President Cyril Ramaphosa. Picture: POOL VIA REUTERS/JEROME DELAY
President Cyril Ramaphosa. Picture: POOL VIA REUTERS/JEROME DELAY

The rollout of the Covid-19 vaccine will be the largest public programme yet undertaken in SA — which makes it imperative the private sector be involved, experts say.

The government needs to be clear that the only way this [distribution] programme is going to work in SA is if, in fact, this is led by the private sector,” said Wits University professor of vaccinology Shabir Madhi during a webinar hosted by the Daily Maverick last week.

Private health-care businesses have far greater reach into rural areas than public health facilities, thanks to their networks of independent GPs and pharmacies, Madhi said.

This is why the state needs to partner with the private sector.

It’s a view echoed by others.

Speaking on a programme organised by the SA Jewish Report, Discovery Health’s chief commercial officer, Dr Ronald Whelan, said the government needs to use the skills of a world-class private distribution network.

In the pharmaceutical sector, the distributors are able to deliver to any pharmacy in SA, twice a day … you need to leverage that capability,” he said. “There are over 3,000 pharmacies across the country, a multitude of GP practices and extensive hospital infrastructure.”

It’s a critical point, since the government, after an outcry from scientists on the tardy procurement of vaccines, now plans to vaccinate 40-million people by January 2022.

It is the most ambitious plan this country has ever undertaken, both in scale and complexity. There’s nothing that compares to this in the last century,” said Stavros Nicolaou, Business for SA’s health working group chair.

And yet, there are still too few details. The government is still in discussions with the private sector on what role it can play — particularly when it comes to the as-yet-to-be-decided issue of how to pay for these vaccines.

Discovery CEO Adrian Gore is leading the private sector negotiations around financing the vaccine, while Nicolaou is part of the discussions around how it will be distributed.

It can’t be easy — particularly as the government hasn’t included the private sector in all its negotiations with pharmaceutical companies. It means that, at times, it is negotiating in the dark.

The government does, however, stipulate that those first in line for the vaccine are 1.3-million health-care workers — including doctors’ receptionists, hospital cleaners and porters.

Phase two will target 17-million people: 2.5-million essential workers, such as teachers, border officials and retail and bank staff; 1.1-million people living in confined settings, such as prisoners and retirement home residents; 5-million South Africans older than 60; and an estimated 8-million adults with pre-existing health conditions.

Phase three involves rolling out the vaccine to another 22.5-million healthy people older than 18, after September.

It’s an “extremely ambitious” plan, say the scientists — and whether it’s achievable is wholly dependent on whether the funding for vaccines can be found soon, and if SA can source enough vaccines.

Thankfully, the first set of AstraZeneca vaccine doses earmarked for health workers and administrative staff, which requires two shots given weeks apart, are arriving this week.

While there isn’t yet a database of who needs the vaccine and where they are, Discovery Health is now asking doctors, physiotherapists and health workers for permission to share details of their staff to populate such a database.

There is, at least, some belated urgency from the government.

The National Treasury has given the go-ahead for Cape Town-based Biovac, which has a private-public partnership with the state, to skip tender processes and take charge of the first-phase storage and distribution contract. And on Friday, the SA Health Products Regulatory Authority (Sahpra) announced that it had approved the AstraZeneca vaccine for public use.

The distribution bidding process to get vaccines to 17-million people is expected to attract interest from Biovac, Clicks’s distribution arm, United Pharmaceutical Distributors, and logistics giant Imperial Logistics.

Madhi warned, however, that flexibility was needed with the second phase of the plan; it can’t just be high-risk groups or nothing.

Vaccines don’t save lives when they’re sitting in depots,” he said. “Vaccines save lives when you vaccinate people. So we need to be … flexible in terms of our approach rather than having some sort of a notion that we need to vaccinate 80% of people in the phase two part, before we get into phase three.”

Madhi also cautioned against plans to have a government online booking system for vaccines.

Anyone who has tried the eNatis [online system] to make a booking for a driver’s licence will know [that this] system, which they’ve been working on for the past decade, still doesn’t work. So we shouldn’t create problems. And we need to be as inclusive as possible.”

All medical aids have to cover the cost of vaccines in full, the Council for Medical Schemes ruled on January 4. This means 7.1-million of the 8.9-million medical aid members older than 18 will not pay for their shots.

And another silver lining of SA’s haphazard planning is that it can learn from countries that have already started vaccine distribution, such as Israel. Japan and New Zealand have also opted to delay the rollout of vaccines until next month, to learn from the experiences of other countries.

India could also provide some lessons. It uses an open-source software system, which records who has been vaccinated and when a second dose is needed. Whelan said this shows that there are existing IT systems which SA can learn from, and adapt for its own use.

Despite what will be an enormous logistical undertaking, Nicolaou is cautiously optimistic, provided enough vaccines are bought and they arrive in SA. “We are a remarkable country at times … when the chips are down,” he said.

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