Progressing Towards Strengthened Vaccination Programmes: Investigating COVID-19 Vaccine Usage in Public and Private Sectors in KwaZulu-Natal, South Africa.

Background/Objectives: Vaccine usage rates (VURs) for COVID-19 vaccines (C19V) in KwaZulu-Natal (KZN), South Africa, remain insufficiently documented. This study assessed VUR for Pfizer-BioNTech (Pfizer) and Janssen Biotech Inc. (J&J) and reviewed monitoring systems in public (PUBS) and private (PRIVS) sectors. Methods: A dual-phase, multicentre study was conducted in PUBS and PRIVS facilities. Phase 1 comprised a retrospective, cross-sectional analysis of VUR for Pfizer and J&J (May 2021-July 2022). Phase 2 involved qualitative interviews with public (PUBSR) and private (PRIVSR) sector respondents (January-March 2024). Results: Pfizer VURs were 78.7% (PUBS) and 104.4% (PRIVS), while J&J recorded 64.7% (PUBS) and 40.2% (PRIVS). Stock reconciliations were complete across PUBSR and PRIVSR, but challenges persisted in stock on hand, reporting systems, and operational indicators. Conclusions: Pfizer achieved higher VURs than J&J, with PRIVS exceeding 100% due to under-reporting of issued doses. Integrated, real-time monitoring of VURs is urgently required to strengthen evidence-based policymaking, optimise supply chain management, reduce wastage, and improve vaccine uptake. Standardised monitoring frameworks across PUBS and PRIVS are essential to align with national objectives.