- South Africa is currently rolling out Pfizer’s COVID vaccine, with just over 500 000 people immunised by June.
- The Discovery vaccination site in Sandton vaccinates over 2 000 people per day and gets through around 400 vaccine vials each day.
- We take you through the process of waiting to get your jab and all the site stops along the way from temperature checks to observation for side-effects.
COVID vaccination centres across the country opened on 17 May and by Monday, 31 May, over 500 000 people had received the first of two Pfizer doses.
A small study that was conducted on 800 people in South Africa showed that the jab was 100% effective in preventing COVID-19 cases caused by the 501Y.V2 variant (now also called the Beta variant). This is the form of the SARS-CoV-2 virus, that causes COVID-19, that is now dominant in the country. A May paper in the New England Journal of Medicine found that the Pfizer jab had an effectiveness of 75% against infection with the Beta variant in Qatar’s real-life roll-out, through which 385 853 people had received their first dose of the jab and 265 410 had been fully immunised.
Most of South Africa’s Pfizer shots will go to vaccination centres in urban areas, as the jabs require freezers, which aren’t always available in rural areas, for parts of its storage. Because Pfizer’s shot requires two doses, vaccinators need to be able to follow up with each vaccinated person to ensure that they return for their second jab — that is often easier to do in urban than rural areas, as people generally live relatively close to vaccination sites in cities and transport is readily available.
The other jab that South Africa will use, Johnson & Johnson’s (J&J) vaccine, will, on the other hand, mainly go to rural sites, as it requires only one dose and can be stored in a normal fridge for up to three months. The country’s COVID vaccine implementation study, Sisonke, used this jab to vaccinate about 500 000 healthcare workers — we’re currently waiting for a batch of 1.1-million J&J jabs to be released from Aspen’s plant in Gqeberha. Aspen can, however, only deliver the jabs once a verification process by the United States’ regulator, the Food and Drug Administration, has been concluded.
But what does the inside of a vaccination centre look like and what happens between arriving and getting a jab in your arm?
We visited the Discovery Health vaccination centre in Sandton, Johannesburg, to show you how a site works and how a Pfizer vaccine is administered.
Step 1: Arriving at the site
On Rivonia Road, the main road passing 1 Discovery Place in Sandton, there’s a long line of cars, moving slowly. They contain people waiting to enter Discovery Health’s undercover parking lot to get their first shot of Pfizer’s COVID jab.
Only healthcare workers and people of 60 and older can enter.
No vaccination site in the country, whether public or private, gets to choose their customers — the government’s booking system, the electronic vaccination data system (EVDS), decides where someone goes.
Mostly, Discovery’s site only vaccinates people with medical aid (it can be any medical scheme, customers don’t need to belong to Discovery Health). This is because the EVDS assigns people without health insurance to public sites, unless there is no space available at a government centre.
Discovery says about 7% of their clients, so far, were uninsured.
Once a person has entered the parking lot and parked, they’re shown to a station where their temperature is taken. If their temperature is above 37°C, they’re not allowed to proceed, as there is a risk that they could be COVID-positive and infect other clients. Such customers are referred for a COVID test.
Customers whose temperature is 37°C and below, are given a seat in a waiting area in the parking lot. Everyone has to wear a mask and the chairs are two metres apart.
Because most of the customers at the centre are people of 60 and older, there are wheelchairs available for those who struggle to walk.
Mostly, only people with EVDS appointment vouchers are helped. But there are exceptions. Today, for instance, a wife, whose husband had a voucher, complained that she registered on the EVDS straight after her husband, yet he got an appointment sms, and she didn’t.
Vaccination centre officials decided to allow her to get vaccinated, it would save her the time and effort of returning alone.
“We do make exceptions based on a case by case basis, and specific clinical criteria,” says Ron Whelan, the head of Discovery Health’s COVID-19 task team. “We don’t take walk-ins because we only have a certain number of vaccines available for each day, and we have to accommodate people with appointments first. In the first week of vaccinations, there was one day on which the EVDS’ booking system didn’t allocate patients to Discovery Place. Rather than leave the vaccination centre empty, we then took walk-ins. Even though we didn’t announce this, the news spread quickly on social media and we were quickly overwhelmed.”
The EVDS books an average of 2 300 appointments for the centre per day, says Whelan. “We’ve had very few no-shows, we’re mostly busy throughout the day.”
