South Africa’s Covid-19 vaccine rollout plan: who gets it, what it costs, and how government says it will work

Health minister Dr Zweli Mkhize has provided further details on the government’s Covid-19 vaccine roll-out strategy, including a three-phased distribution process.

In a presentation to parliament on Thursday (7 January), the Health minister said that the aim of vaccination is to:

  • Prevent morbidity and mortality;
  • Achieve herd immunity and prevent ongoing transmission.

“To deal with the pandemic, the only protection is through vaccination,” Mkhize said. “In terms of the department’s calculation, we need 67-70% of the population to be immunised to break the cycle of transmission – what is called the herd immunity.”

Mkhize said that the South African government will be the sole purchaser of the vaccines for the country and that the Department of Health will contract with suppliers to purchase stock and allocate to provincial health departments and the private health sector.

Given the limited availability of vaccines, Mkhize said it will be necessary to procure available stock from a different manufacturer. This means that there may be multiple vaccines in the programme that are not interchangeable in a two-dose vaccine schedule.

In a follow-up statement, Mkhize said that  South Africa will be receiving 1,000,000 doses in January and 500,000 doses in February from the Serum Institute of India (SII).


Vaccination cards

Mkhize said that the vaccination system should be based on pre-vaccination registration and an appointment system.

Government has also indicated that it plans to create a registry and card system to show that South Africans have received their vaccinations.

In his written presentation, Mkhize indicated that all vaccinated persons should be on a national register and will be provided a ‘vaccination card’.

A national rollout committee will oversee the rollout, including both the public and private sectors.


Prioritised people

Vaccines will not be available for everyone immediately, and a prioritization system will have to be applied. This will be guided by the ministerial advisory committee on vaccines.

Government had indicated that priority will be given to those:

  • In roles considered to be essential for societal functioning;
  • Most at risk of infection and serious outcomes, for example, those over 60 years, those with comorbid conditions and those living in overcrowded settings,
  • Most at risk of transmitting SARS-CoV-2 to others.
  • Decisions will also be based on efficacy of a vaccine for a specific population and on the doses available.

The below table provides an overview of government’s phased approach based on the availability of vaccines:


Phases

Phase one will target a population of 1.25 million people and will include healthcare workers.

Health workers will be divided into risk categories with those in the priority categories receiving vaccination first. These risk categories are linked to the PPE risk categories, and reflect risk of contracting Covid-19.

Phase two will target a much larger proportion of the population (around 17 million people) and will target:

  • Essential workers such as police officers, retail workers, and teachers;
  • persons in congregate settings such as prisons and shelters,
  • Persons 60 years and older;
  • Persons older than 18 with co-morbidities.

Phase three will focus on the rest of the population and persons younger than 18 years old.

Alongside hospitals, Mkhize said that government was looking at using mass vaccination centres as well as pharmacies to ensure that South Africans receive both doses of a vaccine.

Government estimates that 40 million people will need to be vaccinated over a 12-month period (two doses), equating to as many as 316,000 vaccinations per day.

As each vaccinator can vaccinate 50 people per day, approximately 6,300 full-time vaccinators will need to be employed.


Costs

Government has published its budget estimations for the vaccination of the population, with an initial target of R20.6 billion for the 67% coverage planned by the end of the year. For 100% of the population, the budget is estimated at around R30 billion.

The bulk of the doses are expected to be sourced from AstaZeneca, which carries the cheapest price overall.

Pricing assumptions have been made, based on the following distribution into vaccine options:

  • 5% Moderna – R536 per dose
  • 5% Pfizer  – R299 per dose
  • 70% AstraZeneca – R54 per dose
  • 20% Johnson & Johnson – R153 per dose

Additional cost of distribution, administration (PHC, outreach, mass vaccination, community pharmacy), training, M+E, demand creation and No-fault immunisation compensation scheme between R270 and R64 are not included.

The prices also exclude Solidarity Fund donation and recoupment of fees from medical aids, the department said.


Full presentation


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South Africa’s Covid-19 vaccine rollout plan: who gets it, what it costs, and how government says it will work