A few days after being grilled in Parliament for lacking a clear plan, the Department of Health presented a “vaccine roll-out and acquisition plan” to the National Council of Provinces on Thursday, 25 February.

Minister of Health Zweli Mkhize, along with the nine health MECs and the deputy director-general of the Department of Health, Dr Anban Pillay, briefed the National Council of Provinces (NCOP) on the provinces’ state of readiness to roll out the Covid-19 vaccination programme.

Meanwhile, the National Assembly held a hybrid plenary to pay tribute to members of Parliament and all South African who have died of Covid-19.

This comes just a few days after opposition parties voiced their concern about the apparent “secrecy” around the plan and Parliament’s lack of insight and oversight on the matter.

The delegates of the NCOP were most concerned with the decision to centrally procure vaccines and where this left the private sector in the roll-out.

Mkhize and Pillay both said that central procurement would offer the best protection to all people in South Africa. In addition, they said that the private sector could procure vaccines from the government and could provide storage and distribution facilities.

Pillay began the briefing by outlining the government’s plan for distribution during Phase One.

The distribution begins with a provincial list of sites and those who need to be vaccinated. The same applies in the private health setting. The national coordinating committee will consolidate and approve the lists and allocate stock to them. The stock will be distributed to facilities where vaccinations take place.

Healthcare workers are prioritised in Phase One depending on their risk of contracting Covid-19 because of their work – for example, those working in a Covid-19 ward will be vaccinated before those working in the maternity ward. 

In Phase One, vaccines are delivered to public and private hospitals to vaccinate healthcare workers. Thereafter, mobile teams will be deployed to reach healthcare workers in primary-care facilities and private medical centres. In addition, there will be vaccination centres in pharmacies and the like with the capacity to store vaccines.

In Phase Two, the same will be used and mobile teams might visit workplaces such as mines which have their own clinics.

By Thursday, 41,809 people had been vaccinated. Mkhize predicted it would take six months until the second phase could begin. Pillay later stated that it will probably take another three months before another vaccine is registered in South Africa.

Mkhize said South African citizens and documented foreign nationals are guaranteed to get the vaccine. “We will deal with undocumented people as we come across them,” he said.

When it came to question time, the main concerns of the delegates were why the government is the sole procurer of vaccines and the role of the private sector in the process of storing, distributing and administering the vaccines.

Pillay responded that “almost all” countries have a central procurement approach to Covid-19 vaccines. 

“If you want to achieve efficiency in procurement, then it is best if government procures on the behalf of all citizens. You want to achieve equity in access to make sure those who need them most get them, and not based on their financial capability.

“There are a number of provisions the manufacturers have relating to the procurement of vaccines… there are liabilities which government must accept and required adverse event reporting. Many of the companies are also not keen to be selling to individuals simply because of these requirements,” he explained. He added that the South African model of distribution is similar to that of many other countries.

“I think it’s important to say that the private sector will be buying the vaccines. Once we procure the vaccines, they will have access to vaccines from us and their needs in terms of volumes will be addressed in the procurement process that we have,” he said. He said that members of the private health sector sit on the national coordinating committee and are part of the decision-making process.

The vaccination campaign is national, therefore the government must take responsibility “for all citizens”, said Mkhize. 

“We need to do this in a way which takes into account a sense of justice where the poor and unemployed aren’t marginalised,” he added. He reasserted that most of the manufacturing companies are not likely to sell to individual companies.

“The conditions that are associated with vaccination require someone to take responsibility. It is not possible for a private sector company or a province to make commitments on the indemnities that are being raised and compensation funds. It needs one authority to do that. Those decisions mean government must be the one to focus on procurement.” This, he said, also guarantees a certain standard of vaccines. 

“However, government procures and then distributes so the private sector has full access to the vaccines. We are going through this discussion so that the private sector can procure from government, so that’s the basis of the decision. It does not mean we can stop anyone from trying to procure, but the conditions will make it difficult for them to succeed,” said Mkhize.

