Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694846810616.pdf (South Africa)
WHEN THE SUN RISES WE WORK HARD TO DELIVER MP DOH COVID-19 VACCINATION ROLL- OUT PLAN NCOP Disclaimer: Due to differences in reporting times, retrospective data consolidation, and reporting delays, the number of new cases may not always add up sequentially.

The data is constantly cleaned & de-duplicated to ensure quality.
Data presented in this situational update is used to monitor and manage the outbreak, and should not be used as officially reported data 25 FEB 2021 PRESENTATION OUTLINE • Status Update • • Implementation Identification of targeted population • Service deliver platforms • Vaccination sites • Vaccine Safety and Security • Data management • Communication and demand creation 2 STATUS UPDATE • Mpumalanga, as at 24 February 2021, recorded 70 504 COVID-19 cases accumulatively with Ehlanzeni recording the highest number of cases 29 371(42%) followed by Nkangala 22 082 (31%) and Gert Sibande 19 051 (27%).
• The province is having 1 242 (1,8%) active cases, and the sub-districts that contributed to the highest number of active cases are City of Mbombela with 309 (25%) active cases, followed by Govan Mbeki with 125 (10%) and Bushbuckridge at 121 (10 %).

• With the increase in number of active cases in the second wave, the recovery rate once decreased from 97% to eighties though now it is at 67 983 which is 96% with the number of deaths at 1 241 which is a case fatality rate of 1, 8%.
Gert Sibande district accounted most deaths 467/1 241 (38%), followed by Nkangala with 415/1 241 (34%) and then Ehlanzeni with 359/ 1 241(28%) deaths.

• Mpumalanga Province accounts for 264 COVID-19 hospital admissions with Ehlanzeni District accounted for the majority of hospitalizations at 127 (48%) followed by Nkangala District with 88 (33 %) admitted cases and Gert Sibande with lowest admitted cases of 49 (19%).
3 IMPLEMENTATION PHASES Phase I Phase II Phase III Health care workers (HCW) Essential workers Other persons >18 years All health sector workers Target population:69 652 Persons in congregate settings Persons >60 years Persons >18 years with co- morbidities Target population: Open label programme License for use in Open Label Programme Expansion through usual vaccination centres Full Licence 4 DISTRIBUTION ROUTES OF J & J VACCINES COVID-19 Transport Process Description Johnson & Johnson early access J&J Vaccinations distributed to Mzansi Ethical Research Centre, Middelburg J&J Oversee research site process (Rob Ferreira & Witbank hospitals Collection from central warehouse Approved J&J vaccines Generic Distribution to Depot Generic Confirm # vials and distribute to vaccination sites Responsible pharmacist takes receipt 5 PROVINCIAL PLAN ON DISTRIBUTION OF COVID-19 VACCINES • • • • • • • • • • Mpumalanga received 2 000 doses( 1000 vials) for Rob Ferreira hospital and 1 640 doses (820 vials) for Witbank hospital.
These two hospitals were chosen because of their high numbers of HCWs Mzansi Ethical Research Centre has been nominated by Medical Research Council to oversee the vaccination process in Mpumalanga The whole program was implemented in the two hospitals from the 19th February 2021 till the 23rd February 2021 after the official launch by the honourable Premier Ms Refilwe Mtshweni- Tsipane A team of 15 x vaccinators at Rob Ferreira Hospital, and 8 x vaccinators at Witbank Hospital were allocated Research staff maintained cold chain and draw up doses and our Vaccinators administer the vaccines The teams worked from 8am to after 10pm daily to ensure that all the doses were administered as soon as possible and all doses were completed.
On Saturday they accommodated the HCW from Private hospitals and on Sunday they vaccinated private GP’s The South African Medical Research Council has provided additional 1800 doses (900 per hospital) We are starting on Friday (26/02/2021) to cater for those who could not access the vaccines because they were on night duty and on leave from both private and public The next batch of vaccines will be allocated to Mapulaneng and Ermelo hospital 6 IDENTIFICATION OF TARGETED POPULATION - PHASE 1 • • Under phase 1, Health workers are divided into categories with those in the priority receiving vaccination first.
These risk categories are linked to the PPE Risk Categories and reflect risk of risk of contracting Covid-19.

