Update on NHI parliamentary process; COVID-19 vaccine procurement and roll-out update; with Minister & Deputy Minister
30 March 2021
Chairperson: Dr S Dhlomo (ANC)
Video: Portfolio Committee on Health, 30 March 2021
In this virtual meeting, the Committee was briefed on the progress of the National Health Insurance (NHI) parliamentary process and of the COVID-19 vaccination programme.
Members were informed that the report on the NHI public hearings was almost finalised, and parliamentary processing and analysis of the 64 000 written submissions was underway. In the final phase of the process, the Committee would hear 121 oral submissions.
The Committee discussed its programme going forward. The Chairperson said that NHI work would resume after the parliamentary recess. However, the Committee would continue to meet during the constituency period to receive fortnightly updates from the Department and the South African Health Products Regulatory Authority. The Committee also had to ramp up its oversight work in the provinces.
The Department of Health reported that about 244 907 health workers had been vaccinated against COVID-19 to date, towards a target of 608 295 by 17 May. Thereafter the vaccine would be rolled out to over-60s (about 5.5 million people) from 17 May, to over-40s and other high-risk groups (about 13 million people) from 1 August, and finally to all other residents (about 22.5 million people) from 1 November. The Department was committed to vaccinating the entire adult population, about 41.5 million people, before 17 February 2022. 2 085 vaccination sites had been identified in the public and private sectors. Over the next two days, the Department would complete an agreement to acquire 20 million additional doses of the Johnson & Johnson vaccine, for a total of 31 million doses. 20 million doses of the Pfizer vaccine had also been secured. Johnson & Johnson was the most preferred vaccine and was suitable for distribution in rural areas. 200 000 further doses were due to arrive in South Africa over the next fortnight, and production was ongoing. The Department was not currently leveraging its agreement with COVID-19 Vaccines Global Access (COVAX), because it did not want to roll out either of the vaccines – AstraZeneca and Novavax – currently offered on the platform. However, the Department was also in negotiations regarding the Sputnik, Sinovac, and Sinopharm vaccines.
Of particular concern to Members was the Department’s failure to meet its original targets for the first phase of the vaccine roll-out: the target had been halved and the deadline extended. They were concerned that the roll-out had been slow thus far and that the Department was shifting the goalposts. Members also asked about the no-fault compensation fund, the cold storage capacity required for the vaccines, the Department’s decision to partner with Aspen rather than with Biovac, and the Department’s decision to sell its doses of the AstraZeneca vaccine through the African Union in lieu of administering them.
Dr K Jacobs (ANC) opened the meeting because the Chairperson was having connectivity problems.
Plan of action to work during constituency period
Dr S Thembekwayo (EFF) said that the Committee should not discuss its plan of action during the constituency period in front of the invited guests. She suggested that the agenda item be moved to the end of the meeting.
Mr P Van Staden (FF+) agreed that the Committee should discuss the item after the meeting was formally closed and the media had left.
Mr A Shaik Emam (NFP) said that the scheduling was not ideal. Media and observers were already present in the meeting, and the Department was not scheduled to join for over an hour. If the item was going to be moved in order to allow a closed discussion among the Committee, it would have to be moved to the very end of the agenda.
The Chairperson joined the meeting.
The Chairperson said that he had requested to start the meeting before the Department arrived mainly in order to discuss the Committee’s plan of action during the constituency period. The issue would not require closed discussion unless Members requested it after hearing his remarks.
The Chairperson said that he had noted Dr Thembekwayo’s comment, in the previous week’s meeting, that Parliament was in a constituency period and Members had to conduct party work. He had met with Mr T Munyai (ANC), who had also indicated that his party was not “agreeable” to the prospect of the Committee conducting work during the constituency period. He was therefore not going to pursue his initial suggestion that Members continue with Committee work during the recess, although he had received permission for the Committee to do so. However, his underlying concern remained: there was a lot of work for the Committee to process regarding National Health Insurance (NHI) Bill. He and the Committee secretary would consult with the National Assembly (NA) House Chairperson. They would contact Members before the recess ended to work out a plan for dealing with the 121 organisations that wanted to make submissions to the Committee about NHI. Members should also be aware that the Committee might have to meet after parliamentary sittings. The House Chairperson was even prepared to excuse Members from certain sittings if the Committee was pressed with work. Without such strategies, the Committee would not get through its work.
Dr Thembekwayo asked the Chairperson to provide, in a future meeting, an update on the involvement of Parliament’s Enterprise Project Management Office (EPMO) officials, who had been involved when the Committee had first started dealing with NHI. Could those officials be retained to lead the processing of NHI submissions?
The Chairperson said that EPMO would likely be closely involved with the NHI processes, because they had shown experience and provided leadership and support. They were efficient and competent, and would probably lead or play a critical role in the processes.
Ms A Gela (ANC) welcomed the decision about suspending Committee work during the constituency period. Members looked forward to starting the process immediately after the constituency period, so that they would have time to look at the relevant issues.
Ms N Chirwa (EFF) was concerned about the decision. When the proposal to continue with committee work during the constituency period had been raised in the Chief Whips’ Forum, no parties had objected. It was therefore “disingenuous” that objections were being raised now. Moreover, a report by the Auditor-General (AG) had flagged the need for the Committee to apply itself to doing more oversight and more work. It was not just the national Department of Health (NDOH) that was “failing” or “regressing,” but also the Committee.
Ms S Gwarube (DA) said that the Committee needed proper planning and, in particular, to stack the public hearings appropriately, while balancing the need for Members to attend to constituency work and other responsibilities. At the end of the year, Members did not want to be in a situation where they had completed the public hearings but had neglected their constitutional obligations to their constituencies. Members’ work was not limited to Committee work alone. She agreed that the Chairperson and the Secretary should design a programme. The public hearings did not necessarily have to be completed all at the same time, but if four to six weeks were set aside, the Committee could get through them.
Ms E Wilson (DA) said that the Committee had important work to do, particularly at the moment, in the country’s current situation. Some of the Committee’s processes had to continue. Oversight work was difficult during the constituency period, but it was important that the Committee continued to meet to receive regular updates from the Minister and from the South African Health Products Regulatory Authority (SAHPRA). The public hearings, on the other hand, could be staggered. She agreed with Ms Gwarube that Members’ responsibilities as parliamentarians were not limited to their Committee work, and a “balancing act” was needed.
Mr Munyai said that if the EFF had changed their view on the issue, that might require the Chairperson’s consideration. However, he supported the view that there was a need for Members to focus on constituency work. They should not get “hung up in the office” and neglect their responsibility to serve their constituencies.
Dr Jacobs said that it was a difficult situation, and he acknowledged the views of all Members. The Committee had to make a decision that day. It could decide either to continue with its work, or to have the Chairperson and Secretary put together a programme scheduling the hearings for after the recess. He supported the latter option.
Mr Shaik Emam clarified that only certain committees had formally requested to meet during the constituency period. The Chief Whips’ Forum had agreed to let those committees continue, but they had not made a universal decision applying to all committees. He acknowledged the importance of the Committee’s work. He also acknowledged the AG’s comments about the need for greater oversight. However, the need for greater oversight was best addressed through the Committee’s quarterly or annual programme – especially through adjusting the programme to allow more oversight visits or oversight meetings, perhaps by shortening constituency periods in the future. That would require extensive discussion and agreement among members. In the current constituency period, however, he agreed that Members needed to focus on constituency work. The approaching election called for a lot of effort from party members. On the other hand, the next parliamentary term would be busy, with many debates, Committee meetings, and parliamentary sittings. He suggested that the Committee should find a balance or compromise. Perhaps the Committee should meet fortnightly over the constituency period.
Dr Thembekwayo noted that it was her comments, opposing the prospect of doing Committee work during the constituency period, which had initiated the current discussion. However, she had made those comments before the whips had met to discuss the issue. The whips’ agreement changed the situation and the context was now different.
