Health Minister Zweli Mkhize visits Steve Biko Academic Hospital which has its parking is trasformed in to wards due to overcrowding. Picture: Oupa Mokoena/African News Agency (ANA)
Health Minister Zweli Mkhize visits Steve Biko Academic Hospital which has its parking is trasformed in to wards due to overcrowding. Picture: Oupa Mokoena/African News Agency (ANA)

Vaccine registration challenges

By Wesley Diphoko Time of article published Feb 28, 2021

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LAST week on Sunday, some health workers experienced challenges with the vaccine registration system.

They then decided to go directly, without registering, to the Steve Biko Academic Hospital to get their jab, which reportedly led to chaos that involved long queues and resulted in some who had successfully registered on the system being unable to get their jab and being turned away.

South Africa is not alone in experiencing teething problems with vaccination systems.

In the US, the Centers for Disease Control and Prevention outlined the need for a system that could handle a mass vaccination campaign once shots were approved. It wanted to streamline sign-ups, scheduling, inventory tracking, and immunisation reporting.

In May, it gave the task to consulting company Deloitte, a huge government contractor, with a $16 million (about R240m) no-bid contract to manage “Covid-19 vaccine distribution and administration tracking”.

In December, Deloitte snagged another $28m for the project, again with no competition. The contract specifies that the award could go as high as $32m.

Several states that have been using the Vaccine Administration Management System (Vams) have backed away due to technical challenges experienced with the system. Virginia in the US, where many individual vaccination sites had already chosen to adopt alternatives, is moving from Vams to a commercial system, PrepMod. After participating in a trial of Vams, California also picked PrepMod but clinics there have blamed that system for delays in their vaccine reporting.

What seems to be happening around the world are more than just teething problems with vaccine management systems. These challenges will be resolved over time, however, they should serve as a warning to South Africa as the vaccination process moves from vaccinating a smaller population of health workers to the general public.

Technology challenges have the potential of derailing the entire vaccination programme if managed incorrectly.

The reality is that competition for slots as seen in other parts of the world will only worsen when the Covid-19 vaccination priority list opens to the broader public.

One area that could present challenges may be fuelled by the digital divide. In simple terms, the digital divide refers to the gap between those able to benefit from the digital age and those who are not.

In this regard, think about the elderly, those with language barriers, people in rural areas where there’s limited connectivity. How can South Africa avoid potential chaos in the future that may arise due to challenges with the vaccine registration system?

According to Tinglong Dai, an Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of Nursing, believes that to address this anxiety, the system must be designed to reassure people that they will receive vaccines within a reasonable time frame.

In an article he wrote for The Conversation, he points out that in Israel, which leads the world in Covid-19 vaccination, citizens do not need to actively sign up for vaccine appointments. Rather, they are notified when they become eligible via text messages and can then make an appointment.

He recommends a “push” system that involves creating a one-stop pre-registration portal where everyone registers once and is notified to schedule appointments when their turn arrives. The preregistration step helps avoid waves of people trying to get appointments at the same time, which can crash computer systems.

South Africa has adopted this approach, however challenges related to the digital divide may just hamper positive results with this strategy.

Dai points out that a good system will make it easy for people to check their position in the vaccine queue at any time, provide an estimated time to vaccination based on frequently updated supply information, and then send notifications when their date is getting close. Underlying the system, vaccine doses can be allocated among eligible users on the registry using a lottery system.

He adds that a well-designed pre-registration system can also help avoid vaccine doses going to waste because of no-shows, which can be avoided via an active waitlist. With an active waitlist, vaccine planners can match supply with demand in an agile manner and offer appointments to people a few days in advance rather than scheduling appointments weeks out when the supply isn’t certain.

The system adopted by South Africa works well in countries with good connectivity and digitally literate populations. In South Africa, the digital divide challenge with places that have poor connectivity may hamper efforts to get people registered to the system.

To avoid this challenge, more interventions may have to be implemented and consider the digital status of the population by providing further support and perhaps a hybrid model that may include manual registrations offline.

Wesley Diphoko is the editor-in-chief of Fast Company (SA) magazine. Follow him on Twitter via @WesleyDiphoko

*The views expressed here are not necessarily those of IOL or of title sites

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