Step 2: Joining the queue and waiting for verification
From this waiting station, small groups of customers are called to the vaccination site’s registration centre on the ground floor of Discovery’s building.
Here, they need to present their ID, medical aid membership card (if they belong to a medical scheme), as well as their EVDS booking sms along with the unique vaccination code that the system issued.
Medical aids pay for vaccinations in full and reimburse Discovery Health directly. If someone isn’t on medical aid, Discovery can bill the government for the full cost if the EVDS booked the person for an appointment at the site. But for walk-in vaccinations (in other words, vaccinations that weren’t booked on the EVDS) this works differently.
According to Nicholas Crisp, a deputy director general in the health department who helps to manage the COVID vaccination programme, the government will only reimburse “public patient walk-ins” at private sites for up to 5% of the site’s vaccination capacity, because it wants to avoid issuing sites with “blank cheques”. In Discovery’s case, the vaccination capacity of the site is about 2 200 to 2 300 vaccinations per day, according to Discovery Health’s CEO, Ryan Noach, so the government will only reimburse the site for up to 115 public patients walk-ins per day.
Step 3: Getting your jab
Once registered, a client moves on to a waiting area — the last stop before getting a jab. This area is divided into four groups of well-spaced chairs. Generally, no one waits for longer than 30 minutes here.
There are 30 vaccination booths — 15 on the ground floor and 15 on the first floor. Each vaccinator spends about seven minutes with a person getting a shot. They inform and screen them for potential side-effects and then administer the jab. All the vaccinators are registered nurses who have completed an online training course in how to administer a Pfizer shot.
The vaccinators don’t draw up the vaccine in the syringes themselves; they receive a prepared syringe with the correct amount of vaccine (0.3 ml) in it. The syringes are prepared by specially trained nurses, supervised by pharmacists, in a central room in the building. The exact location of the room is kept secret for security reasons. “Vaccines have become hot commodities,” explains Noach. “They come with strict security protocols.”
Preparing the syringes with vaccines is a task that requires skill. Pfizer shots arrive frozen in vials — there are six doses in each vial. The vials have to be thawed and the vaccine then has to be diluted with the correct amount of saline solution in order to get six doses out of a vial. But there’s a snag: the contents of the vials consist of microscopic particles that can’t be seen by the human eye and the vials can’t be shaken when the salt water is added, only gently swirled.
Once the vials are thawed, the unopened little bottles can be kept in a fridge for up to 31 days. But when they’re removed from a fridge and opened, so that the contents can be diluted with salt water, the diluted vaccine will only last six hours.
The Discovery site uses about 400 vials of Pfizer vaccine per day and the site normally has at least four to five days of stock on hand at a time, says Noach. He says the stock normally arrives with an expiry date of two to three months after the delivery date.
The same trained staff dilute all doses, so that the skill of mixing the doses with saline is adequately learned, and the possibility of doses being wasted is as low as possible.
Step 4: Post-vaccination observation for side-effects
The final step is for a vaccinated person to spend 15 to 30 minutes in a waiting area so that they can be observed for potential vaccine-related side-effects such as severe allergic reactions. Most people are asked to stay here for 15 minutes, but those with a high risk profile, such as people with a history of severe allergies, are asked to stay for 30 minutes. A full-time doctor is kept on-site to assist in case of emergencies.
What kind of side-effects can you expect after a Pfizer jab? Side-effects are a normal part of the vaccination process and people ordinarily recover from them within a few days. But almost all vaccine-related side-effects are mild and not life threatening.
Data from a United Kingdom study that analysed the information that people who had received a Pfizer jab reported on an app called the COVID Symptom Study App, showed that 66% of vaccinated people who used the app between December and March reported experiencing local after-effects such as pain, swelling and tenderness at the site of injection. About one in four people declared side-effects that affected their whole body, such as nausea, fatigue and diarrhoea.
In February, the US government’s Centres for Disease Control reported about 4.5 cases of anaphylaxis for every one million Pfizer doses administered (each jab requires two doses). Anaphylaxis is a severe, potentially life-threatening allergic reaction, which could include skin irritations (hives, itching etc), lowered blood pressure, trouble breathing and nausea.
Noach says no incidents of severe allergic reactions have been reported among the more than 12 000 people that had been vaccinated at the Discovery site by the end of last week.
Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.