COVID-19 vaccination rollout programme for the old age homes in the Province

Meeting report

The Chairperson advised that the Committee would be briefed on the readiness of the vaccine rollout programme and the planning that had not previously been placed before the Committee by Ms Christine Quickfall of the BADISA Head Office, Ms Lucia Smuts of the ACVV Head Office and Ms Kirsten Veenstra of the CPOA.

All three organisations would first take the Committee through their presentations which would be followed by engagement with representatives of the umbrella bodies.

BADISA presentation

Ms Christine Quickfall, Chief Executive Officer: BADISA, introduced Sister Christelle Klopper, who was responsible for coordinating the response and was accompanying her to the meeting. The approach of dealing with the vaccine rollout programme was similar to how the organisation dealt with the first phase of Covid-19. All aspects including systems, tactics and messaging were coordinated from a centralised position at the Head Office. On a local level, the local Critical Reaction Committees (CRCs) were taking ownership of operations. The vaccine rollout programme was building on the trust that was garnered through the uncertain period of the first phase in 2020.  

In January 2021, the organisation developed change management protocols with responsibilities and time frames based on the 80/20 principle. The focus was on raising awareness, relying on verified information from the Western Cape Government and the World Health Organisation (WHO). Social media platforms were used extensively to raise awareness. Structural engagement with staff, support groups and families of residents took place on a regular basis. A management information system was implemented to track the reasons for people not interested in getting vaccinated. The results pointed to practical reasons for the hesitancy, especially in some rural communities. In Swellendam, for example, the CRC involved and trained the youth of the community to assist with the registration of people over the age of 60.

Statistics as of 7 June 2021 showed that 55% of staff had been vaccinated while 45% opted not to get vaccinated. Management was proud of the 73% of residents who were vaccinated and expressed the hope that the 27% who chose not to get vaccinated would still make use of the opportunity in the remaining part of the rollout phase. One person from the disability facilities, who was prioritised by the DoH, was vaccinated in the current rollout phase.

Management of BADISA thanked the professional and compassionate staff of the DoH for their level of responsiveness and for including Sister Klopper on the Advisory Committee. Ms Quickfall highlighted that there were still some challenges in terms of the slow rollout of sites for people over the age of 60 and people living with disabilities. The vaccination of essential staff and social workers at youth care centres who were not in line for vaccination was also of concern. The organisation needed the assistance of the Committee to have staff at child and youth care centres classified as essential workers.   

ACVV presentation

Ms Lucia Smuts, National Manager Older Person: Afrikaanse Christelike Vroue Vereniging, said residents and staff were provided with all relevant information regarding the vaccine rollout programme. Management and the nursing staff assisted with the communication process. Posters were placed on the walls of the facilities and service centres. Where needed, residents were assisted by family members with the registration process. Interaction with the DoH took place throughout the process. Local Doctors and Pharmacists also assisted management with information. Staff members who were vaccinated during the early stages of the first phase shared their experiences to motivate residents and other staff members.

The organisation made a request for its facilities to be used as vaccination stations for their own residents and staff. External officials advised that specific equipment such as wheelchairs and power supply devices must be made available in vaccination stations.

The organisation experienced a few problems. A facility in Bellville was unable to upload the Electronic Vaccination Data System (EVDS) template and staff had to e-mail the information to Head Office. Staff of another facility in Bellville had to wait in long queues at Karl Bremer Hospital despite having an appointment. On the day of the appointment, staff was informed by the DoH that the facility was not registered to receive vaccinations. After many discussions, vaccinations were allowed and everyone who was registered, was vaccinated. Another difficulty arose when some facilities already ordered flu vaccines prior to the announcement of the Covid vaccine programme. A 14-day waiting period must be observed after administering a flu vaccine, which meant that some residents could not get vaccinated during the rollout at the facilities that were impacted. Management felt that there was a lack of coordination between the various stakeholders. Another concern was that the elderly at Community-based Care and Support (CBCS) centres, who were registered, were not receiving voucher numbers.  

The ACVV thanked the Local Government and communities, especially in the rural areas for their support. From 13 to 14 April 2021, members of the local community in Swellendam were assisted with the vaccine registration process by staff on the Transnet Phelophepa health train. 

CPOA presentation

Ms Kirsten Veenstra, Marketing and Communications Manager: Cape Peninsula Organisation for the Aged, apologised for not joining the meeting earlier, due to load shedding. She agreed with Ms Smuts about the help received from Local Government and the hospitals that were all on board to assist throughout the process.

