The South African Medical Research Council (SAMRC) presented its recent findings on the Covid-19 pandemic in a virtual meeting with the Select Committee on Health and Social Services, and described the impact of waste water surveillance on its research. As a research institute affiliated with the Department of Health, it plays a crucial role in the administration of COVID-19 vaccines in the country.
The Committee's questions were focused mainly on the waste water surveillance findings, as well as the partnerships and funding that the SAMRC had received. The Council pointed out that waste water surveillance was very critical in the research work that they did, not only for the Corona virus, but for monitoring other diseases such as polio, measles and other infectious diseases, as it helped to identify trends in communities that would lead to future outbreaks.
There had been collaboration with countries such as China, the United Kingdom and Nigeria. With China, they had partnered in research relating to COVID-19 vaccines for children, and for personal protective equipment. They had also tracked international trends to determine what trends, challenges and outcomes they could expect in South Africa. The SAMRC had partnered with South African universities to expand their research, and intended to further this partnership for future research, aside from COVID.
To meet their funding requirements, National Treasury had recently increased their budget. They had also received funding from the Bill Gates Foundation and other international organisations.
The on-going Sisonke programme had been targeted at providing the first doses of the vaccine in the country to healthcare workers, and the SAMRC had been in charge of monitoring the outcomes of those vaccinated, recording the side effects, the death rate post vaccination and hospitalisation. The Sisonke programme had served as a basis to see what challenges might arise once the vaccine started to be rolled out across the entire country, and how they could deal with them. The Sisonke programme would now be re-administering booster vaccines to those healthcare workers who had initially received the J&J vaccine.
The SAMRC also had on-going research involving children who had contracted the virus and those who had taken the vaccine since it had started being administered to them.
Recent findings on COVID-19 related research
Prof Glenda Gray, President: South African Medical Research Council (SAMRC), and her team gave a summary of the progress and outcome of research they had conducted on the Coronavirus in South Africa, COVID-19 funding, research and innovation; the waste water surveillance and research programme, and the Sisonke implementation study.
The SAMRC is a research institute affiliated to the Department of Health (DoH), whose main areas of research include the top ten causes of death and disability. They had also partnered with various other institutions to ensure the accuracy and success of this research.
(Please see attached document for details of the research findings).
Ms D Christians (DA, Northern Cape) had several questions related to the findings on waste water. She said research had found that the Corona virus was found, or could be found, in waste water. This was a problem, particularly in areas such as the Northern Cape, because there were areas where sewage pumps had broken, and sewage flowed in the streets. In addition, there was a huge dam on the R31 where the sewage had formed a lake, and she had noticed that there were children who played in it and obviously were not aware that the water was contaminated. She asked what danger this virus posed where sewage was found in every street. For example, there had been a huge outbreak in cholera because of the sewerage systems that were not properly maintained. Did COVID-19 pose the same risk in areas where sewage was a serious issue?
The current statistics indicate the infection rate is very low, compared to the active cases which are very high. How was the SAMRC keeping track of the active cases, and how accurate were those statistics? How would they ensure that the numbers would not increase for next year?
There was a new anti-viral medication in the form of a tablet. According to Pfizer, the tablet was 89% effective. What was the stance of South Africa with regard to the anti-viral medication? Was there any research being conducted here in South Africa? Would this tablet replace the vaccine? It had already been approved in the UK.
Lastly, considering the trends in other countries such as Australia, where there had been an increase in numbers over the past few months, when could South Africans expect the next wave, if any? How would it be mitigated?
Ms N Ndongeni (ANC, Eastern Cape) asked whether the funding from the Africa Rapid Grant Fund was enough for the SAMRC to carry out its mandate for COVID-19 research and innovation. How much funding did the Council need to fully conduct its future research initiatives?
Secondly, had the SAMRC conducted multi-lateral collaborations with international partners, and what had been the learning outcomes of those strategic partnerships?
Ms Christians also asked what the feedback had been on children who had been vaccinated, and whether there have been any negative effects. Furthermore, what had been the response from parents with regard to giving permission for their children to get vaccinated? Were they continuing with the roll out, or had it been put on hold because of the small response?
