Vaccine trials, procurement & roll-out programme update; with Minister & Deputy Minister
28 April 2021
Chairperson: Mr S Dhlomo (ANC)
In this virtual meeting, the Department of Health updated the Portfolio Committee on Health on Covid-19 Epidemiology, Surveillance and Vaccine Roll-Out. The Department provided South Africa’s epidemiology and surveillance of Covid-19. An update was provided on the South African Covid-19 Modelling Consortium’s preliminary findings on anticipating the third wave. An update on the vaccination rollout plan was also given. This explained in detail the vaccines supply pipeline, vaccination sites and the vaccine dose allocation. It was indicated that the Sisonke Trail was expected to be finalised by the middle of May. An update on the no-fault compensation fund was also given to the Committee. The Department updated the Committee on the Electronic Vaccination Data System registrations. The cumulative number of cases reported in South Africa on 26 April 2021 was 1 576 320. Nationally, the cumulative number of recoveries increased by 0.05% in the past 24 hours to 1 501 880. This represented a recovery rate of 95.3%. There were currently 20 254 active cases in the country. The national case fatality rate (CFR) as of 26 April 2021 was 3.4%. The total cumulative number of deaths was 54 186.
The Committee was concerned about the situation in India. It was asked of the Department what regulations and steps were it putting in place to ensure that South Africa did not have a spike in infections like in India? Why did the Minister want to wait before another crisis and then put restrictions on travellers that were travelling from India to South Africa? Members asked if the Minister could confirm if there had been any serious side-effects or any deaths reported of people who had received the Johnson and Johnson vaccine in South Africa? The Committee discussed the rollout of phase two of vaccinations. Would phase two start during phase one? Would phase one first be fully completed before phase two started? Would the 292 000 healthcare workers that was vaccinated with the Johnson and Johnson vaccine be monitored for any side-effects? Would the total number of 3357 vaccination facilities across the country be enough to administer the vaccines and were they duly prepared to do these vaccinations? When would the members of the Committee receive a final list of the vaccination facilities? Since phase two entailed the vaccination of citizens over 60 years older the members asked questions about the Department preparedness to assist the elderly. What programmes were being put in place to assist the elderly in registration? It was asked if there would there be home calls for elderly registration or do they need to physically do it at a clinic? The members also raised the issue of the regulations for the no-fault compensation fund. It was asked why the public was only given four days to comment and give inputs on these regulations? Why was there so much haste to establish this fund? It was said that the short amount of time given for public comment could amount to an undermining of the democratic process. The members of the Committee raised concern about the Department’s prediction on when South Africa would be entering a third wave. It was asked if the third wave would be more severe than the others? It was asked if the Department would act appropriately and timeously with regard to the third wave? A Member asked how many private applications have been done for the private purchase of vaccines? This had been allowed and the Committee needed to know if any applications had been made. What were the Government regulations with regards to that? It was noted that many people could not return to their places of work or to their studies because they needed to be vaccinated in advance. Was there no way that provision could be made for somebody who could produce a contract or an acceptance into a university to have them included in this vaccine rollout sooner rather than later? The Committee wanted to know how medical schemes and healthcare providers were going to make financial provisions for the vaccine rollout. How did the Department define the price to recover the vaccine and the associated logistical costs from the medical schemes? How would the private healthcare providers, such as pharmacies, be compensated for dispensing vaccines to state patients?
The Chairperson welcomed the Department of Health, members of the Committee, the media and members of the public to the meeting. He thanked the Committee Secretariat for finding time for the Committee to respect the commitment made of having fortnightly updates from the Minister. That was the item for today’s meeting. He would be guided if there were any other items on the agenda. One of the items on the agenda were the minutes that were outstanding. He thanked the team that worked very hard to ensure the Committee and Department sat in these meetings. He asked that the meeting start with a moment of silence to remember a colleague, Ms Jacqueline Mofokeng, who was laid to rest with her daughter the previous day. It was a very tragic incident. A day before she passed on she had lost her daughter. The following day she had also succumbed to Covid-19.
[The Committee held a moment’s silence for her and all South Africans lost to Covid-19].
The Committee Secretariat read out the members present in the meeting and the apologies.
The Chairperson recognised the Minister, Deputy Minister and Director General of the Department of Health. He thanked the Minister for finding time to update the Committee. The Minister updated the Committee a fortnight ago and was detailed in response to the things that were worrying the Committee. Some of the issues were work-in-progress. The Committee made a specific request that it be updated on the vaccine plan and updates on Sinopharm and Sputnik. The Committee was excited to learn that today the Department would be restarting with the vaccine trial. The Department needed to tell the Committee why it was restarting today. It was always indicated to the Committee that the suspension of the trial was not going to be very long. The Department needed its scientists to guide it and provide advice. The Department needed to comment on its readiness to go to the provinces. The Department also needed to provide an update on the registration process of South African citizens who were older than 60. Those were the main items that would be discussed in the meeting. Thereafter, the Committee would deal with its in-house programme. After the presentation the Chairperson would allow the members to ask clarity seeking questions, to make comments and engage with the Minster.
Mr A Shaik Emam (NFP) said he would be boarding a flight in 30 minutes. He had sent some written questions to the Committee to be asked to the Department.
The Chairperson said he would read Mr Shaik Emam’s questions.
Mr P Van Staden (FF+) said he also had questions for the Minister after he was finished with the presentation.
The Chairperson handed over to the Minister to update the Committee.
Remarks by Minister
Dr Zweli Mkhize, Minister of the Department of Health, appreciated the opportunity to share some of the issues that relate to the vaccine rollout programme. There would be times when there would be lots of details and there would be times were there were not a lot of details. It all depended on where the Department was with the process. He said that a number of issues that the Committee previously raised had been cleared. The matter that related to the contracts with Johnson and Johnson had been resolved. The contract had been signed. The Department was expecting 31 million vaccines from Johnson and Johnson. A detailed breakdown would be given during the presentation by the Director General. The Department had also concluded a contract with Pfizer. There were already 30 million vaccines confirmed. The Department would also be sharing some of those details. He said that the Department was finalising a list but it was not ready to be made public. The list would be shared with the members of Parliament on a confidential basis. There was still a lot of work to be done and it was quite a rigorous process. He said it was a complex spreadsheet that needed to be sent around. The Department was not ready for it to be published. The Department was ready to share the information with the members but it needed to be kept confidential so that it did not cause confusion among the public. There was some information that was not secretive but needed to be cleaned up before it was published so that it did not create unnecessary confusion. There were over 3300 sites for vaccinations and the presentation would talk more about that. The Department has also asked that the heads of departments, working with the private sector, must work on the tentative allocations to every province and the private sector. The Department would not give the Committee that information now but it was something that was being worked on. The Department was anticipating that phase two was starting on 17 May as was indicated. The Department was anticipating that the Johnson and Johnson vaccine would arrive in the country soon. The vaccines had been manufactured and were packed and ready. The Department was just waiting on the final audits that were being done by Johnson and Johnson. There were no expected challenges with that. The point that the Department had to report two weeks ago was the cessation of the Sisonke Trial. That study was delayed because it was discovered that there were some people who had suffered Vaccine-induced Thrombotic Thrombocytopenia (VITT) which meant that there was unexplained formation of clots or a clotting disorder. This was discovered in eight people, mainly women, in the USA. That caused the halt of the use of Johnson and Johnson temporarily. The Department did the same in South Africa. The Department has now agreed that the trail would resume as of today. The regulator, SAHPRA, has looked at the matter.
The Department was now issuing warning for people to always be alert that there was a possibility of such side effects although very rare. At this point it was one in a million. An assessment had been done globally indicating that the risk of the vaccine causing thrombosis was much smaller than the risk of getting the infection. It was important to continue encouraging people to use the vaccine. Covid-19 had its own impact in creating clotting disorders and that those were worse than having this rare disorder. The Department wanted the public to be informed of this risk and that they should always be conscious of it. Certain signs had been put up to warn people about getting headaches, dizziness, vomiting, abdominal cramps and any discomfort. If people were experiencing these symptoms they needed to make sure that they were checked. Individuals needed to be on the lookout for these symptoms. It was important for vaccinations to continue as the Department had 3 million Johnson and Johnson coming within the next two months. These vaccines would be utilised across the country. It was also indicated that this VITT was noticed in other vaccines as well such as AstraZeneca. Results show that other vaccines also had this challenge. The Department also received the warning that the Johnson and Johnson vaccines should not be given to pregnant women and lactating mothers. This was a precautionary measure until the Department received concrete information from scientists to say what was needed to look out for in this case. The Department hoped that this information would come in fairly soon. The Minister had asked the Ministerial Advisory Committee together with the Society of Obstetricians and Gynaecologists and SAHPRA to debate the matter so that there was a common viewpoint of the approach to this area. There was huge debate going on among the scientists on whether this pause amongst the pregnant and lactating mothers was actually necessary. That was an issue for the scientists and people should not be alarmed by it. The Department needed to be updated as soon as there was new information in that regard. The Department published the no-fault compensation fund regulations. The Department hoped that this would make it easier for people to understand that they were being protected further. This was to ensure that there was no one who would be exposed to a risk without any form of a redress.
