The Western Cape Department of Health has identified Khayelitsha and Mitchell’s Plain as having the lowest vaccinations and vaccine registrations in the Cape Town metro area. By Monday 30 August, only 22.37%s of Mitchells Plain’s vaccine-eligible population older than 18 years have registered. In Khayelitsha, this number stood at 12.05%.

Some factors contributing to these low numbers, Spotlight found during recent visits to the two areas, include fears around public safety, misinformation, people finding it difficult to register online, and vaccination sites that some say are too far from where they stay.

Many issues in Mitchells Plain 

Nontuthuzelo Chabeni recieving her vaccine at the Covid 19 Vaccine site in Khayelitsha.
Photo by Nasief Manie.

Speaking at the provincial government’s weekly digicon last week, Dr Roland Kroukamp, a family physician at Mitchells Plain Community Health Centre, said the low vaccine uptake in Mitchells Plain was cause for concern. “There are many initiatives such as pop-up sites to help people with vaccination so that they don’t have to take buses and taxis but we continue to see low numbers,” he said.

Kroukamp said public safety in the Mitchells Plain area has been a major concern. The streets of Mitchells Plain continue to be rough, he said, and there are often stories of people being mugged or attacked while on their way to vaccination sites.

“Many of the clients we see at the day hospital have a lifestyle disease such as hypertension, diabetes, to name a few. Having a conversation with them to determine their knowledge of vaccinations, I have picked up that social media is a concern. We understand there is freedom of speech, but a line needs to be drawn between fact and fiction. There are lots of misconceptions,” he says.

Princess Zibi at the Covid 19 Vaccine site in Khayelitsha. Photo by Nasief Manie.

Ivermectin, according to Kroukamp, is the elephant in the room. “There are numerous people in Mitchells Plain using ivermectin as a solution to Covid-19. They don’t believe in vaccination as people believe ivermectin is protecting them,” he says. Kroukamp is deeply concerned about this. “There has been no definitive attempt at stopping these people,” he says.

The scientific evidence on ivermectin for the treatment of Covid-19 remains inconclusive, although the drug has disappointed in a number of studies and one of the most positive studies of the drug has been withdrawn over ethical concerns.

Another issue, according to Kroucamp, is that older persons in Mitchells Plain are not tech-savvy, making registration on the Electronic Vaccination Data System (EVDS) difficult. Mitchells Plain resident Abeedah Adams, who is also a steering committee member of the People’s Vaccine Campaign, agrees that EVDS registration is a concern.

Adams says a team from the People’s Vaccine Campaign recently called a Mitchells Plain vaccine uptake crisis meeting on 20 August to discuss, among other things, vaccine-hesitancy, fake news, and people not being able to register online or access the vaccines.

“We discovered that there was still a lot of misinformation out there about vaccination. To address this, it was decided that 30 volunteers would be trained to educate the community about vaccination. Each volunteer would do five door-to-door educations in their respective community per day. This programme will [start] soon. Some people also raised concerns about working long hours and even weekend shifts, thus not getting a chance to go and vaccinate. We will [go] to workplaces and engage employers to allow workers some time off to go and vaccinate,” says Adams.

Reverend Franklin Williams, from House of Faith Ministries in Mitchells Plain, calls himself “an ambassador for the vaccine”. Williams says when he told young people in his community to get vaccinated, they told him vaccinations are for old people. “These remarks shocked me,” he said.

“As citizens in Mitchells Plain, we should encourage our people to register. Pick up the banner and say I will make an effort to win ten people to get vaccinated,” he says.

The Covid 19 Vaccine site at the Athlone Stadium. Photo by Nasief Manie.

Picking up in Khayelitsha

When Spotlight visited the Site B Community Health Centre in Khayelitsha, facility manager Desmond Grootboom was welcoming residents, mostly older persons, into the facility. Grootboom says he is pleased with the growing number of people who are coming to get jabbed.

“We’ve been seeing an influx of people since last week,” he says. “We have been vaccinating more than 300 residents every day. That’s a huge improvement. We’ve been getting [fewer] than 100 people coming to vaccinate per day. It was indeed worrying. But now the numbers are picking up every day and they can only keep increasing with each day. Residents, especially the elderly, are among the majority of people that we vaccinate each day. But they first interrogate the healthcare workers before taking their jabs. Some of their frequently asked questions are whether they will die soon after being vaccinated or what can they do if their health deteriorates after vaccination. These questions often come from those residents with chronic illnesses, but all the time we assure them they will be perfectly okay.”