Mr M Bara (DA, Gauteng) commented that the number of children vaccinated was low, and also that the number of adults who had been vaccinated had not even reached the halfway mark of the country's population. What was the strategy to reach out to those who were not eager to vaccinate?
With regard to the Sisonke Implementation Study, what did the study show in terms of the efficacy of the vaccination on severe hospitalisation and deaths among healthcare workers compared to non-vaccinated healthcare workers and essential workers in South Africa?
How did the SAMRC Wasteful and Surveillance Research Programme differ from the Water Research Commission, especially in respect of the programme on the surveillance of COVID-19 in waste water, which was launched on 20 May 2020?
The Chairperson asked about the research findings on infection in children from five years old and above. What were those statistics? What did the Solidarity and Crown Coronation trials entail? Had the waste water research programme been effective? Were there prospects of collaboration with the Water Research Commission in the future? What were the difficulties in conducting sewage research to prevent the virus from spreading? How could COVID-19 be transmitted through sewage pumps?
The waste water and sewage problem was not only in the Northern Cape but the entire country, especially in previously disadvantaged areas. It was the most vulnerable people who were facing the sewerage leakages every day. Were people safe? Remedial measures would also help to improve infrastructure in the country, and to ensure the safety of the community.
She asked how long the virus could survive in water, particularly in waste water. What had been the notable gains and skills transfer with universities and other stakeholders? How could the SAMRC expand its network in this regard?
What had been the key lessons in the Sisonke programme of rolling out vaccines to healthcare workers and essential services? She asked for an elaboration on the adverse effects of vaccination, taking into account the different vaccines that were on offer in South Africa.
How long did it take for the SAMRC to evaluate the impact of vaccine effectiveness, and what could have been done differently? What was its stance on the different effects of the vaccine on the different age categories? What were the best ways to ensure safety in the field?
The Chairperson commented that vaccination and immunisation were the most effective preventative measures against serious disease. The media had reported that people who had been fully vaccinated would need booster shots with a year to 18 months, but the research was on-going. However, it was important for the Committee to know what to expect. Could the SAMRC confirm these reports?
The Sisonke programme for booster shots would start the following day (10 November). What was the timeframe for the rest of the population?
Prof Gray said that with the wastewater research, they were working with a degraded virus, not an active one. This virus came from a person’s stools and was not viable, so it would not transmit COVID. It would assist in detecting any future outbreaks very early, so that was the importance of this research.
Sewerage in the country was in a bad state, and they came to the realisation of this only when they embarked on this research. From a municipal level, the sewerage systems need to be sorted out, as they can cause other ill health problems.
Currently, infections were low. The statistics were derived from the people who had voluntarily tested. Testing always under reports the true amount of COVID cases in the country, but they are reassured by using the Council's desk data, which they collate with hospital admissions. Access desk and hospital admissions were showing a decline in the number of infections in the country. Tests would always be a representation, because not everyone who was symptomatic or sick would take a COVID test. However, reports were also collected through hospitals and deaths, which confirm that the rates are low.
In order to keep those numbers low, there was a need to increase the number of people who have vaccinated, as without good vaccination coverage it would be hard to control future surges. Additionally, people needed to continue to wash hands, wear masks and ensure ventilation.
Referring to the new drug, Prof Gray said that during the next phase of managing the pandemic, medication that could help treat COVID would become available, but vaccines would help to prevent and downgrade COVID infections from severe to less severe. This anti-viral drug was a very good move forward. It did not replace vaccines, because they were preventative, but people could take the pill as part of their hospital treatment. They would have to rely on the manufacturing company and perhaps lobby it to work with the South African Health Products Regulatory Authority (SAHPRA) to have the anti-viral pill registered in the country. This would just be an extra tool for them to have in their kit to control and manage COVID for people who were in hospital and who were very sick.
It was important to monitor trends abroad, as borders were opening and people were travelling. In the northern hemisphere during winter, COVID outbreaks were increasing and they were already happening in Europe. There was a need to monitor the variants that were in those countries and how they would impact South Africa.
The Council was currently monitoring waste water at airports, and particularly the international section, to see which travellers had evidence of COVID in their stools and whether there were any new variants present in the stool. In late November last year there had been a surge that had been propagated by the movement of young people had been restrained during the year. Some students in matric had brought COVID into their households. The Delta variant had created a surge in infections, but the arrival of vaccines had reduced the severity and duration of the next wave.
