The Western Cape Provincial Department of Health briefed the Committee in great detail on the preparations made by the Department for the third wave as well on the planning for the rollout of vaccines.
The Provincial Minister of Health explained that the current vaccinations were within phase one of the implementation study by J&J Research Council which was supported by, and formed part of the partnership with the National Department of Health.
The Head of the Western Cape Provincial Department of Health said the Province was at a historical moment to turn the tide against the pandemic. Mass vaccination was the central weapon. But there is a very real risk of a third wave of COVID-19 infections in the next few months. The risk was accentuated by viral mutation, greater population movement as restrictions got lifted and the onset of the winter season when people tended to stay indoors.
Limited doses of the J&J vaccine had been secured. The J&J Vaccine will be arriving in four tranches over 8 weeks. It is anticipated that this will cover 40% of health care workers.
Members commented that it was alarming to see just how residents were not sticking to the basics of what they needed to do, such as wearing masks. Members asked whether the vaccines currently received were sufficient to cover the entire phase one rollout to all health care workers. Were there backlogs in the testing labs and what is the current turnaround time? Where did the Department plan to vaccinate people and in which order would vaccinations be taking place. Perhaps there was rather a need to focus on the spreaders of the virus (who are young) and not on those older people who were unlikely to spread it? Was is correct that prisoners should receive vaccination ahead of law-abiding citizens? What reasoning influenced the decision to move from PCR testing to Antigen testing, despite it not being 100% accurate? Members inquired about the costs of the vaccines and whether medical aids were to charge clients for the vaccines.
The Chairperson welcomed the Members of the Committee and delegation to the meeting. The rules of engagement were explained, after which apologies were tabled.
Dr Nomafrench Mbombo, Provincial Minister of Health, in her opening statement, explained that the current situation was not a rollout of the vaccine but should rather be called that which it was, which was phase one of the implementation study by J&J Research Council which was supported and formed part of the partnership with the National Department of Health.
Regarding the third wave, there was a lot of uncertainty as to whether, when and how it would be dealt with and all depending on the modelling scenario which inevitably made it extremely difficult as they were also dealing with a variant which had been picked up at the end of October 2020.
The data had indicated that those who had been exposed to the variant had the antibodies and elements of immunity which could neutralize another exposure for reinfection, however, more research was being done on that.
Western Cape Government: Health Presentation
Dr Keith Cloete, Head of the Provincial Department of Health, said that the Western Cape was at a historical moment in time to turn the tide against the pandemic. Mass vaccination was the central weapon to reduce mortality, protect the health system from being overwhelmed, and achieve adequate population coverage and develop herd immunity to reduce transmission. There is a very real risk of a third wave as the Western Cape would not achieve herd immunity in the next few months. The risk was accentuated by a range of potential risk factors including viral mutation, greater population movement as restrictions got lifted, the winter seasons when people tended to stay indoors, amongst others. [Dr Cloete presented over 60 PowerPoint slides, which comprehensively covered his comments. Readers are referred to the presentation, which is available on the PMG web page for the meeting.]
Public Health and Social Measures
- The World Health Organisation (WHO) highlights the key role of public health and social measures (PHSM) in limiting COVID-19 transmission and reducing deaths, especially in the context of constrained health services.
- Both introducing and lifting PHSM therefore requires a firm commitment to agile decision making.
- Since the introduction of Level 3 measures on 28 December 2020, all epidemic measures have declined rapidly and we are approaching pre-wave 2 levels of transmission with daily incidence of <300 new cases, <80 hospital admissions and <30 deaths.
President’s Announcements on restrictions
- SA placed on Alert level 1 from 1 March 2021
- Curfew: Midnight to 4am.
- Alcohol sales permitted as normal (not during curfew)
- Mask wearing is compulsory
- 50% of venue capacity to a 100 max inside
- 50% of venue capacity to a 250 max. outside
- Health protocols have to be maintained.
- Stay away from closed or crowded places
- Encourage the use of the SA Covid alert app.
- The National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS -CRAM) study shows 40% compliance with mask wearing, which is concerning.
- COVID-19 fatigue and reduced vigilance is a setting which increases risk of transmission.
- Even with vaccination, the protection is not 100% - so non-pharmaceutical interventions (NPIs) [like mask wearing, social distancing and hand washing] must still be adhered to.