Category Definition Phase 1a Phase 1b Phase 1c Those conducting aerosol-generating procedures i.e.
intubation, ventilation, taking Covid-19 specimens Those in direct contact with known or suspected Covid-19 patients Those in contact with patients (who are not known or suspected to have Covid- 19) Phase 1d Those not in contact with patients 7 GENERAL SERVICE DELIVERY PLATFORM- PHASE 1 8 GENERAL VACCINE DISTRIBUTION AND VACCINATION SITES The push strategy for vaccine distribution starting from the NDOH will be employed when the J&J vaccine is registered.
Further distribution from the provincial medical depot to the respective hospitals (31) in the districts will follow based on their target set.

The hospitals will serve as distribution and storage hubs for their catchment vaccination sites including PHC facilities.
C A V O B I l a c i t u e c a m r a h P t o p e D Outrea ch Vaccinatiion Site (Hospital ) •Vaccinatiion Site (Hospital ) •Vaccinatiion Site (Hospital ) PH C PH C PH C 9 VACCINE, COLD CHAIN, LOGISTICS AND INFRASTRUCTURE • • • Good storage and safe handling is critical for the success of the programme Audit of distribution and vaccination facilities has been conducted in the province For the open label programme, SAMRC is delivering the vaccines , accompanied by SAPS to the hospitals.
At Rob Ferreira Hospital it is being stored in a locked fridge as the distance is more than 139km but it is being transported daily to Witbank Hospital from Middelburg • When vaccines are registered , they will be delivered at the Provincial depot with a dedicated COVID-19 vaccine storage • All 31 hospitals have WHO approved fridges and back-up generators 10 TIMELINES FOR IMPLEMENTATION PHASE 1 All outreach services activated to vaccinate PHC staff (~2 weeks) All hospitals vaccinating their own staff (~2 weeks) Kick Off Open label programme Rob Ferreira and Witbank hospitals(~2 weeks) 11 VACCINATION PROGRAMME • The COVID-19 vaccine roll-out plan will continue at hospital level , immediately after the vaccines are registered in South Africa .
• 31 hospitals have been identified to receive the vaccine , except for Waterval Boven whose vaccines will be delivered in HA Grove Hospital due to limited space in the pharmacy and Sesifuba is incorporated into Ermelo Hospital.

• It is estimated that one vaccinator will vaccinate fifty (50) vaccinees in a day.
All our hospitals have more than one vaccinator and the required period for completion of the vaccination is 7 days maximum, this is informed by the highest number of staff members in our hospitals.

Allocation of vaccines is calculated based on the number of personnel per facility.