Ms H Ismail (DA) agreed with other Members that there should be no oversight visits during the constituency period, but that fortnightly meetings with the Minister and with SAHPRA were important and should continue, given the COVID-19 situation. She agreed that a programme should be designed so that, after the constituency period, the Committee could engage “full swing” with NHI issues.
The Chairperson explained that there was a group of committee chairpersons who met to chat, plan, and “lament” about committee processes. In such a meeting, it had come up that committees could request permission through the NA Chairperson to have time off from their constituency work to continue with parliamentary work, if the committee thought that it would not complete its work otherwise. On the basis of that, and before consulting with his party or its whip, he had made his original suggestion. He had subsequently written to the NA Chairperson to request permission, which had been granted.
The Chairperson said that the Committee would not process NHI work during the constituency period, as originally envisaged; it would “park” those processes. However, it would likely have to continue with briefings from the Minister and from SAHPRA, probably fortnightly. However, that would effectively mean that the Committee would meet weekly, since to hear from the Minister and from SAHPRA in the same day would make meetings unfeasibly long. Other portfolio committees were also continuing with their work, and sometimes met twice a week even during parliamentary sittings because of the pressure of their work. When Parliament reconvened, Members might have to be asked to make the same “sacrifice” they had made during public hearings. Those hearings had been a lot of work, sometimes requiring Members to spend weekends at hearings before driving back to Cape Town. He and the Committee secretary would formulate a plan, but Members should be aware that the Committee might have to meet to hear submissions after parliamentary sittings.
The Chairperson said that Mr Van Staden had approached him to suggest that the Committee conduct its oversight work in the provinces during the current period. Such work had been “shoved on the backburner.” When did the Committee go to the Northern Cape or to the North West, not for NHI work but to visit specific clinics and hospitals? He was aware that members of other committees were “really making sacrifices” to make time for oversight work. He was very interested in visiting certain areas to visit police stations and ensure that they were equipped with rape kits, possibly working jointly with the Portfolio Committee on Police. It was in the Committee’s interest to investigate and “make a noise” if there were deficiencies. He might suggest that the Committee visit provinces on a monthly basis, perhaps on Fridays or Saturdays, although the details could be discussed. He was not yet stipulating details but rather reminding Members that, in addition to the NHI work, the Committee had to do its oversight work. He was aware that the AG had recently identified provinces that had not “done well,” and the Committee had to figure out what had gone wrong.
Mr Van Staden suggested that, if possible, the Committee secretary should draw up a programme schedule covering everything that still needed to be done. The Committee could then deliberate on it.
The Chairperson agreed, and apologised for the lack of a programme. However, he said that Members should remember the nature of the Committee; they might be called in to address emergencies. A programme would still be helpful, even if the Committee had to deviate from it unexpectedly.
In summary, the Chairperson said that the Committee would meet during the constituency period, although it probably would not pursue NHI processes during that time. Despite Members’ heavy constituency schedules, they should allow the Chairperson space to call meetings if critical issues or emergencies arose. Such meetings could be held after the day’s constituency work, at 4 or 5 p.m. The Committee’s visibility to provinces must also be “slotted into” the future programme. Oversight visits would be conducted responsibly, being mindful of COVID-19 risks.
Presentation on NHI parliamentary process
The Chairperson said that the first phase of the NHI process had gone well, with Members working very hard visiting provinces. The report on that phase was almost done and only needed to be polished. The second phase involved written submissions. 32 000 had been hand-delivered and another 32 000 had been submitted electronically. All the relevant processes – editing, collating, and so on – would be done in-house. It would be handled by EPMO, among other entities, with continuous progress reports to the Committee. In the third phase, the Committee had to hear the submissions of 121 organisations. That work could not be outsourced; the Committee had to make time.
The Chairperson asked Ms Ressida Begg, Divisional Manager: Core Business Support, Parliament, to update Members on the second phase, written submissions. He said that he was planning to meet weekly with Ms Begg and the team to monitor the progress, and would provide weekly reports to the Committee if necessary.
Ms Begg said that, as the Chairperson had indicated, it had been decided that all submissions on the NHI Bill would be processed internally. The report on the public hearings had also been finalised, except for minor edits.
Ms Begg said that there were several teams working on the written submissions. There were staff working on base data capturing. Submissions had to be named, indexed, categorised, and recorded in a repository, before they could be allocated to a team for analysis. In a previous meeting, the possibility of outsourcing the scanning of hand-delivered submissions had been discussed; however, that was also being done in-house. There was also a technical team providing information communications technology (ICT) support.
There were two teams who analysed the submissions. One team worked on non-substantive analysis, where non-substantive submissions were brief submissions recording an individual’s support for or opposition to NHI. Another team worked on substantive analysis, analysing detailed submissions from civil society organisations and political parties. About 130 of 200 substantive analyses had been concluded.
Parliament was planning to boost support for various teams – especially the content and research team and the data capturing team – by reallocating resources from other areas. The project needed more staff, especially during the constituency period, to meet the Committee’s deadline. Ms Begg said that, currently, the important issue was scanning hand-delivered submissions.
The Chairperson apologised to Members for the lack of a written report to accompany Ms Begg’s presentation. The day’s schedule had been unexpectedly tight. He would provide a written report later. He concluded that the project was “a work in a progress.”
Mr Munyai said that he welcomed regular reporting on the processes. It would give Members confidence in the work being done. He thanked the Chairperson for his leadership. The presentation was “encouraging.” The parliamentary administration’s efforts should be supported, not just criticised. He agreed that capacity was very important, and noted that the administration was considering involving EPMO to strengthen its capacity.
The Committee adjourned for a break.
Update on the COVID-19 vaccine
The Chairperson welcomed Dr Zweli Mkhize, Minister of Health, and his team. He said that, although Parliament was in recess, the Committee thought it important to honour its fortnightly engagement with the Department in order to get regular updates during the pandemic.
The Chairperson asked Minister Mkhize to address, during his opening remarks, the recent change of leadership in the ministerial advisory committee (MAC). He said such changes were concerning because leadership should be able to sort out their differences internally, even if they disagreed. It was frequently the case that one member of the MAC spoke out publicly with a different view to the collective.
Opening remarks by the Minister
Minister Mkhize replied that, as Members knew, the MAC on COVID-19 had been led by Professor Salim Abdool Karim and co-chaired by Professor Marian Jacobs. They had “ably” led the committee. Professor Karim had been an “outstanding” leader and was a globally renowned scientist. NDOH had benefitted from his guidance and the depth of his knowledge. However, he had requested to return to his research and academic work, which he had left incomplete. He had actually requested to leave as early as September 2020, but Minister Mkhize had persuaded him to stay on to complete a full year on the MAC. NDOH thanked Professor Karim for his work, and he would continue to be available to it in the future. Professor Jacobs was also an accomplished researcher and would continue as co-chair. She had also left work incomplete and had requested to be released from the MAC within the next few months, but she would stay on in the short-term to support the new leadership.
Professor Koleka Mlisana, a “highly accomplished and experienced” scientist and doctor, had been appointed to replace Professor Karim. She was part of the team that had supported the National Institute for Communicable Diseases (NICD) and National Health Laboratory Service (NHLS), and she had already belonged to the MAC, so she was familiar with the relevant issues. NDOH was happy that she had accepted the appointment and looked forward to her “strong leadership.”
