The Committee met with the Western Cape Provincial Department of Health for its last briefing for the year 2021. Members received an update on the progression of the COVID-19 pandemic and the vaccine rollout. Debate focused on vaccinations for those aged 12 to 17; booster vaccinations for healthcare workers, teachers and people over the age of 60; as well as discussions on the new variant.
In her opening remarks, the Western Cape Provincial Minister of Health acknowledged World AIDS day and the 16 Days of Activism Against Gender Based Violence, and explained the link between these two important days and the impact of COVID on women and the economy at large.
The Head of the Department of Health presented a comprehensive report on the above mentioned issues. Details were given on what the Department knew about the new Omicron variant; the plans set in motion in preparation for a fourth wave of the pandemic; statistics on vaccination rates in the province; and plans for the administration of booster doses.
Discussions on the presentation raised issues of concern and debate around vaccine mandates and the legality of denying people their freedom of choice; the cost of vaccine development in comparison to the neglect of a humanitarian crisis of hunger and starvation; strategies to address the slow uptake of vaccines and vaccine hesitancy; actualization of vaccination targets; as well as exploration of other preventive measures against the virus besides mask wearing, vaccinations and ventilation.
Members also sought clarity on what to expect in the fourth wave; symptoms to look for in Omicron; and the implications of mandatory vaccinations for the populace.
The Chairperson welcomed all those present. She acknowledged an apology from Ms P Lekker (ANC) for being absent from the meeting, and a request by Mr G Bosman (DA) to leave the meeting early. She then outlined the rules of engagement for virtual meetings and noted that they emanated from directives for sittings of the House and meetings of Committees by electronic means, which appeared in the Announcements, Tablings and Committee Reports (ATCs) of 17 April 2020. The meeting would be the last briefing by the provincial Department of Health (DOH) to the Committee for the year 2021.
The Department would brief the Committee on the progression of the COVID-19 pandemic in the province with specific reference to the indicators and situational analysis, which would include identification of the new variant; prospects for the fourth wave; an update on the vaccine roll-out, including vaccines for the 12 to17 age cohort; and information on the boosters for healthcare workers and the elderly.
Opening Remarks by the Provincial Minister of Health
Dr Nomafrench Mbombo, Western Cape Provincial Minister of Health, who was in transit, said she appreciated the opportunity given to the Department to make their last briefing. She mentioned that 1 December was marked as World AIDS Day. It was important to acknowledge the day because it had an impact on COVID. It was also a day where additional doses of vaccine would be given to HIV positive people with a CD4 cell count of less than 200, as they were immunosuppressed people, just like cancer patients.
As for other people, Pfizer had applied to the South African Health Products Regulatory Authority (SAHPRA) to provide Covid vaccine booster shots. Currently, the only people on boosters were healthcare workers who were part of the Sisonke rollout that started in Late February. The Department had already vaccinated more than one-third of its staff using the Johnson and Johnson (J&J) vaccine. Based on advice from clinicians and scientists, the Department would be ready to vaccinate and provide boosters for others soon. An average of five to six months was specified for giving boosters to ordinary people. This meant that older persons might get access to the boosters around January, February or March 2022, since they kickstarted their Pfizer vaccination cycles around May 2021.
The Minister also acknowledged the ongoing 16 days of activism against gender-based violence (GBV). Again, this had a huge impact on COVID-19 as available data showed that more women were abused during the lockdowns, especially during lockdown level 5. In actual fact, these women were locked down with their abusers.
Recently, the Department had been provided with the statistics of unemployment in the country and the impact of COVID-19 on the economy. Jobs were mostly lost in the hospitality sector where more women worked. In essence, more women lost their jobs as a result of the pandemic. It was therefore crucial to address these issues during the 16 days of activism against GBV.
She referred to different stages in the spread of COVID-19. There was an “Alert” phase, followed by a period known as a “Resurgence” and after this would be a fourth wave. At the moment, the province was not in a fourth wave. Instead, it had entered the “Alert” phase some two or so days previously. The Department would have to wait for another three days before it could confirm whether the province was in a resurgence or not. As for the new Omicron variant, the Department was still gathering data and evidence, first from the Gauteng data, and then with a proxy using its own samples.
Regarding questions around why the South African health system shared information on the new variant, she noted that it was not the first time it would be sharing information about new variants identified. Information was shared when the Delta, Beta, and Alpha variants were identified. The same applied when the C.1.2 variant was picked up around May 2021. There could be variants of interest that did not necessarily translate to variants of concern. The information on Omicron was shared right after Departments had met with the National Health Council comprising Members of Executive Councils (MECs) and contributions had been received from Heads of Departments (HODs).
