Reply:

 

The department regrets to report that there has been no additional budget for demand generation. The additional resources have been provided by the private sector and voluntarily placement of advertisements and radio slots. The investments include making vaccination mean more to people (through demand creation) and making it easier to get vaccinated (through establishing more vaccination sites, using outreach and extending vaccination site times, primarily to weekends). Doses in the arms, especially of older people mean a lot fewer admissions and savings to the health system. Calculations have been done which show that vaccination of people over 65 years saves the health system around R850 per vaccination based on a cost of admission which is about R75 000 per admission. It has also been estimated that vaccinating 83 men over 65 years could prevent 1 admission, saving R903 in admission cost for this group.

The cost of vaccines and associated supplies remains the major investment. The cost of the logistics to provide the vaccinations increases exponentially as it becomes more difficult to reach people. Increasingly more effort and investment are required to drive towards critical thresholds of coverage. People who are willing to vaccinate if their personal costs or constraints are reduced cost the vaccination programme more to reach than those who have no limitation on access at their own costs.

The public investment case is that COVID-19 has had a devastating effect on both society and the economy:

• COVID-19 has increased the number of deaths by about 30% since May 2020. There were 238,949 excess deaths in South Africa recorded between 3 May 2020 and 14 August 2021 (age-standardised excess death rate of 401 per 100,000 population).

• Vaccination against COVID-19 will provide a return on investment of 11 to 20 times in terms of infections averted and costs to the economy.

• COVID-19 related mortality is concentrated in older age groups: 82% of COVID-19 deaths recorded in South Africa have been among people over fifty years of age and 61% of recorded deaths among people over 60 years.
• The net saving to the health system of vaccinating all men and women over 65 years of age is approximately R1.3 billion (R500 and R250 per person respectively), based on a mortality hazard ratio of approximately 2:1,4 an average cost per hospitalisation managed in a public general ward of R75,0005 and an unit cost of vaccination of R350.

• The vaccination of younger people (aged 18-39 years) is crucial in securing the social and economic returns on investment in the medium-term. In the short-term, the vaccination of younger people will incur a net cost to the health sector (about R300 p.p.). However, they constitute over half (56%) of the total population and their uptake patterns will largely determine whether or not we reach critical thresholds of coverage.

END.

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