The Portfolio Committee on Health considered and adopted 26 sets of minutes dating back from 10 February 2021 to 10 April 2020.
Members commented on the time delay between the meeting and the follow up on the consideration of minutes. Where the minutes omitted to note concerns made in these meetings or resolutions taken, these were requested to be added to the minutes by various Members.
The point was also made that when the oral responses in the meeting are insufficient, then written responses are requested. However, the Department or its entities often do not respond. Matters arising from minutes need to be followed up.
The most extensive amendments and discussions on the adoption of minutes were made on the three previous February 2021 meetings. These covered concerns raised by Members about the efficacy of the vaccination roll-out strategy, along with questions on the choice of the AstraZeneca vaccine and Johnson & Johnson as suppliers. There was a consensus that increased communication was required between the Portfolio Committee and the Minister and Department for information transparency.
The Chairperson said the Committee would consider and approve the outstanding 26 sets of minutes. The Committee would go through each and have the opportunity to adopt with changes or no changes.
Ms E Wilson (DA) said there should be an explanation why the minutes were not presented to the Committee since July 2020. They are being asked to adopt minutes that took place within a large time span, when a lot has happened in between.
The Chairperson replied that the Secretariat has faced challenges in taking minutes and motioned to the Secretary to highlight the challenges.
Ms Wilson said the most important challenge was time. When virtual meetings were started in April 2020, MS Teams was the platform used for meetings. They were allocated two hours for meetings, and this was insufficient time for discussions and consideration of presentations. They requested the Chairperson to start meetings earlier to adopt minutes each week.
The Chairperson noted the rush to meet with all the provinces and the Ministers and MEC needed time to explain what has happened as to oversight. There has been internal pressure due to the work overload. This has indirectly impacted the prioritization of consideration of minutes.
Ms Wilson replied that time constraints have been brought up repeatedly; the Committee needs to have time to hold the Minister and MECs accountable. A solution is either to have more regular meetings or delegate time to do things properly. She reiterated the call for a special meeting with the Chair of Chairs to deal with this as they have complained about this “incessantly”.
The Chairperson replied that the Chair of Chairs has acknowledged the letter and they are awaiting his response. The constraints of virtual meetings made it difficult to extend the time of meetings.
Dr S Thembekwayo (EFF) acknowledged the challenges expressed by the Secretary. She suggested at the start of future meetings to allow two minutes for approval or after every meeting the Committee allocate 10 minutes to allow approval. However, the specific purpose of this meeting was to address the outstanding minutes.
Ms A Gela (ANC) agreed to proceed with the minutes as the Secretary has given reasons about the time challenges. She supported addressing the approval of minutes before or after a meeting. She appreciated the Secretary and the Chairperson for convening this meeting. They will be able to recall issues brought up in previous meetings due to the records provided.
The Chairperson noted the concerns raised by Committee Members and the advice to address minutes. The Committee would request a time extension.
Consideration of Outstanding Minutes
The Chairperson took the Members through each set of minutes page by page. If there were no concerns or changes, each were formally adopted. It was noted that where it was a joint meeting with the NCOP Select Committee, that committee would adopt the same minutes separately. The minutes included:
• 10 Apr 2020: COVID-19 Update: Minister of Health briefing
• 27 Apr 2020: COVID-19 Update & Government Response: Minister & Department briefing
• 13 May 2020: Department Strategic Plan, Annual Performance Plan and Budget: AGSA analysis
• 20 May 2020: Department Strategic Plan & Annual Performance Plan
• 28 May 2020: COVID-19 Update by Health Ministry/Department; Committee Report on Health Budget
Ms S Gwarube (DA) asked the Chairperson look at the recommendations in the Resolutions. It is important that when oral responses are not covered or answered sufficiently in the meeting, written responses must be given to the Committee. This does not always happen, the Department or its entities often do not respond.
The Chairperson noted this concern. The Western Cape and Eastern Cape have forwarded their responses.
Ms H Ismail (DA) supported the point that written responses have not been received from all the provinces, and that this is an issue. It is important to receive a report back on the registration of health professionals. Matters Arising from minutes need to be highlighted.
The Chairperson said those matters that have not been resolved should be.