In addition, Professor Barry Schoub, chairperson of the MAC on vaccines, had been released from the primary MAC in order to focus full-time on the MAC on vaccines. New members, experienced in modelling, genomics, and other areas, would be added to the MAC. The list would be shared as soon as it was finalised. Professor Marc Mendelson, a top clinician based in the Western Cape, would also be released from the primary MAC to chair the MAC on anti-microbial resistance. Anti-microbial resistance was a “silent pandemic,” and the Department would work closely with the MAC to increase its profile and alert people to the dangers of anti-microbial resistance. The level of resistance was rising in South Africa and worldwide. The MAC would look at a number of issues, including fungal as well as bacterial resistance, drug-resistant tuberculosis, and the use of antibiotics in veterinary services such as in cattle farming.
Thus the changes in leadership would strengthen the MACs and enable it to do more work. The primary MAC had stabilised and the situation was “much more comfortable” than it had been previously. There was also an MAC on behavioural change led by Bishop Malusi Mpumlwana, which continued to do its work in collaboration with civil society, churches, and traditional leaders. That MAC was expected to do a lot of work during the vaccination programme, driving the acceptance of vaccines in civil society.
Minister Mkhize said that NDOH was committed to vaccinating the entire adult population within a year of the programme’s start date, 17 February. It was committed to vaccinating as many adults as possible in 2021. NDOH officials were as “keen” as all South Africans were to establish parity with global counterparts, and NDOH considered itself a participant in a global vaccination campaign.
Since mid-February, NDOH had been rolling out vaccines through a phased programme. The programme would see healthcare workers vaccinated within the first three months, high-risk groups vaccinated in the following six months, and healthy adults vaccinated in the last three months. Dr Mkhize said that the programme was still “on track,” despite delays during phase one. Negotiations on vaccine procurement had been completed with two companies and agreements would be signed within the next 48 hours. NDOH had strengthened its working relationship with manufacturers through continuous engagement, beginning as early as June 2020. The country had not had the “financial muscle” to engage in unhedged bets about the success of various vaccines, and instead had had to wait and observe the research and development of each vaccine. However, NDOH had begun to engage with companies about vaccine procurement as soon as there was clarity about the safety and efficacy of various vaccines.
As a result of that process, South Africa had procured 1.5 million doses of the AstraZeneca vaccine. However, the decision had subsequently been taken not to administer the AstraZeneca vaccine. That had delayed phase one of vaccinations. If the AstraZeneca vaccine had been administered as planned, more than one million doses would have been dispensed to date.
Minister Mkhize said that, as announced by the President, South Africa planned to acquire 31 million doses of the Johnson & Johnson vaccine. 11 million doses had already been secured, as he had indicated in previous Committee briefings. NDOH had also successfully “pushed” for a further 20 million doses from Johnson & Johnson; the terms were currently being negotiated. The agreement would be closed in the next day or two. NDOH and the MAC on vaccines regarded the Johnson & Johnson vaccine as the most convenient, due to the ease of storage and the one-dose regimen. It would likely be deployed to rural areas, to areas where storage was a challenge, and to population groups, such as the elderly, who would struggle to return for a second dose. NDOH would ensure that those in rural areas would receive high-quality vaccines like everyone else. The Johnson & Johnson vaccine was a “high-priority vaccine” and the majority of South Africans would probably receive it.
The first batch of Johnson & Johnson vaccines had been ready since March and was currently undergoing compulsory safety and sterility checks. Production was ongoing, which provided “a huge boost in terms of excitement and hope.” The proximity of the Johnson & Johnson manufacturing plant had proved to be of strategic importance and laid the foundations for the advancement of local intellectual property and the expansion of manufacturing capability. The President was going to address the nation that evening about the previous day’s inspection of the manufacturing plant. The inspection had been “very successful” and that NDOH was “very excited” about the President’s leadership in that regard.
In addition to the 31 million doses from Johnson & Johnson, NDOH had already announced that it had secured 20 million doses from Pfizer. It also had a signed agreement with COVID-19 Vaccines Global Access (COVAX). Those sources also formed part of the “armament.” However, currently, COVAX could only offer AstraZeneca and Novavax’s vaccines. NDOH had advised COVAX that, in line with MAC guidance, those vaccines were not currently suitable for the South African setting. Minister Mkhize had seen comments in the media opposing that decision, but NDOH’s position was that the availability of good alternatives made it unnecessary to use AstraZeneca and Novavax.
NDOH would continue to leverage its strong relationship with COVAX to ensure that South Africa could be prioritised when COVAX was able to acquire other vaccines. There would be a lot of engagement with COVAX, especially regarding the constraints COVAX faced in supplying the preferred vaccines. NDOH thought that COVAX should not be put in a difficult position because of South Africa’s decision regarding AstraZeneca. That decision had been based on South African research findings announced by Professor Shabir Madhi. Mr Sandile Buthelezi, Director-General (DG), NDOH, had been directed to engage further with COVAX.
Dr Buthelezi had also been directed to complete negotiations around the Sputnik, Sinovac, and Sinopharm vaccines, and to report back to NDOH on an urgent basis. Applications to SAHPRA were being considered on a rolling basis. There had been positive progress in the Sputnik application: some of the sites, including one in Turkey, had been submitted to SAHPRA for inspection. Sinovac had submitted its application about two weeks ago, and the application was being analysed. Sinopharm had obtained a file number and SAHPRA was awaiting its detailed submission. Dr Mkhize said that there was a lot of “interest” in NDOH engaging with those particular players, because people believed that BRICS countries needed to work together on vaccines. NDOH also continued to monitor the progress on the Cuban vaccine, Soberana, and to engage with the Cuban ambassador.
Minister Mkhize was happy to report that NDOH had vaccinated over 230 000 people through the Sisonke programme, using Johnson & Johnson vaccines. 200 000 further doses would be arriving on schedule within the next two weeks. NDOH was “very appreciative” of the support of Johnson & Johnson’s global team. When batches arrived slowly, it was often because clearance was needed in various countries to release and relabel the doses.
NDOH was currently in the “advanced” stages of preparing for the rest of the mass vaccination programme. It hoped that, at the programme’s peak, it would vaccinate up to 200 000 residents daily; it was “hoping to push” the daily vaccination numbers. Over 2 000 vaccination sites had been identified. In the next few days, he would release a concrete monthly vaccine delivery schedule, which was currently being finalised, pending input from manufacturing companies. The schedule would represent a more granular scheduling commitment and would allow NDOH to begin opening the other vaccination sites, knowing exactly how many people were going to be vaccinated and when.
Dr Buthelezi had been directed to meet urgently with the private sector to agree on the allocation of vaccines between public and private sector sites. Once the daily and weekly vaccination targets, and the vaccine delivery schedule that they were based on, were finalized, NDOH would be able to calculate how many doses had to be reserved for the private sector. All vaccine channels would be rolled out at the same time. Engagement with the private sector was continuous and announcements would be made in due course. Recognising the “inextricably tied fortunes” of the public and private sectors, government, business, and civil society had “come together in an extraordinary feat of social solidarity” to ensure the success of the mass vaccination campaign.
The Human Sciences Research Council (HSRC) had conducted research which had shown that most South Africans wanted to receive the vaccine, despite the misinformation and conspiracy theories that circulated. Confidence in the vaccine had been fostered by the scientific community, which consistently assured residents that the government approached vaccinations with “precision and utmost attention to scientific evidence.” Residents appreciated that and had “full confidence” in the vaccines procured by the government.
Minister Mkhize said that his major concern was not vaccine hesitancy but that that there would be “overwhelming” enthusiasm for vaccinations. NDOH needed to communicate well with communities so that they did not “swarm” and overwhelm the vaccination sites. To date, there had been “very good cooperation.” During the third and fourth quarters, the vaccine would be more easily available and numbers would ramp up – by then, the system would be “much better oiled.”
All parties had a part to play in building confidence in and supporting the implementation of “the most ambitious vaccination roll-out campaign of all time.” History would judge them not based on their ability to debate the issue but based on how they contributed: what they did to ensure that the South African people were protected and the economy saved. Every Member of Parliament (MP) was in a position to mobilise his or her constituency. Government was committed to providing the requisite information – as they were doing in the current briefing – in order to empower MPs to help the public effectively participate in the vaccination campaign. All leaders needed to be working together. There had to be one message from leadership about how people could access the vaccine.
