• More than 7 000 healthcare workers and about 4 000 people of 60 years and older had received sms messages for vaccination appointments by 11pm on Sunday. This morning by 8:30am seven of them had been vaccinated.
  • People with comorbidities are no longer being prioritised for vaccination — rather, the health department is going by age.
  • Provincial health departments are prioritising public healthcare workers for vaccination, after which workers at private healthcare institutions will be targeted by their employers and then those working from home.

The national health department has confirmed that 7 707 health workers and 4 288 people of 60 years and older had received sms messages by 11pm last night for COVID vaccination appointments on Monday. According to Nicholas Crisp, who is helping to manage the roll-out of phase 1B for health workers, seven people who had received such messages had been vaccinated by 8:30am this morning. 

Crisp says the people who received messages had been selected on the basis of who registered first on the government’s electronic vaccination data system (EVDS). “First in, first vaccinated,” is the general rule, Crisp says. “If you registered early, we will select you first, but, of course, within the context of making the selection geographically representative.”

More sms messages will go out today and each day of the week for vaccination appointments, although people residing in old age homes will be prioritised in most provinces (people in homes won’t receive sms messages for appointments, as teams will visit the institutions and register and vaccinate residents on-site). 

We answer four questions that people in South Africa raised on social media today. 

1. Will all healthcare workers be vaccinated this week? 

Last night, Health Minister Zweli Mkhize said the remaining 700 000 healthcare workers in the country — so those who were not one of the 478 733 health workers covered by South Africa’s implementation study, the Sisonke trial — will get jabs this week. Pfizer, however, requires two jabs, generally three weeks apart, so all health workers who get vaccinated this week will have to return for their second shot. Mkhize said South Africa is still deciding on how long after a first Pfizer jab, the second shot will be given.    

Crisp says there will be local challenges at different sites with giving all healthcare workers their first shot this week. “Some will be stuck in theatre, some will miss their appointments or be on night duty, and some will be on maternity leave. So it’s possible that all workers won’t get vaccinated this week. But the reality is, if a healthcare worker doesn’t get vaccinated this week, they’ll get vaccinated next week,” he says.

Crisp says public healthcare workers are being prioritised by provincial health departments, after which workers at private healthcare facilities will be targeted by their employers and those in private practices such as doctors and psychologists working from home will be managed through a separate appointment system. We will announce the arrangements soon.”

Crisp says South Africa has enough vaccinations to cover all healthcare workers within the next two weeks. According to Mkhize the country has received 975 780 Pfizer doses and another batch of 325 260 doses will arrive next Sunday. 

2. Are comorbidities in or out as a prioritisation category? 

Crisp confirmed that comorbidities are no longer used as a category to prioritise vaccinations. Rather, age is.  

Why? 

Research has shown that age is the strongest predictor of how likely someone is to end up in hospital or die of COVID. According to the US government’s Centres for Disease Control more than 80% of COVID-19 deaths occur in people over age 65, and over 95% in people older than 45.

Because many COVID-related comorbidities such as diabetes are more likely to affect middle-aged and older people, a sizable proportion of comorbidities would be covered if older people are vaccinated first.  

In South Africa, people older than 40 years make up the bulk of people living with comorbidities (such as high blood pressure or diabetes), according to a South African Medical Research Council policy brief. 

Also, if the government prioritised people with underlying conditions such as high blood pressure or diabetes, people who are unaware that they have comorbidities wouldn’t be included, explained Lesley Bamford during an April presentation to union leaders. Bamford is the co-chair of the national vaccine coordinating committee. 

Crisp says comorbidities are also complex to verify on the EVDS system and age is therefore a considerably more reliable indicator to use for prioritisation. 

But Crisp says, although the EVDS generally prioritises people on the basis of age, age within a cohort, for instance, age within the category of people of 60 and older, doesn’t play a role. “Those in a certain category, for instance, healthcare workers of people of 60 and older, who registered first, will get sms messages for appointments first, not those who are the oldest.” 

3. What will happen to the unused doses of the Sisonke trial? 

The Sisonke trial, which ended on Saturday, received 500 000 Johnson & Johnson doses — of those doses, 21 267 were not used. The jabs will now be used for research by the South African Medical Research Council. For what? To test vaccines on specific groups of people, such as people with HIV, pregnant and lactating women, as well as people with comorbidities. 

Why can’t we use the left-over Sisonke doses for phase one B (healthcare workers not covered by Sisonke) and phase two (starting off with people of 60 and older)? Because the Sisonke doses were donated by Johnson & Johnson for research purposes and they were registered in South Africa for use in a research setting. They can therefore not be used outside of a study environment.  

4. How do people who don’t have internet access register? 

Last night, provincial health representatives announced that teams are being sent out to villages, churches, shopping malls and South African Social Security Agency (Sassa) payout points to help people to register. Provincial health departments are also working with traditional healers to get people registered. In addition to this, the government has launched an USSD service that can be used with an analog phone and doesn’t require phone or data credit to use: 

Dial *134*832* and your ID number or *134*832# if you don’t have an ID number to register

There is also a Whatsapp service: Whatsapp the word ‘Register’ to 0600 123 456 and follow the instructions  

By Sunday, 2.1-million people in South Africa — 914 000 out of 1.2-million healthcare workers and 1.227-million out of 5-million of people older than 60, had registered on the EVDS system. 

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Mia Malan is Bhekisisa's editor-in-chief and executive director. Under her leadership, Bhekisisa’s online readership increased 30 fold and its donor funding eightfold between 2013 and 2019. Malan has won more than 20 African journalism awards for her work and is a former fellow of the Reuters Institute for the Study of Journalism at Oxford University.