University of Fort Hare comments on phase 2 of SA vaccination strategy

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The University of Fort Hare’s Faculty of Health Sciences has welcomed Phase 2 of the South African government’s Covid-19 vaccination roll-out strategy which commenced yesterday, but has indicated that rural and remote provinces require unique approaches and much greater efforts.

“Challenges and obstacles for the Department of Health in Phase 2 are much greater with specific emphasis on undertaking a vaccine roll-out in remote and rural portions of the country, and especially the Eastern Cape,” said Professor Leon van Niekerk, Acting Dean for the Faculty of Health Sciences at the University of Fort Hare.

“The target for Covid-19 vaccinations in the first phase was the private and public healthcare community, which was relatively concentrated and easily accessible to that specific population stratum that required inoculation. Regardless, however, Phase 2 has started with a back lock of nearly 700 000 healthcare workers countrywide, that still need to be vaccinated before the target population in Phase 2.

“I anticipate a slow start, that will pick up momentum as the drive continues. With 21 vaccination sites, the Eastern Cape has the highest number of locations to administer the vaccine to members of the population over the age of 60, followed by Limpopo and the Free State.  These are traditionally classified as South African rural provinces.”

“In these remote and rural communities, and especially the Eastern Cape, the Department of Health’s vaccine roll out will face three major obstacles,” said Professor van Niekerk.

“The first challenge relates to accessibility.  The majority of the Eastern Cape’s population is geographically dispersed and beleaguered by intergenerational poverty.  The majority of individuals targeted in Phase 2 rely on state grants and pensions, and financial support by members of their families.  Access to online connectivity and smartphones to register, as well as transport and availability of commuter services may constrain travelling to vaccine centres,” he said.

Referring to a study published in 2020 in the African Journal of Primary Health Care and Family Medicine, Prof Van Niekerk stated the walking distance for individuals to their nearest and fixed government healthcare services in the Eastern Cape was more than twice the acceptable WHO-designated walking distance to medical centres in developing countries.  “In this regard, the study suggested that mobile services could make an important and significant change for the good for many people in the Eastern Cape.  We are confident this will be considered by the Department of Health for Phase 2 of the vaccine roll-out in the Eastern Cape,” said Professor van Niekerk.

Professor van Niekerk indicated that a much clearer picture and strategy will be required to understand how obstacles in getting the vaccine to frail and elderly communities in rural and remote portions of the Eastern Cape and South Africa can be overcome. It might be necessary to adopt an approach where vaccinators “go to the people, rather than the people coming to the vaccinators”.  

The second obstacle for the Department of Health in the Phase 2 vaccination roll out relates to perceptions around Covid-19 with specific emphasis falling on uncertainty on whether vaccination is important.

“Uncertainty exists amongst some people in rural portions of the Eastern Cape on whether they will or will not take the Covid-19 vaccine.  A big challenge for the Department of Health will be to convince people to change perceptions they may have around Covid-19 vaccination.  We believe many people still have doubt around the vaccine, with some even questioning whether Covid-19 is real.”

“Related to this is the communication ecosystem of rural and remote communities.  We know that face-to-face communication is one of the most important drivers in healthcare communication in non-urban settings in South Africa.  Thus, in order for Phase 2 to be effective, strong healthcare communications must be a priority to overcome vaccine uncertainty.”

Prof van Niekerk underscored and encouraged the Department of Health to hone efforts by working closely with faith-based leaders, traditional healers and grassroots NGO’s in remote and rural communities. They are well-established and strong influencers in their communities and the role they can play in the effective role out of phase two of the vaccination should not be underestimated.

Finally, Prof. Van Niekerk noted that while 21 vaccine centres are a good start for Phase 2, he questioned whether it is enough.

“It is our view that in addition to vaccine centres and the procurement of vaccine numbers, the focus should fall on health care worker resourcing to vaccinate an estimated target set by the Department, of 1.5 million people in the province during phase two. On the assumption that one health care worker will inoculate 56 people per day on an 8-hour shift (one inoculation every 7 minutes), that translates to 280 people per week, and in just one year one health care worker will inoculate approximately 14 560 individuals.  In addition to sourcing, distribution, and storage of vaccines, the question must be whether enough health care workers are available for rural and remote provinces.”

He further indicated that the Faculty has not been approached by the Department yet, but we have an abundance of resources in nursing students. Our 3rd and 4th year nursing students are trained to provide such health care services and can assist under supervision if necessary. If a third wave hits the Eastern Cape, many of the health care workers might be recalled to care for the ill and infected in hospitals, reducing the availability of vaccinators to inoculate people.

He concluded:  “The roll out vaccination will be particularly slow and challenging for South African rural provinces, and that is why public and private organisations  will be required to apply out-of-the-box thinking.”