This has allowed for all of the vaccines to come into the country because the no-fault compensation setup protected everyone. That had been published from last week.
The Department had also been following up on the issue of Sputnik and Sinovac. The Department had the latest reports indicating the progress in the process of registration by SAHPRA. The Department requested an additional 10 million of these two vaccines so that the negotiations were processed while the registration process was ongoing. That work was on course at this point. The Department was expecting that by 17 May it would be able to proceed with phase two of the vaccination process. The Department would be prioritising senior citizens, those over 40 who had comorbidities and those people who were workers on the frontlines that included teachers, police, industrial workers and community workers who ran a risk of being infected or themselves infecting the public. That was the batch of people that the Department was targeting between May and October. It would take the Department six months to vaccinate about 16.5 million people. The Department was continuing with that plan in place. The number of vaccines, as will be presented, was going to slowly increase. When it increased it the Department would achieve the maximal output of about 250 000 per day. That output would likely be reached around September. The Department would be incrementally increasing the sites. The Department would also be using of the Pfizer vaccine to study. This was just to make sure the Department received the same lessons with Johnson and Johnson and Pfizer vaccines. All of this was on course. The 16.5 million people were the vulnerable groups that were spoken about. The frontline workers were also part of that core. The Department would like to start with those people over 60 and then would move to the industrial setting. Prioritisation helped the process. The Department estimated that between now and June it would have just over ten million vaccines. The 5.5 million people who were over 60 could be vaccinated and then there was another five million people who would be vaccinated at the same time. If everyone cooperated, then the Department could do a lot to protect those who had a higher risk. The presentation will show the Committee how the Department was tracking the numbers of the Covid-19 situation.
There were three provinces that were causing concerns. These were the Northern Cape, North-West and the Free State. Those three were showing numbers that were increasing. However, because those numbers were low compared to the total population of South Africa the Department was working on reducing the further spread in these particular areas. That would be shown in the slides. It was important to indicate that the modelling for the third wave was being done. Everything about the third wave remained uncertain with regard when it was going to arise and how bad it was going to be. There were indications that it was not likely to be worse than the second wave. The Department would like a situation where it would vaccinate as many people as possible without having to be troubled by the next wave. The Department noticed that there were a number of countries going through these waves. Some people had made comments about concerns of people coming from India. The Department had been monitoring that situation. There was no indication that there was a direct risk to South Africa but the situation would continue to be monitored. Similar problems have been seen in the UK, Europe and America. Government needed to be vigilant as it managed this situation. There had been reports of other variants that have appeared in different parts of the continent, particularly in Tanzania. There was no indication that that variant was in this country although it had been spotted in other parts of the continent. The Department will know more about it as the scientists were working together. As he was going through a presentation by the WHO, the Afro-region, it became clear that the south eastern part of the continent has got the 501.V2 variant which was the one which was more dominant in South Africa. The Department would continue to do genomic sequencing to check what was happening in the other provinces so that it could be ahead of the curve on this issue. Those were the comments that he wanted to make. The presentation would be given by the Director General. It would highlight these issues and give more specifics. Thereafter, the Department would respond to questions.
Briefing by the Department of Health on Covid-19 Epidemiology, Surveillance and Vaccine Roll-Out
Dr Sandile Buthelezi, Director General, Department of Health, briefed the Committee on Covid-19 Epidemiology, Surveillance and Vaccine Roll-Out. The presentation first detailed South Africa’s epidemiology and surveillance of Covid-19. An update was provided on the South African Covid-19 Modelling Consortium (SACMC) preliminary findings on anticipating the third wave. An update on the vaccination rollout plan was also given. This explained in detail the vaccines supply pipeline, vaccination sites and the vaccine dose allocation. The Committee was informed that the Sisonke Trail was expected to be finalised by the middle of May. An update on the no-fault compensation fund was also given to the Committee. Lastly, the Department updated the Committee on the Electronic Vaccination Data System (EVDS) registrations.
South Africa Epidemiology and Surveillance
- The cumulative number of cases reported in South Africa on 26th April 2021 is 1 576 320 reflecting a 0.05% increase, with 849 new cases reported over the past 24 hours.
- Nationally, the cumulative number of recoveries increased by 0.05% in the past 24 hours, to 1 501 880. This represents a recovery rate of 95.3%.
- There are currently 20 254 active cases in the country, reflecting a 0.58% increase in active cases over the past 24 hours.
- The national case fatality rate (CFR) as of 26 April 2021 is 3.4%. The total cumulative number of deaths 54 186 reflecting an increase of 38 reported deaths as of 18:00.
- Of the reported deaths 36.8% (14) occurred in the past 48 hours.
Summary of Key Indicators as of 26 April 2021
- Two provinces recorded an increase in positivity compared to 7-days prior. These are Limpopo and Mpumalanga with increases of 23.1% and 11% respectively.
- The majority of cases reported today were from Gauteng which accounted for 31.4% (267) of all new positive cases, followed by the Free State with 30% (255); the Northern Cape with 16.4% (139), North West with 8.1% (69); the Western Cape with 5.4% (46) and Mpumalanga at 3.5% (30).
- Provinces with the lowest proportion of new cases today were: KwaZulu-Natal with 2.9% Limpopo with 1.9% and Eastern Cape with 0.2% of all new positive cases.
- Five provinces showed positive percentage changes compared to 7-days prior: Free State 19% increase, Gauteng 1.4%; Limpopo 24.8%, North West 2.2%; Northern Cape 28.7% increase.
- Over the past 24 hours, the highest number of new cases per 100 000 population were reported in the Northern Cape at 10.8; followed by the Free State at 8.7; the North West and Gauteng at 1.7; Western Cape at 0.7 and Mpumalanga at 0.6 new cases per 100 000 population.
- The Northern Cape currently has the highest number of active cases per 100 000 population at 256.3; followed by the Free State at 102.3; the North West at 66.7; KwaZulu-Natal at 44.4 and the Western Cape at 28.7 active cases per 100 000 population.
SACMC – Anticipating the Third Wave
- In the absence of a new variant, we expect the peak of the 3rd wave to be lower than the 2nd wave.
- The time from initial increase in transmission to the peak is on average 2-3 months.
- In all age groups, the hospital admissions are projected to be lower than levels in the 2nd wave.
- The admissions at a provincial level are dependent on the Seroprevalence after 2nd wave, age distribution and prevalence of comorbidities. Seroprevalence is highly uncertain in some provinces. An additional range of scenarios will be developed for each province.
- Monitoring trends in cases is the best estimator of when a third wave is likely to begin. Guidelines to using the Epidemic Explorer will be shared with the provinces.
- The emergence of a highly transmissible new variant may result in a third wave of the same size or worse, if it is more severe or provides an opportunity for immune escape. Testing and lineage classification is ongoing.
- Delaying the start of the third wave allows for more time for vaccination.
Update on Vaccine Rollout
Resumption of the Sisonke trial
- Announcement of the pausing of the Sisonke trial based on reports of unusual blood clotting.
- MAC, SAHPRA and the relevant Ethical committees were consulted to further investigate, whilst trial halted.
- Reports were released and decision to resume the trial with heightened surveillance for side effects.
- Sisonke trial is expected to be finalized by the middle of May 2021.
Update on the establishment of the NFC Fund
- Regulations were published for Public Comments which clo9sed on the 19 April 2021 and were tabled to Cabinet on 21 April 2021.
- These were gazette on the 22 April 2021.
- Government working on the directions to affect the regulations.
- By publishing the regulations, government was able to meet the conditions precedent to the delivery of the vaccines.
Mr Shaik Emam said that the Minister knew that there was a crisis in the country. When Covid-19 first started the healthcare sector in South Africa was badly impacted. Why did the Minister want to wait before another crisis unfolded in the country and then put restrictions on travellers that were travelling from India to South Africa? India has a crisis. There were 52 passengers who travelled from New Delhi to Hong Kong, who tested negative in their country, tested positive on arrival in Hong Kong. Why did the Department have to wait and put South Africans first by putting some restrictions on travel from India into South Africa right now? He asked why the vaccine was not rolled out to all of the private sector including pharmacies and medical practitioners so that it was rolled out in a matter of urgency given the crisis in the country? He asked if the Minister could confirm if there had been any serious side-effects or any deaths reported, according to his knowledge, of people who had received the Johnson and Johnson vaccine? He knew that the Minister was going to say that certain restrictions would be put in place. There was an increase in infections in Vereeniging as a result of the returning foreign nationals from India. Was the Department aware of that? He wanted the Minister to guide the Committee as to what the Department was going to do. He did not want there to be a crisis in South Africa, where people were infected, and the Department not be in a position to deal with the crisis. Could the Department act appropriately and timeously?
The Chairperson read out Ms H Ismail’s (DA) questions as she was having connectivity issues. What programmes or methods were being put in place to assist the elderly in registration? Many did not know how to use laptops and registering on a cell phone was difficult. What budget had been put aside for the installation of devices, at sites, to assist with registering the elderly? Would there be home calls for elderly registration or do they need to physically do it at a clinic? That would be a covid risk and it would be a challenge for them to physically go there to register.
