Three months of living, breathing and dreaming the Sisonke study

First published in the Daily Maverick 168 weekly newspaper.

As South Africa eagerly watched the tally of vaccinated healthcare workers go up, there were research teams around the country making sure it happened – and to the highest standards. In three months, more than 478,733 healthcare workers were vaccinated in the Sisonke research programme.

As they go back to “normal life”, the researchers have recounted how they dreamt of vaccines at night, how they orchestrated photos for elated healthcare workers, and how they dealt with the guilt of being vaccinated while others were not.

Once-in-a-lifetime study

The feeling of vaccinating thousands of fellow healthcare workers “is something I don’t know if I’ll ever feel again in my lifetime”, says Anusha Nana. It still brings her to tears.

Research pharmacist Nana was a co-principal investigator at the Chris Hani Baragwanath Hospital and Lenmed private hospital sites. They vaccinated 25,000 to 30,000 people over the three months.

She has worked in the Perinatal HIV Research Unit for 15 years, including on HIV vaccines. Working on the Covid-19 vaccine has shown her what is possible for vaccines. “I didn’t think I would see a vaccine developed in one year in my lifetime,” she says.

It showed her that it is possible to vaccinate almost 500,000 people in just a few months. It showed that people were willing to receive vaccines in secret at 3am from a military escort just to keep them safe.

It showed that despite moments of chaos – such as tents being blown away, queues getting unruly and issuing so many vouchers – it could get done. “It was an honour and privilege to be part of this project.”

Her daughters, aged six and 10, quickly became knowledgeable about the work she was doing.

“They would ask questions and truly understood what I was doing and why. Despite their young age, they were incredibly supportive and grew up so much in that time. I couldn’t have done it without that support,” she said.

Pharmacist, Perinatal HIV Research Unit (PHRU) Kliptown Research Site Director and Sisonke Co-principal Investigator Anusha Nana at the PHRU Vaccination Centre at Chris Hani Baragwanath Academic Hospital. (Photo: Shiraaz Mohamed)

Collaboration was key

“Sisonke was the first of its kind,” said Dr Sheetal Kassim. Never before had the national Department of Health, the provincial departments of health, hospitals and research teams been brought together in this way, she explained.

Kassim was the primary investigator of the Sisonke study at the Groote Schuur Hospital vaccination site. She is an HIV treatment and vaccine researcher for the Desmond Tutu Health Foundation.

The study brought together total strangers and presented them with the task of vaccinating thousands of people when usually they would enrol a few hundred, she explained. It was an enormous undertaking.

Early each morning, the pharmacists would draw up the vials. The research team would oversee the entire vaccination process to make sure it met study standards. Meanwhile, hospital staff vaccinated and queue marshals tried to manage expectations.

“The way that everyone came together and collaborated on this was amazing. I don’t think we could have done it without the Groote Schuur vaccination site and team. They really jumped on board with our processes. They understood the research process, the hiccups and bumps and also the approvals,” she said.

Together, they managed to vaccinate more than 21,000 healthcare workers – nearly a quarter of all those vaccinated in the Western Cape in the study.

The “rollercoaster” three months were worth it. “A healthcare worker waited the whole day to get her vaccine and when she did, she had tears in her eyes. She couldn’t believe this time had come.”

Dr Sheetal Kassim of the Desmond Tutu Health Foundation, coordinators of the Sisonke study on single-dose vaccines for healthcare workers at Groote Schuur Hospital in Cape Town. (Photo: David Harrison)

‘The best and worst of humanity’

“The last three days when we had a tremendous rush on the vaccine centre were absolutely horrible. We really saw the best and the worst of humanity,” said Professor Francois Cilliers, an investigator at the Groote Schuur vaccination site. The site had an influx of people after misinformation spread that it would vaccinate anybody.

The University of Cape Town seconded Cilliers for three months to assist in the study. He is part of clinical work with the Desmond Tutu Health Foundation and has worked in health professionals education for the past two decades.

The team encountered a person who demanded to be vaccinated because their business supplied the medical industry with equipment. “This person was not only rude and demanding to be brought to the front of the queue, but also said that if the nurses were to drop dead from Covid it would make no difference but if he were to drop dead it would influence the healthcare system,” he recalled. “That’s the depths that we saw”.

However, they encountered the other end of the spectrum much more often. “The excitement and relief was palpable – ‘this is my moment and my turn’. And that’s what kept you going after being in the vaccine centre day after day after day. It was exhausting but that excitement kept you buoyed and moving on,” he said. Selfies and laughter were the order of the day.

People were filled with grace. He recalls being moved when a carer asked to have her vaccine voucher transferred to the unwell 75-year-old man for whom she cared. Cilliers explained why this was not possible and both graciously thanked him for his kindness and patience. They asked him to give their two packets of M&M chocolates to the team “because it looks like you guys will need it today”.

