(MSF)
  • All South Africans are encouraged to register on the electronic vaccination data system (EVDS) in order to secure an appointment.
  • Once you have registered, you will receive an SMS confirming the details of your appointment. So far, 7 707 sms messages with appointment details have been sent to healthcare workers and 4 288 to people of 60 or older
  • People will not be allowed to choose which jab they get. The Pfizer jabs will be administered mostly in urban areas while Johnson & Johnson shots are mainly earmarked for rural areas because they can be stored at normal refrigeration temperatures (2 to 8 °C).

South Africa’s moves to Phase one B (health workers who have not been vaccinated) and phase two (starting off with people of 60 years and older) of its COVID vaccine roll-out today.   

The country has received 975 780 Pfizer doses so far, Health Minister Zweli Mkhize said last night. South Africa is expecting to receive a total of 1.3-million Pfizer jabs by the end of the month.

A further 3-million Johnson & Johnson (J&J) doses are expected to arrive by the end of June. The first installment of 1.1-million doses has been manufactured and is waiting to be released from the pharmaceutical company Aspen’s plant in Gqeberha — the release date depends on when a verification process by international regulators, that is currently underway, is concluded. Mkhize said he hopes to know the date of release by the end of the week.

Phase one B will cover health workers who had not been vaccinated by Phase one A, South Africa’s COVID vaccine implementation study, known as the Sisonke trial, that ended on Saturday.   

The Sisonke study vaccinated 478 733 health workers. The trial received 500 000 J&J jabs. The remaining 21 267 doses cannot be transferred to this week’s national roll-out, but will instead be used for COVID vaccine research by the South African Medical Research Council (SAMRC). Mkhize said the SAMRC will test jabs on groups such as people with HIV, people with comorbidities, pregnant and lactating women. 

Phase one B and two will happen simultaneously and in most provinces, phase two will start off with vaccinations in old age homes.  

But what exactly will this roll-out look like and how can you get your hands on a COVID shot? We answer five key questions.

1. Who is eligible to get vaccinated?

The national roll-out aims to vaccinate 41-million adults across the country, with those most likely to get infected (healthcare workers) and those most vulnerable to falling severely ill being prioritised (people of 60 years and older).

So far, the jabs have only been approved for use in people over the age of 18 by the South African Health Products Regulatory Authority (Sahpra) — so no children can be immunised at this stage.

This will be the largest immunisation programme undertaken in South Africa to date and it’s been broken up into the following three phases:

  • Phase one aims to reach 1.2-million healthcare workers. According to a South African Medical Research Council Press release, the health department defines health workers as “all people engaged in actions whose primary intent is to enhance health. This includes all health personnel who are currently working in any department of health office or registered public and private health facility (hospital, clinic, laboratory, pharmacy, care facility) or who provide health services at a community level on behalf of the public or private sector.” This definition includes support staff such as porters, cleaners, community healthcare workers and also traditional healers.

For the first part of phase one (phase one A), South Africa has been using an implementation study, called Sisonke, which ended on May 15 and covered just under 500 000 healthcare workers. The remaining 700 000 workers will be vaccinated from May 17 in Phase one B.

  • Phase two will begin to target high-risk groups and includes 16.6-million people. It will happen at the same time as Phase one B — at least initially. 

Phase two is a much larger endeavour than phase one and, as it is being rolled out,  vaccination sites will be upscaled. People targeted in phase two have also been broken down into smaller groups: essential workers, people living in crowded areas, people over the age of 60 and people of 40 and older — with the oldest people who have registered taking first priority.

But what about people living with comorbidities?

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 people with high blood pressure or diabetes), according to a South African Medical Research Council policy brief. 

Also, if the government prioritised people with underlying conditions, those 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. 

  • Phase three will reach the remaining 22.5-million adults not covered in the first two parts of the roll-out.

2. What do you need to do to get a COVID shot?

You can’t get an appointment for a COVID shot without being registered on the government’s electronic vaccination data system (EVDS).

So far, only health workers and people of 60 and older should register on the system. On Sunday night, Mkhize said 2.1 million people — 914 000 healthcare workers (out of a total of 1.2-million workers) and 1.227 million people of 60 and older (out of a total population of 5 million people in this age group) — had registered on the system by Sunday.    

The health department will announce when new groups should register on the system.

To sign up go to vaccine.enroll.health.gov.za and follow the instructions. The process should take about three minutes to complete.

You will need:

  • Access to the internet
  • Your ID number, passport, an asylum seeker or refugee number
  • Your contact information, primarily a cellphone number
  • Your work or home address

The department has also launched two alternative ways to register aside from the online portal:

  • Whatsapp the word ‘Register’ to 0600 123 456 and follow the instructions
  • Dial *134*832* and your ID number or *134*832# if you don’t have an ID number to register

Your cellphone number will be used to communicate with you about the details of your appointment.