At the same time, the global scientific community, including the World Health Organisation (WHO), had warned that the response to COVID-19 should remain “multi-pronged” until population immunity could be scientifically demonstrated. Thus South Africa had to continue with basic health protocols and the containment measures that had been shown to work. Positive COVID-19 test results had fallen, but “superspreader” events could “turn the tide” and hasten a third wave of cases. The country had to be “very cautious.” The President would issue guidance about what precautions would have to be observed during the Easter holidays, and NDOH urged residents to comply for the sake of South Africa’s health and its economy. After Easter, winter would increase vulnerability to high transmission, but the virus would be combatted through adherence to protocols and regulations, especially wearing masks. The country needed to learn from experience and to persevere until population immunity was achieved. Minister Mkhize, the Deputy Minister, and Dr Buthelezi had approved an Easter holidays campaign to conscientise citizens about preventing a third wave. They had also approved a high-frequency communications campaign, which would share information with members of the public and mobilise priority groups as and when they were called upon to be vaccinated.
Minister Mkhize thanked Members for being available during the parliamentary recess. He agreed that regular updates remained important. The vaccination campaign would not be perfect, but he was “very hopeful at this point.” Members’ advice would always be welcome as NDOH moved into “unknown territory.”
Presentation by the Department of Health
Dr Aquina Thulare, Technical Advisor, NDOH, presented on behalf of NDOH.
Dr Thulare said that the MAC on vaccines had recommended that the following vaccines should be considered for current implementation:
Johnson & Johnson;
Those vaccines had been selected based on the following criteria:
Safety, efficacy and immunogenicity (reactogenicity, short and long term safety and efficacy, population groups studied as well as humoral vs. cellular immunogenicity);
Ease of use and schedule (including number of doses required);
Stability during storage and distribution;
Supply and sustainability (i.e. supplier capacity);
SAHPRA approval (full licensure or emergency use authorisation).
Dr Thulare provided updates on the government’s ongoing negotiations regarding the Sputnik, Sinovac, and Sinopharm vaccines (see slides). In each case, government was awaiting regulatory approval and/or further clinical data. The Johnson & Johnson, Pfizer, Sputnik, and Sinovac vaccines were under review towards approval by SAHPRA (see slides). Applications for the Sputnik and Sinovac vaccines had been submitted on 23 February and 12 March respectively. Dr Thulare noted that the Johnson & Johnson vaccine was close to approval for full market authorisation; the application process was in the fourth of four phases.
Almost all of South Africa’s one million doses of the AstraZeneca vaccine had been distributed to African countries through the African Union (AU). The purchase agreement had been signed with the AU on 15 March and payment was being awaited. The vaccines had been allocated to 14 African countries, including 300 000 doses to Nigeria. Around 39 000 doses remained in South Africa and, conditions permitting, those would be distributed before 1 April.
In total, NDOH expected to vaccinate about 41.5 million residents before March 2022. Dr Thulare described the three phases identified in NDOH’s vaccine roll-out plan:
Phase 1 (17 February – 17 May), targeting 608 295 healthcare workers;
Phase 2A (17 May – July 31), targeting 5 449 980 residents over the age of 60;
Phase 2B (August – 31 October), targeting 12 900 160 residents over the age of 40, and prioritising those with co-morbidities and workers in high-risk settings; and
Phase 3 (November – 28 February 2022), targeting 22 600 640 other residents.
Dr Thulare added that NDOH had initially planned to vaccinate 1.2 million healthcare workers during phase one, but that target had been reduced due to resource constraints. The Sisonke Programme would contribute 300 000 vaccinations in the first phase, almost half of the target.
Regarding the Sisonke Programme, Dr Thulare said that 776 000 healthcare workers had been registered on NDOH’s Electronic Vaccination Data System (EVDS). About 245 000 healthcare workers had been vaccinated to date, mostly in Gauteng (62 000), KwaZulu-Natal (45 000), and the Western Cape (44 000).
Outside of the Sisonke Programme, 2 085 vaccination sites had been identified for phase one. The public sector plan had been agreed with all provinces in February 2021, and was being updated to accommodate the logistics required for the Pfizer and Johnson & Johnson vaccines. In addition, private sector sites had been identified, including about 300 pharmacies.
Dr Thulare described the distribution plan over all three phases, providing a breakdown of which provinces would have depots and which would require direct delivery of the vaccine (see slides).
Dr Thulare said that the overall aims of the vaccination programme were community survival and to prevent lockdowns and other social and economic disruption. Accordingly, there were two objectives. In the short term, the programme aimed to prevent as much severe COVID-19 disease and death as possible. That would be achieved by vaccinating the highest-risk groups first. In the medium term, the programme aimed to reach herd immunity. That would be achieved by vaccinating as many people as possible, as quickly as possible.
To maximise the speed of the rollout, all available resources in the public, private, and non-governmental sectors had to be deployed. There would be three parallel vaccination queues: the general public (in public or private health facilities), occupational health services, and care and correctional services institutions. To ensure fair and efficient access for all, and to ensure that procedures remained as simple as possible, only one’s age would decide one’s place in the general or national queue. Older people would be prioritised in every queue, using “age-based sequencing,” because they were the most vulnerable. However, Dr Thulare said that if rationing the vaccine became necessary later, once those older than 60 had been vaccinated, then workers in high-risk industries should be prioritised over the general population.
NDOH’s occupational health services (OHS) workstream worked towards the vaccination of 20 million workers in the informal and informal sectors, leveraging existing national occupational health infrastructure. The workstream was engaging with stakeholders at the National Economic Development and Labour Council (NEDLAC) and within OHS, and was engaging with beneficiaries in the public sector, private sector (including in mining), and state-owned entities. A multi-departmental project team, reporting to the workstream, had been established to oversee the vaccination of public servants.
In phases two and three, temporary vaccination centres, either fixed or mobile, would be used alongside existing health service infrastructure as vaccination sites. The latter category included not only public and private hospitals and clinics but also pharmacies, general practitioners’ (GP) offices, and workplace programmes. Residents would be able to register on EVDS, or would be assisted to do so, in order to schedule vaccination appointments.
Dr Thulare said that the next steps for the vaccination roll-out were:
For phases 1B, 2, and 3, granular definition of target groups and equipping service delivery platforms;
Provincial implementation plans;
Provincial and district vaccination implementation teams;
Linking with communication and demand generation streams;
Registration and scheduling systems; and
Establishing a call centre.
Finally, Dr Thulare said that NDOH recommended that South African officials posted abroad and foreign diplomats posted in South Africa, along with their families, should be eligible for vaccination in South Africa, but not on a priority basis. Of particular concern were South African officials and their family members posted in other African countries, where vaccines might not be readily available.
The Chairperson noted that the discussion would be subject to time constraints, since the President was due to address the nation in an hour.
Mr Van Staden said that the goalposts had kept moving since the first Committee meeting on vaccinations in January. Initially, 40 million people were to be vaccinated by the end of the year. 1.1 million people were supposed to be vaccinated by the end of March, then that target changed to 700 000, then again to 500 000, and finally, in today’s presentation, NDOH had set a target of vaccinating 600 000 people by the end of May. He also noted the targets for the other phases. It might seem that the programme, as laid out in the presentation, was “unrealistic,” and that the targets would never be reached, even if the goalposts continued to shift. The Committee and NDOH must be honest with each other and with citizens, and should acknowledge that the vaccination roll-out programme seemed like “a bit of a disaster,” just like the vaccine procurement programme. NDOH should be honest about the problems it faced and acknowledge that the population would not be vaccinated on time. That would prevent citizens from being disappointed when targets were not reached. He asked how NDOH planned to roll out the programme it had presented and stay on course, without moving the goalposts again.
