The Committee received briefings from the Provincial Department of Health on the acquisition of the vaccine for the COVID-19 virus, and from the Provincial Treasury on the funding for the vaccine. Both MECs were confident that their respective departments were competent to prepare for and to implement the national vaccine roll out programme.
Members enquired about the date when the first jab would be administered in the province, the province’s infrastructural and storage capacity in the vaccination roll out, the allocation of the different types of vaccines, the national government’s responsibility to cover the roll out expenses, measures in place to prevent another COVID-19 surge, safety protocols among farm workers in Overberg and the Western Cape Premier’s indication that the province could procure its own vaccine. Members asked about the Johnson and Johnson vaccine and the use of ivermectin to treat COVID-19 and warned the government not to neglect the care of patients with diseases other than COVID-19. A member suggested the government make a vaccination dashboard to record progress, similar to the existing COVID-19 dashboard. The issue of undertakers was highlighted—this is a key sector that should be prioritised for vaccination, because of potential exposures to the virus.
The Chairperson had received apologies from Ms L Botha (DA), Mr F Christians (ACDP) and Mr K Sayed (ANC). Mr B Herron (GOOD) indicated that he would leave the meeting early.
The Chairperson said the Committee would be receiving two briefings from the provincial departments of Health and Finance: the latest update on COVID-19 vaccine planning in the province and a briefing on the funding of the vaccine.
The Chairperson said that the province had fortunately passed through the second peak. Since now the country has relaxed some of the regulations pertaining to adjusted level 3 lockdown regulations, the Committee’s work should be focusing on vaccine planning. With the first batch of vaccine arriving in South Africa that week, the Provincial Government was waiting with great anticipation for more details around the allocation of vaccine to the Western Cape.
Western Cape Department of Health briefing
Dr Nomafrench Mbombo, Member of the Executive Committee (MEC) for Health, said that briefing covered the receipt of the vaccines in all phases, the vaccine roll out planning, the possibility of new vaccines that are being developed, the acquisition of vaccines, as well as the roll out prioritisation. One million vaccine doses had already arrived and a further 500,000 would be arriving at the end of March. Those doses were purchased by the National Department of Health and National Treasury from the Serum Institute of India.
The Phase 1 of the vaccine roll out will be primarily targeting healthcare workers in both the public and private sectors—those on the Personnel and Salary Administration System (PERSAL) employed by provinces, those who were not on PERSAL but are working for the Department of Health in the public sector as well as workers appointed by the City. She said that students fall under part of the “other” category with community care workers and traditional health practitioners.
Dr Mbombo informed the Committee that the vaccines consisted of two doses. Currently there are 702 000 health workers in South Africa of which 133 000 are in the Western Cape. She said that these figures helped determine the total number of doses needed for the first phase.
Dr Mbombo dispelled the myth that vaccines would protect a person totally. She said that a vaccine does not protect a person in totality but rather it reduces the chances of infection, transmission and death. Thus, it protects the health system overall. She urged everyone to adhere to health protocols and discouraged people from attending huge gatherings such as at churches and restaurants.
Dr Keith Cloete, Head of Department (HOD): Western Cape Department of Health, repeated that the province has already passed the peak of the second wave and now shows a decline in the number of daily infected cases. Places like Caledon almost had no active coronavirus cases and Garden Route is also showing a declining trend.
Various data were presented to show the province’s COVID-19 response. These included hospital admissions by area [slide 15], acute care availability and utilisation per drainage area [slide 17], and tons of daily oxygen consumption [slide 18].
Dr Cloete outlined the Department’s plan to assist and safe-guard the wellbeing of healthcare workers.
The detailed vaccine implementation plan was provided to the Committee. Dr Cloete explained that herd immunity would only be achieved if more than 70%-80% of the population were immunised.
Details on the various types of vaccines with their efficacy results were provided to members. Dr Cloete said that Johnson & Johnson was the only vaccine that had a local manufacturer - Aspen in Port Elizabeth. Information on the development of the vaccine was provided to the Committee and it was believed that the vaccine would work against the new variant 501.V2. The goal is to vaccinate 40 million South Africans.
The rest of the presentation focused on the various issues around vaccine implementation updates [as illustrated in the health slide presentation].