- Requires renewed efforts through messaging, social mobilization.
- The Department will convene the behavior change experts to advise.
- Perhaps the most important lesson to be learnt from the previous two waves of COVID-19 is the need to adapt policies and strategies to ensure that they are rapidly flexible and appropriate to the stage of the wave.
- Importantly, policies should not be wasteful of resources – they should either be directly contributing to disease control or be withdrawn.
- It would be preferable to have the policies clarified beforehand and ‘implementation-ready’.
- Have ‘pre-specified’ trigger points at which different policy switches are implemented.
- Polymerase chain reaction (PCR) testing is expensive. Antigen testing is cheaper and provides more rapid results but is less sensitive (it misses about 30% of cases as detected by the gold standard PCR).
- The positive cases that antigen testing misses are those that are late in their infection, who are considerably less infectious, and so the impact on disease control is (arguably) not too severe.
- Throughout the epidemic the Department needs to be prepared to review the value of testing (in terms of its contribution to epidemic control). The value of testing at hospital (admission) level is different, as it relates to case management
- The COVID-19 Ag test result is available within 15 minutes – so there are implications for responding to results at the same time as opposed to remote action via call centre.
- Off-site Testing: there should be a place for ‘off-site’ testing to try and control recognised outbreaks - in ‘containable’ populations (Old Age Homes, prisons, schools) – this is better suited to antigen testing.
- The Surveillance and Testing Advisory Group (STAG) will be sustained to advise on changes in testing criteria and strategies.
Intentional Grieving, Healing and Recovery
Massive impact on Staff – both frontline and Support staff
- Moral Injury – sheer scale of making life and death decisions daily
- Witnessing death – more than 10 500 deaths from Covid in the Province
- Relentless service pressure
- Emotional anxiety and fear for oneself and loved ones.
- Impact of health care workers and support staff (HCW+) being in Quarantine and Isolation (Q and I) and impact on remaining staff
- Loss of colleagues – 115 staff.
- Exhaustion, burnout, grief
Intentional Grieving, healing and recovery
- Creating structured safe spaces to connect with staff and leadership.
- Showing our vulnerability and expressing our grief and sadness.
- Allowing frontline and staff to speak their minds and leadership actively listening.
- Slowing down, pausing and allowing for healing and recovery.
- Pacing the recovery and pursuit next set of priorities.
- Providing emotional and counselling support.
Prioritisation for Phase 1 for J&J Vaccine (Sisonke Programme): Limited doses of the J&J vaccine has been secured as part of the Sisonke Programme (300 000 – 500 000 doses). The J&J Vaccine will be arriving in four tranches over 8 weeks. The first tranche, received on 17 February 2021, contained 13 160 doses for private and public sectors. It is anticipated that this will cover 40% of health care workers over the 8 week period.
The launch took place at Khayelitsha District Hospital on 17 February from 14:00 where President Cyril Ramaphosa and Minister Zweli Mkhize were among the first South Africans to receive the vaccine. Groote Schuur Hospital (GSH) and Tygerberg Hospital (TBH) commenced vaccinations on the same day as the launch. Karl Bremer Hospital started vaccinations on 23 February 2021.
Four Important Considerations
- There is urgency to maximise the vaccination of the priority categories within the next three months (March-Apr-May) to pre-empt and mitigate a possible third wave.
- While phase II [in which the roll out of vaccines extends beyond HCW+] will not be enough to get us herd immunity, it will go a long way to reducing mortality amongst the most vulnerable, protecting the health system from being overwhelmed and protecting critical sectors in the functioning of society.
- There needs to be an efficient delivery system that can enable quick access to the vaccines by the largest number of people in the shortest space of time.
- Given the limitation of vaccine availability, contingency plans to procure additional vaccines for the country and the province should be urgently explored.
- Prioritisation / Sequencing for the phase II needs to be urgently refined so there is a readiness to titrate access of the most vulnerable with the available doses to achieve greatest impact on reducing mortality.
Ms W Philander (DA) congratulated the Department on their audit outcomes. It was alarming that residents were not sticking to the basics and what everyone should have realized by now was that government could not do this alone. In terms of the quantities and dosages of vaccines, she wanted to know if it was sufficient to cover the entire phase one trial rollout. How would the Department manage those quantities in phase one, with a looming third wave was something which needed to be addressed? Lastly, by when were more vaccines expected and would those supplement or complement what had already been received?
