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COVID-19  VACCINATION ROLL-OUT IMPLEMENTATION PLAN FOR SOUTH AFRICA 

A PROPOSAL TO THE SOUTH AFRICAN COVID-19 COMMAND COUNCIL & THE CABINET OF THE REPUBLIC OF SOUTH AFRICA. PREPARED BY: I.N. MDAKA 31st March 2021 

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South Africa is the most hard-hit  nation by Covid-19 in the Africa According to JHU CSSF COVID-19 DATA,  South Africa has, as at midnight 30th March 2021,  the following Covid-19 statistics:  1.55m cases, 1.47m recoveries, and 52 710 recoveries. The South African authorities are working  hard around the clock to curb the spread of the virus.  According to Martin Gustafsson of the University of Stellenbosch (17th April 2020),  South Africa is one of 30 countries out of 139 countries in the world that has reached  the maximum Covid-19 stringency level. All these measures in an attempt to rescue  its nation from the Covid-19 virus. The current hope the nation has , as do other nations of the world,  is in the vaccination of its population. 

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Luckily, sourcing the Covid-19 vaccine doses is  not such a mammoth task.  According to the Department of Health (09 February 2012),  the options available are  the Covax facility (12m doses),  Johnson & Johnson (9m doses), Pfizer (20m doses), and  the latest Johnson & Johnson offer  (30m doses) from the South African Production as announced  by the State President about two days ago. If the above is anything to go by, then South Africa is  potentially equipped to source  41m doses compared to its planned 43m vaccination plan. (Vaccination plan according  to Business day 11th March 2021).  If the recent 30m is not a duplication of the initial 12m doses from Johnson & Johnson,  then the potential doses achievable are 71m. This is 6m more doses than the South African estimated  total population of 65m people.  Unfortunately, as with the introduction of any product or  program in the market,  the formulation of an effective Covid-19 rollout strategy in South Africa remains  illusive according to the views of a sizeable number of journalists and  political commentators in South Africa. 

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According to the South African Strategy,  the Covid-19 rollout will follow  the following phases: Phase 1,  targeting 1.25m health workers;  Phase 2, targeting 17m people among essential workers such as police,  teachers, retail workers,  persons in congregate settings such as prisons and  shelters, persons 60 years and  older, as well as persons 18 years and  older with co-morbidities;  and Phase 3, the rest of the population and  persons younger that 18 years of age. (Business Tech undated). According to Times Live 27th March 2021,  the number of health workers vaccinated  so far is 231 605 out of the 1.25m health workers envisaged. 

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Whereas it is understandable that the speed of vaccination is  dependent on an array of factors —  among which the speed at which doses are  delivered to the country —  given the statistics available and  assuming a month of implementation already,  the 231 605 health workers doses given  so far translates to 7 720 doses per day. (231 605 divided by 30 days). Assuming the same rate of vaccination will be  maintained over the three phases planned , 5 570 days are required  to cover the 43m target (43 000/5570). Assuming that vaccinations will be  done 5 days per week regardless of public holidays,  then there are 270 days to do  the work in any given year. 5 570 days required to complete  the vaccination program divided  by 270 days in a year points in the direction that it will take  South Africa 21 years to complete  the vaccination program. Admittedly, the speed will not be  as linear as illustrated as improvements will occur  over time. Nonetheless, the projected  term it will take is too scary to imagine. 

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The above being said, it is also important to mention  that South African Authorities are  not oblivious to the potential dragging on of the roll-out strategy. Recent adjustments in the strategy aims  to target 200 000 vaccinations per day done  over 2000 vaccination centres throughout the country. (Sunday Times 27th March 2021). The recent adjustments translate  to 54m vaccinations in 270 day. Assuming that the 200 000 vaccinations per day are  possible, then there can be  no concern regarding the dragging of the program as the program will be  completed in one year. 

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Considering that South Africa has  a well-nourished national outreach machinery in the country in the form of the Independent Electoral Commission (IEC),  it may just save South Africa time and  money to consider the IEC facility as its machinery of its National Rollout Strategy in contrast to developing  an alternative 2 000 centre machinery envisaged. Imagine, it takes about 2 minutes or  so for a voter to collect  a ballot paper from the IEC officials' desk and  to mark it and place it in the ballot box.  Those two minutes are more-or-less the same amount time it takes  a nurse to draw the vaccine from the vaccine tube and  to inject it into the shoulder of the patient. Bearing in mind that the national election takes  one day to conclude, it can be  deduced that using the IEC machinery,  holding the availability of doses constant,  will theoretically equally take  1 day to complete the national vaccination. 