Mr Van Staden said he had a lot of issues he wanted to raise today. He discussed the compensation fund that was gazetted last Thursday on 22 April. Why was the public only given four days to comment and give inputs on these regulations? He had sent the Minister an urgent letter to bring this matter to the Minister’s attention. A process of public participation should be extended by at least three days so to afford the public and affected organisations a fair chance to comment on this compensation fund. He had only received a letter of acknowledgement. Why was there so much haste to establish this fund? Taxpayers would be responsible for amassing the R250 million needed for the compensation fund. Did the Department not think that they had the right to provide input on how the fund would be spent? Further information on the fund was not clear. For example, how many people would serve on the fund’s panel and would consider the relevant claims and appeals? He wanted the Department to provide more clarity on this matter. Had the Department actually forgotten to establish the fund? The reason he was asking this was that the Department knew South Africa was too rich to qualify for a World Health Organisation covid compensation fund so why were the regulations for the fund not published in January 2021 to give enough time for public comments and inputs?
He noted that the Sisonke Trial was continuing today to complete the vaccination of healthcare workers that now stood at a tally of 292 000. What was the Department’s new target to vaccinate the total of 1.5 million healthcare workers? Would phase two start during phase one? Would phase one first be fully completed before phase two started? Would the 292 000 healthcare workers that was vaccinated with the Johnson and Johnson vaccine be monitored for any side-effects just to make sure that they would be okay? Healthcare workers who were not vaccinated had to now ask for permission to be vaccinated. Would the permission be giving in writing or how would the Department handle these matters? The Committee needed some clarity on this matter as well.
He discussed women who were lactating and pregnant who could not take part in the vaccination programme as SAHPRA had announced. He asked that the Minister provide more reasons for this announcement. Was the Department suspecting something for SAHPRA to make such an announcement last week? It was seen over the past few days that the public healthcare system in India had totally collapsed under the pressure of Covid-19. If South Africa had to reach an infection rate of over 300 000 positive cases, overnight, would the public healthcare system be able to hold up under such enormous pressure? The budget of the Livingstone Hospital in PE had been cut by more than R100 million. This had also been reported in the news this past weekend. Basic services such as clean linen and food for patients could not be provided for at this hospital. Medical claims against the Eastern Cape Health Department amounted to R36.75 billion. Was the Department worried about this? What precautions did the Department have in place to prevent and eradicate problems like these? What was the Department’s prediction on when South Africa would be entering a third wave and would it be more severe than the others? Will the total number of 3357 vaccination facilities across the country be enough to administer the vaccines and were they duly prepared to do these vaccinations? When would the members of the Committee receive a final list of the vaccination facilities?
Mr T Munyai (ANC) thanked the Minister for updating the Committee on a regular basis. He would appreciate if this particular opportunity could be sustained. The Committee was updated on real-time issues and that was very important. The Committee welcomed the update by the Minister. It was helpful because at some point there were provinces who sought to be federal in a unitary government. They did not have confidence that the vaccine was going to come in areas such as the Western Cape and others. He encouraged the Minister to work very hard. The update was very necessary. After the receiving the presentation by the DG and also the Minister, he did not have any further questions because the update was so fundamental and provided clarity to the ‘doubting Thomas’ of the capacity of the Ministry to provide the vaccine needs for the people of South Africa.
Ms E Wilson (DA) asked how many private applications have been done for the private purchase of vaccines? This had been allowed and the Committee needed to know if any applications had been made. What were the regulations with regards to that? Apart from the very slow and stagnated rollout vaccines the country had phase one, phase two and phase three. The Department was still trying to get the healthcare workers vaccinated and then would move onto the over 60-year-olds. However, the Committee was receiving calls. She had asked this question several times and she had not received a response. There were people from South Africa who were employed overseas, who had acceptance to universities overseas and who had contracts overseas. These were predominantly young people who were unable to find work in this country. Some people were unable to return to their countries of work as a result of the covid lockdown over the last year. A lot of those people could not return to their places of work or to their studies because they needed to be vaccinated in advance. This was concerning. Those people could not be employed in this country. The employment rates and opportunities in the country were about zero for young people. Those people who had employment overseas needed to get back there. This was all foreign currency that came back into South Africa. Was there no way that provision could be made for somebody who could produce a contract or an acceptance into a university to have them included in this vaccine rollout sooner rather than later? This needed to be done so that there were no more lost opportunities because the South African economy just could not support them? The Committee had queries about this across the entire country, across the board.
She directed a question to the DG. There was a slide ‘testing positive by health sub-district’ where the DG discussed the dark reds. On that slide there were areas in white where it stated there was no data. It was very concerning to see how many sub-districts on that slide were actually white. In other words, the Department had no data from those areas. She found that a bit upsetting and a bit alarming. Why was the Department not receiving data from certain sub-districts? Was it because there was nothing there? Or was the Department not receiving data from them because they were not efficient or behaving in an effective manner? She wanted clarification on that matter. She then discussed the situation in India. India was really being hit hard by covid. The situation there was dire. She sent thoughts and prayers to those people who lost their lives in an explosion in a hospital. She said that there would be a lot of Indians coming to South Africa, potentially. What plans was the Department putting in place to ensure that the Indian crisis was not brought to South Africa? She then discussed SAHPRA and the review of Sputnik and Sinovac. The Committee has seen this in reports for several weeks. How long did a review take? Was this an indefinite thing? Was there a timeline? Was there a time and a place where the Committee could expect a response on this? The Committee was constantly hearing that it was under review. It was frustrating particularly during a time where there was very slow vaccine rollouts and insufficient vaccines in the country to create national immunity. The Department spoke about 10 million doses. Those 10 million doses were critical. The Department was aiming to order them but was held up by a review. Could the Department give the Committee some clarity on the matter.
Dr S Thembekwayo (EFF) passed on her condolences to the family and friends of Ms Jacqueline Mofokeng and her daughter. She said the issue of India and vaccination phases had already been covered by the other members. How were the medical schemes and healthcare providers going to make financial provisions for the vaccine rollout? How did the Department define the price to recover the vaccine and the associated logistical costs from the medical schemes? How will the private healthcare providers, such as pharmacies, be compensated for dispensing vaccines to state patients? What was the Department’s level of readiness should there be an unexpected abrupt third wave occurring? At the present moment the Department procured Johnson and Johnson and Pfizer. The Department was not sure if those vaccines could be used against the occurrence of the third wave. The Committee heard from the presentation that there was progress made towards the Sputnik vaccine. There were people who would prefer to receive Sputnik as their alternative vaccine because of its safety and effectiveness. It has been proved through studies. According to the results thereof there was no serious adverse effects that were detected. Most adverse effects were mild except experiencing pain at the injection site as opposed to clots and death in respect of the Johnson and Johnson vaccines. How speedily could the Sputnik be procured so that people could exercise the choice of their preferred vaccines?
She said that in these engagements she also asked questions that had nothing to do with the vaccine update but that was because of one reason. When she asked questions to the Department no one came back to her with answers except in a sitting like this. She found that to be unfair and unacceptable. The officials of the Department did not respond to her queries in time about the problems that she raised. She was going to continue to ask the same question that had not been answered about the internships in Gauteng province who were not receiving a stipend. These interns were already in their fifth month of work but they did not received stipends like all the other provinces in the country who were receiving a stipend. She wanted her questions to be responded to outside of the Committee meeting.
Ms A Gela (ANC) welcomed the presentation and the briefing by the Minister. She was very happy about the slide that spoke about the Sputnik and Sinovac vaccines. She was happy that there was progress and that there would be engagement. She looked forward to the Committee receiving an update on that issue. Was there a need for the provinces to buy their own vaccines? She wanted clarity on that question. So far she was happy about the progress and the update that the Department kept on giving the Committee so that the members understood exactly what was happening around the vaccination process. She thanked the Minister for his commitment with the team and the work that they were doing. She said the country and Portfolio Committee were happy with the work that the Department was doing.
Dr K Jacobs (ANC) appreciated the presentation by the Minister and DG. The Committee noted the progress that was made to restart the vaccine rollout today. The Committee commended the Department for that and was thankful that the process would be starting again. There was a general concern with the pace of the vaccine rollout in South Africa especially considering that there were 880 new cases in the past 24 hours. There was increased hospitalisation in certain provinces although there was a national decrease of 12.7%. People generally have a concern of the third wave coming sooner than expected. The Committee noted that there were no new variants in South Africa but it was noted in the presentation that variants may emerge at any time. What was the Department’s current thinking on contingency plans should the third wave arrive sooner in South Africa than what was anticipated?
He then asked questions around the preparations for the potential third wave. What was the hospital, and other facilities, readiness for this? What were the treatment regimes in place and were they being kept as they were before? Was there continued work in order to improve on the treatment regimens? What was the oxygen availability in South Africa? This was a major challenge in India. Was the Department still working on improving this? What was the EMS preparedness? He then discussed temporary facilities. He hoped that the temporary facilities were being retained and kept for a potential third wave. He hoped that the Department was not actually closing those.