The CPOA registered all its residents, whether in care facilities or independent residents. The organisation has 27 units, of which seven had been successfully vaccinated. Staff at a number of the units were being trained in order for the organisation to do its own vaccination rollout when the second round becomes available. Everyone was encouraged to get vaccinated but not everybody was interested.

The organisation had its own Covid unit which helped with getting symptomatic people at the villages and care centres into dedicated Covid units. This was of great help in curbing the flow of the virus in the centres. Ms Kirsten offered to share the information about how the Covid unit operated with others.

Discussion

The Chairperson thanked the representatives of the three organisations for the interesting input and for the work they do in helping the elderly. She opened the meeting for engagement.

Mr G Bosman (DA) was grateful that the three organisations indicated that they received support from the DoH. He wanted to know whether the organisations were satisfied with the support received from the DSD in the Western Cape. The percentages in terms of those registered and who chose not to get vaccinated were interesting. He asked the BADISA representative to expand on the reasons why some of the staff and residents in the care facilities were not interested in being vaccinated. He requested a breakdown of the age of staff in the child and youth care facilities to see whether they could be classified as teachers in order to qualify for the next round of vaccinations.

Mr A Van der Westhuizen (DA) urged the organisations to spread the message that people would be assisted on their first visit. To expect people to come back for a second or third visit, as requested by the DoH, was awkward. It might be difficult for people, especially in rural areas, to return for multiple visits where long distances needed to be travelled to the care facilities. The Committee learned from previous meetings with the HOD of the DoH, Dr Keith Cloete, that there was a considerable drop in infections (100% success rate) amongst staff who had been vaccinated. It was the only effective way of protecting people at care homes. He asked what the policy was in terms of indemnity and if a proxy was obtained from specific family members to sign on behalf of people in care who were not able to decide for themselves. Some care facilities were reluctant and sensitive to vaccinate those in care without the organisation being indemnified.

Mr B Herron (GOOD) said the percentages in the presentation were interesting, but it would be more useful to get the actual numbers of residents who were vaccinated in facilities of the three organisations. He wanted to know whether the organisations allowed non-residents, from communities and neighbourhoods in the residential areas where they were located, to participate in the vaccination programme. He asked what the impact for immunity was on the facilities where 45% of the staff and 27% of the residents declined to get vaccinated. He questioned how effective the programme could be when such a high number of staff refused to be vaccinated. The Committee should pass the suggestion by the ACVV regarding the second round on to the DoH. The hesitancy may be reduced if residents see others being vaccinated without experiencing complications.

Ms P Lekker (ANC) acknowledged that the three organisations worked hard to ensure that people were informed but she was concerned about the 45% of staff that chose not to get vaccinated as it would have a direct impact on those who had been vaccinated. Reports suggested that some people who received vaccinations, contracted the virus again. She found it worrisome that in some communities, people chose to not get vaccinated while in other communities, people opted to walk-in to get vaccinated in cases where they did not get SMS confirmation of registration. It was important for the DoH to consider the choice of a second visit for those who did not believe that they could be helped. She wanted to know whether employees of the Department would be taken to task or educated about the implications of choosing to not be vaccinated while they had the responsibility to take care of people. She was concerned about the poor planning from the Department that led to people being invited to a vaccination site but are then required negotiating to get the vaccine, as was the case at Karl Bremer hospital. She wanted to know what steps had been taken to remedy this kind of situation. She asked for a more concrete plan from the Department, detailing how many people were vaccinated and whether those who did not receive vaccinations, received communication about when they would get vaccinated.

BADISA response

Ms Quickfall explained that the position was the same as in the previous year when everyone was still learning about the virus. She acknowledged that all systems might not be running smoothly but together with its partners, the organisation was doing its best to enable Government to deliver the programme. The organisation was in constant communication with the DSD which had been immensely supportive in removing barriers, but some things were not in its control. The whole process was being dictated to by the DoH. She recommended closer alignment between the DoH and DSD.

She said that she did not have information about the age groups of staff at children and youth homes at her disposal but promised to make it available within a few days. She did not have knowledge about the rollout process affecting teachers but would take the opportunity to familiarise herself with this category of essential staff.

