On Sunday night South Africans heard how, after a fumbled start, the country’s vaccine strategy is being ramped up. About 43 million vaccines have now been ordered, due to arrive in staggered intervals throughout the year.

Roughly 65,000 healthcare workers have been vaccinated, with the process picking up pace as it becomes more streamlined. Phase Two of the roll-out will begin in April.

While the government is the sole procurer of the vaccines, the private sector in the form of  B4SA, the alliance of business supporting government efforts to combat Covid-19, has quietly stepped back up to the plate.

“No, the private sector cannot procure the vaccine,” says Martin Kingston, chairman of B4SA. “This is a government-run process around the world.”

But what B4SA can do is back these negotiations with the necessary technical, medico-legal and contractual support. 

“And where we can apply pressure and leverage in accessing or securing access to vaccines, we will do that. But the negotiations must be led by government. When there is a surfeit of vaccines it will be different.”

As recently as November the members of B4SA were winding down their operations, with the different workstreams transferred to their permanent homes. For instance, the economics hub, which pulled in dozens of experts to chart an economic recovery plan is now under the wing of Business Unity SA and the personal protective equipment (PPE) procurement hub has been absorbed by the Department of Health. The legal entity and management structure was hibernated, waiting to spring into action when required. 

They did not expect it would be so soon. 

“We did not anticipate the second wave, its severity and extent,” Kingston says. But in December it was quickly apparent that the far more contagious strain of Covid-19 was going to have a severe impact on people and the economy. 

At the time, the government was comforted by the fact that it was part of the Covax initiative, which was designed to ensure equitable access to vaccines. Beyond that, there was no urgency to procure additional vaccines or to plan a robust roll-out strategy.

“We reconvened the board before Christmas and agreed that B4SA would be revived with a single focus — to support the government-led national vaccine programme,” says Kingston.

If a second wave could be so severe, what of a third or fourth wave? The realisation dawned that without a vaccine strategy the economy would sink ever lower with each successive wave of the virus.

“In three months, when the weather turns cool, we will find ourselves in the middle of a third wave. We needed to kickstart the programme urgently and get through phases one, two and three as quickly as possible,” Kingston says.

The government, represented by President Cyril Ramaphosa, Minister of Health Zwele Mkhize and Finance Minister Tito Mboweni, agreed that the private sector, via B4SA, had a role to play.

We need to limit — to the extent we can — any scope for corruption and malfeasance. When it comes to procurement, there is next to no chance. And in the supply chain it will also be difficult — there are a very limited number of companies with the technical capability to maintain the cold chain.

Tracking the arrival, distribution and administration of — at first, tens of thousands of vaccines, but soon millions — is an administratively burdensome task. This became patently clear following the chaos at Steve Biko Academic Hospital towards the end of February when thousands of health professionals queued for a vaccine for hours with no regard for whether they had a booking or not, or whether or not they worked in a high-risk part of the system.

 “This process must be predicated upon information systems. We need to know which vial of vaccine is where, and whose arm it went into and whether that person needs one dose or two.”  

Within a matter of weeks, B4SA had nine workstreams in operation, each meshed with a workstream in the public sector and all backed by professional project managers to ensure the process is integrated.

Who will pay for the vaccines is a critical question. While the government has agreed to underwrite the cost, it generally accepted that private sector support is required.

Discovery CEO Adrian Gore heads the workstream tasked with ensuring the process is properly funded. He is responsible for getting buy-in from medical aid schemes for some cross-subsidisation of the government sector by the private sector. A single exit price will be agreed on per vaccine, and the medical schemes are likely to agree on a higher rate. 

“In the final analysis, this decision must be the responsibility of the boards of trustees, who must act in the interest of members. I think it’s an easy decision,” Kingston says.

In addition, if people want to donate, the Solidarity Fund will accept contributions. Kingston acknowledges that people’s appetite to contribute has been dulled by the corruption around PPE procurement, which unfortunately has also damaged perceptions of the efficacy and integrity of the vaccine roll-out process. 

“We need to limit — to the extent we can — any scope for corruption and malfeasance,” he says. “When it comes to procurement, there is next to no chance. And in the supply chain it will also be difficult — there are a very limited number of companies with the technical capability to maintain the cold chain.” 

The last step is the administration of the vaccine — a job that will be carried out by clinics, pharmacies and other public and private healthcare practitioners. 

“Government will set a fixed price for this. I imagine that some may want to insert themselves into this process, but unless a company can demonstrate they have the skills, we will resist that.”

Crooks may try to take advantage of the growing market for counterfeit vaccines. 

“For sure, people will try to insert themselves into commercial opportunities. One needs to have the systems and processes to guard against this.”

That said, B4SA is not awarding contracts — that is the Department of Health’s job. 

“We are not going anywhere near that. We will provide the tech support and assistance to ensure the process can withstand scrutiny.”

And if it can’t withstand scrutiny? 

“We expect suitable and appropriate consequences.” DM/BM

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