• 10 Jun 2020: NHLS COVID-19 test backlogs; Life Healthcare & Netcare COVID-19 state of readiness
• 08 Jul 2020: Department of Health COVID-19 Special Adjustments Budget
• 15 Jul 2020: Health Budget: Committee Report; Medical Research Council on alcohol impact on health services
• 22 Jul 2020: Eastern Cape COVID-19 Interventions; Alcohol Impact on Health Services
The Chairperson called attention to the Resolutions section and noted: “The Committee Members agreed that the agenda item on the impact of alcohol on health services will be rescheduled as soon as possible.”
Ms Wilson asked to go through the resolutions and brought up medical scooters. What were they being used for and for whom?
Ms Gwarube supported this concern as there was a challenge about the suitability of the scooters being classified as medical transport. There was no clarity on their usage for medical patient or medicinal transport. This was a subject that was under review and criminal investigation.
The Chairperson asked that this point be tagged for follow up for the Department to address.
• 19 Aug 2020: KwaZulu-Natal Department of Health response to Covid-19
Ms Gwarube brought forward the point that the MEC was not in attendance at this meeting, and it had needed to be rescheduled to engage the MEC. It needed to be made clear in the Resolutions section to ask the MEC about questions raised during the HOD presentation. The presentation could not be engaged due to the MEC’s absence.
Ms Wilson agreed. She noted parking lots had turned into wards. She questioned the illegality of this.
The Chairperson said these concerns should be brought forward.
• 02 Sep 2020: NHI public hearings: planning session
Ms Gwarube said there were Committee Members who were not happy with the minutes on the oral submissions. However, there were Members who wanted minutes and not the report on the oral submissions. She recalled that the Chairperson had asked that Members who were dissatisfied with the record of the meeting needed to submit their amendments. Had Members since given amendments?
The Chairperson acknowledged this point and said no more amendments would be accepted after the end of this month - that is the deadline for comments.
Dr Jacobs asked about insourcing the summary of the NHI submissions.
Ms Chirwa said that insourcing was brought up in this meeting, albeit briefly.
The Secretary replied that hiring external service providers was brought up in this meeting, and whether the submissions should be summarised internally or externally. The report was discussed at a different meeting.
Ms Chirwa replied that the discussion on external service providers was mentioned in all meetings when questioning internal capacity to do this.
The Chairperson acknowledged Ms Chirwa’s point that this matter had remained unresolved.
• 07 Oct 2020: National Health Amendment Bill: Dr Thembekwayo briefing
The Chairperson reminded them that this matter is still outstanding and needs to be reviewed.
• 08 Oct 2020: Department of Health 2019/20 Quarter 1 - 4 performance
The Secretary said there is a draft report on this and it will be brought to the next meeting for adoption.
• 13 Oct 2020: Notifiable Medical Conditions Amended Regulations: Minister's briefing
• 13 Oct 2020: National Health Insurance (NHI) public participation: way forward
• 21 Oct 2020: National Health Amendment Bill: Department of Health response
The Chairperson said the agreement by the Committee to seek permission to meet on days falling outside the Committee slot was an outstanding request. This is if it does not clash with party caucus meetings.
• 04 Nov 2020: NHI Bill submissions: servicer provider to process comments; Provincial NHI Public Hearings Report
The Chairperson said that there were Members that highlighted unaddressed gaps in the NHI Public Hearings Report. Input from Committee Members was to be given to the Secretary.
Ms Gwarube said the resolution was that Members who were unsatisfied and felt there were gaps in the report were encouraged submit inputs.
Dr Jacobs brought up internal or external service providers being put to a vote. Due to contention around this point, the decision should be placed under Resolutions, as it still needed to be discussed and considered. The Chairperson agreed that this should be placed under Resolutions.
Ms Ismail brought up the point about receiving feedback from the Project Management Office about whether there is capacity to insource submissions through Parliament. The Committee had not received feedback nor a report. The Chairperson replied that he has plans to meet with Mr Bandi and highlighted that he planned to meet with him next week (22 February 2020) to go through this issue and consolidate other outstanding points brought up within these minutes.
• 11 Nov 2020: National and Provincial Departments of Health and Entities Audit Outcomes: AGSA briefing
• 18 Nov 2020: Department of Health 2019/20 Annual Report
The Secretary noted that issues raised in this meeting by Committee Members were incorporated into the Budgetary Review and Recommendations Report.
• 25 Nov 2020: Minister of Health on Forced Sterilisation of Women living with HIV/AIDS in South Africa
Under Resolutions, the Chairperson said that “the Commission should be invited to brief the Committee on its report” remained outstanding. This matter needed to be dealt with.