Western Cape Finance Briefing
Mr David Maynier, MEC for Finance, acknowledged the challenging task that lies ahead for the provincial treasury in the vaccine roll out. The rough cost estimate for vaccination in the province amounted to R1.7 billion. Ensuring sufficient funding for vaccines is the top priority for treasury at the moment.
The MEC commented that currently there is significant uncertainty around the demand and supply forecasting of vaccines as well as the finance options available. The provincial treasury is in conversation with the National Treasury at the technical level and is waiting for further information on the financing of vaccine roll out. He said that the provincial treasury was concerned that the national government may not allocate sufficient fund to the province. So treasury is proactively exploring other available options such as reprioritisation budget, utilising provincial reserve and mobilising private sector for resources. Once the budget process at both the national and the provincial levels had been concluded, more information around the financing of the vaccines will become available.
Mr David Savage, HOD, Western Cape Provincial Treasury, remarked that this COVID-19 vaccination is an unprecedented exercise. He reminded the Committee of the confined fiscal environment at large. There is significant budget reduction driven by the new national strategy for the public sector’s compensation and non-compensation expenditure.
Dr Roy Havemann, Deputy Director-General: Fiscal and Economic Services, Western Cape Provincial Treasury, briefed the Committee on the cost of vaccines. At the moment, a single dose is estimated at R2.33 and this amount doubles for two-dose vaccines. R231 is the estimated administrative cost per person related to the vaccines. He emphasised that each item will be carefully calculated by the treasury and there is a specific methodology in place in the rolling out of vaccines. There are also upfront payments such as building vaccination centres. All these made it crucial for provincial treasury to ensure that there would be sufficient budget to cover the 5.1 million people across sectors in the province. The current estimated cost for the entire vaccine roll out was between R1.2 to R1.7 billion. The Department is also reviewing methods to recoup some of the costs, such as utilising medical aid, etc. He assured the Committee that the provincial treasury is working closely with the national government to ensure sufficient budget available for the vaccine roll out. In addition, provincial treasury is also monitoring the types of vaccine arriving in the country.
In conclusion, other factors to consider for the 2020 and 2021 budget were outlined to the Committee. [See the finance presentation slides.]
MEC Maynier concluded that there is significant uncertainty at the moment in respect of to what portion of the vaccine roll out will be funded by the National Treasury. He hoped that this uncertainty would be reduced in the coming weeks. The provincial department needs more details.
Ms W Philander (DA) asked when the first jab of vaccination would be administered in the Western Cape. In relation to the functional processes of vaccination, she asked whether the province had sufficient administration locations for vaccinations and whether the infrastructural capacity is equipped to perform the task. She enquired about the United Vaccination Initiative which was started by the Western Cape Government. She commented that this was a hugely welcomed initiative and asked how other sectors fit into this initiative. Community healthcare workers had done an extremely wonderful job in reducing COVID-19 infection and containing the spread. She asked how they had received the news about vaccination. Finally, Ms Philander wanted to know which level of government would decide the types of vaccine that was allocated to each province. Was it national or provincial?
Ms D Baartman (DA) asked the provincial treasury whether or not National Treasury would foot the bill for the roll out of vaccination? She had done some basic calculations on the total cost of two different types of vaccines. It was said that R231 was the associated cost per person, if this amount was multiplied by 5.1 million residents in the province, it amounts to R1.2 billion. If residents are taking AstraZeneca which was the cheapest vaccine multiplied by two doses and by 5.1 million residents, this amounted to R813 million. Moderna would cost R3.8 billion. In addition to those huge expenses, she had also heard conflicting reports on the procurement of vaccination. The national government says that it would be the only authority in South Africa to procure COVID-19 vaccination whereas the Western Cape Premier indicated that the province would explore its own way to procure vaccinations. In light of that, she said that her view was that the one that is responsible for purchasing shall be liable for the full expenses.
Ms R Windvogel (ANC) asked the HOD of Health what present measures government has put in place to prevent another surge of infections despite vaccination as the country is easing its restrictions. She referred to slide 13 of the presentation that reported the challenges that contract workers faced in Overberg [This was the presentation from the previous meeting – see below]. She wanted to understand the situation and the corresponding strategy in place to handle the situation. She asked if the Department has had any engagement with the farmers to address the safety protocols in transporting farm workers to and from work.