On the current state of the province in terms of COVID, the number of cases, positivity rates, reproduction rates and other metrics were visible. While deaths and hospitalisations might be minimal, and the number of cases minimal, the Department was still picking up cases. There was a national fatigue about vaccinations, which was also reflected in the Western Cape as only 49 percent of people in the province had been vaccinated. The Department was concerned about low vaccination rates, especially because it had previously boasted about increasing its capacity to vaccinate from 30 000 to about 40 to 60 000 people daily. Although the latter target was yet to be met, the Department still had the capacity to vaccinate as many people as possible.
The Department was concerned about those in age group 50 and above, specifically ages 50 to 59, where a number of people were still unvaccinated. There were about 1.4 million people aged 50 and older and only about 60 percent of them had been vaccinated. Ideally, the target had been to vaccinate 85 percent of the over-50s by the end of 2021, while 65 percent of other age groups would be vaccinated. Unfortunately, the Department was unable to meet this target. But it had done its best in exploring different innovative interventions such as pop-up sites in the malls; pop-up sites at SA Social Security Agency (SASSA) offices; vaccine taxis; and Emergency Medical Services vehicles that provided music for minstrels and other people to dance to - the Department would be dancing with them again on Saturday somewhere in the Cape Winelands. The Department was doing all it could to get as many people vaccinated. Attention was being given to healthcare workers who were in the line of defence regarding COVID response. The first line of defence within the community was prevention. The Department had reached out to the people it could identify, especially those on chronic medication. People were no longer expected to bring themselves to health facilities to get vaccinated; instead, the Department was now going to people. The team from the Department had gone to clubs and danced with the youths. It was for this reason that the Department was appealing to everyone, including Members of Parliament (MPs), constituency heads, and other people who had information on unvaccinated people to share such information with the Department, as it would be impossible for the Department to single handedly identify everyone.
The Minister mentioned that she had met with the universities on 30 November 2021 to discuss issues of mandatory vaccinations. Universities had been upfront and open about the vaccine mandate. She also met with Higher Education Institutions (HEIs). There were 32 TVET colleges and 22 community education and training centers, which constituted a great concern for the Department. The Department was looking forward to assisting HEIs to vaccinate first-year students during their open days in January, as they were potential super spreaders. The Head of Department, Dr Cloete, would talk more about the 12 to 17-year-olds.
In conclusion, she said that although it was important to vaccinate everyone, her greatest concern was for the over-50s, because they were more at risk of being hospitalised or dying.
Presentation by the Western Cape Department of Health (WCDH)
Dr Keith Cloete, Head of Department, WCDH, took the Committee through an update on COVID-19 and the vaccination roll-out. The presentation focused on:
-an update on COVID surveillance and response;
-response to the COVID-19 fourth wave;
-current status of the health platform; and
-an update on vaccine implementation
As far as surveillance was concerned, the Department was tracking every metric being reported on. So far, the province had had three waves, and was now starting to see an increase in cases. The national trend was that there were steep increases in Gauteng and other provinces except the Free State and Northern Cape. Every province had gone into what was known as the “orange period”, which signified a sustained increase experienced in every province, including the Western Cape. The Western Cape was now recording an average of about 100 new cases per day. The province was now in a “resurgence”, as an increase of more than 20 percent sustained for seven consecutive days from the 21 to 28 November had been recorded.
As for the new variant, the rapid emergence of Omicron accounted for 68 percent of specimens in South Africa by 21 November, while more than 60 percent of Western Cape specimens had PCR markers for Omicron. As of 30 November, the province had recorded 15 gene sequence confirmed cases with Omicron.
Regarding what the Department knew about Omicron, scientists were still tracking it to see whether it was more transmissible than the Delta or Beta variants. When the evidence, which was expected to emerge in the next seven to 10 days, became available, the Department would be able to shed more light on transmissibility
Some evidence existed on the reinfection risk, but the Department was unsure of whether the protection versus severe disease rate was maintained. Nonetheless, there were no early signals to suggest that people would be severely ill because of Omicron. Scientific evidence would be needed to determine this.
When it came to diagnostics, the variant was detectable, particularly through the PCR test.
On the big question of vaccines preventing Omicron, again the protection against severe disease should be maintained to an extent. No evidence existed to suggest that vaccines would not protect against Omicron. People should get vaccinated to protect themselves against severe impact.
As for clinical disease severity, there were reports of more young people and children being admitted. This was mostly due to the fact that people in these age groups were likely to be less vaccinated and be involved in events where the virus could be spread.