The Chairperson asked what were the necessary steps that the Department was putting in place to assist the elderly, especially in the rural areas, with registration? The numbers being registered were okay but they were still small. The Minister’s input was helpful to the Committee that the Sisonke Trial was restarting today because the risk of thrombosis with the vaccine was far, far less than the Covid-19 infection. The Department would be monitoring lactating and pregnant women in South Africa. The Committee accepted that and it was helpful. He noted that the Johnson and Johnson contract was signed and was moving along. The Pfizer vaccine was also on track. He said that maybe the Minister would indicate if the pressure the Committee put on him by disclosing some of the things he did last time have actually helped accelerate finalising the negotiations with Johnson and Johnson, Pfizer and others. He commended the Department for engaging with Sputnik and Sinovac because those countries were South Africa’s friendly forces in the world. Therefore, South Africa should also be seen supporting them. He noted that the matter was still with SAHPRA to finalise. He asked the Minister and his team to respond to the questions posed.
Dr Buthelezi responded to Mr Shaik Emam’s question about rolling out to the private sector. He said that there were sites from the private sector both in the form of pharmacies and private practitioners. This was a work in progress. The Department was doing a curation with the pharmacy council so there quite a number of private sector sites there were. He discussed serious side effects and deaths that were linked to the Johnson and Johnson vaccine. The Department had not received any. SAHPRA reviewed the data and the reports and so far there were no serious side effects or deaths related to the administration of the vaccine. He then responded to the question raised by Ms Ismail and the Chairperson on the programme or methods used to assist the elderly. The Department was working with the provinces. The Department agreed that it needed special programmes in the rural areas for registering the elderly. No one would be turned away from the site if they had not registered with the EVDS. There would be a kiosk for registration at the sites. However, to fasttrack the process the provinces, in the meeting with the HODs, were using community health workers. The health workers were using tablets and cell phones to go to households and register the elderly beforehand. The Department was also trying to promote that if in the family there were younger people who could assist to register the elderly that they should do that. If that did not happen when they get to the site, they would be assisted and vaccinated.
He then discussed the new target for healthcare workers. With the Sisonke Trial the Department was going to be doing about 500 000 healthcare workers because of the doses that were available. The Department already did the allocation to do the mop up of all the healthcare workers. Those were the doses for the phase 1b that were presented today to ensure that the Department cleared up to the 1.2 million that was initially raised as the target. There was a protocol to follow up on the vaccinated workers. They were able to call a number if they had issues. This was part of the protocol as approved by SAHPRA on the study so that they were able to report if there were problems. Those problems would be picked up.
He discussed the issue of lactating and pregnant women. The scientists of the Ministerial Advisory Committee and the South African Society of Obstetricians and Gynaecologists were working together. He had communication with the Chairs last night to state that the Department really needed proper guidance on the matter of lactating and pregnant women so that it was able to communicate this as it moved on.
He said he would have to reach out to the Eastern Cape to get more details on the issue of the Livingstone Hospital budget. The Department’s CFO was on the call so if he was needed he would guide the Department. The Department would be able to provide a response on that issue. The issue of medical claims was a problem not only in the Eastern Cape but in the whole country. The Department was working out mechanisms on how to deal with medical litigation to be able to deal with it. The Department was looking towards the future on how it can, like other countries, start to develop a compensation system that would be able to help it to deal with medical negligence claims.
He responded to Ms Wilson’s question about the private application for the purchase of vaccines. Currently, the Government was procuring the vaccines for the whole country and then the private sector would procure from Government. The Department was working on a mechanism, it was awaiting the Minister’s approval, on how it would get the reimbursement for the vaccine which would cover the actual cost of the vaccine, the logistics of the vaccine and the other areas that needed to be covered. Government’s price would be an all-inclusive price that covered all the costs that were associated with the vaccine administration.
He responded to the question about how long the Sputnik review would take. It all depended on the provision of the relevant information from the applicant. Both the two vaccine manufacturers had appointed local representatives because it could only be the local representatives that could lodge an application for review with SAHPRA. If all the information was available that was needed for the review it became quicker but if there was some more information that still needed to come in then it would take longer. Especially in South Africa with the different lineages, like the 501.V2 variant, some testing needed to be done to ensure that any vaccine would be efficacious against that variant SAHPRA needed more data and that is what caused delays. It depended on the readily available data and any further data that was needed. However, the regulator was trying to fast track this process for the Department. The regulator was sending out extra communication today for them to get extra data so that they could move quicker. It was difficult to put a time on how long the review would take. He then discussed the country’s level of readiness. The Department would follow up in terms of what was available. The Department had a hospital readiness stream that looked at the facilities available, the availability of beds and ventilators. South Africa had a lot of ventilators through the National Ventilator Project. There was also a team that worked directly with the suppliers of oxygen. The Department felt that it was ready. Any time there was a problem the Department would be able to deal with it. The Department made sure it had everything available should it start receiving increase admissions. He then discussed the availability of beds. Some of the field hospitals were decommissioned but it took a very quick turnaround time to recommission them. He provided an example in KwaZulu-Natal where some of the field hospitals were decommissioned and when the Department needed them to be recommissioned it took around ten days to have the hospitals up and running. The Department was ready to ensure that beds were available for the third wave.
Minister Mkhize responded to the Members concerns about what was going on in India. India was going through a huge wave. The number of people getting infected and dying per day was huge. People were panicking and saying that maybe that number was underestimated. He understood the panic and concern that such a situation should not come to South Africa. He aligned himself with those people who expressed sympathy, support to India and condolences about the wave. However, South Africa did not have a direct flight from India. Members needed to be aware of that. He had seen a lot of messages circulating on WhatsApp that Government was not aware and that flights were not being monitored. There were no direct flights from India right now. Government was demanding PCR tests for the people who were coming into the country. Government would be checking if people were coming from any part of the world with a positive report. The Minister asked his team to look at ways of how to track anyone who would have come from India. Just to make sure that everything was fine and if there was anything the Department needed to worry about. He assured the Committee that the Department was aware of that situation. The Committee needed to be aware that there was no direct flight from India that would suddenly offload so many people. The problem of the restrictions from all these countries is that people can go via other parts of the world and by the time they got here it would not show that they used a direct flight. That was an issue that needed to be kept in mind.
He responded to the question by Mr Shaik Emam on why not rollout to the pharmacies and GPs. The Department was actually rolling out to the pharmacies and the GPs. The members needed to be aware that the Department was doing that. The rollout would not be to all the pharmacies and not all of the GPs but to some. It was the logistical issues that was being involved here. He asked the Department to show the Committee some of the list so that the members could go through the spreadsheet. It was quite an elaborate spreadsheet that had too many names and that was why at this point the Department did not want it to be published. There was still a lot of cleaning up that needed to happen. Because the members felt like there was no list the Department would provide it to the members. The Department asked the Committee to allow it to finish the work. There were no serious side effects from the Johnson and Johnson vaccine so far in South Africa. The Department was keeping watch for any side effects that were reported in other parts of the world but South Africa did not have them. Mr Shaik Emam had said there was an area where there was a huge increase in the number of people who were positive and that they came from India. The Department did not have that information so he asked Mr Shaik Emam to share that information with the Department. The Department was monitoring different parts of the Free State and the Department could break down the report further for the Committee. The Department was following up and monitoring. At the moment the Department had not received a report suggesting that it was due to India. The Department was seeing this in different parts of the Free State and that was why it reported the matters. The Department was involved in continuous genomic sequencing and so the Department would pick up any variant that might come from India.
He responded to Ms Ismail’s question about how the Department was assisting the elderly. The registration portal would help those who can register. Community health workers would be assigned to go out and help to register some of the elderly and citizens in general. However, when it was time for vaccination the registration in the portal would not be a prerequisite. A person needed to come in on the basis that it was their turn based on the category that was being vaccinated. The Department would then register people as they presented themselves. People should not fear if they saw that not many people were registered that meant that they would not be vaccinated. The Electronic Vaccination Data System was there to record who has been vaccinated which means that if one was not registered before they came then they would be registered and vaccinated at the same time. No one should panic about that matter. The Department was not envisaging house calls but setups would be made for those who were in settings with large number of senior citizens like old-age homes. The Department would be making announcements as to when the vaccination would be starting and in which areas. The Department would receive whoever came there even if they were not registered beforehand. There was always going to be a risk of exposure but if the risk of exposure to covid was linked to getting the vaccine then he thought that distancing and the use of masks and sanitizers for that particular day was a worthwhile risk. In about 14 days after the vaccination the person would develop antibodies. He said that people must not be frightened to go to the vaccination site. There might not be a situation where the Department could get a doctor or a nurse who could into every house and vaccinate. The Department did not have that as an arrangement because of the population size that the Department was dealing with. The Department would only be calling people to a vaccination site. The Department would try and protect them as much as possible as they came into that site.