Dr Francois Cilliers of the Desmond Tutu Health Foundation, coordinators of the Sisonke study on single-dose vaccines for healthcare workers at Groote Schuur Hospital in Cape Town. (Photo: David Harrison)

Bringing hope, one vial at a time

Melissa Mitchell has spent the past three months as an “uberadministrator”. Whenever and wherever vaccine doses needed to reach rural healthcare workers, there she was ready for a road trip with her team. She heads the TASK Eden Clinical Research Centre, which worked with George Hospital to run its Sisonke study site. She did everything from issuing vouchers to distributing vaccine doses wherever they needed to go. Some days she worked up to 19 hours. But it was worth it – the small team vaccinated more than 8,000 people.

“We took the game to the field. We didn’t sit and wait. George Hospital was the main site, but the distances made it difficult for people to travel,” she explained.

As a result, they devised a plan to do outreach visits to reach healthcare workers in Plettenberg Bay, Mossel Bay, Oudtshoorn and Beaufort West. This entire area was serviced by three pharmacists, three syringe-fillers, two doctors and two support staff. “They kept rocking up. I could see in their eyes they were ready to go. We were part of something so much bigger than ourselves,” she recalls.

Healthcare workers had different reactions to being vaccinated. Some were terrified of needles, while others came forward only when they saw the jabs hadn’t killed people they knew. Most were overcome with excitement and relief – two brought flowers to hold in the photos after the jabs. “It was a good vibe everywhere I went,” she says, chuckling. “I think Sisonke brought hope to the people who have to bring hope to the rest of the country.”

Vaccinating the vaccinators

Dr Kathy Mngadi’s heart raced as she took selfies with a long-time colleague – she was in the queue to receive her Covid-19 vaccine and she couldn’t stop smiling.

Suddenly they were on the other side of the process they had spent so much time overseeing. Their colleagues took them through the motions of consent to be in the study, side effects and even distracting them as the needle went in.

Mngadi is a clinical researcher in charge of a site at Tembisa Hospital in Johannesburg. She supported research teams at Sisonke study sites at Steve Biko Academic Hospital, Sasolburg and Charlotte Maxeke Hospital. She was part of vaccinating more than 20,000 people.

“It was a joyous moment,” she recalls. Her entire research team was vaccinated on the same day – “It felt like a party!” she laughs. Their own pharmacist prepared their vaccines and their new colleagues administered the doses.

“It was a celebration because we knew from that time onwards we could say to people in the queue: don’t be nervous, I just got vaccinated 10 minutes ago and look at me: I’m fine, I’m here!

“It was a great moment. It was something I will never forget,” she says.

Her 30-year-old daughter, who has asthma, as well as her older siblings, wait with bated breath for their turn. Being the first in her family to be vaccinated was “so difficult”, she says. “Many people at the centre shared this feeling… Every person has a story of how Covid has affected their lives. It was a bittersweet feeling to be able to have the vaccine but know that there are people in my family who are at risk who couldn’t receive it then,” Mngadi explained. In the meantime, she has kept them informed of all the recent vaccine roll-out developments and answered their vaccine questions. “The best thing for me was to soothe them and for them to see that you can have the vaccine and be fine.”

Dr Kathy Mngadi, who is the Clinical Research Site Leader for Aurum in Tembisa, at her home in Fairways, Johannesburg. (Photo: Shiraaz Mohamed)

‘Hang in there’

“When I saw someone being vaccinated for the first time I cried like a baby. When we vaccinated our last person I cried like a baby. The emotions were overwhelming because it was amazing that we could do it,” recalls Dr Erica Lazarus.

Lazarus was the co-principal investigator at the Chris Hani Baragwanath Hospital and Lenmed private hospital sites. She is a researcher at the Perinatal HIV Research Unit.

The three months were filled with “ups and downs”.

It was much like having a baby,  she says.

“It was a very quick pregnancy because we found out on the Monday that we were vaccinating on the Wednesday. It took a whole day to give birth to this child on the Wednesday.

Dr Erica Lazarus was the principal investigator at the Chris Hani Baragwanath Hospital and Lenmed private hospital sites during the Sisonke study. (Photo: Michelle Cavanagh)

“The newborn phase was wonderful, but it wasn’t smiling or walking yet. Some of those teenage years were horrid but there are so many special moments of raising this child with your village,” she explained.

“It’s that exact feeling, because your child flies the coop on the last day and you’re so happy that they’re grown up and they can leave and they’re marrying the national Department of Health but also this bittersweet feeling of having to say goodbye,” she remembers.

She urges those running Phase 2 to “hang in there”. “You might feel tired now, but you’re saving lives every day. Go easy on yourself and know in your hearts that what you’re doing is so important for South Africa.” DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.