In preparation for the fourth wave, the Department appointed and extended the contracts of an additional 863 COVID staff until the end of March. The Department also had 1 471 healthcare workers and support staff, which included 603 interns for the vaccination drive. There were also an additional 803 applicants that could still be appointed if and when the need arose.
On the status of vaccinations, although 2.4 million people had received the first dose of vaccinations (which was roughly 50 percent) and 2.1 million people were fully vaccinated (accounting for 43 percent), there were still 2.5 million people aged 18 years and older who were yet to be vaccinated.
Administration of booster doses for the general population over the age of 50 would start in the first week of January 2022 when people would be six months beyond their second dose of Pfizer. The Department was expecting all processes required for this kick-off to be finalised with SAHPRA and the National Department of Health (NDoH). Announcements would be made about the exact dates when the booster doses would be made available to the public.
The department’s fourth wave risk mitigation was targeted at the vulnerable. Grocery vouchers had been extended to those over the age of 50. The Department’s key message remained that vaccination was important; people should wear masks even if they had been vaccinated; windows should be opened to ensure proper ventilation; and more meetings should be held outdoors.
Ms W Philander (DA) thanked the Minister and Dr Cloete for the detailed and extensive presentation.
While highlighting the various innovative interventions embarked on by the Minister and the Department in getting vaccines to the public - interventions such as the drive-through facilities; accommodation of the hospitality industry, night clubs, taxi ranks and so on - she asked if these innovations had proven to be successful and what indicators existed to prove this.
Apart from the weekly digital broadcast, radio broadcast, print media, website, and dashboard used by the Department to provide information to residents across the province for the purpose of tracking response to the pandemic, what other plans did the Department put in place to address slow uptake and vaccine hesitancy? The Western Cape’s fourth wave resurgence plan as indicated on slide 22 of the presentation that also covered various key interventions was noted and welcomed.
The Premier, during his address to the Ad-Hoc Committee in September, had mentioned that the province’s communication strategy had been informed by various medical experts. The Department’s presentation also placed emphasis on the strategic focus outlined on slide 28. Based on this, she wanted to know if the Department would support an oversight body of the Western Cape Provincial Parliament (WCPP) to embark on a targeted approach of engagement with specific communities that had shown signs of a slow uptake and vaccine hesitancy.
Based on the President’s announcement on Sunday, 28 November 2021, the national government would now set up a task team to look into the possibility of making vaccines mandatory for specific activities and locations. She asked for the position of the Western Cape Provincial Government (WCPG) on this issue.
Mr C Dugmore (ANC) asked the Minister and Dr Cloete if the WCPG was in support of mandatory vaccinations. He asked for an explanation of the term “mandatory vaccination”, as his understanding was that the term signified the need for proof of vaccination to be shown before one could gain access to workplaces or public places.
Referring to the 42 percent vaccination rates in the province, and the President’s speech on low vaccination rates nationally, he expressed concern around such low percentages posing great risk of infection with the new variant. It was more disturbing because available information on the new variant said that prior vaccinations could not prevent people from contracting Omicron, but getting a vaccine would increase one’s chances of not getting sick and ending in the hospital.
Regarding the Department’s claim of capacity to vaccinate 40 000 people in a day, he said that was not an actual target. With the low vaccination rates in Khayelitsha and elsewhere, surely the department should set actual weekly targets aimed at increasing vaccinations in specific communities. He asked for the overall vaccination target in the province, as well as actual weekly targets per area. He was concerned that there seemed to be no actual provincial target or practical plan to actually reach the set targets. He therefore wanted to know what the target was and what weekly plans were in place to reach the target.
Mr B Herron (GOOD) referred to the claim by the Minister and Dr Cloete that the Department had the capacity to vaccinate more people in the province, yet targets were not met because people were not showing up for vaccinations. He asked if there were any talks or plans in place to implement a vaccine mandate for Western Cape employees and Members of the Provincial Parliament. There was evidence of increased vaccinations in other parts of the world due to the implementation of a vaccine mandate. Even in South Africa, Discovery Health, for instance, reported an increase in vaccination rates from 20 to 96 percent in just three months after the introduction of a vaccine mandate for their employees. Why was the Western Cape government delaying, if it was, implementation of the mandate for its employees in the province? What plans were in place for the Western Cape provincial Health Department to implement a vaccine mandate for places like restaurants and places of entertainment, given the powers that it had in terms of the National Health Act? Clearly, there was a need to increase the number of vaccinated people, since persuasion and communication had not been effective. He opined that it was time to consider the vaccine mandate.