The approach of the organisation in terms of awareness interventions was to inundate all programmes with general awareness and solid information, based on the scientific principle that it would cover 80% of the population. The rest of the interventions were streamlined to concentrate on the remaining 20% in order to convince this section of the population to get vaccinated. It could not be assumed that the 45% all refused to get vaccinated as it might be attributed to the DoH not yet having reached all the sites. She did not have the facts to reliably substantiate the reasons for people not being vaccinated. The fact that people did not get side effects or allergic reactions might help to persuade reluctant residents and staff to also get vaccinated. In January and February 2021, the organisation considered implementing a policy to enforce vaccination of all staff but was advised against doing so by legal and labour law professionals. To further promote awareness, video clips were being created based on the experience of those already vaccinated.

The organisation involved all family members in terms of indemnity. The choices made by the residents, even if vaccination was refused by some who were ‘toerekeningsvatbaar’ (accountable), were confirmed with family members.

At the old age centres, 875 staff and 2 401 residents had been vaccinated. The organisation was grappling with making it compulsory for everyone, but this posed an ethical dilemma. The organisation would be in a better position to know what logically and factually could be done after the visit of more sites by the DoH which would be taking place within the next two to three weeks as per the agreement.

The complaint about people in communities not getting SMS messages had also been raised by residents at BADISA. She confirmed that residents were allowed to go to a site to get vaccinated once they had been registered. Officials from the DoH would also assist people with registration when they visited the sites.  

ACVV response

Ms Smuts said that the organisation worked hard to empower all residents, members and staff and assisted them in making the choice to register and get vaccinated. It was difficult to give actual numbers due to the constant changes in the numbers. She acknowledged that there was a level of fear about the negative effects of the vaccine amongst the staff, but management relied on doctors to give the correct information. She was grateful to the DSD who acted as the middleman in sharing information and providing posters and to the DoH who kept the organisation up to date during the whole process.

Indemnity forms were provided at a stage when application for residency was made. The proxy would sign the consent form. One person in the family is normally appointed as spokesperson and would share information with the rest of the family.

Concerns were raised mostly be female staff who were worried about the impact that the vaccination would have on a future or existing pregnancy. Although education was provided, it remained a personal choice.

CPOA response

Ms Veenstra had no complaints about support from the DSD. An issue that could be improved on was the handling of documentation. Some level of repetition was noted when both the DoH and DSD required the same documents to be completed. Documents could be centralised, and the process streamlined but she acknowledged that it was a new process which might lead to some confusion.

The CPOA had twelve facilities with 2 364 residents of which 897 had been vaccinated and 129 refused the vaccination. Not all facilities had received vaccination dates, but residents were being kept informed. All notices from the DoH were being displayed on notice boards. Managers reached out to residents by encouraging them to get vaccinated without putting pressure on them. Management thanked everyone for assistance in getting dates for the majority of the facilities. It was done professionally. Two of the facilities received dates which were cancelled on short notice. The organisation was awaiting new dates.

Indemnity forms and refusal forms were sent to family members for completion. The signed forms were being kept on file. There was a positive response to the programme. Only 129 of the 2 364 residents refused the vaccine. The number might drop as more people got vaccinated.

Further discussion

Mr D America (DA) said the high percentage of staff that was reluctant to be vaccinated was concerning given the propensity of the virus to mutate and having regard for each case to be treated on its merit. From his perspective, the environment in which care centres were operating was unique and staff could possibly expose themselves to disciplinary measures should they be responsible for infecting people that they worked with. In terms of employment security, care facilities should implore and encourage staff to get vaccinated should they persist and refuse to be inoculated against the virus.

Ms Quickfall replied that it was of concern to her as well, but she wanted to see whether, in the next two weeks, the enhanced awareness mobilisation intervention would have a positive effect. She committed herself to revisit the legal opinion obtained in January to ascertain whether anything had changed in the legal environment since more information was now available. She did not want to appear before the Commission for Conciliation, Mediation and Arbitration (CCMA) without legal support. There were some unintended consequences in terms of employment security. The sector was facing unique challenges as a result of the brutal effects of the pandemic. Logically, the expertise and experience should be retained, and innovative ways should be found to get people to voluntarily be vaccinated. This issue would form part of the second round of the vaccination programme.

Ms Smuts speaking on advice from Mr America, said that she would personally get involved in encouraging staff members to get vaccinated. She had three regional managers reporting to her in the Western Cape and would put all efforts to ensure that everybody got the message.