The Council had needed more money for the research, and had cobbled a budget together. They had been fortunate to be given more money by Treasury and from the Department of Science and Innovation, and they had worked with the Technology Innovation Agency (TIA). If they wanted to be involved in vaccination development, they would have to fund a lot of innovation into local drug and diagnostic development.
The SAMRC was able to leverage their money, which had helped them to work with other collaborators such as the National Institute of Health (NIH) and CIPLA, which had helped to conduct the vaccine trials and establish whether the J&J vaccine worked. They had also worked with the Gates Foundation, together with the ELMA and DELL Foundations, which had funded the Sisonke programme. They had also worked very closely with BRICS (Brazil-Russia-India-China-SA), as well as the South African Development Community (SADC) and the African Union (AU), on the diagnostics, and had supported the latter with surveillance.
They were indebted to China for their support in the diagnostic development and support of access to personal protective equipment (PPE), and were conducting an on-going study in South Africa that was looking into the Corona vaccine for children. It was a two- dose vaccine which had already been given to 30 million children worldwide, and they were evaluating it among children from as young as six months to 12 years. 2 000 children have been enrolled in the research programme in South Africa.
Parents who brought their children for vaccination research were parents who had already enrolled for vaccination research, and saw the importance for COVID vaccination research. The single dose Pfizer had been given to children over 12, and it had been going well. The reason to vaccinate children was to keep the academic school year open, as 40% of school days had been lost. Vaccinating children would prevent severe COVID, keep the schools open and protect other learners and teachers and households.
Children over 12 could consent to interventions, but there had to be a lot of collaboration between parents and children. In order to control COVID transmission in the country, there had to be an increase in coverage, and they needed to ensure that all the age groups eligible for vaccination were vaccinated.
A lot of people were undecided, but were not anti-vaxxers, so more time had to be spent in rural areas and among and other age groups to understand why there was the fear of vaccinating. Once people had knowledge on the vaccine, the more eager they were to take it. In the beginning of the roll-out, there were supply issues so they had to be cautious how they created the demand. Now that supply had been secured, a lot more innovation needed to be done, such as working in the South African Social Security Association (SASSA) grant queues, where the Vooma scheme offers one R100 if one gets vaccinated.
The Sisonke implementation study did establish the effectiveness of the J&J COVID-19 vaccine in healthcare workers against death and hospitalisation. In both the BETA and the DELTA wave, the vaccine has shown protection. Healthcare workers who received vaccination in the early stages would be receiving boosters, because data had shown that a booster for the J&J vaccine increased its effectiveness. It was safe, and increased the vaccine's efficacy. This would also protect the healthcare workers against a possible wave in December.
Children were being evaluated against the vaccine so that those with TB, HIV or adverse illness who contract COVID avoid getting a post-inflammatory syndrome, which was why it was important to prevent any severe outcomes for children who contract the virus.
The lesson learnt in the Sisonke trial was how the electronic system worked, by testing the electronic data system and developing an electronic record which would give them access to a vaccine certificate they could use around the country. They were able to track the healthcare workers and could track immobility, hospitalisation, and the impact of age and HIV on vaccine effectiveness. This would help to enhance the durability of vaccines. It also helped with assessing waning efficacy and to time when the boost was needed for people who had received the J&J vaccine, and what was the best time to receive the boost.
The vaccine side effects were not different from what was being reported worldwide. The vascular and immune disorders were not different from a global level. There had been rare side effects that had been recorded, such as Guillain-Barre syndrome -- one in a million for men, and two to four in a million for women. If recognised, it was easy to treat. They had been able to develop the capacity to treat side effects to ensure that the number of side effects in South Africa were not more than what had been reported elsewhere in the world.
Most of the infections had been mild, and there had been a reduction in hospitalisation and deaths post vaccination. The value of Sisonke was that they could track the healthcare workers over time. If healthcare workers decide not to get boosted, they would make a comparison with those who did get a boost, and with any other vaccine that is available to the healthcare workers.