The Chairperson explained that in the previous briefing, the Committee learnt that 117 thousand Pfizer vaccines were meant to arrive by February 2021. She wanted to know whether those vaccines had arrived and if not, was South Africa still going to receive them. Secondly, would General Practitioners (GP’s) be participating in phase two and three, in assisting the Department in the rolling out of vaccines? She sought clarity on whether False Bay Hospital would become a vaccination site and lastly, whether any cases of the Brazil variant of the Corona virus has been identified in the Western Cape.
Ms R Windvogel (ANC) stated that she sought clarity with regards to the civilian strategy and the backlog in the testing labs. She highlighted the plight of farmworkers who travel in the back of trucks with no possibility of social distancing and at times when wearing masks seemed very unlikely. She wanted to know what the Provincial Government was doing regarding that situation, along with the assistance to communities who were without water for extremely long periods of time – some still currently without water.
Mr M Xego (EFF) said, in reference to slide 32 and the escalation of the load on hospitals critical care since the lifting of the alcohol ban, that he sought to understand what advice the Department of Health was issuing out to Government in order to deal with that. Was the Department not worried that the continuous unrest and engagements with organized labour could lead to unrest and strikes during critical times? With the estimated target of vaccinations for healthcare workers being 40% [slide 40], he failed to understand how that would be possible when places such as the Central Karoo and other hotspot areas did not have any vaccination centres.
Mr P Marais (FF+) asked how the Department planned to vaccinate people and in which order they were to be vaccinated? He argued that the manner in which people should be vaccinated, should rather be focused on the people who were considered as “spreaders” of the virus. How long after vaccination occurred, was a person most likely to acquire immunity? He asked if any discussions were held with the private sector in the Western Cape, regarding logistical assistance as the rollout of vaccines was a major task.
The Minister responded that the rollout of vaccines formed part of the implementation study using the 500 thousand doses which South Africa received from J&J which were initially from leftovers of the 3A phase of their trial studies.
Regarding the GP’s, she stated that they had always seen the Provincial Department of Health as a steward for other pathways in regard to accessing healthcare services. In their rollout plan, they indicated that they had 378 public vaccination sites and 41 private vaccination sites – be it in Clicks [pharmacies], GP offices or hospitals. The initial plan was to use the existing research sites which were being used by J&J at the time in their own research and accounted for 21 sites. Tygerberg and Groote Schuur Hospitals were the initial vaccination sites for the Western Cape.
There needed to be balance and rationale to decisions made regarding the rollout of vaccines. Indeed, the elderly were being prioritised over their bundles of joys who were likely the spreaders of the virus, however, the rationale behind prioritising the elderly was to protect them in the event that they contracted the virus and were more at risk of complications than their bundles of joys. The aim was to prevent the healthcare system from collapsing.
Indeed, the issue of social determinants of health such as water, sanitation, sewerage, poverty, access to nutrition, all played a part in keeping the system alive and preventing its collapse if it was managed properly.
When allocations occurred for a facility or area, it was not only allocated for the staff but for the emergency medical services (EMS), GPs, healthcare workers, health care students, etc. Hence why Khayelitsha District Hospital had lesser numbers as it accommodated less workers in comparison to the other hospitals. There has been various engagements with the National Command Council where proposals were given and accepted. Engagements are occurring at various levels whether through the National Health Council or with the National Command Council.
Dr Cloete responded that there were 378 vaccination sites for Phase two, which included the False Bay Hospital. He assured the Committee that scientists had not picked up any other variant other than the one which South Africa had, called 501-B2. There was no documented proof of any other variant within the South African setting. There was no backlog in labs and testing.
The issue of the farmworkers was one which needed to be dealt with by District Disaster Management. Each district municipality had a Joint Operation Centre which brought the various government departments together.
Once vaccines had started, more than 83% of healthcare workers agreed that they wished to take the vaccine. The moment the vaccination process started, people became less anxious and wary of taking it. The Health Department had also issued recommendations from a health perspective regarding the sale and restrictions of alcohol, which were being tabled with the appropriate departments.