Ms Veenstra remarked that it was the duty of the organisation to ensure that everybody was safe. Lots of time and energy was spent to ensure that every resident and staff member gets the correct information. They were constantly motivated to be vaccinated and in compliance with Government guidelines, it was not being enforced on anybody. It may change the view of staff members if approached from an upliftment rather than an enforcement angle. The majority of the staff either received the vaccine or were planning to get it done.

Closing remarks

The Chairperson thanked the three organisations for the work they did for the elderly in the Province and for sharing the information with the Committee. The engagements were helping Members to understand what was happening in communities regarding the vaccine rollout programme.

The CEO of BADISA thanked the Committee for the opportunity to share information and for understanding the context in which the organisations were operating. She was counting on the assistance of the Committee to remove the barriers in terms of troubleshooting the challenges between the DSD and DoH and the drive to get essential workers at child and youth care facilities vaccinated.

The National Manager of the ACVV said it was a privilege to work in the older persons’ sector. She was thankful for the opportunity to engage with the Committee.

The Marketing and Communications Manager of the CPOA appreciated the opportunity to share information with the Members and valued the work of the Committee.

The Chairperson expressed her gratitude to the three organisations and confirmed that some of the issues raised would be included in the Committee Report which would be sent to the DSD and DoH. The issues would also be raised directly with the two Departments through the Provincial Parliament.  

Resolutions and actions

The Chairperson requested the procedural officers to include the concerns relating to the DoH and DSD in the Committee Report. She indicated that Members had the opportunity to raise further questions by Monday, 14 June 2021, however, some Members used the opportunity to make further comments and posed additional questions as noted below.

Mr Van der Westhuizen said it was clear to him that an advocacy campaign was still needed. The Members were all taken aback by the high percentage of people who were reluctant to get vaccinated. Fortunately, people have seen that the vaccine had no adverse effects on their colleagues and were being influenced to also get vaccinated. The Province should get more high-flying people over the age of 60 to spread the message that the advantages outweigh the disadvantages. People did not need to die from Covid.

Mr Bosman asked whether it was possible to get a breakdown, either from the Provincial or National Government, of the online platforms e.g. USSD or WhatsApp engagement tools that people use to register on the EVDS. He wanted to get a sense of what people over the age of 60 were struggling with so that the barriers could be removed for the registration of the next age group, which might include teachers and child and youth care centre workers.

The Chairperson replied that the Provincial DoH might have the information that Mr Bosman required. She indicated that other avenues might also be explored and that it would be included in the request for information.

Ms Lekker requested a breakdown, per district in the Province, of people registered but not yet vaccinated. Remedial action was required for the balance of people not yet vaccinated to see if persons over the age of 60 could be afforded a second chance.

The Chairperson indicated that in addition to adopting the minutes and the Committee report, other issues also required attention. Firstly, based on a resolution taken the previous year, the Committee had been receiving a weekly report from the DoH on hospital admission numbers, oxygen use and testing. Mr Herron suggested that the report be expanded to include the following: different phases of the rollout programme, a record of vaccines received from central procurement and the number of vaccines administered. Furthermore, the Chairperson proposed the inclusion of registration numbers per phase of the rollout programme and the number of operational sites.

The proposal was accepted without objection. Mr America added that it could be useful to include the number of registrations per phase and district to address potential bottlenecks. The Chairperson undertook to communicate with the Department regarding the expansion of the report as per the resolution. Ms W Philander (DA) attempted to add to the discussion but could not do so due to a failing network connection. The Chairperson advised Ms Philander to raise her issue in the Chatbox or to send it via e-mail.

Communication from the Secretary of the Committee, to parties represented in the WCPP, regarding non-compliance with Covid-19 protocols was the second additional issue that needed consideration. The Chairperson said that she would be requesting a report from the Secretary to gauge how regularly different parties were reporting on the Covid status of staff and Members. It was important that everybody was held responsible. The request for the report was accepted without objection. 

The Chairperson notified Members that the next meeting, scheduled for 23 June 2021, was for a briefing from the DoH on the third wave, the vaccine rollout programme and on the new vaccine Centre for Hope.

Committee minutes

The Committee considered and adopted its minutes of 25 May and 31 March 2021.

Committee Report for March 2021

The report was adopted without any amendments.

The meeting was adjourned.