Ms Gwarube remembered asking “what is the relationship between the Commission for Gender Equality findings versus the Health Ombudsman process”. She remembered that the psychological support provided for the women was not enough, that some may want to pursue medical legal claims.
The Chairperson acknowledged that this point could be brought to the Commission for further processing of the report and that this could be referred to the Ombudsman.
• 02 Dec 2020: Health Budgetary Review and Recommendations Report
• 07 Jan 21: Minister on Covid-19 Vaccine Rollout strategy & status of healthcare services in provinces
Ms Ismail has said that there are numerous outstanding Resolutions, specifically the inadequate briefing by the Minister on COVID-19 vaccines. Instead of being appraised of new developments by the Minister directly, they received information through the media. The Chairperson said that this issue had been raised with the Minister and that he had responded. However, it is an area of improvement for the Committee to schedule properly.
Ms Gwarube said that this had been raised and recalled the Minister’s response was he has a separate programme to address the nation. The Minister comes to the Committee by invitation. The impetus is placed on the Committee to decide if they would like the Department to give a weekly status report to which they invite the Minister or Deputy Minister to attend. What the Minister does in his public webinars is for stakeholders. The Committee is briefed by the Minister through an invitation to do so.
Ms Ismail agreed. It is the Chairperson’s responsibility to bring this matter to the Minister, so that the Committee may be briefed directly by the Minister and receive updates.
• 13 Jan 21: Covid-19 Update and Vaccine Plan: Eastern & Western Cape
Ms Wilson noted that at this meeting she had asked that the Committee makes sufficient time for discussions, questions raised and points of clarity during presentations. She emphasised that “under no circumstances” should the Committee be sitting under restricted time to allow for a sufficient response on pertinent issues. She suggested that this point sits under Resolutions.
The Chairperson asked that this point about creating enough time for discussion by the Committee is captured in the amended minutes.
• 14 Jan 21: Covid-19 Update and Vaccine plan: KZN & Limpopo
Dr Jacobs said that it would be important to receive written responses by the Provincial Departments on the matters raised by the Committee during this meeting.
The Chairperson asked the Secretary to bring this outstanding matter to the attention of KwaZulu-Natal and Limpopo Provincial Departments of Health.
• 03 Feb 21: SAHPRA on Ivermectin; Gauteng Health Department vaccine plan
Ms Ismail said that a major issue brought up by her and Mr Emam was the vaccine choice and the switch made from AstraZeneca to Johnson & Johnson. She had questioned how government decided to use AstraZeneca without SAHPRA approval. This needed to be reflected in the minutes as a concern.
The Chairperson acknowledged this point should be included.
Ms Wilson said that she had raised a concern because in the SAHPRA presentation there was a huge variance in cost between AstraZeneca and Johnson & Johnson.
The Chairperson acknowledged this concern. Another concern raised by Ms Wilson was that they were given a presentation by SAHPRA after the organisation had gone to the media with some of the concerns the Committee raised. Ten days prior to the meeting, SAHPRA was unavailable, and then it went ahead with a media briefing without first consulting the Committee about issues raised.
Ms Ismail agreed with this point.
The Chairperson noted this concern.
Ms Chirwa raised that the Kalafong Hospital patient negligence case was not acknowledged in the minutes.
The Chairperson agreed that this point be included. The response from the Department was that details surrounding the case were unclear; however, once details were obtained, they would give a response. He said that this response must be tracked and replied to.
Ms Wilson asked for her concern to be included that they must meet with SAHPRA on a regular basis fortnightly or monthly to receive continual vaccine development updates.
The Chairperson acknowledged this point.
Ms Chirwa raised her request to SAHPRA to receive a detailed report on vaccination sites across provinces.
The Chairperson acknowledged this point and indicated the Secretary follow up on this issue.
Ms Ismail mentioned that they had requested financial reports from SAHPRA.
The Chairperson replied that SAHPRA was not aware of this but was available to do a briefing on this.
Mr T Munyai (ANC) clarified that the request was to get a list of SAHPRA funders not the financial report.
Ms Ismail pointed out that she requested the SAHPRA financial report.
The Chairperson said that at the SAHPRA presentation on Ivermectin and vaccines, SAHPRA indicated they are willing to do a presentation on financial aspects. He reassured the Committee that there would be oversight on SAHPRA.