Ms P Lekker (ANC) enquired about vaccine storage capacity in the province. Since Dr Cloete had mentioned that law enforcement officers had been utilised to secure those vaccine storage places, she asked whether there were also private security companies that had been recruited to assist this mission. If so, she wanted to know how transparent the recruitment process was.
Mr B Herron (GOOD) thanked the HOD for the very thorough and well planned vaccination implementation plan. He recommended the plan be published for the people in the Western Cape to read so as to boost public confidence in government’s strategy in the roll out of the vaccine. He said that the presentation made no reference to the Premier’s indication that the Western Cape province would procure its own vaccine. He wanted to get more information on the Premier’s plan to procure its own vaccine. Similarly, in the presentation by the provincial treasury, there was also no reference made on the topic of the self-procurement of vaccines in the province.
Mr Herron asked Mr Savage whether the R1.7 billion cost in the presentation was the cost of the provincial implementation that was mentioned on slide 6 [of the finance presentation].
Mr P Marais (FF Plus) remarked that the Johnson and Johnson vaccine is the only vaccine that can be locally produced. However, of the 9 million doses, 20,000 comes from Pfizer. He was confused and asked if there was a reason Johnson and Johnson could not produce. Was that because of price, efficacy or any other reasons? He asked about the first doses which were planned to be administered among healthcare workers. He wanted to understand whether the vaccinating percentage would be equally applied to all different categories health professionals or would certain health professionals such as specialists be prioritised and thus had a larger percentage share of the vaccinated population? He asked why the Department of Health still orders the vaccines that require two doses if there is vaccination that only needs one dose. He warned government not to neglect patients who have other chronic illnesses other than COVID-19. He highlighted that budget cuts or reappropriation sometimes takes budget away from other necessary items. He hoped that government would not be taking budget from patients with kidney issues and using that money for COVID-19.
Dr Mbombo explained that the roll out of phase one covered vaccines designated for the 35 000 healthcare professionals in the province. They fall under the Occupational Safety context, hence, the administering of vaccines would be utilised in their own health facilities. On Phase Two rollout of vaccines, the Department had already had engagements with Old Mutual to negotiate whether some of the sites and buildings owned by them could be used as vaccination sites. There are also conversations between the Department with municipalities on the roll out as well.
Dr Mbombo commented on fake news and condemned its negative impact on COVID-19. She found it worrisome that influential people in high positions just spread fake news without realising the negative impact on others.
She explained that information around vaccination had been customised for the Department’s engagements with traditional practitioners to explain how vaccines work. For instance, Department officials had to use traditional terms to explain some of the terminology around vaccines. On community health workers, during Phase One, the vaccination process would begin with employees employed at the national and provincial departments such as those on PERSAL. It was estimated that there would be 702 000 health care workers falling under this category, of which 43% of them work in the private sector and the rest in public. Some people in society have expressed confusion on why the government planned to vaccinate the health professionals in the private sector instead of going for other categories of populations such as students. She said that it had already been embedded as part of the national plan noting that those categories of populations had already been insured by their medical aid.
Dr Mbombo commented that people would have a choice to be vaccinated. Of the different types of vaccines, the first arrival batch would be Oxford/AstraZeneca/Covishield. The presentation also shows that COVAX would be arriving in South Africa in April and Pfizer could be arriving in May. She said that those different types of vaccines could be running in parallel but each patient will be administered with the same vaccine [if more than one dose is required].
In terms of specific requirements for vaccine storage, Dr Mbombo said that most universities such as the University of Cape Town and Stellenbosch University had their own storage for vaccine as they own their own research centres, bearing in mind that some vaccines require minus 70 degrees for storage, and some vaccines need to be discarded after being out of fridge for more than six hours.
