expected to accelerate in the weeks ahead.
Attention is now turning to the next stage, but details of who is eligible for vaccination in phase 2, when it will start, who will be at the front of the queue and how the private sector fits into the distribution plan remain sketchy.
The broad brush strokes of the government’s strategy were set out in a presentation health minister Zweli Mkhize made to parliament in early January, which described three phases for immunising 67% of the population, or 40-million people. Phase 1 prioritises SA’s estimated 1.25-million health-care workers, a group the government estimates to be at three to four times higher risk of coronavirus infection than the general population; phase 2 will cover people over the age of 60, adults with co-morbidities that increase their risk of severe Covid-19, essential workers, and people in congregated settings such as care homes and prisons — an estimated 16.6-million people. Phase 3 will target everyone else over the age of 18, estimated at 22.5-million people.
However Mkhize’s ministerial advisory committee on vaccines has yet to finalise its recommendations on who should be offered a jab in phase 2 and when it should start, says chair Barry Schoub. A technical working group is grappling with the details of who to include and how to sequence the target population, guided by international and national expertise, he says.
“We need to get health-care workers vaccinated first. They are the most essential workers and the most exposed. But you are never going to get 100% [of them]. A calculation will need to be made of when you have saturated your health-care workers and then you move on to the next cohort,” he says.
Extensive work is also under way at Business For SA (B4SA), a broad coalition of businesses helping the national health department plan and implement its Covid-19 vaccine strategy.
Not only does the government need to figure out how to order people in phase 2, but it also has to match vaccine supplies to the groups it calls up for inoculation, and set up the systems to consume this stock as efficiently as possible, says B4SA’s Ronald Whelan, chief commercial officer at health and life insurer Discovery.
“We are all gunning to get phase 2 done as quickly as possible and get high-risk populations vaccinated by midwinter. We have to ramp up to vaccinate between 250,000 and 350,000 people a day, and will need models for the last hour of the day to make sure stock isn’t wasted,” he says.
It is clear the government faces a supply crunch for the months ahead, as only 2.8-million of the 11-million doses committed by Johnson & Johnson (J&J) in a deal signed last week will arrive between April and June. The only other vaccines it has secured with certainty are the 500,000 J&J doses earmarked for the Sisonke implementation study, which began providing shots to health-care workers on February 18 as a short-term solution to the government’s decision to halt its planned rollout of AstraZeneca’s shot after a small clinical trial showed it offered minimal protection against the 501Y.V2 variant dominating transmission in SA.
The health department is in the final stages of negotiating with Pfizer, but it is not clear yet how many doses of its double-shot jab are in the offing for SA. Mkhize has previously said Pfizer had offered 20-million doses to SA but told parliament last week that this number might change.
The government has indicated that the private sector will be involved in the distribution and administration of vaccines in phase 2, but once again, there are no fine details of how GP practices or community pharmacies will be involved, or the role large employers are to play.
There is extensive health-care capacity in the private sector that B4SA expects to be harnessed, ranging from mine hospitals to occupational health services in sectors as diverse as manufacturing and financial services. The private sector will also contribute an element of funding, as medical schemes are expected to purchase vaccines from the state. But once again, there is no clarity on what mechanism will be used to do this, and when it will come into play.
One of the most difficult and contentious aspects of phase 2 will be the government’s decisions around who is deemed an “essential worker”.
The clinical evidence for prioritising high-risk populations such as the elderly, and people with conditions such as diabetes and hypertension, is very clear. But it is much harder to determine which workers should be first in line, says Whelan.
“Miners, taxi drivers, teachers, retail workers — everyone has a case to make. But it is very difficult to determine their prioritisation as the data on their risk of infection is not clear,” says Whelan.
Discussions about who to include as essential workers are under way at Nedlac, but nothing has yet been decided, says trade union federation Cosatu’s Matthew Parks. “Everyone wants to be in phase 2, which is understandable. But there is still a lot of work to do,” he says.
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