Ms Angela Mathee, Director: Environment and Health Research, SAMRC, concurred with Prof Gray on the points she made regarding waste water surveillance. On broader health concerns, it had been shocking to see the dysfunction and lack of security at the plants, and in some instances they had declined to include certain waste water plants in their programme because they were dysfunctional and could not be useful to their programme and their concerns for public health
They had received funding from the United Kingdom (UK) and Nigeria, and hoped to intensify their research into communities without sewerage.
The Water Research Commission funds the National Institute for Communicable Diseases (NICD) to do the waste water surveillance for them, and the SAMRC did have a partnership with the Institute. They had meetings, with links between their two dashboards and discussions on joint projects, so they can compare methods. They belong to the same waste water surveillance networks in the country.
Regarding capacity development, some of their partners were the Universities of Fort Hare and Venda, and the Sefako Makgatho University, and they had been able to provide equipment suitable for laboratory and field training. In December they were hoping to a data analysis programme support and writing training. Where there had been no capacity before, the MRC had been able to fund those poorly resourced institutions, and there would be collaboration in future for non-COVID related research.
Ms Michelle Mulder, Executive Director: Grants Innovation and Product Development, SAMRC, said they have been co-supporting the Solidarity and Crown Coronation trials. The Solidarity trial was undertaken by the Wits Reproductive Health Institute, and they were significant participants in the global trial. Unfortunately, the results indicated that the four drugs that were used had no direct effect on hospitalisation and/or initiation of ventilation or preventing deaths. There was a plan for the same sites to be involved in the Solidarity-plus trial, but the different drugs that were going to be used were not feasible for use in South Africa due to contra-indications with existing standards of care and various other reasons.
The Crown Coronation study had started as a study looking into hydroxycholoroquine, but they realised early on that it would not have an effect for prevention on healthcare workers, so they had amended the protocol and were looking at the MRM vaccines as a potential preventative. This was being done in the context of new vaccines for COVID coming on board and ensuring efficacy, and they had had to adapt to expand it to beyond healthcare workers. As of March 2021, there were 11 sites recruiting, with around 1 200 participants in South Africa.
At this point Ms Ndongeni took over as Chairperson, because Ms Gillion had issues with the network.
Ms Marcelle Williams, Select Committee Secretary, asked two questions on behalf of Ms S Lehihi (EFF, North West). What had the key lessons been for the roll out for the healthcare workers and the nation. Secondly, what were the difficulties in conducting sewage water research for virus spread monitoring?
Prof Gray said they had learnt how to scale up the importance of electronic records, which was critical for national health insurance (NHI) and the country's future health system. They had never done an adult vaccination programme, and the Sisonke period had taught them how to go to scale, how to manage the whole vaccination process, and how to move people through the various stages for a site to be able to do 100 vaccines in an hour. The preliminary stage had taught them how to take the vaccine to scale, and the country now had the capacity to do between 250 000 and 300 000 vaccines a day. Initially they could do only 20 000 vaccines a day due to the lack of supply. They had also learnt how to manage safety. They had established a safety desk and supported the National Department of Health in how to manage the safety events in their study.
They had also been able to train vaccinators on how to administer the vaccination and establish the cold chain storage. They had needed a system to move the vaccine through the supply chain management (SCM) process. It had taught them how to manage vaccine deployment and how to manage the cold chain. The movement of the vaccine was now well orchestrated. The Electronic Vaccine Data System (EVDS) was critical for stock management, numbers and side effects and to evaluate from a population level how the vaccines were doing.
Waste water surveillance was important for polio, measles and other infectious diseases, and would alert them to a lack of vaccination. Last year, a lot of children did not get immunisation because parents were scared. By doing waste water surveillance, they could alert authorities that there was a break in vaccination coverage in certain areas. It also helped with information on people who take medication for hypertension or antiretroviral drugs (ARVs) to help understand how people were managing chronic diseases. Waste water was also important for drugs in terms of illicit drug use. By looking at waste water they could look at communities where there was illicit drug use, so it helped to manage drug use in the country.
Ms Mathee said that the difficulties were the regular challenges. They had a passionate team that was determined to make a difference to help prevent diseases and save lives. Funding and resources were always a challenge. They had ideas about extending the platforms the MRC had created, and additional funding would be well received.
The Members adopted the Committee's fourth term programme.
The meeting was adjourned.
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