She assured the Committee that the Department’s contingency plan was in place. In terms of COVID-19 response, the Department’s many interventions are derived from the Disaster Management Act, and the management of Notifiable Medical Conditions (NMC) which COVID was part of. These issues were centralised so that systems would be more efficient and adaptive to handle unexpected scenarios. For instance, the National Laboratory Services is at the national level. When it happened at the national level that there would be long waiting time and queues, provincial laboratories would immediately adopt and provide alternative back up plans to assist. Similarly, when the national department was battling to procure oxygen, the provincial department also assisted to work with officials at the national to negotiate with the private sector. She was confident of the flexibility and adaptability of the system to deal with emergencies. In terms of vaccines, a contingency plan was in place in cases when vaccines become insufficient to accommodate the population. She explained that the Constitution stipulates that health services are areas of concurrent national and provincial legislative competence. The provincial department is the ultimate authority to provide sufficient vaccines. There is a standardised process on the procurement of vaccines. Currently, Covishield is the only vaccine that has received approval in South Africa. [Covishield is the name in India for the Oxford-AstraZeneca COVID-19 vaccine developed in the UK and manufactured by Serum Institute of India.] The provincial department, as the procurer, is responsible for ensuring approval and quality control of the vaccines as well as bearing the consequence of any further legal litigation around vaccination.
Dr Mbombo highlighted that COVID-19 affected everyone in the society. The issue was not only a health problem but a societal problem. As more restrictions are eased such as restaurants start to open, it really requires collaborative effort from all sectors of the society. For instance, if someone is not wearing a mask in a public space, anyone can go and interfere. The extent to which the Health Department can assist is only to provide credible information. She noted and informed the Committee of the worrying situations at Shoprite, among grant recipients and at bottle stores, as those places pose potential risks for the spread of COVID-19. She reiterated that SAPS as well as health officials would work together to ensure the safety of vaccines storage.
Dr Cloete responded to Mr Marais’s question on why government was not procuring vaccines from Johnson and Johnson. He said that although Johnson and Johnson produces vaccines locally, its first production would only commence in June. Dr Cloete said that getting vaccines from Pfizer temporarily was purely about ensuring the volume, availability and timeousness of vaccines for people. If JandJ was producing now, government would definitely procure vaccines from them without a second thought, considering the cost and that only one dose is required for patients. He also asked Mr Marais to bear in mind that the vaccine landscape might look very different by June from how it is now. People would have more options by then. He said that there was no percentage pertaining to a specific category of health workers, as Mr Marais had said. Vaccination applies to all healthcare workers working for the Western Cape Government. For the private sector, the vaccination applies to all healthcare workers registered by their professional bodies. The third category is for community health workers, students and people that work for the City of Cape Town. Once the allocation for them is concluded, the province would have a total allocation for the province. There is an expert advisory committee that advises that if there are more people than doses, there is a principle that people that deal with patients get the doses first and those that don’t directly deal with patients get the doses second.
On budget choices, Dr Cloete pointed out that the provincial health department did not have any budget to deal with the third or fourth wave, nor the budget to administer and procure vaccines. Treasury understood the Department’s predicament that it had shortfall to even cover the basic things in the roll out of the vaccines. So when it comes to budget choices, it is about rendering COVID services, rendering non-COVID services as well as making sure that the Department made the right choices and balances. Hence, the Department could balance the needs in relation to what would be available.
The Department anticipated that the first dose would arrive somewhere before 15 February. As to where and how vaccines would be administered, Dr Cloete said that more details were to be finalised in the coming week. There were 378 public sector sites as well as 41 private sector sites to administer vaccines. The vaccination allocation information can be found in the presentation. The Department assured the Committee that there would be sufficient capacity to do what needs to be done.
In response to Ms Windvogel’s question, Dr Cloete explained that the slide 13 she mentioned referred to the previous presentation where reference was made about the update in Overberg which involved contract farm workers travelling to the Eastern Cape and back. The requirement on COVID-19 health protocols was for them to be tested before they leave the Eastern Cape because massive testing of these farm workers would put on a tremendous burden on health testing capacity. Dr Cloete pointed out that the farm worker issue is really only about logistics and not about the health status of those on the farm. He noted that now there has been a streamlined process developed with all the farms in Overberg to deal with this issue.