You can also register in person at vaccination sites, according to Bamford’s April presentation. 

Mkhize says, so far 7 707 sms messages with appointment details have been sent to healthcare workers and 4 288 to people of 60 or older. 

3. Where can you go to get vaccinated?

Once you have registered, you will receive an SMS confirming that your registration has been successful. 

An SMS with details of your appointment will follow thereafter — but this could take between two and three weeks, the Western Cape health department said on Thursday. In the Western Cape, old age homes will, for instance, be covered first in phase two. People of 60 and older who don’t reside in homes, will therefore only receive an sms with information on where and when they will receive their vaccinations within two to three weeks after May 17.   

On Sunday night Mkhize said people in some provinces will receive messages this week. It is, however, unclear whether the appointment dates in the messages will be for this week or thereafter.

You will be directed to a vaccination site that is closest to either where you stay or your place of work.

Over 2 000 sites have been identified across the country, President Cyril Ramaphosa said at the end of March. A further updated list including over 3 000 potential sites was presented to parliament on 28 April.

These places include hospitals, community clinics and pharmacies, retail outlets and some larger sites like stadiums and conference centres.

The sites are being reviewed by the South African pharmacy council in collaboration with the national health department to ensure they meet all requirements prior to coming online.

The requirements include being able to properly store the jabs and having the appropriate people to safely administer them, Vincent Tlala, CEO of the South African Pharmacy Council, told Bhekisisa.

Tlala said certificates have been issued to public and private hospitals, community health centres, primary health clinics, retail pharmacies, mobile clinics and occupational health clinics.

Some of the 92 sites that were used for the Sisonke study will also be used for the national roll-out. 

The review process is ongoing and more sites are expected to be added as phase two progresses.

Here’s a look at which sites were active under Sisonke:

The following sites will be active on 17 May in the Cape Metro:

You can find the vaccination sites in Gauteng, along with the dates on which each site will open below. The information was released by the KwaZulu-Natal department of health.

Gauteng vaccination sites – Week 1 by Bhekisisa Health on Scribd

Bhekisisa will publish an updated map as more sites come online for the wider roll-out. 

Retail pharmacy Dis-Chem has also identified 32 vaccination sites nationwide, according to a press release. The first eleven of these sites will be active from 24 May. Staff at Dis-Chem’s sites have undergone training and are expected to administer 600 shots each day, says the group’s chief executive officer Ivan Saltzman. Fifty more people could be vaccinated at Dis-Chem’s in-store clinics each day as long as there is stock. 

He explains: “Should government stock be readily available, the group will be able to vaccinate approximately 800 000 people each month.”

4. Can you choose what vaccine you get?

Short answer: No.

For now, South Africa’s national roll-out will use both the J&J jab along with Pfizer’s shot — although we will initially only have Pfizer shots available (until the J&J jabs are released from Aspen’s plant in Gqeberha).

There are differences between the two jabs which will influence how they get distributed across the country. For instance, the shots have different cold chain requirements and are also packaged with a different number of doses per pack.  

Pfizer doses will mainly be used in metros, as these sites can reach a larger number of people and Pfizer requires freezers that aren’t always readily available in rural areas. Pfizer arrives in packs of 1 170 doses that will be stored at -20°C at sites in South Africa, but the doses can only be kept at that temperature for two weeks. Once the packs are opened and the vials are thawed, the doses can be stored in a fridge between 2 and 8 ℃, but only for five days. Larger sites are therefore ideal for the use of Pfizer, because in urban areas where there are more people, doses can be used more quickly and are therefore less likely to become unusable.

Because Pfizer requires two doses, vaccinators need to be able to follow up with each vaccinee to return for their second shot — and that is often easier to do in urban than rural areas. 

J&J, on the other hand, requires only one dose, minimal follow-up and can also be stored at normal fridge temperatures between 2 and 8 °C for three months. The jab will therefore largely be used in rural areas. 

Once you have been given an appointment and assigned to a facility, you will not be able to select which jab you receive.

As the national roll-out will kick off with Pfizer shots only, most initial sites are likely to be in urban areas.

5. Does anything change if you’re on medical aid?

The Council for Medical Schemes (CMS) in November 2020 listed COVID-19 vaccines as a prescribed minimum benefit. That means all medical schemes must pay for their members’ COVID jabs. Your medical aid is therefore not allowed to ask you to pay for getting vaccinated and then claim back the money — the scheme has to pay the provider directly. 

South Africa’s biggest private medical scheme Discovery Health has launched an online registration system called Vaccination Navigator which is similar to the health department’s EVDS. Members of the scheme must register on both portals.

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Aisha Abdool Karim is a senior health reporter at Bhekisisa.

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Joan van Dyk is a senior health journalist at Bhekisisa.