Ms Chirwa said she believed NDOH had previously aimed to vaccinate 1.5 million healthcare workers by the end of April. What had prevented NDOH from meeting that target? The presentation had mentioned resource constraints. In that case, what would prevent the same problems from reoccurring and preventing NDOH from meeting its new target? The new target almost halved the initial target, and extended its timeline to May. Why had the public not been updated on NDOH’s failure to meet the initial target? What consequences had NDOH faced for its failure? Access to quality healthcare was enshrined in the Bill of Rights. What would happen if NDOH continued to fail to meet its targets, not just in vaccinations but across the board?
Ms Gwarube said that Members were clearly concerned about NDOH’s failure to fulfill the commitments it had made, including around the roll-out of vaccines through the Sisonke programme. It was very important for Members to have concrete targets and a concrete plan against which the government could be held accountable. NDOH and the Minister had set the vaccination targets, yet they had not met them, and they had not provided an explanation. The Department had initially said that 1.2 million healthcare workers needed to be vaccinated, so if the target for phase one had been reduced to just over 600 000, what would happen to the remaining healthcare workers? There had been large variations in the number of people vaccinated daily, and on some days, like the previous Sunday, there were no vaccinations at all, apparently due to administrative issues.
Ms Gwarube was very concerned about the “very slow pace” of the roll-out. NDOH must be transparent in explaining government’s “spectacular failure.” Why had NDOH failed? Why had the goalposts shifted? How could the Committee trust that NDOH would meet its future targets, if it had failed to meet its targets for healthcare workers? Mass vaccination would require many more resources, including more health infrastructure, which in some cases was not in place.
Ms Wilson asked about recent news articles which reported that vaccine procurement had been delayed because government had failed to sign or complete the required documentation. She said that when NDOH reported that procurement or other processes were “in the pipeline,” that was “disturbing.” It was worryingly vague. The “pipeline” could be very long – “from here to England or from here to Polokwane.”
Ms Wilson responded to Minister Mkhize’s comment, in his opening remarks, that history would judge stakeholders based on their concrete contributions to the vaccination programme. She said that, in the long run, Minister Mkhize would be judged on the vaccine roll-out, and on the number of people who died or suffered from COVID-19 because the roll-out had been slow. People would be judged based not only what they had done, but also on what they had failed to do.
The Chairperson said in summary that Members seemed particularly concerned that NDOH’s current plan deviated, in terms of figures and dates, from the plan it had previously presented to the Committee. Did NDOH acknowledge those deviations? What challenges had caused them? How would NDOH make up the time lost?
Dr Sandile Buthelezi, DG, NDOH, confirmed that NDOH had reallocated some of the healthcare workers, because the Sisonke programme could only cover 500 000 of them. Others would be covered by the first batch of the Johnson & Johnson vaccine. NDOH had initially been working with a number of 1.2 million healthcare workers.
Minister Mkhize said that there would be three phases in the vaccination roll-out: phase one, lasting three months; phase two, lasting six months; and phase three, lasting three months or longer, depending on the “flow” of the vaccines. NDOH had acknowledged from the outset that the rate-limiting step was the number of vaccines it could acquire to make available for distribution. In that respect, one major disruption had been the decision not to use the AstraZeneca vaccine, 1.5 million doses of which had already arrived at that point. NDOH had been put in a situation where it was operating on a kind of contingency arrangement. The other delay had come from Pfizer. The process with Pfizer had been delayed by many contractual issues. NDOH could not even receive vaccines from COVAX until its agreement with Pfizer had been signed. Such delays had largely been related to the technicalities of negotiations. The explanation he was now giving to the Committee had also been provided to the public.
To Ms Wilson, Minister Mkhize said that the problem was not that the government had failed to sign the documentation. Negotiations were dragged out for various “nebulous” reasons, some of which were not even related to the agreement itself. Certain “misunderstandings” arose. For example, sometimes manufacturing companies required Minister Mkhize to sign the contract, not understanding that, under the Public Finance Management Act (PFMA), the DG was expected to sign. There were also registration issues. Moreover, the team on the other side of the negotiations tended to take a long time to process anything that NDOH sent to them. If an issue arose or something required clarification, NDOH would be put into a queue before the matter could be processed and sent back to them for the next step. It was an “exhausting” process, but NDOH was getting over the challenges and did not expect similar challenges in the future. Many countries were going through the same challenges. Global supply chain delays and shortages would always be a potential problem, for all countries, and NDOH should be alert to that.
Minister Mkhize said that NDOH was looking at vaccinating a total of 40 million people over a 12-month period. The programme might spill over its allotted time frame, but what was important was NDOH’s “determination to push” and not to become compliant. He did not think that the targets were unrealistic. The flow of vaccines was a temporary issue, and would improve by late April. Vaccines would definitely arrive in South Africa by the second or third week of April. The Minister noted that, although NDOH would have achieved more if not for the delays, the deadline for the end of phase one had not yet arrived. NDOH had intentionally allocated three months for phase one, knowing that the supply of vaccines would be very limited in the first quarter.
Minister Mkhize disagreed that NDOH had moved the goalposts. The numbers would be continuously revised depending on what was happening, but the “overall thrust” was that NDOH was trying to reach as many South Africans as possible. The context was important.
Ms Ismail asked whether the Committee could be given a full list of vaccination sites, broken down by province.
Mr Van Staden also asked where exactly the vaccination sites would be in the nine provinces, in both the public and private sector. Had the number of hospitals increased from the 23 hospitals that were initially slated to provide vaccinations? If so, how many were public and how many were private, and could the Committee be provided a list?
Minister Mkhize replied that NDOH would provide a list of the sites. He would ask Dr Buthelezi to attend to the matter quickly.
Ms Ismail asked whether there was a clause in the Johnson & Johnson contract that required government to establish a no-fault compensation mechanism to cover damage claims. If there was, how fast would government be able to establish or implement such a mechanism, which entity would be responsible for implementing it, and how would it be funded?
Mr Shaik Emam echoed the question about compensation mechanisms and asked for an update about how compensation would be handled in cases where the vaccine caused serious side effects.
Minister Mkhize replied that the no-fault compensation fund was required by a number of manufacturers, including Johnson & Johnson and Pfizer. However, NDOH embraced it as a very important protection mechanism for all South Africans. The fund was a “work in progress” and “on course.” NDHO had begun the process of structuring the fund, following the regulations needed to establish it, and discussing with the relevant departments, especially the Department of Justice and Treasury. Treasury would identify and allocate the funds to be used. However, NDOH was still investigating whether any existing entity was allowed, under legislative requirements, to administer the fund.
Minister Mkhize said that NDOH could assure all people that, by the time the vaccines were widely available, they would be protected. In the future, the no-compensation vehicle or approach could help NDOH get medical legal cover for all South Africans. Anyone who suffered adverse effects from the vaccine would be eligible to use the program. However, those who had received the Johsnon & Johnson vaccine in the current period were covered by a slightly different fund, linked to research trial processes.
Ms Ismail asked what security or tracking measures had been put in place to prevent theft of vaccine doses. How would medical staff be able to check that a dose was legitimate and had not been tampered with?
Minister Mkhize replied that there was a team in the inter-ministerial committee which was looking at issues of theft and corruption from the perspective of risk mitigation. Batches of the vaccine also included safety features which allowed officials to track a vaccine according to the packaging, batch box, and date of delivery. There was also a safety feature which indicated if the batch had been interfered with.
Ms Ismail asked why Aspen had been chosen over Biovac for manufacturing the vaccines.
