Large scale vaccination programmes won’t work without digital: lessons from South Africa supporting 34.7 million vaccination events.

By Dale Sandberg, ME: Health & Social Innovation (Mezzanine); Dr. Peter Breitenbach, Head of Product & Strategy (Mezzanine); & John Vorster, Chief Operations Officer (Mezzanine).

As we observe World Immunisation Week this week, we recognise the role vaccines and immunisation play in protecting individuals and communities from preventable diseases, particularly as we are still battling the COVID-19 pandemic. The COVID-19 vaccination programmes taking place around the world are a remarkable testimony to the depth of science, discovery, and collaboration. The necessary scale and speed of the vaccine delivery process would, however, not be possible without digital technologies to support everything from planning and delivery to monitoring and management. 

Digital technologies help public health authorities and global health funders to ensure that the right vaccine gets to the right person in the right place at the right time and in optimal condition.

The digital technology powering the COVID-19 vaccine rollout in South Africa

In South Africa, the digital infrastructure underpinning the COVID-19 vaccine rollout is called the Electronic Vaccination Data System (EVDS). It was created by the National Department of Health with the support of various partners, like Mezzanine and the Council for Scientific and Industrial Research (CSIR). At the end of April 2022, the system has supported the total vaccination of over 18.3 million individuals and 21.2 million individuals have had at least one dose.

An online system with consumer, healthcare provider, policy-maker and planner user interfaces, EVDS supports pre-vaccination registration, bookings, individualised communication, incentive programmes, vaccination events and post vaccination surveillance as well as digital certification.  EVDS is designed to track every vaccination event and key information about every individual embarking on the vaccination journey in order to ensure compliance with guidelines and visibility for planning. 

Here are a few lessons we learned working with the National Department of Health and other partners to make the vaccine delivery process as smooth as possible. These lessons focus on the digital aspect and form part of a much larger wealth of experience across partner organisations regarding programme deployment and operational realities.

Keep it simple

When you’re looking at something as big as a national vaccine rollout, it’s imperative that you keep it simple. Break the task down into smaller parts and make sure that what you’re doing actually addresses the problem at hand. Often, we want to create something with all the bells and whistles but it is far more important to build something scalable and reliable that gets the job done. 

That being said, anything you build must be interoperable using data standards, API integrations, and agile methodology to ensure that changes can be made and that business rules can be updated and pulled through correctly. Remember that whatever you build must make life easier for people on the ground. There’s little value in adding a digital layer if it makes the end user’s job harder than it was in the past.

Use digital to power an inclusive rollout

In addition to creating a simple and user-friendly web portal for individuals to register for vaccination, it was important to make registration available via other channels so that all eligible individuals could register, regardless of their circumstances. Bulk registrations were enabled for those who couldn’t register themselves, including those incarcerated, institutionalised, or undocumented citizens and immigrants. USSD and WhatsApp registration channels were also made available so that people could register using whatever platforms suited them best. The low barriers to access enabled communities to self-organise and support registration processes for their vulnerable populations.

Don’t reinvent the wheel & plan for change

Leveraging our experience and investment to date in supporting Expanded Programmes for Immunisation (EPI) in other countries, plus the existing work done by the Department in South Africa, we were able to build the EVDS in record time. It was important to build EVDS to be configurable to respond to the rapidly changing programme environment. This configurability will enable utility in other programme areas, including EPI, third-line TB, and HIV etc. where a high degree of visibility and control is required.

Use automation to prevent loss to follow-up

Once registered on EVDS, each individual is issued with a unique voucher code per healthcare interaction to keep tabs on them as they move through the system. The code is also used to flag vaccine eligibility and vaccination status. Couple this unique identifier with automation and it’s possible to send prompts, alerts, and reminders to individuals about availability, eligibility, potential side-effects, and to ensure that they get their second, or booster, vaccines if and when they should. 

Digital platforms make it far easier to communicate with end users without any need for human intervention and delivering these notifications via SMS means that personalised information can be sent securely to anyone, even those without smart devices. 

Enable end-to-end visibility through data standards and integration 

EVDS doesn’t function in isolation. It has to be interoperable with other systems to enable the end-to-end visibility that is so important. To ensure the right volumes of vaccine doses and vaccine commodities are available at the right healthcare facilities at the right time, the Stock Visibility Solution (SVS), co-created and used by the department of health since 2014 and enabled by Mezzanine, was used as part of the South African COVID-19 programme. With data available from both EVDS and SVS, the management of stock and supplies across all primary healthcare facilities in SA could be monitored with an understanding of total demand. As part of the department’s COVID-19 response, SVS was used to monitor vaccine stock, other commodities and PPE at different public and private sites. Using simple dashboards and delivering updates in near real-time, the system eliminates any need for paper-based reporting and provides visibility about what is and isn’t needed at each site.

If you look across global healthcare systems, you will find that there are many point digital solutions being used but often these are deployed using very fragmented, siloed approaches and questionable business models. These disparate systems won’t speak to each other and don’t deliver the value they could if they were properly integrated with each other. EVDS serves as a great example of how private-public collaboration can enable effective outcomes, up interoperability, boost overall efficiency, unlock key insights, deliver much-needed services to those who need them most and ultimately achieve the goal of improving broader healthcare outcomes.