Dr Cloete responded to Mr Herron’s question and informed him that the framework to which he referred had been updated and would be forwarded to the Committee. The updated dashboard provides information on the vaccination sites, numbers, additional information that had just been shared with the Committee. For instance, he said that he himself as HOD would be reporting to Cabinet as an overall accountability measure. The last thing on the framework was that if the national government could not get sufficient vaccines, the province would step in and consider procuring vaccines in support of national programme.
Dr Cloete explained to Ms Lekker that the National Joint Operational and Intelligence Structure (NATJOINTS) has instructed all its provincial branches to work with the South African Police Services (SAPS) to ensure the safety of vaccines. He has no insights on whether SAPS is outsourcing the function to private security companies. Even if SAPS does so, the Department would not have any perimeter of control over that.
MEC Maynier responded to Ms Baartman’s question around the total cost of vaccines. He said that at this stage the provincial treasury was uncertain of the types, quantity and cost since this information still had not been determined and made available. He anticipated that the provincial procurement, should it happen, would have to be funded by the provincial treasury. On Mr Herron’s question on the estimated cost, he said that a rough estimate, together with the associated costs of vaccine roll out, would have to take into account of the acquisition of the type of vaccines (which is AstraZeneca), roll out costs, as well as the population, which is 5.1 million in the province. He was acutely aware of the vaccine roll out programme and he assured the Committee that the provincial treasury remained fully supportive of this process.
Mr Savage responded to the questions posed by Ms Baartman and Mr Herron. He said that the cost of vaccination contains both acquisition and delivery which the treasury currently assumes would be a 50/50 split. So far he believed that the assumption of the 50/50 split has held up remarkably well. Since it’s a suppliers’ market, Mr Savage reminded Members to bear in mind of the volatile nature of the market. However, he assured the Committee that the Department also reviews its own historical data to make judgements on the pricing. Further, if there is any direct purchasing of vaccines, enhanced transparency measures had been put in place in the Department. A range of issues will be considered in the purchasing of vaccines. The provincial treasury had adopted a practical and structured approach, should the province procure vaccines to support the national effort. All potential suppliers will be matched against the demand and acquisition modalities. It is a complex, mass scaled programme. Further, Mr Savage assured the Committee that all contingency plans are in place.
Mr R Mackenzie (DA) asked the Department of Health if any contingency plan was in place to deal with load shedding, theft and road accidents for COVID-19 vaccine doses. He wanted to know if someone that had recovered from COVID-19 also needed to be vaccinated. He suggested the Western Cape Government make a vaccine dashboard similar to the one that the province has on COVID-19 cases. Mr Mackenzie asked how undocumented individuals would be tracked in the vaccine system. As it is only two months from Easter, Mr Mackenzie asked whether an individual would be able to get the second dose at a different province other than the province that had administered the first dose. For instance, if a person gets the first dose in Cape Town and then travels to Port Elizabeth before the second dose is due, will the person still be able to get the second dose in Port Elizabeth? Further, he wanted the Department to provide some clarity on when COVID-19 vaccines would become more accessible in general pharmacies other than the 800 designated venues that administer the vaccine.
Mr C Dugmore (ANC) enquired about the province’s practical efforts to procure vaccine for the province following the Premier’s indication. He wanted to know which suppliers had been engaged and what their responses were. He reminded the Department to not forget the risks that undertakers are exposed to when dealing with bodies where the deceased died of COVID-19. He felt that this sector was often neglected. Although the presentation did make reference to staff working in mortuaries, he believed that workers in this sector should be prioritised to take vaccines. He said the procurement of vaccine should not be seen as competition but rather a joint effort.
Mr Dugmore asked the HOD at the provincial treasury whether it received indication from National Treasury on whether the R231 per person vaccine associated cost would be covered by national government.
Mr Herron was not satisfied with the Department’s response. Hence, he repeated his question. The Western Cape Government pronounced that it would procure its own vaccine. What he wanted to understand was that why the Western Cape plan was not presented to Committee Members? He understood from the MEC for Health that Western Cape Government procurement of vaccine supplies was not the actual case but rather a contingency plan in the event that the national government fails to procure sufficient vaccines for the people in the Western Cape. He wanted the Department to confirm whether there was a case for the Western Cape procuring its own vaccine or was it just a back-up plan?