Minister Mkhize said that there was an agreement between Johnson & Johnson and Aspen. Pfizer, on the other hand, when it had first engaged with NDOH, had wanted to work with Biovac. However, Biovac had said that they would require “huge” amounts of investment to facilitate the technology transfer required. NDOH was now working with Biovac to see what could be done. NDOH would also consider other manufacturers, in other parts of the country, that had the capacity to participate. Lots of work was being done and NDOH would update Members when progress was made.
Ms Ismail asked whether the President and others in the African National Congress (ANC) leadership had shares in Aspen, and, if so, how many.
Minister Mkhize had no knowledge of who owned shares in Aspen. He was not aware of the President or any other ANC member holding such shares.
Ms Ismail said that the Minister had previously said that South Africa expected to receive 600 000 doses of the Pfizer vaccine before the end of March. She asked the Minister to confirm when those doses would arrive and whether that timeline was still correct.
Minister Mkhize replied that NDOH had not received the 600 000 doses expected from Pfizer, largely because contractual issues, like those mentioned earlier, had delayed the process.
Ms Ismail said that the Pfizer vaccine required long-term ultra-cold storage at lower than 70 degrees Celsius, or short-term storage (less than two weeks) at lower than 20 degrees Celsius. Doses could also be temporarily stored in their shipping containers, using dry ice. Which storage option would South Africa use for the Pfizer doses it received? A few weeks ago, the Minister had said that specialised cold storage facilities had been secured for the Pfizer vaccine. Which facilities were those, and where were they located? She said that NDOH had a team which investigated cold storage capacity in South Africa and asked for more details about the team’s findings. Were there any additional measures NDOH had to put in place to store the Pfizer vaccine, and, if so, how long would those preparations take?
Ms Gwarube also asked about cold storage in primary healthcare facilities. Minister Mkhize had said that certain vaccines would be allocated to certain parts of the country based on the ease of distribution. What was the cold storage capacity of the various distribution sites? Primary healthcare facilities had to be properly equipped in order to facilitate the broader roll-out.
Minister Mkhize replied that there were laboratories that had facilities appropriate for long-term cold storage, including of the Pfizer vaccine. NDOH would make the relevant information available to Members, although he thought that NDOH had already presented it twice to the Committee. In rural areas, there were hospitals and other facilities that had adequate storage mechanisms. Hospital fridges were already equipped to refrigerate at between 2 and 8 degrees Celsius, which was adequate for the relevant vaccines.
Ms Ismail asked where the Pfizer doses would be distributed once they arrived in the country. Would NDOH use the same vaccination sites as used under the Sisonke programme, or would the Pfizer doses be sent to new sites? She noted that the Minister had said that rural areas would probably receive the Johnson & Johnson vaccine.
Mr Van Staden asked about the one million doses of the AstraZeneca vaccine that had been sold to the AU. For what amount had they been sold, and when would payment be received?
Minister Mkhize replied that payment for the AstraZeneca doses had been received. They had been purchased at a price equal to the price South Africa had paid for them, so there was no problem there.
Mr Van Staden asked why so few healthcare workers had been registered through EVDS. Were there problems with the online self-registration system that the Committee should know about?
Dr Buthelezi said that there were only 380 000 registered healthcare workers in the public sector. The private sector had initially reported “huge” numbers of healthcare workers. However, when NDOH had begun to register the workers and request their names, those numbers had decreased. Currently, NDOH had registered just under 800 000 healthcare workers. It was still working to register other groups – such as outsourced cleaning and security staff in hospitals – who had not been included in the initial public sector numbers but who were exposed to patients. In addition, there were many issues relating to the registration of staff in private practices and GP offices. NDOH relied on each practitioner to report how many employees they had, and that number was very difficult to confirm. The current number of registrations was not a firm cut-off and would increase. All healthcare workers would ultimately be covered.
Mr Van Staden welcomed that NDOH listed one of its central objectives as preventing lockdown and other social and economic disruptions. He welcomed the re-opening of society, education, and the economy at full capacity. However, lockdowns and stricter regulations should not be resorted to even while government was not reaching its vaccination targets.
Mr Van Staden asked when NDOH planned to open phases two and three of the roll-out for registration. What were the exact dates?
Mr Mkhize replied that, according to the team working on the system, the system should be ready to receive registrations by 15 April.
Mr Van Staden asked how NDOH planned to ensure that people did not jump the vaccination queue, as had been seen earlier that year, and that they instead waited their turn to be vaccinated.
Minister Mkhize replied that he was aware that officials sometimes requested access to vaccines for certain people. NDOH would have to be vigilant.
Ms Chirwa asked for clarification about who would replace Professor Karim on the MAC.
Minister Mkhize confirmed that Professor Mlisana, who had worked in related areas before, would be replacing Professor Karim.
Ms Chirwa asked about the division of vaccines between the public and private sector currently and across all three phases. How many vaccines were being distributed to each, and what was the ratio? This ratio should be considered in light of the fact that the private healthcare sector catered for only 10% of the population.
Minister Mkhize replied that, currently, about one-third of the vaccines were allocated to the private sector. This was because public servants under medical aid, including health workers, would be accounted for by the private sector even though they worked in the public sector. As he said in his opening remarks, the precise allocation would be determined by the DG and the private sector.
Ms Chirwa asked for an update on the distribution and storage tenders for the vaccination programme. There had been complaints about the tenders, on the grounds that the capacity of the state and public sector should be strengthened. Had NDOH taken that recommendation?
Minister Mkhize confirmed that the tenders had been released. Government agreed that state capacity should be increased. Where there was state capacity, there would be no need to use the private sector. At the same time, the delivery schedule would indicate how much storage space was needed. NDOH would “wait and see.” It might be possible to have a system where vaccine deliveries arrived just before being used, so that extensive storage space would not be needed.
Ms Chirwa asked for an update on the Special Investigating Unit (SIU) investigation into alleged corruption by Minister Mkhize. Was the company under investigation, Digital Vibes, still carrying out business with NDOH? Did the Minister, in line with the recent announcement by the ANC President, plan to step down to allow the investigation to unfold? The Committee had to be aware of what to expect in order to decide how to deal with the matter.
Minister Mkhize replied that the SIU investigation continued, and that NDOH had offered its “full cooperation.” Staff members, officials, and managers had made themselves available to be interviewed. NDOH had made available the documentation requested by SIU. As the President had said, Minister Mkhize and NDOH would wait for the investigation. Once the investigation had concluded, they would engage with the outcome.
Ms Chirwa asked about South Africa’s position on vaccine nationalism, which was manifesting as “vaccine racism.” How was NDOH ensuring that this did not occur in South Africa, if it had not already happened? She asked for details about the demographics – inclusive of race, age, and gender – of people that had been vaccinated so far in South Africa.
Minister Mkhize replied that vaccine nationalism was a challenge worldwide. It was unfair. However, NDOH would continue to fight it and ensure that South Africans got their “fair share” of vaccines.
Ms Chirwa asked for the daily target of the vaccination programme. The Minister had mentioned vaccinating 200 000 people per day, but did that target apply to all phases of the programme, or only to the last phase?
Minister Mkhize said that NDOH would report on its daily vaccination rates to date and would provide regular reports in the future.
Ms Chirwa asked whether NDOH had engaged with Nigeria about the new Nigerian vaccine.
Ms Chirwa said that a senior medical scientist at NICD, a black woman, alleged that she had been “kicked out” or dismissed because of racism at NICD. Ms Chirwa had written to Minister Mkhize about the issue. She asked the Minister to commit to making an intervention of some kind to address it.
Minister Mkhize was not aware of the issue. If Ms Chirwa had sent the relevant documentation, NDOH would follow up on it.
Ms Wilson said that South Africa had apparently been offered, and had rejected, five million doses of the vaccine from China. She asked whether that was true and, if it was, on what grounds the offer had been rejected.
