Case Study 

Covid Vaccination Rollout – Matching Supply and Demand  

Summary 

In response to the COVID-19 pandemic, the South African National Department of Health engaged the Lean Institute Africa to facilitate the setup and operation of mass vaccination sites. The focus was on maximizing throughput and minimizing vaccine wastage.  

Understanding the problem 

Situated in the central business district, Cape Town’s International Convention Centre (CTICC) mass vaccination site had the capacity for several thousand attendees. Operating from 8 am to 4 pm, Monday to Friday, the site accommodated individuals or large groups without the need for appointments. Each day commenced with several hundred people awaiting vaccination. Vaccine doses, prepared onsite, had a 2-hour administration window; hence, preparation occurred just before the site opened to meet initial demand. Following the morning rush, arrivals persisted in varying numbers. Registration for vaccinees took 2 minutes, and the entire preparation process for 6 doses per operator consumed approximately 21 minutes. 

Challenges included a daily influx of individuals, the need to administer vaccine doses within 2 hours of preparation, and varying arrival patterns.  

• At the beginning of each day, the surplus production of vaccines ensured an ample supply. However, as the day progressed, the pharmacist overseeing the vaccine preparation process faced increasing difficulty in aligning supply with demand, given the short 2-minute notice before a vaccine dose was needed.  
• In the initial days of operation, this mismatch between supply and demand led to the unnecessary production of excess doses.  
• This situation was deemed unacceptable for two primary reasons: it represented a financial waste and the squandering of a vaccine dose that could have been administered, potentially saving a life.  
• On average, there were between 40-60 wasted doses daily. 

How the changes were implemented 

• To ensure the alignment of vaccine doses with demand, the process transitioned from a push system in the morning—where overproduction guaranteed immediate availability from opening—to a pull system for the remainder of the day, ensuring only necessary doses were produced. 
• Following the production of the initial batch for the morning, staff continued preparing doses, maintaining a buffer stock of 50-100 doses beyond the number of registrants.  
• As registration slowed or midday approached, vaccine production was decelerated, gradually depleting buffer stock levels until 2 pm.  
• At 2 pm, a ‘Lock Down Count’ was initiated, every person waiting for vaccination inside the building was tallied and compared to the remaining vaccine doses.  
• This allowed the teams to understand if there were surplus doses available, or in the case of a deficit, the precise number of additional doses required was determined.  
• Throughout the remaining operational hours of the day, new arrivals formed a queue outside and were systematically counted.  
• Individuals were invited to enter the building in groups of six. Following this, the Site Manager would specify the precise number of vaccines needed for the newly admitted group.  
• This process ensured that vaccine supply equalled demand, maintaining a pull system until the conclusion of the day’s operations.  
• A Standard Operating Procedure (SOP) for the 2 pm Lock Down Count was established to ensure consistency in its execution, regardless of the staff member overseeing it.  

 Measurable outcomes and impact

• Following the changes implemented on the 21st July, the team saw a 93% reduction in overdrawn or discarded vaccine doses.  
• Where overdrawing occurred, it was identified that the SOP had not been fully adhered to. 

How this improvement benefited patients 

• Preventing any wastage of vaccine doses at this location enabled the redirection of extra, unused vaccine vials to other vaccination sites in need of additional doses.  
• The absence of financial waste through discarded doses ensured that the Health Department’s funds were not needlessly depleted, allowing allocation for other essential health expenditures. 

Contact Details
Melika Chiswell
Lean Coach
leaninfo@lean.org.za