Clinic container Covid-19 vaccine
Nursing unit (Image supplied by Cipla/Sha'p Left)
  • Clinics and chronic medication pick-up points housed in containers have helped ease the strain on public resources during the fight against Covid-19.
  • Approximately 70 of these fully equipped units are currently deployed across South Africa as part of the Cipla Foundation’s Sha’p Left project.
  • Now, the pharmaceutical giant says it has been approached by government to assist with the vaccine rollout.
  • But practical details are scarce and willing participants in the private sector are anxiously awaiting official regulations from government.
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The success of South Africa’s Covid-19 vaccine strategy relies on cooperation between the public and private sector. Repurposed shipping containers, housing clinical solutions in under resourced urban settlements and isolated rural towns, offer a feasible solution to the burgeoning question of equitable access but await government approval.

South Africa’s vaccination programme is due to start in February 2021, almost a year after the country registered its first Covid-19 case. While government’s vaccine acquisition programme has drawn fierce criticism, the practical approach to administering millions of doses, in a country plagued by chronic service delivery issues, remains one of the greatest concerns.

The private sector – including medical aids, pharmacies, and retailers – has offered assistance to government, which aims to vaccinate 67% of the population before the end of 2021. Leveraging well-oiled logistical operations and a fresh wave of innovative solutions in the private sector remains government’s best chance of successfully recognising its three-phase vaccination approach.

One of South Africa’s biggest pharmaceutical companies, Cipla, confirms that government is interested in extending the vaccination rollout to container clinics. These moveable clinics, as part of the Cipla Foundation’s Sha’p Left project, have been deployed to deprived areas since 2017.

Clinic container Covid-19 vaccine
Inside nursing unit (Image supplied by Cipla/Sha'p Left)

Working closely with the department of the health, these containers have been used as Centralised Chronic Medicine Dispensing and Distribution (CCMDD) points. In the Western Cape, these are referred to as Chronic Dispensing Units (CDU). In total, Sha’p Left operates almost 50 of these containerised clinical solutions across South Africa, with the bulk of the projects in Gauteng and KwaZulu-Natal.

Larger containers house nursing staff who are equipped to administer primary healthcare services to patients. Sha’p Left was able to increase the number of chronic medicine dispensing units and nursing facilities thanks to a hefty cash injection from the United States Agency for International Development (USAID).

Clinic container Covid-19 vaccine
Chronic Medicine Dispensing and Distribution unit (Image supplied by Cipla/Sha'p Left)

Both of these units have played an integral role in South Africa’s fight against Covid-19 and stand primed to assist with the next phase of the battle, the national vaccine rollout.

“The surgeries were active during the Covid-19 period because a lot of patients steered clear of government facilities,” explains Paul Miller, the Chief Executive Officer of Cipla South Africa and Trustee of the Cipla Foundation. “This is for a number of reasons. The queues [at government facilities] were too long, the higher risks of infection by being close to other people and we saw a serious increase in visits to the [Sha’p Left] nurses during this period.”

Security remains a priority in both CCMDD and nursing units, protecting both the medicines and staff housed within. Access controlled gates and a lock-up-and-go design ensures the safety of product and personnel. CCMDD units are fitted with shelves, countertops, and data processing systems to track the dispensary’s operations. Nursing units are equipped with fully functional consultation rooms, which allow for surgeries and medical treatment. Depending on the size and fittings, these units cost between R150,000 and R250,000, and have the potential to secure temperature-sensitive vaccines in refrigeration units. 

Clinic container Covid-19 vaccine
Inside nursing unit (Image supplied by Cipla/Sha'p Left)

These container solutions serve vulnerable communities in areas where public healthcare resources are severely strained. These are the same communities which are at greatest risk of being “left behind” during the vaccine rollout. Making matters worse is the dependence on chronic medications required by people with comorbidities, seen first-hand by Sha’p Left in the volume of collections at their containerised distribution centres.

One of the busiest CCMDD units in Gauteng administered 3,000 packages in a month.

“We were approached by the Western Cape department of health to get actively involved in discussions about how to solve this vaccine challenge going forward and there was definitely national representation in those discussions as well,” says Miller.

“We’re raising our hands, saying we have a footprint of around 70 units consisting of nursing surgeries and CCMDD facilities in rural and peri-urban areas which we might offer to the vaccination service should the government decide to lean into us.”

Clinic container Covid-19 vaccine
Deploying Chronic Medicine Dispensing and Distribution unit (Image supplied by Cipla/Sha'p Left)

And while government, as the sole acquirer and administrator of doses, continues to actively engage with players in the private sector in search for solutions, willing stakeholders describe an anxious wait to receive clarity on the regulations regarding vaccinations.

“Once the government lays down their requirements, in terms of what they see as the minimums that are required for a third party or private party, to administer on their behalf, it’s easy for us, who are willing to partake in this vaccination programme, to comply to those various rules,” explains Miller.

The first phase of South Africa’s vaccine rollout, which targets 1.25 million frontline healthcare workers, is critical in learning and adapting the practical clinical approach to mass immunisation. Government’s learning curve will be steep, admits Miller, but to successfully roll out and track vaccines, problems which arise during phase one need to be ironed out as a matter of urgency.

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