South Africa

GROUNDUP

Right of reply: Vaccine rollout — it’s not so simple, argues health department

Nearly three quarters of users of the SACTWU clinics have been vaccinated, the union says. (Graphic: Lisa Nelson)

National Department of Health director-general replies to GroundUp op-ed article.

First published by GroundUp.

In an article on 24 May, GroundUp editor Nathan Geffen and Spotlight editor Marcus Low questioned the slow rollout of vaccines in the first week of the programme, suggesting changes that could be made to speed up the process. Here, Nicholas Crisp, deputy director-general in the National Department of Health, responds.

I respect the work that GroundUp does but I am afraid that I found this article a rushed and sloppy job and am disappointed that you did not take time to contact anyone who could have helped you to understand the issues that you raise in the article. It will be good if we can assist in answering some of the technically difficult issues for your readership.

Why are so many patient-facing workers still unvaccinated?

There are two major groups: health professionals registered with Health Councils, and other healthcare workers. The professionals were vaccinated in the Sisonke study but not all were seen. Many live far from Sisonke sites. The national rollout (Pfizer) has taken over the remaining list and is vaccinating those people.

Some in the private sector were not vaccinated for the same reason and they are also being sent SMSes and are being vaccinated.

The challenge is with the non-professionals (admin staff, support workers, traditional healers, mortuary workers, etc) where it is not possible to verify their employment.

The public has abused this badly and the Department of Health decided to terminate this option until an alternative, secure solution can be devised.

There is no point comparing South Africa to the UK which has hoarded vaccines and been at it for months. We have had a week of vaccinating with the national programme (after the Sisonke study) after being in a queue for vaccines on the international market. How is it helpful to speak of the UK’s 400,000 per day?

Vaccine stock

Vaccine stock does not far exceed what is being used. That is misleading and indicates a lack of appreciation of the law and regulatory compliance requirements.

The vaccine that arrives in the country goes through rigorous quality testing and this is done in only one national laboratory in Bloemfontein. This is an international protocol and cannot be accelerated. It is scientifically not possible.

So we wait for the release of the vaccine for use, even if the public thinks it is “available”.

Once the stocks arrive in regular weekly deliveries this will be a smooth flow with known timelines.

We agree that there is “no reason to keep any vaccine in stock” and nothing is kept in stock. It is moving all the time.

But the vaccine is stored and managed in strict cold chain conditions. The Pfizer vaccine is stored and managed at far colder temperatures than anything we have managed in the past so it cannot be distributed to the periphery in bulk and needs to move in smaller volumes more frequently.

This will be easier in future now that the regulator (Sahpra) has approved easier storage conditions.

The registration system

You provide an anecdote of a health care worker in a care home who reports a problem with dealing with the Electronic Vaccine Data System (EVDS) as a “bottleneck”. You then trash the need for EVDS rather than report what it is, what it does and why it is important to the people of the country. Just a few reasons for health care records:

South Africa’s a constitutional democracy and the authorities must respect the law and the people. Therefore there is a need to obtain and record consent before vaccinating people.

Adverse events do occur and there is a need for complete records to manage the event and protect the patient and care worker. Knowing which vaccine, which batch and lot were used for the vaccination are important.

Many people need proof of their vaccination for travel, and some form of certification is important as part of a patient’s health record.

The system is essential to matching workload across hundreds of sites to the available supplies, vaccination capacity and reporting.

According to you, EVDS is not necessary for scheduling the second dose: a simple little card would suffice. Just a few reasons why this is wrong:

  • EVDS is matching supply and demand of vaccine;
  • It is scheduling first and second doses at the same sites to avoid over-demand on-site capacity; and
  • It sends an SMS near the appointment date (not everyone remembers appointments 42 days hence).

Slow registration

Most people over 60 have not registered with EVDS. This is exactly why your article should be helping them to do so. EVDS registrations by over 60s are rocketing daily.

Community leaders all over the country are mobilising to assist elderly people to register (traditional leaders, clergymen, politicians, etc). Children are assisting their families and others — it is easy for a child with access to a cell phone. Health service providers are assisting with the registration.

“Have you assisted an older person to register today?” should be a campaign of GroundUp.

Electricity

You suggest the EVDS is not viable because of problems with access to electricity and with load shedding. Do you really think that is not provided for?

Cell phones do not need the power to be on for registration and will work as soon as the towers are working if their power went down.

As with supermarkets and airlines, the EVDS has a paper-based backup and there is a back capture of records, as there was through EVDS during Sisonke.

Provincial control

Five provinces, not just the Western Cape, were “given control” and all active private sites. There is nothing magic about the Western Cape.

The EVDS is designed to be managed at site level, not even the provincial level. Once the staff are confident and managing they take over their own scheduling.

However, SMSes are still sent from the national database for everyone.

Weekends

Why not vaccinate at weekends? This is in the plan but not for everywhere, because health care workers also need rest. A third wave will suck them dry. And the budget for overtime work is not limitless.

Other vaccine sites

You suggest vaccine sites in shopping malls, at taxi ranks, and other places. There are some but they need pharmacy licences because this is a Schedule 4 medicine and those on-site need to be able to manage vaccines and treat adverse events. As far as using the Independent Electoral Commission to help roll out the vaccines is concerned: we investigated and it is not legal. DM

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