Both he and Pillay emphasised that the government has at no time gone through an agent or intermediators to procure vaccines. The department has interacted with the manufacturers directly through their local or global offices.

In terms of vaccine safety and storage, he said the department had investigated most provinces’ infrastructure and readiness. Universities were prepared to loan specialised freezers and Pfizer would supply special storage units, he said. There is a plan and a team working on how these vaccines will be stored and distributed.

For now, vaccines will be stored by BioVac until a contract is awarded, said Pillay. The tender for storage and distribution closes on 26 February. Mkhize added that storage will be in both the public and private sectors, depending on capacity.

They assured delegates that the South African Police Service (SAPS) will secure the vaccines.

The health MECs of all provinces – bar North West because of technical problems – presented on the state of readiness of their provinces to continue the vaccination roll-out. 

The provinces all intend to increase the number of vaccination sites as more batches of vaccines come in and to expand into more rural areas. They are all following the prioritisation strategy the national department has put forward and are focused on keeping vaccines safe – from high temperatures and also theft.

Here is what they had to say:

Eastern Cape

By Tuesday 23 February, 1,687 healthcare workers out of 200,000 had been vaccinated, said acting Health MEC Xolile Nqatha. He said the province needs to vaccinate 3.9 million people in order to reach population immunity. The province aims to vaccinate 1.5 million people during Phase Two and another 2.8 million during Phase Three.

The province has vaccination centres at Nelson Mandela Academic Hospital and Livingstone Hospital for now. He conceded that turnout was “slow” at Nelson Mandela Academic Hospital. The province aims to have 5,414 vaccination sites and will dispatch mobile units to 33 rural communities. In addition, about 2,000 schools will be used as sites when no classes are taking place.

Free State

By 24 February, the province had vaccinated 2,121 people at two sites, Universitas Academic Hospital and Pelonomi Tertiary Hospital, said Health MEC Montseng Tsiu. There are currently 56 vaccinators working across the two sites and both have ICU and trauma specialists on site to manage emergencies.

Gauteng

Steve Biko Academic Hospital had used all of its allocated 5,720 doses by the end of Thursday, according to Health MEC Nomathemba Mokgethi. Chris Hani Baragwanath Hospital gave it 2,000 doses so it could continue vaccinating. The province received 16,800 doses, of which 5,571 went to private healthcare workers and the remaining 11,229 went to the public health sector.

KwaZulu-Natal

The province received 10,800 doses and had administered 7,337 as of Thursday, said Health MEC Nomagugu Simelane-Zulu. The province will provide security during distribution and will use community halls and schools as vaccination centres.

Limpopo

This province will use schools, churches, halls and tents as vaccination sites, said Health MEC Dr Phophi Ramathuba. More than 5,000 doses have been administered out of 7,160. As from next week, after the next batch of doses arrives, more hospitals will be added as vaccination sites. The province already has 96 mobile clinics and over 169 vaccinators.

Mpumalanga

All 31 of the province’s hospitals have fridges (which lock) and back-up generators, said Health MEC Sasekani Manzini. As in many other provinces, only two hospitals are administering the vaccines at the moment but this is set to increase from next week. Manzini emphasised that the SAPS will escort the vaccines during distribution and that the vehicles will have tracking devices. No stops en route will be allowed.

Northern Cape

The province has set its sights on completing all three phases by the end of 2021, according to Health MEC Maruping Lekwene. By Thursday, 1,815 healthcare workers had been vaccinated – almost half of all healthcare workers in the province. The province has received 3,920 doses so far. Lekwene appealed to the Department of Health to allow the province to include more hospitals instead of one MediClinic, arguing that the province is largely rural and this strategy will help them to reach many more people across all five districts. 

Western Cape

The province aims to vaccinate 132,000 healthcare workers in the first phase – by Thursday, 7,116 had been vaccinated, said Health MEC Dr Nomafrench Mbombo. It has received 13,160 doses so far, which will cover 40% of healthcare workers. Mbombo acknowledged that all of the sites are currently in Cape Town, but assured delegates that from March 2 rural areas will be included. MC/DM