Mr Marais enquired on the usage of ivermectin to treat COVID-19. He was disappointed that the Department had not mentioned anything about that. He remarked that this is the cheapest option. Given South Africa’s lack of funding and poor economy, there was need to look into using ivermectin to treat COVID-19. He personally knew someone from Durbanville that had to go to the length of going to vets to obtain ivermectin in order to treat COVID-19.
Dr Mbombo responded to Mr Mackenzie’s question on the department’s contingency plan to deal with situations such as load shedding. She said that she understood the specific requirement for vaccine storage that some of them need to be stored in temperature around minus 70 or minus 80 degrees. She said that those university storage spaces are all connected to generators as most universities have their own generators. The tracking of people requires collaborative effort and community support. The Department alone cannot guarantee that people return for their second dose in time. It is the same like child vaccination, the Department also cannot make sure that a child will be back for vaccination in time. What the Department can do is to provide all the necessary information. Dr Mbombo highlighted that it is imperative to build a trust relationship between those that have been vaccinated and the Department. The Department trusts that people will return for their second dose in time. The tracking dashboard is already in place. The vaccination register system is already up and running. People can register using their name and ID number. The first category of people that would be vaccinated would be staff on PERSAL and healthcare workers.
Dr Mbombo anticipated that phase one of the vaccination process would stretch beyond Easter. It is highly unlikely that an ordinary person would get any vaccine at the moment. She responded to Mr Herron that the Western Cape Government will not be procuring its own vaccines. However, the contingency plan is that, in the event of vaccine shortage, the province would request the Cabinet to approve a framework on which provincial procurement could take place to supplement the national plan. Under such a plan, maybe some people with connections in the UK could fast-track the procurement process. She pointed out that the country cannot run two procurement programmes concurrently. There are too many complex issues involved such as a vaccine has to obtain approval from the South African Health Products Authority (SAHPRA) and needs to go through the appropriate quality control measures. Hence, provincial department’s role is to supplement but not replace the national department in its efforts to procure vaccine.
Dr Mbombo also highlighted the issue of equity and fairness in the allocation and distribution of vaccines. At the domestic level, there is the fairness issue around whether health workers who are not directly exposed to patients, but go door to door to do screening should be among the first to receive vaccinations. At the international level, there has also been competition amongst countries as every country such as America, UK, China, Russia or India all wanted to get vaccines for their countrymen first. This has already happened in the acquiring of Moderna. She said that it is important to emphasise equity in the distribution without penalising those that came late to the vaccine negotiation table. It is all about balancing.
Dr Cloete understood that 364 undertakers’ names had been submitted and hence would be among the first to be vaccinated. He clarified that people who had previously contracted COVID-19 should be vaccinated just like the rest of us. On Mr Marais’s question around ivermectin, he said that like all medicines, there is an expert advisory committee which consists of clinical specialists whose job was to review all credible evidence to provide inputs on whether a type of drug is safe to use in the country. Although he is aware of the high court’s decision, SAHPRA states that there is not enough credible information on ivermectin as yet.
Mr Savage commented that the sourcing strategy, as well as the necessity to have contingency strategy in place, had been addressed by both ministers. He agreed that contingency plan was crucial and assured Members that the plan is in place for procurement in the event that the province is called upon to procure vaccines on its own. However, it is not in the formal process at this point because national government was responsible for the procurement so far.
He said that strategy was worth mentioning. Elements such as demand planning, market analysis, engagements with suppliers, and regulatory analysis are processes which are all under way. These processes are necessary before one enters the market to procure vaccines. Mr Savage clarified the national government’s contribution to vaccines. He said that the provincial treasury is having detailed technical discussions on a regular basis with the national government on the issue. The next scheduled meeting was on the coming Friday [5 February 2021]. For the present, the provincial treasury’s understanding was that there would be resources available for the vaccination programme as a whole. However, some more detailed questions, such as share for each province, remained unclear at this stage. Nor did the provincial treasury know the overall figure for the vaccination programme, or whether the fund would be transferred from the national revenue to provinces or be a new conditional grant.
The Chairperson thanked the Departments and MECs for the presentations.
The Draft Committee Minutes of 13 January 2021 and the Committee Report for December received majority support and were both adopted.
The meeting was adjourned.
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