Ms Chirwa raised a concern about George Mukhari Hospital, and the Department had been unable to respond in the meeting.
The Chairperson asked the Secretary to follow up on this matter.
• 05 Feb 21: Covid-19 Vaccine Rollout: with Minister & Deputy Minister of Health
Ms Ismail recalled that she requested a report from the Minister on the Sputnik V vaccine.
The Chairperson called on the Secretary to make a distinction between concerns that come up within meeting discussions and resolutions. The Minister had replied to questions raised about the Sinopharm vaccine and Cuba verbally. He acknowledged Ms Ismail’s point, and asked that this request is added to Resolutions and any points brought forward by Members.
Dr Jacobs asked if any resolutions were taken in this meeting; there were none as far as he recalled.
The Chairperson acknowledged this point.
Ms Wilson asked for clarity on proper disposal and monitoring of medical waste particularly the vaccine vials. This was due to incidents that occurred in China. A request in this meeting was that the Committee should receive updates on vaccine allocation and daily vaccination rates within the data capture system.
The Chairperson acknowledged this point and asked for the Secretary to capture this point in the minutes. They need to know from the Minister if there is a data system capturing the vaccines allocated and the health professionals and general population vaccination rates.
Ms Ismail added that there was a request to the Minister to get a report on the vaccine distribution across provinces. The Minister acknowledged this request, and said it would be provided in due time.
Ms Chirwa raised two points that were not reflected in the minutes. The first was the science surrounding the roll-out strategy for phase two and three on the criteria used and how many doses are rolled out in a community. The lack of scientific knowledge about factors such as race, age, geography, social cultures, and economic status was a point that the Minister took as constructive. This point needed to be highlighted.
The second point was the inadequate levels of community engagement on vaccine production. This was the concern that the vaccine was novel. As a result, people may not be aware of what is entailed in the vaccination process and educating the public should be regarded as a primary health care obligation and Department responsibility. She asked for it to be noted that the “conscientisation” of the public on the vaccine and its production was not sufficiently done by the National Department of Health.
The Chairperson acknowledged this point and asked for this to be captured.
Ms Ismail raised another point on the Gauteng report. Full details of the infrastructure expenditure were requested. Secondly, the Committee requested from the Minister clarity on procurement on why medical aid cannot procure vaccines. She reiterated the point that Discovery is South Africa’s largest private medical aid scheme and this point should be highlighted. On the centralised procurement point system, including the private healthcare system in the vaccination rollout could be beneficial in helping the country achieve herd immunity as soon as possible.
The Chairperson took this point.
Dr Jacobs raised a point on data management of vaccination processes. On the percentage of people to be targeted, and who will be receiving the vaccine, he reiterated that the Committee would like to receive presentations about this from the Department.
On AstraZeneca vaccine procurement, Dr Jacobs said that “the Minister informed the Committee that it was readily available”. Dr Jacobs disagreed. He recalled that it was due to an agreement with a COVAX facility that AstraZeneca in its initial studies had reflected a good efficacy against Coronavirus prior to its mutation.
Ms Ismail pointed out to Dr Jacobs that the Minister was asked about the basis for the AstraZeneca vaccine procurement. Was this due to factors such as pricing, availability or appropriateness against the South African variant of Coronavirus? She reinstated the Minister's response that it was readily available, and that was in line with what was said in the meeting.
Ms Chirwa agreed with Ms Ismail. In the meeting she brought up the point why South Africa chose to procure a vaccine with an approximate 66% efficacy rate? What does this mean when other vaccines showed a 99% efficacy rate? Was it a matter of pricing or availability? The Minister’s response was that AstraZeneca data was readily available.
Dr Jacobs acknowledged their points, but countered that the words “readily available” were not the words expressed by the Minister. He asked that the Chairperson allow the Committee to stand off on these minutes and listen to the audio recordings for clarity.
Ms Chirwa was willing to hold off on this until further clarification. However, the position the Minister held on the vaccine being readily available is a point that is brought up constantly within media briefings and responses to the Committee. This point was not only brought up as a reason for AstraZeneca, but as a response in a follow up meeting about the availability of the Sinopharm vaccine and others in production by various pharmaceutical companies.
The Chairperson asked the Secretary to check the record and these minutes will be adopted before 24 February 2020.