Minister Mkhize replied that there had been an offer of vaccines from China, but the offer had not been rejected. NDOH had initially thought that the offer was a donation, but had later found out that there was a price attached, which had to be negotiated. Negotiations would continue, either with Sinovac or Sinopharm or subject to regulatory registration.
Ms Wilson said that people from all over the country, both young and old, had raised issues stemming from the need to be vaccinated in order to travel. Those people could not find work in South Africa but had been offered jobs, training positions, or educational opportunities in other countries. Most had documentation to support their applications. However, until they were vaccinated, they could not enter those countries and take up their new positions. She requested that such people be prioritised as part of an early group for vaccination. Unemployment was the highest it had ever been in South Africa, people were “desperate” for work, and money they made overseas would come back into the country. Government should not deny job opportunities to people, when so many had already lost their jobs.
Minister Mkhize replied that NDOH was not currently able to accommodate Ms Wilson’s request. Such people could of course be vaccinated “when their turn comes,” and NDOH encouraged them to participate at that time.
Ms Wilson asked about the “nasty” new Tanzanian variant of COVID-19. Was NDOH aware of the variant? Had it implemented any measures to regulate arrivals from Tanzania? Was NDOH equipped to deal with the variant, and, if not, what would it do about it? Would current vaccines protect people from the variant?
Minister replied that NDOH had been briefed on the new variant, which had been discovered in Angola. NDOH continued to work with the Africa Centres for Disease Control and Prevention (Africa CDC), which was investigating the variant. Africa CDC would obviously investigate how the variant responded to various vaccines and would advise NDOH accordingly.
Ms Gela said that NDOH had vaccinated around 230 000 workers, towards the target of 608 298 healthcare workers; only a quarter of the total number of healthcare workers in the country. Did NDOH expect to meet its target before the phase one deadline, 17 May?
Minister Mkhize replied that healthcare workers were indeed being vaccinated. NDOH hoped that the vaccination of healthcare workers would be concluded by the end of April, so that it could move onto the next phase without anyone “left behind.” Phases one and two could even overlap if necessary, once there were sufficient doses available. Once South Africa had received doses from both Johnson & Johnson and Pfizer, that would be possible.
Ms Gela said that the vaccination programme was not going well in the Northern Cape. What were the challenges? Did NDOH plan to provide any assistance to the Northern Cape?
Mr M Sokatsha (ANC) agreed that the vaccination programme in the Northern Cape was “a real concern.” Did NDOH and Minister Mkhize share Members’ concern?
Minister Mkhize replied that NDOH would examine the issue and would see how it should assist.
Ms Gela welcomed the briefing from the Minister. The Committee appreciated his good work and his regular updates. Members should not criticise him or be doubtful, because NDOH and the Committee were “in this together” and had the same goal. The Committee fully supported the Minister.
Minister Mkhize agreed. The Committee and NDOH were both responsible for leading the South African people in these matters, and they had to share as much information as possible to that end.
Ms M Sukers (ACDP) said that faith-based organisations could assist with “strong public positioning,” to educate and inform people about the vaccine roll-out. How would faith-based organisations be considered or approach to assist with the roll-out?
Minister Mkhize said that NDOH was working on a programme to reach various communities, share its perspective on the vaccines, and ensure that vaccine reception was good.
Ms Sukers acknowledged what Minister Mkhize had said about the leadership changes in, and increases in the multidisciplinary capacity of, the MACs. She had two related questions. First, she said that it did not appear that citizens’ ethical concerns had been considered in the vaccine procurement process, contrary to what Minister Mkhize had said at their first engagement in January. She had questioned Minister Mkhize in the NA about the use of HEK 293 and PER C6 cell lines in the design, development, production, or testing of the vaccines procured by South Africa. He had appeared unaware of the issue. She would forward Minister Mkhize the information she had shared with the Committee, and she requested that he meet with bioethicists to examine the issue. If all leadership and all citizens were to have confidence in the process, such concerns must be addressed, not dismissed. The Minister had said that the capacity of the MACs had increased. Who were the bioethicists who sat on or advised the MACs, and did they represent all sectors of the diverse South African society?
Minister Mkhize confirmed that he was not aware of the ethical issue that Ms Sukers referred to, and was “not sure what to make of it.” He asked her to provide him with the relevant information. NDOH would have its experts go through the information and engage as necessary. Ms Sukers could even meet with the experts personally.
Second, Ms Sukers echoed other Members that the vaccine roll-out had been delayed and government had failed to provide its citizens with access to vaccination programmes. It was concerning that the roll-out plan did not identify contingencies that could delay the roll-out or identify alternatives that could accelerate the process. It indicated a lack of procurement planning and skill. This was related to the concern that had been raised in previous meetings about strategic sourcing. The NDOH presentation showed “critical sourcing failures.” But the South African private sector contained world leaders in strategic sourcing. Would the Minister draw on those skills to accelerate the roll-out, and urgently look into best practices in strategic sourcing? This was another opportunity to augment the multi-disciplinary capacity of the MAC leadership.
Minister Mkhize replied that he did not believe there had been a failure of strategic procurement, such that the private sector needed to be brought in. The private sector would not be able to easily procure vaccines with the same kind of safety assurances that NDOH obtained. However, NDOH had agreed that it would make vaccines available to the private sector. Currently, there was no problem in vaccine procurement. The 31 million doses from Johnson & Johnson and the 20 million doses from Pfizer took NDOH “a long way” towards its targets, although it was still negotiating for some additional doses.
Ms M Hlengwa (IFP) asked what guarantees NDOH could provide to South Africans that the vaccines were safe and would not have harmful side effects. Had all the vaccines being used in South Africa undergone successful clinical trials?
Minister Mkhize replied that NDOH could guarantee that the vaccines had gone through the trials necessary to ensure safety and efficacy. South Africa was, like other parts of the world, administering vaccines on a wide scale.
Ms Hlengwa asked how long it would take suppliers of the Sputnik vaccine to obtain regulatory approval from SAHPRA. What specific steps were involved?
Minister Mkhize replied that, as he had mentioned in his opening remarks, NDOH was awaiting Sputnik’s registration with SAHPRA. SAHPRA was going to visit one of the Sputnik sites. Rolling submissions continued – that is, SAHPRA reviewed information as it became available.
Ms Hlengwa noted that Sinopharm had required the government to sign a non-disclosure agreement. Was that standard practice? Had non-disclosure agreements been signed with all suppliers? Transparency was critically important.
Mr Shaik Emam said that NDOH was in “a very difficult position,” so he was not surprised when it had to continuously move the goalposts. He was hopeful that “at least some” people in South Africa would be vaccinated.
Mr Shaik Emam asked how NDOH was funding its vaccine programme. The Minister of Finance had said that the programme would be given R10 billion over two years, but NDOH’s figures seemed to far exceed that.
Minister Mkhize said that most of the funds would come from the Treasury. However, the option of private sector support was still available.
Mr Shaik Emam asked how much NDOH was paying for the Johnson & Johnson doses.
Mr Shaik Emam said that Professor Madhi, an expert, had said that the AstraZeneca vaccine could have, and should have, been used in South Africa. Professor Madhi could not understand why it had not been used. The expiry date had also been pushed. Why had NDOH not used the AstraZeneca doses for South Africa’s purposes?
Minister Mkhize responded that the decision not to use the AstraZeneca vaccine had not been taken lightly. It was Professor Madhi’s research which had alerted NDOH to the problem. NDOH had then met with the WHO and explained the results, indicating the need for additional research. When WHO said that AstraZeneca could be used in areas where there were COVID-19 variants, it was because, in other countries, the variants were sensitive to the immunity generated by the AstraZeneca vaccine. South Africa’s situation was slightly different, as reflected by the results of Professor Madhi’s research.
