Once begun, mass vaccination cannot be halted

On 17 May, a long race against the clock starts, one in which every day and every vaccination matters. We should aim to administer at least 250 000 doses a day.

On 17 May, South Africa’s mass Covid-19 vaccination programme is expected to finally kick off. This will start a long race against the clock in which every day and every vaccination matters. Delays or pauses of even just a few days are likely to have serious consequences in terms of infections and deaths.

The fact that, unlike many other countries, our mass vaccination programme has not yet started, has already left us much more vulnerable to a potential third wave than we should be. To use a cricketing analogy, for the past 10 overs we’ve been batting at around two runs an over and the required run rate is now well over 10 an over for the remaining 40 (obviously the actual numbers are even starker than suggested here).

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The government will hopefully publish the number of people vaccinated every day, ideally broken down by province and district. But how will we be able to judge whether these numbers are high enough?

There are two main factors impacting the speed of our vaccine rollout: how many vaccines we have in stock and our ability to get these vaccines into people’s arms. For now, it seems we will get a reasonable amount of vaccines for the next six months, so the main challenge is likely to be how effectively we can get vaccines from depots to arms. If we manage to run a highly efficient vaccine programme, supply will again become a problem.

What targets have been mentioned?

Widely varying targets have been mentioned in recent weeks. The situation obviously remains fluid and no targets should be taken as the final word. 

At the end of March, the government’s stated target was to vaccinate around 13 million people from May to October. This amounts to 2.17 million vaccinations per month and only around 72 000 per day. At the time, the stated intention was to vaccinate at a much higher rate from November to February.

Since then, however, a much higher target rate of 250 000 per day has also been mentioned in the media. This would work out to around 7.5 million a month and 30 million in four months. 

Business Live has quoted Wits vaccinology Shabir Madhi saying that we need to vaccinate 15 million people in four months. That works out to 3.75 million per month or around 125 000  per day.

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Head of the Western Cape Department of Health Keith Cloete said during a media conference on 22 April that the province will initially aim to vaccinate 26 000 people per day. If the rest of South Africa’s nine provinces were to vaccinate at the same rate relative to their population, South Africa would vaccinate around 220 000 people per day.

Medical insurance scheme Discovery Health has indicated that around 50 000 of their members could be vaccinated per day, providing they have a sufficient supply of vaccines.

Some countries have managed to vaccinate at much higher rates than the targets mentioned so far. The United Kingdom, for example, has at times administered as many as 500 000 doses per day. The UK population is estimated to be around 67 million, not much bigger than that of South Africa. South Africa is a larger, more rural country, but even so, the UK example suggests that levels above 250 000 should be possible in South Africa, providing we can secure sufficient vaccine doses.

So, what is a good vaccination rate for South Africa?

The government indicated previously that the aim is to vaccinate around two-thirds of the population, or 40 million people, to reach population immunity. With complexities such as new variants and changing behaviour, population immunity is more complicated than just the 40 million target, but it is a useful target and reaching it should move us a lot closer to “normality”.

To keep things simple, we will work with doses rather than complete vaccinations. With the Johnson & Johnson vaccine, one dose equals a complete vaccination, but with the Pfizer/BioNTech vaccine, two doses are required (which makes the calculations slightly more complicated).

With all that in mind, this is how we suggest classifying the daily rates:

  • Red – Fewer than 150 00 doses a day: 150 000 per day works out to 4.5 million a month and 27 million in six months. Given the massive impact Covid-19 has on our society and the imminent threat of a third wave, we should be aiming higher than this. 
  • Orange – 150 000 to 250 000 a day: 250 000 doses a day gets us to 7.5 million a month and 45 million in six months. Anything between 150 000 and 250 000 thus presents a middle zone, where we are doing reasonably well but not quite meeting the target. 
  • Green – More than 250 000 a day: this gets us to at least 45 million in six months, which in our view is the required rate considering our late start. Judging by what has been achieved in other countries, this is a realistic target, providing we can procure sufficient doses to maintain this rate.

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There will no doubt be teething issues in the first week or two after 17 May, but the importance and urgency of the mass vaccination programme mean that things simply have to be sorted out quickly. If that means more public-private cooperation than we have seen so far, so be it. It is, after all, in everyone’s interest to get the numbers as high as possible, as quickly as possible.

Either way, even setting a target of at least 250 000 per day is probably selling ourselves short. We are not a poor country and we do have decent infrastructure. If the UK can do 500 000 doses a day, why should we settle for less than half of that?

This article was first published in Spotlight.

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