Grootboom says it helps that residents don’t have to take taxis or buses to access the facility. “It is right on their doorstep,” he says.

But that sentiment is quickly dismissed by Princess Zibi (81), who is waiting inside the marquee and gulping a glass of water. Zibi was just dropped off after taking a taxi from her home in Litha Park about 10 kilometres away. She is accompanied by her cousin Nobuzwe Zimema (43), who is on crutches and recovering from a stroke.

Zibi says she was not aware of the Red Dot Taxi service provided by the department which transports residents from far-away areas to vaccination sites. “If they can just bring the sites closer to the people it would certainly make a huge difference. In fact, they can even do door-to-door vaccinations for the elderly and people with disabilities,” says Zibi.

Even though she is terrified of needles, Zimema says she looks forward to getting her jab and wants this done “once and for all” (she received the J&J vaccine). After their jabs, Zibi says, “I didn’t feel a thing”.

Living in Khayelitsha is risky because it is densely populated, says wheelchair-bound Nontuthuzelo Chabeni (47). “The risk of contracting the virus is very high. That’s why I decided to come and get the jab. But to be honest I was very sceptical. All the stories of infertility or dying after getting vaccinated really terrified me. But the more and more I saw people close to me getting vaccinated and [who are] fine [afterwards], the more I realised it is important for me to come and get jabbed. After all, it is about my health,” she says.

Desmond Grootboom, the Facility Manager at a Covid-19 Vaccine site in Khayelitsha. Photo by Nasief Manie.

Speaking to Spotlight in-between administering vaccines, healthcare worker Wandisile Mzangwe says he is delighted that more people are now coming in numbers. “From the 24th of May when I started here we saw a lot of [people].” He says the numbers were low for the 60 and older age group and increased again with the 50 and older age group. “It is hard to tell what drives the numbers, really, but ever since the 18 to 35s have been allowed to register and vaccinate, the numbers have been climbing.”

A day before Spotlight’s visit, Mzangwe says they vaccinated about 365 residents. He admits he has not been vaccinated yet. “[That’s] not to say I don’t believe in the effectiveness of the vaccines, but I am still deciding. I will definitely get vaccinated when the time is right.”

‘Urgent need’

Mzangwe’s colleague Thembakazi Nyengule, who has been jabbed,  says there is an urgent need for all people in South Africa to get vaccinated. “Nothing brings joy to my heart more than seeing more people turning up here,” says Nyengule. “And the knowledge that what I’m doing here is helping in the fight against this deadly pandemic is a cherry on top. Personally, I’ve lost some loved ones due to Covid-19 but I have to soldier on and ensure that there is no more loss of life and hopefully things can return to normality soon.”

At the Athlone Stadium vaccination centre Colin Samson (54) is walking hand-in-hand with his wife Michelle Samson (51). In just two months the Mitchells Plain father of three says he lost two brothers to Covid-19. “Besides having to deal with the grief, I was scared of all the congestion and long queues. But the whole experience has been fantastic,” says Samson. “This has been a year from hell for my family. It pains me to see some people being hesitant to take the vaccine. This virus is deadly, we all need to heed the call to vaccinate,” he says.

Worried about coming to vaccinate alone, Malawi-born Agness Nyarisa came with her sister Margaret Agibu. Both sisters are documented foreign nationals living in South Africa.

“We didn’t encounter any problems at all because our papers are in order. For a while, we’ve been sitting at home procrastinating, but today we decided to put our fears aside and come together to give each other support,” says Agibu.

According to spokesperson for the Western Cape Health Department, Mark van der Heever, the department identified the need to have everyone, especially the vulnerable, vaccinated. “This is why we already made available assistance to undocumented persons to be accommodated at our vaccination sites and through our outreach services,” he said. “Undocumented persons [those without valid identity documents] can be registered for vaccination using a paper-based registration form, where all available information of the person is captured. Following this paper-based registration, the client can be vaccinated and provided with their vaccination card. Their details will be kept and captured on the EVDS once the field is activated on the system nationally. The whole purpose is to reach the most vulnerable and not leave anyone behind,” Van der Heever stressed.