He responded to Mr Van Staden’s question on why the Department did not publish the no-fault compensation fund regulations in January. The Department was going through discussions and consultations. It had taken a lot of discussions and ideas to put together these regulations. The Department had to go through those discussions with different Departments, getting approvals and negotiating what this would come to. In January, the Department was not ready. There was not enough information about it in the first instance. Although this matter had been discussed the timing of it was such that it had not been possible to immediately publish some of those regulations. The Department gave four or five days’ notice for comments mainly because it needed to confirm to the manufacturers that when it started the vaccine would be protected. There was an agreement with the manufacturers that the Department would have the publication of the no-fault compensation fund and that that fund would be publicly set up and announced before 30 April. The Department did not feel that it should wait until the last day because if it did wait till the last day then the manufacturers would wait until the last day before it would start preparing to release the vaccines. It was just to make sure that everything was properly aligned. That was the issue. If there were people who wished to make comments, then they were welcome to make comments. The Department would look at them and consider them. The Department thanked all of those South Africans who commented because, as reported last week, the Department had over 13 000 responses. Even though it was only four days that did not stop South Africans from commenting. If the Department did not get any comment he would have been worried that people were given too short a time but that time period did not stop the 13 000 comments. The members should not feel frustrated about the four days given to comment because people did respond. The haste around it was to ensure that all of the issues were aligned. If the Department came to the Committee and said it was still waiting for public comments and waiting for the manufacturers to release the vaccines, then the Committee would be very upset with the Department. The Department needed to balance all of these issues. Although the Department knew that people needed weeks or months to comment on some of the issues some of the issues came a bit fast and that needed to be understood. The public had a right to comment, they did comment and the Department appreciated the comments. These comments were very, very important for the Department and this was the thrust of democracy. Government wanted to know what the public thought. The responses were all well thought out comments and were helpful. Some of them were issues the Department agreed with. The Department appreciated those comments even if they were in five days. More information would be publicised when the Department announced more details about the fund. For now, the Department just wanted everyone to know that there would be such a fund and then it would be made public. Some of the questions asked about how many people would be served and all of that will come through in directions. It did not need to come out through the earlier regulations that were gazetted. That would still come. He responded to the question of whether phase two would start when phase one had not been concluded. Yes, it would. The Department expected that there would be vaccines before the date of phase two started. In phase one there were healthcare workers that still needed to be vaccinated past 17 May. That would not stop the Department from starting phase two because the Department would have enough vaccines for that time. That was not going to be a problem. The Department expected that in the first two weeks of May it would have received close to 600 000 vaccines. There would be enough vaccines to start phase two while the Department was doing phase one at the same time. There would be enough Johnson and Johnson vaccines as well.
He responded to the question of the permissions. Everyone who had to do the vaccine had to give consent. The vaccine always had to have consent. It did not matter which one. In this case, the Department was asking people to sign a consent form. It did not have to be a big or long set of forms. It was just a matter of saying that the person was aware that they were taking a vaccine and therefore that they agreed to it. It had been asked for before. The Department asked that people re-sign it this time just to acknowledge the fact that there had been additional information of side effects to watch out for. He responded to the question about the lactating and pregnant women. It was a precaution. The local regulator has asked to make comments and has given this guidance. The Department asked the Ministerial Advisory Committee and the Society of Obstetricians and Gynaecologists to debate the matter. It was not a universally agreed position. It was just a precaution that the Department was taking while the scientific research was being evaluated. The Department continued with that precaution and the reasons for it were that the safety needed to be established for those categories of women. This arose from the fact that most of the studies had been done on people who were above 18 and therefore there may be issues with certain areas such as the impact on new-born babies. That is what the scientists wanted to look at. He then responded to the question about what would happen if India collapsed and South Africa got 300 000 infections overnight. He said that the members must not try and bring too much panic into South Africa. South Africa had been through very difficult times in the two waves. It was not possible to suddenly, overnight, wake up with 300 000 people infected. It will not happen like that. It would build up over a period. As it did the Department would be matching its response to the rising numbers. It was important to ‘trust each other’. The country had gone through this problem before. It had been very difficult in the last surge but in the first instance the Department wanted to make sure that its beds and staff were ready. It was important for the Department to have a short response time in the event that there was a need for additional services. The Department would respond in the same way. It was anticipating that there would still be a wave that would come but not to the extent of 300 000 infections overnight. It was important to say that the Department was monitoring the situation. The numbers would not suddenly overwhelm the Department overnight. The Department was breaking it down right to the lowest level. The Department had numbers of how many people were positive per ward. On that basis there would not be a huge number that the Department did not anticipate. That was the understanding that the members needed to have.
He was not able to go into details on the Livingstone Hospital because he did not have that information at hand. There was a challenge. Most of the Departments had a budget cut. The Department had to manage those cuts and see how it could deal with it. Many provinces had raised this issue of the budget constraints. The Department had to live within that and unfortunately that was the situation that it needed to face. The Department had to work with the hospital to try and make sure that they can cope even though they have those challenges. The real issue was the medico-legal bill. He had had long discussions with the Eastern Cape. It was a major problem in the whole country. No province could deal with it alone. The reason he raised the matter of the no-fault compensation fund last week was because a similar fund needed to be put up to take care of medico-legal claims. The Department would be able to budget for it and keep it within a particular level. Right now medico-legal costs ‘were a runaway horse’ that no one could control. There was a lot of exploitation of Government resources which needed to be stopped at a certain point. The only way to do so would be to create a framework which allowed Government to curb the costs, the expenditure and the level of claims. To make sure that there was an easier way for people to get protection in cases of mismanagement or negligence. So that if they suffered any harm they would be able to go through that process without having to face exorbitant charges by lawyers. There was a lot of extortion that was happening. He was very unhappy about it. This was something Government needed to reign in and stop. People needed to be protected and people needed to be compensated in cases of neglect and mismanagement. It must be made simpler. People needed to work into the office and say that they were harmed and needed attention. Those people needed to be assessed. Once they were assessed they should be given due compensation which was pre-established. On that basis they must feel like justice has been served. The medico-legal bill was really above what Government can afford. It caused a huge dent on the services that Government needed to render. It was unjustifiable. Because it went through the courts Government could not do much. Quite often the problem has to do with the fact that the records were lost and all of those things could be cured. The Department was going to work on that and make sure that it was not going to be a problem that was going to be ongoing. He responded to the question of when the third wave would be coming and if it was going to be worse. This was the third presentation the Department gave on the third wave. On the first occasion the Department indicated that it did not have an exact timing of when it was going to happen. It could happen at any time because it was based on behavioural change. Secondly, the current model suggested that it would not be much bigger than the second wave. Therefore, the Department hoped that it might not be as bad as the second wave. No one could say for a fact that they were able to predict it. The Department was watching out for it and respond as fast as possible.
The Minister said he had asked that the members receive a list of vaccination sites. It was a complex set of spreadsheets that the Committee should have. It was easy to open up on a computer. It was not for publication, it was not for the media and it was not for the public. The Department just wanted to answer the questions of the members. The Department was saying that it did have these lists. Because there were lots of issues to clean up the Department was saying it was not ready to publish. Once the Department was ready then it would publish the lists. That list should be available but the members should not publish it because the Department was not ready for the publication yet. The Department did not want to answer questions over things that it had already changed.
The Minister thanked Mr Munyai for his support and appreciation of the presentation. He responded to the question by Ms Gela of whether there was a need for provinces to buy their own vaccines. The answer was there was no need for provinces to buy their own vaccines. If they did it would almost amount to fruitless and wasteful expenditure. All of the vaccines that all the provinces needed had already been calculated in the total that Government was providing. National Government bought on behalf of the entire country and calculated the needs of the provinces. The provinces would not be able to buy for themselves because it would need deviations from Treasury. Treasury had already given deviations for the Health Department, encompassing everybody. That was not just for provinces but for a national purchase arrangement. There were deviations for prepayment. One needed authority from Treasury to do that. Treasury had already given that to the National Department of Health on behalf of all the provinces so there was no need to repeat that kind of deviation. There was a need for Government to negotiate large volumes with various manufacturers. That had been done at a national level and there was no province that could come with better volumes or to get a better price with the manufacturing company than what the National Department has done.
He discussed sovereign guarantees and indemnities that had been put in place. No province had the authority to do that and it had been done via the decisions discussed with Treasury, the Inter-ministerial Committee, the National Coronavirus Command Council, Cabinet and with the Presidency. It was a whole combination of Government institutions that had to participate in taking these decisions. There was not even a need for contingency. The Department announced the numbers. Those numbers were actually taking into account all the provinces. Most of those vaccines would be dispensed by provinces and would not be dispensed by the National Office of the Department of Health. There was no need for any province to buy any vaccines. He had been in the Western Cape and this issue was discussed. He had made it quite clear, to the Premier and the MEC, that all of their needs were catered for and that there was no shortfall in the requirement. If they calculated how many vaccines they needed they were already in the batch. It was asked if there was any need for a contingency arrangement. The amount of vaccines that were already ordered were such that they were a contingency on their own. There was no need to buy from somewhere else. The provinces needed to wait for the batches that were going to be distributed. The Heads of Departments were going to sit together to decide who needed how many vaccines. Every province will get as many vaccines as was needed. The private sector will tell Government how many vaccines it would need and get them. Government calculated all of that based on the needs of the country and not on the needs of any specific province or private sector. It was a combination of everyone working together.