He said the Department had an extremely progressive and helpful relationship with organized labour. Engagements were productive, clear and transparent. The issue of salary negotiations had been explained to be a bargaining chamber issue and, as such, negotiations never occurred at a provincial level. The rapid antigen test which was being proposed was a test which issued out results within 15 minutes.
Mr R Mackenzie (DA) said he had received a social media request from the South African Offshore Workers Association. They wanted to know as to where they fell with regard to the rollout of vaccines as they were working in other countries and not within the borders of South Africa. Who could they contact in order to find out more information?
Mr A Van der Westhuizen (DA) stated that he had received a request from elderly people who were on medical aid and anxious as to what procedures to follow in order to receive their vaccinations. He wanted to know what the costs of the vaccines were and whether they were being charged as an expense against medical aid for those who were on medical aids.
Ms Windvogel asked why the Department planned to move away from the PCR testing to Antigen testing [slide 26] despite it not being 100% accurate, as well as whether it had been raised with the Command Council. What were the cost differences between the two tests, and where did the Department receive the tests from. She asked what caused the limited utilization of quarantine and isolation facilities, including how many of those facilities remained opened currently. The Department was asked to give an update on the Western Cape’s vaccine procurement process, including which companies were being engaged and what kind of vaccines they were looking for, along with what commitments had been made and what the provincial budget for the vaccines were.
Mr Xego stated that there was a list of health workers which had been identified, however, there seemed to be no proper coordination of things and he wished to know what was being done to assist with that.
Mr Marais stated that he was confused regarding the change in supplier when at first they stated that they lacked the capacity, however, were now suddenly able to vaccinate 11 million people with that supplier. He did not believe a word which was coming from the National Government at all! Regarding labour, was there a plan B where private hospitals could assist to accommodate the overflow of patients if such a scenario occurred.
The Minister responded that the question in relation to the South African Workers Offshore Association still required that those individuals meet the set criteria in order to be vaccinated. It was emphasised that the vaccines were free and no exchanging of money at any of the sites was to occur, as the vaccination was a national programme. The National Minister for Health stated that the vaccinations would be free. Recently, the National Minister for Finance stated that they had budgeted around R9-20 billion depending on the vaccination plus the compensation fund and would not be increasing taxes at the current point in time. While the province would be receiving the vaccinations for free, it was still responsible for the consumables and the ancillaries such as the syringes and needles which needed to be purchased for the rollout and anticipated that around 3 million people would be vaccinated in phase 2.
The Minister highlighted that it was important to note that at the current stage there was no vaccine which had been approved, except the J&J which received emergency approval but within their clinical trial platform – It was an implementation study. The list and definition of health workers was extended far beyond that of the individual and conventional health worker and it was not just limited to those who worked for the Department. When they shared their vaccine rollout at the time when they were dealing with the AstraZeneca vaccines, they engaged with all those stakeholders and not only those which necessarily fell part of their conventional health system.
Dr Cloete said that the cost for the PCR test was approximately R600, whilst the antigen test cost R120. He stated that they were not in any process of procuring any other vaccine because nothing had been approved by SAHPRA (South African Health Products Regulatory Authority). Regarding the registering of elderly people, once the systems have been set up and everything was in place, people would know and receive clear guidelines as to how to register for the vaccinations.
They would be testing the samples to check the immunity levels in two weeks’ time which would give insight into the vulnerability and preparation needed for the event that there was a 3rd and 4th wave. They have issued clear recommendations on how to mitigate against the trauma load issue which they had given to the appropriate departments in order to be tabled.
Mr Van der Westhuizen asked if the Committee could get an indication of the percentage of trauma cases which were directly linked to alcohol. An indication should be provided to the Committee of the percentage of cases which were related to other external factors.
Mr Windvogel recommended that an invitation be extended to the District Councils, to attend one of the Committee meetings.
Mr Marais stated that he was mystified by the fact that prioritisation for the vaccines were being given to people in prisons over law abiding citizens. He stated that he was very disturbed by this. He recommended that the question be posed to the Department as to how the decision had been reached.
Mr Mackenzie responded that he believed it had more to do with the risk factor associated to confined spaces in prisons, as oppose to whether or not individuals were law abiding citizens or not.
The Committee adopted its minutes of 3 February 2021.
The Committee also adopted its reports on activities undertaken in the month of January and February 2021.
The Chairperson thanked the Committee for their attendance and wished them well.
The meeting was adjourned.
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