• 10 Feb 21: COVID-19 Vaccines update, with Ministry; Northern Cape Covid-19 update & vaccine plan
Ms Wilson said concerns were raised in the meeting about the cost variance of some of the vaccines. The bulk of vaccines were being purchased from Johnson & Johnson and she had asked why they were selected as a supplier compared to other cheaper variants.
The Chairperson said that this question was captured in the earlier minutes.
Ms Wilson said that the first time it was directed at SAHPRA. This question would be directed to the Minister.
Ms Ismail said she had asked if SAHPRA officially registered the vaccine and this point needed to be stipulated in the minutes. As in the previous meeting, Ms Ismail had raised the Sputnik V vaccine and noted it was not mentioned in these minutes.
The Chairperson acknowledged this and asked that this concern be included in the question about the procurement of the Sinopharm vaccine.
Ms Chirwa said that NDOH gave an impression of AstraZeneca’s efficacy on the dominant variant first found in South Africa. Research findings on AstraZeneca were shared, whereas research on the efficacy of other vaccines was not. This concern was raised with the Minister, as the website used to source its information (www.biorxiv.org) contained data on the efficacy of Sinopharm and Sputnik V testing on the South African variant. This information was not shared by NDOH yet was made available on the website on 4 February 2021. She asked that this point be reflected in the minutes.
The Chairperson said that the discussions on Sinopharm and Sputnik V were not disputed by NDOH.
Ms Chirwa said that the matter was captured in the minutes. However, she reiterated that the question she raised to the Minister was: why did the Department create the illusion that AstraZeneca efficacy against the South African variant was the only data available? There were research findings on the same website that showed efficacy of other vaccines such as Sinopharm against the South African variant. This information was excluded in the Department’s presentation. She asked that this be stated in the minutes.
Ms Ismail added she had asked how much data is available on the Sputnik V vaccine’s efficacy against the local Covid-19 variant. How many Johnson & Johnson doses would be needed to vaccinate South Africa’s healthcare workers? The current number of vaccination dosages is not enough to cover them.
Ms Wilson said she raised the question of vial disposal and tender procurement for the distribution of vaccinations. What were the stipulations for people who were applying for tenders, and did they have to comply to an appropriate infrastructure standard?
The Chairperson asked the Secretary to capture the Sinopharm and Sputnik V vaccine point. Ms Ismail’s point on the number of Johnson & Johnson doses was captured in the minutes yet asked that it be rephrased to better reflect Ms Ismail’s concern.
Ms Chirwa asked why the Johnson & Johnson trial was not inclusive of placebo details. How would this affect the efficacy of the vaccine generally? How would this affect the South African variant? The placebo details were not requested from the manufacturer. Additionally, the Minister needed to provide clarity on what Sinopharm and Pfizer neutralisation against the South African variant means in relation to their efficacy. There were the only two vaccines that offered neutralisation at different levels to the dominant variant found in South Africa.
Dr Jacobs requested to answer the questions brought forward by Members. The Minister spoke about the AstraZeneca vaccine trials, mentioning other sites such as “UK and Brazil”. The new study was brought to the attention of the Minister because the research was conducted in South Africa. The Minister spoke about all of the vaccines (Johnson & Johnson, Pfizer, Sputnik V, Sinopharm and Moderna), and that Johnson & Johnson showed increased efficacy against the 501Y.V2 variant. There was a securement of Pfizer doses and Sputnik V. There was engagement with the manufacturers and evaluation studies were being performed. China made offers on the Sinopharm vaccine and an NDA was signed. Moderna had continued engagement. An ensemble study was being conducted. The questions raised by the Members needed careful consideration as to how they would be captured, in relation to the Minister’s response.
The Chairperson said that the presentation given by the Minister summarized the work of five scientists that had been present during the webinar. He requested that the minutes be investigated properly by the Secretary, and that minute amendments from 5 and 10 February 2021 are prepared for the Wednesday 24 February 2021 meeting.
Dr Thembekwayo asked about her Private Member's Bill – National Health Amendment Bill – what would be the next step?
The Chairperson asked the Secretary what the next phase is with the Private Member's Bill.
The Secretary replied that it would be for the Committee to adopt its motion of desirability. This motion would include a report on if it would be desirable or not for the Committee to continue with the Bill.
The Chairperson said that a meeting would need to be arranged to follow through on this step based on Dr Thembekwayo’s briefing on the National Health Amendment Bill that was presented to the Committee.
The Chairperson thanked the Members and adjourned the meeting.
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