• The province has given an allowance of 10 working days to accommodate personnel who are on leave, day off or sick leave to access the service.
• The plan aims at vaccinating all hospital personnel as the extra consignments are received to allow the process to flow smoothly to the next level which is Primary Health care.
12 WORKBASED VACCINATION SITES District Sub District Health Facility Where Appointed Bushbuckridge City Of Mbombela Nkomazi Thaba Chweu Chief Albert Luthuli Dr Pixley Ka Isaka Seme Govan Mbeki Lekwa Mkhondo Msukaligwa Dr JS Moroka Emakhazeni Emalahleni Steve Tshwete Thembisile Hani Victor Khanye EHLANZENI GERT SIBANDE NKANGALA Mapulaneng Hospital Tintswalo Hospital Matikwana Hospital Barberton Hospital Themba Hospital Rob Ferreira Hospital Barberton TB Bongani TB Shongwe Hospital Tonga Hospital Lydenburg Hospital Matibidi Hospital Sabie Hospital Carolina Hospital Embhuleni Hospital Amajuba Memorial Hospital Elsie Ballot Hospital Bethal Hospital Evander Hospital Standerton Hospital Standerton TB Piet Retief Hospital Ermelo Hospital Mmametlhake Hospital HA Grove Hospital Impungwe Hospital Witbank Hospital Witbank TB Middelburg Hospital KwaMhlanga Hospital Bernice Samuels Hospital 13 Staff Members No.
Of Vaccinators VACCINATION SITE PROCESS FLOW There are 6 stations at the vaccination site: Screening for illegibility Health education Registration Observation and appointment Vaccination Pre vaccine administration screening 14 OUTREACH /MOBILE TEAMS Outreach teams vaccinate healthcare workers in smaller health facilities • Mobile clinics, OTLs and school health teams will move from facility to facility to vaccinate eligible health care workers (using WHO approved cooler boxes) • • This will include PHC facilities, CHCs, EMS and private stations Teams coordinated by District Health Services 15 • • IDENTIFICATION OF TARGETED POPULATION - PHASE 2 & 3 An estimated total of 3 157 026 will be vaccinated during this phase of implementation (phase 1 population and under 18 excluded).
Phase 2 will include :  The essential workers  Persons in congregate settings  Persons above 60 years of age  Persons above 18 years with co-morbidity • Phase 3 will have :  Other persons below 18 years of age 16 SERVICE DELIVERY PLATFORM- PHASE 2 & 3 The following service delivery platforms will be used to implement the vaccination programme: Health facility vaccination: Suitable in rural settings for community access Vaccination Centres: Facility based or standalone vaccination centres e.g.
pharmacy practices, GPs or NGOs Outreach vaccination programme: Service provided by outreach teams Suitable for congregated settings e.g.

old age homes •Work-based vaccination programme: Suitable for essential workers e.g.
mining sector, industry and departments 17 WORKBASED, REMOTE FACILITY AND OUTREACH VACCINATION CENTRES This service delivery platform will include all essential workers and general population • • • The service will be delivered in the work place through wellness clinic and vaccination teams, information to create database is already being collected Other sector department, vaccination programme will be led by healthcare professionals in their work place This service platform will utilise community halls in the 400 municipal wards • Mobile, OTLs and school health teams will reach out to all designated remote vaccination centres (using WHO approved cooler boxes) 18 VACCINE SAFETY AND SECURITY • • • • There is a need to ensure that vaccines are safe from the Distribution site to the user There is therefore a two-fold plan of ensuring that the vaccines are safe The first fold is by ensuring that the vaccines will be given to the right person at a right time, hence there will be registration of people through EDVS People will be called per appointment and ID barcode will be scanned to ensure that the vaccine is given to the right person at the right time • We will have the SAPS to provide en-route safety of all vehicles transporting the vaccine from the Pharmaceutical Depot to various vaccination sites as our second fold of the security plan.
• • All vehicles transporting the vaccine will have tracking device.
During the in-transit all unnecessary stops shall be avoided 19 SAFETY SURVEILLANCE • • • COVID-19 Adverse Event Following Immunisation (AEFI) will be integrated into the existing Patient Safety Incidence (PSI) committee at all levels Vaccine AEFI tools will be used to report any AEFI during the vaccination period within 24 hours Investigation of AEFI will be conducted at all levels 20 DATA MANAGEMENT •       • Electronic Vaccine Data System (EVDS) will be used to register all target populations including migrants For the Open label programme - HCWs will have to register on EVDS as they have already registered They will receive the SMS prompting them to respond to SMS invite for early access They will then be expected to provide consent to take part in the Open label programme After giving consent they will receive a vaccination voucher number.
This vaccination number will be linked to the vaccine batch number that is administered They will be invited to the vaccination centre for administration The process of EVDS will kick in Data quality will be conducted on regular basis • Weekly and monthly reports will be generated through EVDS 21 COMMUNICATION AND DEMAND CREATION Communication strategy has been developed and is being implemented to: • • • • Address myths and vaccine hesitancy Improve acceptance and uptake Approach community leaders to influence and mobilise communities Create awareness using different media platform However a special communication strategy was developed to address the process of Open label programme so that there can be buy in from HCWs 22 RECOMMENDATION It is recommended that the honorable members of the National Council of Provinces note the presentation of the vaccine rollout plan in the province and the progress made and provide inputs and guidance on how to further improve the plan.
23 Thank You