Minister Mkhize said that the view that the AstraZeneca vaccine was better than no vaccine was irrelevant. The situation was not one in which there were no other vaccines available. Because there were other vaccines available, the MAC would face ethical questions if they recommended the use of the AstraZeneca vaccine. Why would they use a vaccine that had been proven in scientific studies not to have the desired results? The MAC had indicated that the Johnson & Johnson vaccine had optimal results. It had also flagged the Pfizer, Moderna, and Sputnik vaccines. Currently, NDOH had “no regrets” about the decision taken not to use the AstraZeneca vaccine. It had used its best judgement and thought it had made the right decision. If it had decided to use the AstraZeneca vaccine, that decision would probably also have garnered questions and complaints. In addition, the expiry date on the vaccines was an issue of scientific analysis and quality analysis, controlled by regulators and manufacturers working together. The expiry date had therefore been considered.
Mr Shaik Emam asked what would be done with the 39 000 doses of the AstraZeneca vaccine that remained. The NDOH presentation had said that those doses would be distributed before 1 April.
Mr Shaik Emam was concerned about the suppliers involved in the vaccine procurement process. Ms Ismail’s question, about why Aspen had been chosen over Biovac, was “very interesting.” Aspen had repeatedly been caught inflating the cost of cancer drugs, and Johnson & Johnson had been found to manufacture cancer-causing baby products. He asked whether anyone in government had ever received any funding from Aspen or Johnson & Johnson which might have influenced decision-making. This was especially important given, for example, Ms Wilson’s comment that South Africa had been offered and had rejected vaccines from other sources.
Minister Mkhize replied that NDOH had noted the reputational issues surrounding Johnson & Johnson, but did not believe that they affected the work being done in the present. NDOH would remain “vigilant.” He was not aware whether any government officials had received funding from Aspen. He thought that Aspen could provide the relevant information if requested to. He also clarified that the offer from China had not been rejected.
Mr Shaik Emam also asked about the involvement of McKinsey & Company. McKinsey had been fined by the South African government, and had also been fined by the American government for its role in distributing harmful drugs. Was there any link or current relationship between Aspen and McKinsey? Dr Boitumelo Semete-Makokotlel, Chief Executive Officer (CEO), SAHPRA, had had a working relationship with McKinsey for many years.
Minister Mkhize said that he was not aware of the issue and would need more information in order to address it.
Mr Shaik Emam asked why NDOH was not pursuing or looking into Ivermectin, despite the accumulating evidence in its favour. Professor Helen Rees, when asked about Ivermectin by the Committee, had said that she had received an application many months ago which had shown an 87% efficacy rate. Professor Rees had handed the matter over to Dr Semete-Makokotlel, but no action had been taken.
The Chairperson replied that Professor Rees had answered that question “exhaustively” when she had spoken to the Committee about Ivermectin the previous week. He would ask the Committee secretary to provide Mr Shaik Emam with a clip of the answer.
Mr Shaik Emam raised a point of order. He said that the Chairperson’s response was “misleading.” Professor Rees had said that she had sent the application on to Dr Semete-Makokotlel.
The Chairperson said that that was a SAHPRA matter and should not be raised in the present discussion.
Mr Shaik Emam said that SAHPRA reported to NDOH and Minister Mkhize.
Minister Mkhize said that Ivermectin had been discussed before in the Committee. NDOH still did not have a conclusive report sanctioning its use in South Africa, but work was ongoing.
Mr Shaik Emam asked for an update on the anticipated third wave of COVID-19 infections. Minister Mkhize had mentioned the danger of a third wave, but what would NDOH do to prepare? According to leaked information, the government would not be implementing more stringent lockdown measures.
Minister Mkhize said that a third wave of infections remained a possibility. No model had provided an exact date for the start of the third wave. However, it was important to be aware that non-adherence to containment measures could easily precipitate a resurgence of COVID-19.
Mr Shaik Emam asked for clarification about the number of Johnson & Johnson doses. He thought that 80 000 doses would be received every 10 days, meaning that about 8 000 would be dispensed daily, but he had also heard that 10 000 doses would be rolled out.
Mr Shaik Emam asked when the vaccination of all healthcare workers would be complete.
Minister Mkhize replied that although phase one officially ended on 17 May, NDOH hoped to have begun phase two before then.
Mr Shaik Emam asked about the vaccination of foreign nationals living in South Africa. How would it be addressed?
Mr Shaik Emam asked what would happen if the vaccines did not protect against the new variants of COVID-19.
Dr Thembekwayo noted that, according to the roll-out plan, phase 2A would involve vaccinating almost 5.5 million people from 17 May to 31 July. How would that target be achieved, especially given the anticipated third wave of infections? What was NDOH’s level of readiness for the anticipated third wave?
Minister Mkhize replied that NDOH hoped to have begun phase two before 17 May. It would continue to conscientise communities on containment measures, so that South Africa could avoid a third wave of infections.
Dr Thembekwayo said she was going to revisit two questions she had asked NDOH in the 5 March meeting which Minister Mkhize had not attended. Firstly, Eastern Cape Province had notified several healthcare workers, including the brigade of Cuban doctors, that their employment contract would expire on 31 March and would not be extended. The day before, 29 March, the Daily Maverick had reported that, according to the Eastern Cape Member of the Executive Council (MEC) for health, there were severe specialist shortages in Eastern Cape hospitals, with a vacancy rate of up to 50%. Was NDOH not able to stop the termination of those healthcare workers’ contracts?
Dr Buthelezi said that all contracts had been renewed for the relevant workers, including community health workers and contracted nurses. He had personally signed letters to all the provinces regarding the Cuban doctors, following NDOH’s negotiations with the Cuban Ambassador. The matter was now closed. He sent Dr Thembekwayo the relevant press release, published the day before, and she acknowledged receipt.
Secondly, Dr Thembekwayo said that she had previously asked about internships in Gauteng public hospitals, especially Tambo Memorial Hospital. The interns did not receive stipends. She felt it was unfair that interns in Gauteng were not given stipends, but were in other provinces.
Minister Mkhize replied that he was not aware of the issue and needed more information. It was possible that they were not being given stipends if their employment was not covered by the South African government.
Dr Buthelezi said that NDOH would have to investigate. The relevant interns could not be medical interns, because medical interns were appointed against the positions. They might be doing in-service training. He had contacted the head of the Gauteng Department of Health and would follow up directly with Dr Thembekwayo.
Mr Sokatsha asked about the vaccination of South African diplomats posted abroad. The presentation had emphasised the situation of diplomats posted in African countries only.
The Chairperson congratulated Professor Mlisana on her appointment to the MAC. Professor Mlisana had been part of the National Health Laboratory Services (NHLS) delegation which, led by Dr Karmani Chetty, had briefed the Committee in the past.
The Chairperson reminded Members that, when the Committee had noticed that presentations from NDOH contained gaps, they had invited SAHPRA, NHLS, and the South African Medical Research Council (SAMRC) to brief them and close the gaps. Those briefings had provided helpful clarification. Many Members had repeated questions that had been asked, and answered, during those briefings. Notes on those previous meetings could be provided to Members.
The Chairperson said that Members could forward their questions to him or to the Committee secretary if they had not received satisfactory answers, and they would follow up with NDOH. He thanked Minister Mkhize and his delegation for making an effort to brief the Committee fortnightly on the COVID-19 pandemic.
The meeting was adjourned.
Dhlomo, Dr SM
Chirwa, Ms NN
Gela, Ms A
Gwarube, Ms S
Havard, Dr X
Hlengwa, Ms MD
Ismail, Ms H
Jacobs, Dr KL
Mkhize, Dr Z
Munyai, Mr TB
Phaahla, Dr JM
Shaik Emam, Mr AM
Sokatsha, Mr MS
Sukers, Ms ME
Thembekwayo, Dr S
Van Staden, Mr PA
Wilson, Ms ER
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