His second question was about a statement made by the Premier earlier in the week that there was no vaccine hesitancy, but instead a problem with access to vaccines. He found this statement quite surprising, seeing that the provincial DoH had the obligation to make vaccine sites accessible. Why did the Premier make such a statement on radio? If ,indeed, there was a problem of lack of access, how was the Department addressing this? Was the Department taking vaccinations to people who were unable to reach vaccination sites?
Mr F Christians (ACDP) said that besides the preventive measures of mask wearing, vaccinations and ventilation, the Department had not promoted immune boosters or Ivermectin. He asked for the Department’s stance on immune boosters, Ivermectin, and zinc.
He also asked the Department to shed more light on the symptoms of Omicron as there was speculation that symptoms were not severe and could feel like a normal cold. With people taking the J&J and Pfizer vaccines, what was the need for boosters? He sought clarity on the severity of the new Omicron variant, particularly with regard to talk about previously vaccinated people getting infected and needing new vaccines, as their previous vaccinations might not fully protect against Omicron.
He sought clarity on the definition of mandatory vaccinations, and the implications for people who did not want to be vaccinated.
Mr P Marias (FF+) said he did not doubt the intellect of Dr Cloete, nor did he doubt the efforts the Department had put into fighting this pandemic. However, he questioned what the bold plan was in terms of actually fighting the pandemic, and what exactly was going on with regard to the way the vaccine was evolving into new variants. In his words, COVID was an “engineered virus”, and not a natural one, and so were the vaccines, which contained spike protein. He asked for an explanation on what constituted spike protein, and how it affected people with comorbidities, such as diabetic patients or those with heart problems. Wouldn’t the vaccine exacerbate their conditions, especially since information shared at the initial stages of the pandemic was that more deaths would be recorded among people with preconditions such as diabetes or heart problems? He asked the Department to explain what was going on. If it took years to create a vaccine, how come the scientists were able to quickly develop new vaccines for the new variants of COVID within weeks? What was in the new vaccines being developed? He was indeed baffled and mentioned that in all his years of being MEC for Health in the Western Cape, he had never seen anything like this.
He referred to an Oxfam report in India that gave a statistic of 11 people dying every minute from hunger and starvation. Organisations like the United Nations (UN) and the World Health Organisation (WHO) claimed not to have money. He wondered how these organisations could suddenly afford billions to develop vaccines, yet could not address world hunger.
He asked for the source of new vaccines that were developed to address the evolution of new variants.
Lastly, he wanted to know the rationale behind the ‘scare tactic’ used by the health sector, as people had started calling him to ask questions around the projection of 10 000 infections on a daily basis.
Mr G Brinkhuis (Al Jama-Ah) mentioned that many infected persons in the second and third wave were very sick and experienced a lot of severe symptoms, ranging from tiredness to very deep fever and many other symptoms. With the upcoming fourth wave, a lot of people in Gauteng province were already experiencing the new Omicron variant. He asked if the Department could share with the Committee the kind of symptoms being experienced in Gauteng for the purpose of figuring out what symptoms to expect in the fourth wave.
The Minister responded to Mr Brinkhuis’s question on Omicron symptoms. COVID started with symptoms of flu, hence the introduction of thermometers to check temperatures before entering a place. As it evolved, it birthed more variants, which led to varying symptoms, with some people experiencing mild symptoms, while others experienced a bunch of severe symptoms. Some young children did not even fall sick, while some people only experienced loss of smell or loss of taste. A time would come when the use of thermometers would be questioned, just like the obsession with cleaning surfaces, which was based on aerosolisation and droplet collection at the time. Now, the virus was in the air and poor ventilation would cause more infection. Symptom identification was therefore complicated due to the nature of the virus. As for Omicron, it was still too early to determine its exact symptoms. Although the South Africa Medical Association (SAMA) had said that some doctors noticed some mild symptoms in their clients, it was still too early to confirm any symptoms, because it could be that the symptoms were detected in young people. It should also be noted that symptoms might vary depending on whether infected people were vaccinated or not.
As for the question of ingredients contained in the vaccine, she said that she was not aware of the ingredients in Panadol, but it was the go-to prescription for headache. One close look at a pack of Panadol and one would quickly notice the clause that it should not be used for more than 10 days without consulting a doctor, as adverse use could result in severe effects like a coma. The same with the drug for diabetes; she was not aware of the components in a diabetic treatment but because it was a major condition in Western Cape, especially among females, insulins and oral diabetic treatments were always administered. The same applied to treatment for hypertension; never had the Department been asked to explain what the ingredients were in the drugs prescribed or administered. With today being World AIDS Day, conversations were focused on antiretroviral (ARV) drugs which HIV patients had been taking for a long time. Now, a new pill was being introduced which could be taken by everyone irrespective of whether one was HIV positive or not. The Department was yet to receive any criticism about this.