The Minister assured everyone that at the moment Government had more than 60 million vaccines purchased which would be coming through. On that basis no part of the country would run short of the vaccines. With the additional amounts from Sputnik and Sinovac that would take the country to probably 70 million vaccines. There would be about 50 million people vaccinated. Government was doing this because the demand for vaccines would outlast the original calculation for herd immunity. Scientists were debating whether 40 million would be adequate. The Department did not want to be caught short on this one. The Department would make sure that these vaccines would be made available.
He responded to Ms Wilson’s question about how many private sector transactions were there on the purchase of vaccines. Right now the private sector was part of Government’s national rollout plan. There was a mechanism for how the private sector would buy vaccines through Biovac and get them to their own sites. This would likely be paid for through medical aid. The Department had lots of discussions on this and the team was finalising the costing associated with it. The vaccines would move from public to private. The private sector would activate payment through the medical schemes. There had also been a discussion for the insurances to be made available to the uninsured. The Department was working through that. He had a discussion last Thursday with the Board of Healthcare Funders. They were looking at these numbers and once refined the team would provide a proper report. Medical schemes would be the basis on which Government would get a lot of private sector payment of the vaccines then there was also the insurance of the uninsured workers that was also going to be part of it. Anyone else who was not covered in those two would be covered through the national vaccine programme that Government was funding. Government has put money aside for those who could not pay for themselves.
He discussed the issue raised by Ms Wilson about people who were accepted for jobs abroad and could not return to work. The Department only got this as a question from Ms Wilson. No one else had given the Department such a request so the Department had not really considered it. The Department had just explained how it was approaching the phases. He suggested that if there were any such situations then those people should give the Department something concrete so that the Department could see how it would apply its mind to it. The challenge was for the Department to avoid queue jumping. Everyone wanted to make sure that everyone was given a fair opportunity to get the vaccine at the right time. The Department was getting different letters asking it to consider different groups. The Department said it would be dealing with people who were frontline workers. Then there was that group who had comorbidities and a certain age. That was what the next six months was all about. If there were concrete issues, then maybe the Department needed to get a formal request so that the Department could see if it could assist or not. At this point the Department wanted to explain how it was approaching the vaccine rollout. The exceptions that were now coming in were things the Department had not had any direct requests about. If there was something concrete, then the Department would deal with it. It would be difficult to deal with it in generalities. The Department did not know what work a specific individual would be facing. It might be something that the Department could do something about. That was how he would deal with the matter. He said that he would make sure that everyone gave the Department enough information. This was in response to the query about the data being missing. He said that no one should be frustrated about the issue of Sputnik and Sinovac not being finalised. The Department already had vaccines that were in place. The Department was procuring more vaccines as soon as the processing was in place. Why should it be more frustrating when the country already had over 60 million doses confirmed? The members were concerned about the 10 million that were not already confirmed. The Department was working together with the manufacturers and with the embassies of those particular countries to fast track the process. The Minister had correspondence because he was checking everyday to see where the situation was. If the regulator needed certain information, the Department could not intervene politically to tell them to ignore that information. The Department had to tell them to speed up the process. The best it could do was to liaise with those countries to ask them to help the team and provide the information. Some of the information that was asked of Sinovac was information that the local agent did not have. They had to keep asking to get a hold of that information. That was the kind of delay that the Department was facing. The Department already had over 60 million doses that were in the pipeline and ready for use. This process the Department would work through. The team was working with the WHO as well so that if it did not have the information it could get it from the WHO just to speed up the process of those two vaccines. They were Government’s allies and Government needed to work with them. The Department was not just looking at vaccines but also future collaboration for creating more capability for South Africa to manufacture its own vaccine in collaboration with partners from BRICS. The Department was quite interested in working with them. Even if there were delays the Department would make sure that those delays were attended to and dealt with appropriately. The Department was also concerned about what was going on in India and would be monitoring that nothing overwhelmed the country coming from India. The medical schemes would pay for the cost of the vaccines and that figure would be calculated. The medical aid would pay for the vaccines. The Department would calculate the costs.
He then discussed the payment for pharmacies. The figure the Department was working on was probably around R60 per person. That would cover the staff that dealt with the dispensing of the vaccine, the needle, the syringe and the swab. That cost would be standardised. He wanted to make sure that the costs were standardised so that no one was asked to pay an additional amount on top of what medical aid would have paid. The Department wanted to avoid anyone being made to pay when in fact Government was already paying for it. The Department wanted to make sure it was standardised. The Department would make an announcement once that issue was closed. Some people wanted to push the price higher but Government was saying that it needed to be kept at that level. He then discussed the issue of preference for the Sputnik vaccine. The Department was working hard to make sure that it was able to get these vaccines. When those vaccines would come the Department needed to make sure that the necessary registrations had been dealt with. The Minister was receiving updates on this matter two or three times a week because he wanted to know when this aspect would be closed. He told the Director General to integrate the interest in purchasing so many vaccines from Sputnik and Sinovac so that while the Department went through the processing it went through the negotiations at the same time. He said he would not go into the issue of prices. The Department’s team must work on those issues because the prices were being negotiated downwards and he hoped to succeed on that. He responded to the question that was unrelated to covid about the interns. This matter was referred to the Gauteng MEC. He suggested that Dr Thembekwayo write a letter to the Department and provide the specifics. The Department would see if it could investigate from its side and it would send the matter to the province. If it was a general question, then the Department would send it as a general query to the province. The Department did not know if it had been resolved or not. He requested that Dr Thembekwayo write a letter directly to the Minister and provide a list of names of the people involved and the hospitals. The Department would deal with it and it would not have to be dealt with ‘by the way’. He saw that Dr Thembekwayo was not getting the responses she wanted. She should write a letter directly to him and he would deal with it. In the past when there were queries it was referred to the provinces and the provinces were asked to look at it. The Department would be dealing with it directly to that it could follow the area of Dr Thembekwayo’s concern. Members knew that they were welcome to write questions to the Minister. The Ministry would follow up on the questions the members asked.
The issue of the third wave was raised by Dr Thembekwayo and Dr Jacobs. He discussed the modelling as to when the third wave was expected. The third wave was unpredictable and uncertain. The Department hoped people would pay strict adherence to masks, sanitizers and distancing so that it did not come so fast and so strong. Clearly from the models the determinant for when and how heavy depended on behavioural change. If people were able to keep on with the non-pharmaceutical interventions, then the third wave would be able to be kept away. The Department was monitoring hospitalisations as shown in the presentation. The Department would be increasing the numbers ahead of each of those hospitals so that it was able to activate some of those temporary structures if need be. Right now the Department was monitoring and there was no need to increase the number of beds but beds would be available in the event that they were needed. The one lesson seen in the last wave was that the confidence amongst the staff was such that even with a heavy bout that it went through there was no panic. People knew what to do because they were very experienced now in dealing with covid. The Department would be monitoring all of this. The Department was monitoring the number of people who were positive, the number of tests that had been done, the number of people who were presenting and the number of deaths, both direct and expected deaths. The Department was monitoring everything so the hospitals would be focusing on that as well. The Department would also have to deal with the issue of staffing and where there was need the Department would make contingency measures to increase the staff to match the need that arose. The same applied to oxygen. The Department got oxygen to be set up in a number of hospitals which did not have oxygen tanks before. The Department would be predicting where the needs would be arising so that oxygen would be made available as well as emergency medical services. They would be put on alert. The Department prioritised when it came to the covid situation. If need be the Department would have to limit the amount of elective surgery, elective operations and admissions that could be treated at home. The Department did a lot of things to try and make sure that the situation the Department was in did respond. The Department was working from a base of a very compromised health services because there was a huge need for infrastructure, for human resources, for increased budget and for a lot of other issues that needed to be corrected. It did not mean in the absence of that the Department was not able to respond. The Department would respond as it did in the first wave and the second wave. The Department would continue to respond as such.