‘I don’t want to die young’

For 19-year-old Mitchells Plain youth Azra Lakay Covid-19 hit close to home. “My mother contracted it twice and so did my sister. I saw my world crumbling right in front of my own eyes. I feared the worst. Then, while I was dealing with that, my granny who is 79 also contracted the virus,” she says where she sits waiting on her vaccination at the Athlone Stadium vaccination site. “But thank God everyone at home is okay now.”

“So being here for me is a way of trying to say ‘let’s rise up as the youth and lessen the numbers,’” she says. “I don’t want to die young.”

Lakay says it irks her to see her peers still being hesitant about taking the jab. “It just makes my blood boil. We are supposed to know better. We’ve seen our parents and grandparents falling victim to this virus and we need to be the ones who say ‘it’s time to stop this virus,’” she says.

Joining Lakay in the queue are siblings Tariq Mia (21) and Miska Mia (19). Miska says the whole family, except Tariq, tested positive for Covid last year and for her, it was “the worst experience ever”. But Miska says her peers are all eager to get jabbed and calls on government to go to places where young people converge and encourage them to vaccinate.

The numbers

By 30 August, the Western Cape vaccination dashboard showed that of the 363,859 people older than 18 and eligible for vaccination in Khayelitsha, only 17.5%, or 63,690, have registered to be vaccinated.

In the Mitchells Plain subdistrict which includes Mitchells Plain, Philippi, and Crossroads, there are 210,139 people older than 18 eligible for vaccination in Mitchells Plain of which 32% have registered, 196,362 eligible in Philippi with only 7.7% registered, and 10% of the eligible population of 29,842 in Crossroads registered.

Western Cape Health spokesperson Shimonay Regter says the province recorded 69,960 vaccinations for the Khayelitsha Subdistrict and 109,683 vaccinations in the Mitchells Plain Subdistrict since the start of the vaccination programme in February. She pointed out that when considering the numbers, it is important to note that people from all areas in the metro accessed sites in Mitchells Plain and Khayelitsha for vaccination and that people from Mitchells Plain and Khayelitsha could have accessed vaccinations at a vaccination site outside of these areas.

Western Cape Health responds

Provincial health spokesperson Mark Van Der Heever says that while there have been “impressive” vaccination numbers in the province, the numbers in some areas are cause for concern. He says since the start of the pandemic in March 2020, the provincial government has embarked on several communication campaigns in partnership with local community organisations and teams to share accurate information with citizens.

“We have also empowered our healthcare voices. Our doctors and nurses are sharing stories [about] how we are addressing misinformation and overcoming hesitancy. This is part of our ongoing communication activities to provide accurate, truthful information to our citizens. On our Facebook page there are several FAQ (frequently asked questions) videos which are addressed by vaccine experts — all with the aim of sharing information with our citizens,” says Van Der Heever.

Through the health department’s dashboard and vaccine cascade, Van der Heever says they can identify areas with low registrations and can then intervene.

Sharing information also extends beyond the department’s social media platforms.

Van der Heever says they have teams on the ground sharing information to ensure residents make informed decisions around vaccination. He says the department is making progress. “There are some areas with low uptake, such as Mitchells Plain, but these are being addressed through localised initiatives. We are working with a range of partners on innovative initiatives through which we can take vaccines to the vulnerable communities, making vaccination easier accessible for them.”

Van der Heever lists among these initiatives the department’s outreach and community mobilisation drives, sites for weekend vaccinations, pop-up vaccinations sites in communities, and partnering with the South African Social Security Agency (Sassa) and stores such as Boxer. The department also has teams of health interns and community health workers who work with local neighbourhood watch members for its door-to-door registration drives.

Van der Heever says the department has also repurposed its Mobile Wellness bus, which is used for school health programmes, to aid with vaccine outreach activities in some communities.

He says the Red Dot Taxi service is operating in outlying areas and if needs be, can be scheduled for the metro areas. He says some bedridden patients are receiving vaccinations at home. This is done based on need as identified through the database the health teams have of all patients that are bedridden but, van der Heever says, “bedridden people can also ask the local health team to be added to this list”. DM

*This article was produced by Spotlight – health journalism in the public interest.