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HOW THEN COULD THE IEC MACHINERY BE ENGAGED 

STEP 1. Parliament to sit virtually asap to approve  the program and the IEC Act and  the Disaster Management Act are  amended instantly to give  effect to the program as a temporal emergency measure.  There may be other alternatives government may consider  to expedite the process. Step 2. IEC officials resume their 2019 positions in the various polling stations. Step 3. All 231 605 health care workers already vaccinated  are deployed to the 22 925 voting stations established  for the 2019 elections. (IEC undated). This translates to an average of 10 health workers per voting station.  It is likely to be less than 10 because some of the health workers vaccinated  are not professional medical staff,  but the principle holds. Step 4. Health workers deployed to voting stations vaccinate  all IEC officials in their respective voting stations and  assist IEC official to sanitise  the voting stations professionally. 

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Step 5. All heath centres in the country are  encouraged to split their staff into five groups. e.g. A hospital with 200 healthcare workers will have  five groups of 40 healthcare workers in each group while a private surgery with just 5 healthcare workers including  the doctor will have 1 healthcare worker in each group. Step 6. Group 1s in each healthcare centre visit  their nearest voting station at 8am. Group 2 at 10am and so on. (There may be another way of spreading  the vaccination workload among voting stations. That too can be applied.) By the end of that day, all healthcare workers are  vaccinated. In this way health facilities will always have  a minimum of 60% of their staff at all healthcare centres while others go  for vaccinations. Therefore, no total collapse of the healthcare centres will occur. Step 7.  Increase deployment of healthcare workers in voting stations as shall be  informed by the number of voters in the voters' role. According to IEC, the largest voting station had  8000 voters in 2019 while the smallest had 100. Deploy healthcare workers accordingly. Step 8. Invite everyone on the 2019 voters' roll for vaccination. Everything is done. 

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The process of identifying the voters by means of the voters' roll and  the application of it to curb corruption applies as is  done in the normal voting process. The only difference is that instead of the voter marking  a ballot paper, the healthcare workers give  the voter a jab. Advantages. No registration is required because the voters' roll is  already in place. The vaccination program will at the most take  a month to complete. The sooner everyone is vaccinated  the sooner the country gets to Level 0 of Covid-19,  everybody can go to work and  everybody can focus on how best to rebuild  the economy Disadvantage The voters' roll is 3 years outdated 

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Step 9. Visiting disabled peoples at their homes to give  disabled's and the sick their jabs at home. IEC officials assists healthcare workers to identify  such people in the same manner they do  during elections Step 10. In the following month, the IEC engages in updating  the voters roll by all South African Nationals of the age range 16 to 20 who are  not in the 2019 voter roll. Step 11. Vaccinate those in the voters' roll as per step 10. Step 12.  Invite all foreign nationals to the voting stations to take  their jab. IEC create a register of foreign national per voting station as vaccination continues. Such register will identify  each foreign national by name and  address in South Africa and  home address of the country of origin. Advantage for foreign nationals. Home Affairs will be able to serve  them better now knowing foreign nationals better. 

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The presentation made above is  by no means intended to instruct  government what-to-do or what-not-to-do but to make  information what the author considers  important for government to consider  as another option in its Covid-19 vaccination rollout plan;  just in case such information was not considered. The proposal made above suggests  that South Africa's Covid-19 vaccination program can be  completed in a period not longer than a month or  in two months at the longest.  Having observed Covid-19 fatigue in past Covid-19 programs,  one is tempted to assume  that any slow vaccination rollout could lead  to Covid-19 vaccination waiting fatigue. Should such fatigue occur with great prevalence,  the required percentage of the South African population required  to take the vaccine in order to guarantee  the country's immunity level could be missed. Missing such immunity level could lead  the country to have difficulty in eradicating Covid -19. Eradicating Covid-19 faster as proposed , has a better chance to limit  the spread of the third Covid-19 wave or  any other potential future wave or waves. 

COVID-19 VACCINATION ROLL-OUT IMPLEMENTATION PLAN FOR SOUTH AFRICA

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