The Department assured the members that the concerns they had were being looked at. He reaffirmed that there was no need for the provinces to buy their own vaccines and made specific mention of the Western Cape. He said that they should be spending all of their resources and logistics in ensuring that there was adequate training and provision of staff so that people were vaccinated as soon as the vaccines arrived. The last thing he wanted to see was vaccines sitting in the fridge because the system was too slow. His point to the rest of the provinces was that when the vaccines arrived they needed to go into someone’s flesh immediately. He did not want there to be a delay. Pfizer has indicated that they would give the country 300 000. 300 000 doses could be disposed of in a very short space of time. The provision of these vaccines needed to be made available. He discussed the comments made by the Chairperson. The Department did address them in terms of some of the unreasonable demands. The matter took quite a lot of public interest. When the Department discussed with Johnson and Johnson it was quite clear that there was an understanding that there were no new preconditions and so the contract was signed. They indicated a lot of interest in further investments in South Africa to expand South Africa’s capacity for vaccine manufacturing. The Department welcomed that and believed that it demonstrated adequate support for any inbound investment in improving the capacity to manufacture vaccines. This was not only for Aspen but for Biovac and others. This was in line with the Heads of States in the African Union. It was said that the continent of Africa must not be left behind to deal with future emergencies without capabilities that were part of the continent. He raised the matter of ‘vaccine nationalism’. The US said it would only vaccinate in the US before it was distributed to other countries. Countries like Germany have made statements to that effect. There have been huge challenges in India. The African continent must, on its own, have its own capabilities so that it did not have to rely on what other continents might be looking at when they felt under pressure. They would obviously prioritise their own citizens. This was the basis on which the Department had to encourage more of the current manufacturers to be party to the partnership that was taking place in South Africa. He reaffirmed that community healthcare workers would assist the elderly where possible. If not, the Department would get the elderly to the vaccination site and they would be registered on site. There should not be a problem there. The risk of thrombosis was much lower as was indicated. This phenomenon has happened one in a million which was considered to be very low risk which meant that people should not be discouraged because this has happened. The other factors that were associated with this needed to be analysed. It has been known that eight women aged between 18 and 48 were affected. As to what else was underlying in this the Department did not know. Therefore, the Department needed to make sure that further elucidation came from scientific research. At this point it must be said that that risk remained very low and that people must continue to take the vaccines. The Department would be encouraging leaders from various sectors to come forth when the Department started the second phase. For example, religious leaders and church leaders need to come forward and be seen to be vaccinated to allay the fears among the congregants to show that this was a safe exercise. Political leaders, party leaders, MPs and Councillors must be seen taking the vaccine so that they could assure the public that there was no need to fear the vaccines. Business leaders, leaders in civil society, traditional leaders and all different levels of leadership needed to be in the forefront when the Department called for the next phase. People needed to understand that even their leaders had subjected themselves to be vaccinated. President Ramaphosa was among the first few to take the vaccine. It was important to send a strong message to say that people needed to be protected through the vaccines.
The Chairperson thanked the Minister for his elaborate response. The Chairperson allowed members to ask follow-up questions to the Minister.
Ms Wilson thanked the DG and Minister for their responses. The responses were appreciated. The queries will be directed directly to the Minister and the DG with regards to people who have work to return to or contracts or studies. She did not want anyone jumping the queue either. There were genuine concerns and those would be directed to the Minister. There would be no queue jumping but if somebody had a contract and visas had been applied for then these were situations that must considered. She appreciated the fact that the Minister had given the go-ahead for her to submit to the Department and get consideration made. She only had one concern. It remained a big concern because she knew of large multi-national companies who were based in South Africa who had requested information on how they could buy vaccines directly to vaccinate all of their staff. She understood that not all of their staff were over 60 and not all of them have comorbidities and were not all health workers. South Africa’s vaccine rollout was exceptionally slow and exceptionally behind. It was all well to talk about the purchase of 60 or 70 million doses but people wanted to be vaccinated now and if a company of that magnitude was in a position to buy a vaccine then that was obviously accredited by SAHPRA. She did not understand why it was that they were not allowed to purchase directly? The point of vaccination was to protect the people of South Africa and to create an immunity. If somebody was able to do that without having to wait six or eight months, and leave their staff at risk, and protect those people now then she still did not understand why this was not acceptable? She heard what the Minister said that the private sector must apply to Government. She said medical aids needed to be put aside. She was talking about the private sector. She was talking about multi-national, large, companies who were in a position and were willing to buy vaccines directly in order to ensure that their staff were protected. She really had a serious problem with this.
Mr Van Staden thanked the Minister for his responses. He appreciated it. He had a follow up on the compensation fund. He heard what the Minister said about not being ready to publish the regulations earlier this year than predicted. His view was that because of that the democratic process of public input was undermined. Was this the way to handle business in such a very serious time in South Africa during the pandemic? He heard what the Minister said about the 13 000 responses that the Department received. It seemed like these regulations were being snuck in through the back door. Therefore, he wanted to see that this Committee be given feedback every month about the compensation fund. The Minister must come and report every month about the administration of this fund so that the members could fulfil their oversight role. The members must be kept up to date with what was going on in the administration of the fund and how the money would be spent through this fund.
Dr Thembekwayo said that she had forwarded all the relevant information in connection with the internships a long time ago to the DG, to the Deputy Minister and the relevant officials. She would not re-write and re-send the information. The Department should be able to inform the Minister and do as they were requested. The Department should make some follow ups and then get back into contact with her.
The Chairperson said he thought the Minister meant when the members made requests or questions on issues related to a specific province then the Minister would write to that province and tell that province to provide him with the following information. That was how the Chairperson understood the Minister’s response. The Minister would answer to those comments.
Minister Mkhize said he would follow up internally on the issues that Dr Thembekwayo raised. He was not aware of the specifics other than the general question that she had asked. He would follow it up to see where the matter would have gotten stuck. If Dr Thembekwayo had submitted letters, then there was no need for her to do it again. He said he was trying to answer the question but that he had not received any feedback. He would check with the rest of the team and would report back to her on that matter. If there were specifics, then it would be easy to deal with. If it was general, then the Department needed to move beyond that point. If she had submitted documentation, then that was fine.
The Minister disagreed with Mr Van Staden. The Department had not undermined the democratic process. The fact that it did go out for public comment was important for Government. If it was requested that there be more days and Government could not afford them that did not mean the democratic process had been undermined. If Mr Van Staden was worried about what happens in the future the Minister indicated that there would be directives that the Department would issue. There would be reports that would be brought to the Committee. The Department would account for the regulations. There was no problem on that point. He did not think that a statement made that there was an undermining of a democratic process. If someone woke up and found that there were regulations and not any public announcement them those comments would be justifiable. At this stage the Minister thought Mr Van Staden’s statement was unjustifiable. He responded to the question of having to report back to the Portfolio Committee. It was correct. The Department needed to do that. The Committee could indicate ahead of time the areas that it wanted the Department to respond to. The Department would cover those areas. The no-fault compensation fund was the Department’s institution so the Department would be deal with it. It was an issue that needed to be refined for the purposes of protecting the people of South Africa. The comments of the members on an ongoing basis would still be welcomed because Government was doing something to protect its people. He did not agree with Mr Van Staden that democracy had been undermined. Government had fought for too much to be seen to undermine democracy. Mr Van Staden had the right to his views and the Minister had the right to his views. He did not agree with Mr Van Staden but said there was a need to ensure that Mr Van Staden continued to make inputs into this situation. There were people who had huge disagreements about why Government went ahead with this issue not because they thought it was wrong but they asked why Government let the manufacturers get away without putting any money into this. At this point protecting the people of South Africa was a lot more important and that was the point that he thought needed to be focused on. The comments made about the administration of the fund will be part of the discussion.
He responded to Ms Wilson’s comments. It was difficult for the Department because they got accused for whatever they did. The Department was criticised for whatever it did. In this case, the Department was trying to make sure that South Africans were approached on an equitable basis so that no special considerations unless there was a justifiable for it. If Ms Wilson was able to share information with the Department, it would see if it could assist in this situation or not. The Department’s biggest concern was that it could not change things for people who might not necessarily be deserving. The Department would have to look at the matter the specific individuals were raising and try and attend to that. Those instances will arise where there would be specific consideration but that depended on case by case. The Department could not answer it as a general issue. The Department was happy to receive the questions from Ms Wilson on those specific individuals so that it knew how to assist if it could do so. He responded to the question about the multi-national companies. When Government approached the issue of vaccines it embarked on it on a national programme which was for all South Africans. It would not be fair to allow those who had money to go and buy the vaccines. That was the approach that Government had taken. It was an equitable approach that said ‘let’s get South Africans to support each other’ to make sure that they received a vaccination. There was no problem, in his view, if a company decided to buy a vaccine somewhere else and on their own. If the company wanted to work with Government, then Government would sell them the vaccines. Government would get the vaccines available to them. Vaccines would be available in the context that he had indicated. Medical schemes, insured workers and then any multi-national company could actually come in at that level. Business for South Africa was helping Government on that side. Ms Wilson was raising a slightly different issue that he wanted to clarify now. Government would not stop a multi-national or any company from going out to buy their own vaccines. Government would not stop them. When Government said that this was a national programme it was saying that it wanted to work with everybody so that it could vaccinate as many South Africans as possible. Any company that wanted to go and buy vaccines would not be stopped by Government. The Minister raised a few issues. There could not be a cross protection on the demands of the manufacturer extended to someone who goes to buy their own vaccines. The issue is that Government would not be party to that transaction. Right now these vaccines were going through rigorous evaluations over quality so that Government knew that there were no fake vaccines that were introduced into the country and there was no risk to the people of South Africa. Government could not vouch that anyone else would have done so. That would be the company’s own responsibility. Secondly, when Government said that there was no-fault compensation fund it could not cover anyone who had been vaccinated with vaccines that were not part of the scheme that Government had spoken about. Government could not vouch for the safety, the quality and the authenticity that had to do with anyone who received the vaccine. That company would have to deal with that on their own. The Minister had checked this across different countries and institutions.
He discussed Covax. When vaccines were made available in the country would the Government cross cover anyone else who was in that country and was vaccinated outside of the Covax supply? The other countries said no. There was a specific issue here about who the no-fault compensation fund was going to cover. Government could not be sure about what the company actually got. Government was not able to do so. Those were some of the issues. Government was aware that most of the major companies were actually trying to sell to governments because of the volumes and the guarantees that they required. It was not possible to get a government guarantee based on a certain number of people who were recorded and registered as having been vaccinated. Then suddenly Government would get a claim from someone who had nothing to do with that system. That was the risk Government was worried about when Government said ‘let’s try and work together’. No one could stop companies from buying their own vaccines. Government did not need to get involved. If anyone wanted to buy from outside there was no problem with that. Government could not be pulled into that system. Government would procure and the private sector would work with Government and that was because of the national collaboration that was established. It was not to say that companies could not buy their own stuff. There was no problem with that. but the question of being covered through the no-fault compensation fund became an issue. It would be based on who was on Government’s EVDS. Government would not be able to register someone that it did not know. Government had already seen fake vaccines coming in. Government should manage the whole thing so that it could avoid the development of a black market in this situation. Government must manage the costing so that nobody had to pay extra. Government did not want a new parallel market to be created for vaccines. It wanted to avoid corruption and also wanted to protect the people of South Africa. Anybody could do whatever they would like to do. This system was defined as Government indicated here. His advice to the private sector was that it should work together with Government. Government had secured enough vaccines to cover a lot of people in South Africa. Not all the people might be covered on the same day. He said that ‘all of us would like to get vaccines on day one’. That would not be possible. It was necessary to work together to try and schedule how quickly Government could make sure that all those who needed vaccines could receive them. It would take Government close to a year to deal with this. It was the availability of vaccines globally that was causing the challenge. It did not stop anyone from buying their own vaccines. If they did they had to adhere to the regulatory framework that was guiding the whole process. He wanted to make that clear. He did not see how any of the major private sector companies could not receive vaccines if they worked together with Government. Government would have to meet with them about how to get the vaccines through. The vaccines that Government had were already inclusive of all South Africans in the various industries. That was going to be important. The vaccines were available but not exactly at the same time. The Department had given the Committee the numbers at this point. The dates that Government knew it was receiving the vaccines it made public so it was not like there was private information that Government had. When Government received information it shared it. What Government did not share was information that it did not have. There would be times that the manufacturer would not be able to give Government concrete information. If they did not give Government information, then Government would not make announcements. When manufacturers gave them information it would be made public. It was the public’s information. It was necessary for everyone to cooperate with the process. If particular companies would like to meet with Government, then it would be happy to discuss these issues. Companies needed to be aware as to how Government was approaching it. Companies should not feel as if they were being stopped. Government would not stop them. When Government said it was a national programme it was just explaining how it was going to run. It did not mean that no one else would be allowed. There were complications if companies went out on their own. That needed to be understood. Government had a number of forums that it could bring companies to so that they understood how Government was working with the private sector that was already part of the programme. He pleaded that everyone needed to cooperate on this because there were enough vaccines ordered for everyone to be able to access as part of South Africa.
The Chairperson thanked the Minister and his team for the responses. The Chairperson said that part of the information received today was that there were more than 60 million doses confirmed. That meant that the vaccines would go right over the population heard immunity that was scientifically projected. It was also confirmed that the Department was restarting the vaccines today. There had also been a process to focus on the elderly and that no one would be turned away from the site of vaccination even if they had not registered. The Department was also taking away the anxiety of South Africans about the availability of vaccines. What remained an issue was the pace. The Committee requested that South Africans to follow the arrangements that had been outlined because the risk was much greater on his grandmother and grandfather than it was to his teenage daughter. The Committee noted the compensation fund update which the Minister should continue to update the Committee on. The Chairperson thanked the Minister and his delegation. He hoped that the Committee Secretariat continued to find a meeting time again so that the Committee could receive updates. He asked the Minister to make any closing remarks.
Minister Mkhize asked that if there were any issues outstanding for the members to work and assist the Department so that it could deal with the issues even before the next meeting so that the members could have their answers.
The Chairperson asked the Committee to deal with the minutes of the previous meetings. He informed the Committee that he had received a letter of complaint from SAHPRA about two members. He would forward the letter to the members indicated in the letter. He had requested a process of how to handle that matter. He had spoken to the House Chairperson about how to handle that complaint from SAHPRA. The Chairperson would report to the Committee if there was a need. For now, he would forward the letter to the two members that were mentioned in the letter then a process would be started of relooking into that matter according to the advice received from the House Chairperson. The Chairperson asked the Committee Secretariat to display the minutes. He apologised for last week. He had not realised that the Committee had two sets of minutes and he ended the meeting while one was outstanding.
Consideration of the minutes dated 30 March 2021
The Chairperson asked for members to comment on or call for the adoption of the minutes.
Ms Gela moved for the adoption of the minutes. She also wanted to check which two members were mentioned in the letter by SAHPRA?
The Chairperson said that he would answer the question in the Committee chatgroup.
Mr M Sokatsha (ANC) seconded the adoption of the minutes.
Consideration of the minutes dated 14 April 2021
Ms Gela moved for the adoption of the minutes.
Dr Jacobs seconded the adoption of the minutes.
The Chairperson said that for now he did not want to divulge the name of the two members who were complained about by SAHPRA. He would liaise with those members directly. He would work on the process that had been suggested by the House Chairperson. A resolution should be found. The point was that in this platform, because the Committee was made up of honourable members and an extension of Parliament, when allegations were made against someone there were certain rules. The Committee would be able to work on it and adjust it accordingly. The Committee needed to go through that matter together with the members and SAHPRA to find an amicable solution to the matter. The Chairperson said there was a marathon of meetings starting on 4 May. There would be meeting on 4, 5, 6 and 7 May.
The Committee Secretariat confirmed that next week the Committee was meeting from Tuesday up until Friday.
The Chairperson said that the members needed to be prepared for four full days of meetings. That would also be in preparation for the budget vote. He requested that members be available for the entire week. All of those meetings would be virtual.
Mr Van Staden asked if the meetings on the 4,5, 6 and 7 May would also start at 9am?
The Committee Secretariat said that all the meetings would start at 9am except for meeting that would be on Thursday. That meeting would start at 8am.
The Chairperson said that all meetings next week would start at 9am except for the meeting on Thursday because there was a caucus for parties. The meeting on Thursday, 6 May would start at 8am. There would be a break in the meeting for the members to attend party caucus meetings.
Mr Shaik Emam said he missed the part where the Chairperson alluded to the issue of the letter from SAHPRA. He raised his concern that correspondence had been sent through to SAHPRA and deliberately SAHPRA chose to respond to certain things and not to others. He had written to them to provide any information of whether they were aware of any serious side effects or deaths that had occurred which had been reported to them. To date they had not responded. He had also asked them questions in a Committee meeting.
The Chairperson said that the Committee was not aware of SAHPRA’s responses to him. If the responses were not satisfactory then the Committee would have to make a follow up. The Chairperson was not raising a discussion point. The Chairperson would not know what SAHPRA had responded to Mr Shaik Emam and what it would have left out. If Mr Shaik Emam felt that SAHPRA had left out responses, then he knew how to handle that. If Mr Shaik Emam needed the assistance of the Chairperson, then he would be available to help out but it was not an item for discussion. He was just pointing out that there were two members he would forward the complaint to. He had already asked the House Chairperson for assistance on how to process that when it had been raised in that fashion.
Dr Thembekwayo asked how far the Chairperson was in inviting Mr Frolick to the Committee. As things were going and questions were asked she felt that the Committee would never be able to hold an entity appearing before the Committee accountable. The Committee would never be able to do that. She supported that the request must be done. There were certain occasions where it was said that the Committee was doing good on matters that it was not doing well in at all. She pleaded with the Chairperson to continue asking for intervention.
The Chairperson said he was not able to respond to Mr Frolick when he asked questions. The Chairperson wrote to him and then it was decided they would have a meeting. Mr Frolick wanted the members to inform him what they wanted him to talk about. He wanted to know what should be addressed in the meeting. What were the specific areas Mr Frolick should come in and speak to? For him to come to the meeting he needed to be well-prepared. He wanted to know prior information so that he could address certain issues. He foresaw a situation where he would have to come to the Committee twice. The first time would be to come and listen. The second time would be to come and respond.
The Chairperson requested that the members indicate what were the issues that Mr Frolick should address. What were the things should he prepare to answer? It might not be exhaustive but the Chairperson had no clue exactly, in terms of details, and the members needed to indicate that part.
Dr Thembekwayo said that the first time Mr Frolick came to the meeting the Committee did not have to know. She provided the example that if an entity was coming to the Committee to present. The Committee did not need to know that Mr Frolick has joined the meeting so that he could observe the members’ responses and what it was the members did. When the Committee engaged him he would have a clear picture of what was happening in the Committee. The Chairperson was able to ask questions that were to the point but the same could not be said for the other Committee members under the Chairperson. It was better if Mr Frolick came to the Committee unannounced.
The Chairperson noted Dr Thembekwayo’s suggestion and would ensure that Mr Frolick made his time available to be a part of the Committee’s meeting. He thanked the members in the meeting and told them to be prepared for the schedule of meetings the following week.
The meeting was adjourned.
Dhlomo, Dr SM
Gela, Ms A
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
Thembekwayo, Dr S
Van Staden, Mr PA
Wilson, Ms ER
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