With regard to COVID, she explained that once there was a complication and a person was hospitalised, oxygen would be administered and nobody would query what was in the oxygen; nor did people query the components of antibiotics administered to them; all they wanted was to be saved. Overall, the benefits of vaccinations far outweighed all other assumptions and queries, hence, the need for people to get vaccinated. Dr Cloete would provide more information on the ingredients within the mRNA vaccine.
Regarding the Department’s stance on immune boosters and Ivermectin, she reminded Members of her reference in her opening remarks to immunosuppressed individuals receiving additional doses. What they would be getting was not boosters, instead they would be getting additional doses of vaccine because its duration was prone to waning quickly in immunosuppressed persons. This also applied to cancer patients; as well as those with AIDS with a CD4 cell count of less than 200.
To better explain what booster doses were, she cited the example of children needing certain immunisations at intervals of different ages and milestones from birth to six weeks, six months, nine months, 12 months, 18 months and so on. Some immunisations like the ones for polio and measles were usually repeated at various intervals. In actual fact, some of those immunisations acted as booster doses. The same rule applied for adults, as there were certain immunisations that required several doses over a specific interval. An example was the yellow fever immunisation requested by certain African countries. Once a jab was taken, one would be expected to take another jab after nine years. The annual flu jab was another example. Similarly, there was nothing wrong with taking booster doses alongside vaccines, especially because COVID was a new virus and this meant that new data would continue to emerge regarding the number of vaccine jabs to be taken. For instance, it was said that one dose of J&J was sufficient, while two doses of Pfizer were prescribed, but now it had been said that a booster dose was needed for Pfizer. With new variants came new evidence; new vaccine prescriptions; and issues around vaccine equity. As for the latter, the Department started with healthcare workers. Those who were part of the Sisonke rollout would be getting the J&J, but it would soon be open to people outside of Sisonke. People would be offered an opportunity to choose between J&J and Pfizer.
There was nothing new about boosters; they had always been there and were part of the science that kept evolving. There was no certainty around the vaccines and how often they would be required to be taken. There could come a time when it would be expected that they be taken on an annual basis; it all depended on the variants that emerged.
Regarding the question about vaccine mandates and whether government employees had been mandated to take it, as well as the comment by the Premier, she emphasised that it was still one health system, irrespective of the different roles that each department had to play. It would be ideal to ask that people get vaccinated before renewing their SASSA card for instance, especially because the category of people that needed this card renewal were the main targets for the vaccination - people aged 50 and above. But the reality was that only 60 percent of these 50-year-olds had been vaccinated.
Even if the Department desired a situation where proof of vaccination would be requested for government employees to access work places, in reality, this would be impossible as things did not work like this in South Africa. Although it might seem easy for institution-based employers to implement the vaccine mandate as seen in universities, these universities still had to follow certain processes such as presenting the policy to the Senate council, obtaining legal opinion and so on. The Department as an employer would be unable to implement such a mandate without organised labour. Therefore, consultations had to be made with organised labour at the national level. In her opinion, the vaccine mandate should start with healthcare workers, especially because only about 60 to 70 percent of them had been vaccinated so far. It would be best to start with the unvaccinated healthcare workers so that the Department could lead by example for other sectors like the social services, teachers and so on.
Viewing the vaccine mandate from an ethical and constitutional point of view, the policy would be based on the need to protect other people from getting infected. Also, based on the Occupational Health and Safety Act, employers had an obligation to protect their staff from harm.
On vaccine hesitancy, the Minister said she could not speak on behalf of the Premier but in the Department’s presentation, reference was made to geographic prioritization and equitable access. For example, in Mitchells Plain, there were three areas where the Department recorded lower uptakes of the vaccine especially among older people. Similar records were made in Khayelitsha and Central Karoo.
In Mitchells Plain, it was not about people not being informed; instead it was about the role played by the influencers. A majority of these influencers were people with a knowledge of the vaccines; people like general practitioners and pastors, etc. These people were highly respected and used as a source of information for some households. People respected the stance of these GPs and usually went with whatever they advised, especially those who had been using the same GP for many years. The Department therefore adopted an approach of working with these influencers to help change the minds of people towards getting vaccinated.
For Khayelitsha, it was more about misinformation around the vaccine causing infertility, and so on. For this reason, the Department adopted the “ask a doctor” approach. In the past week, the Minister said, she had visited Khayelitsha where four doctors from the Khayelitsha hospital and some GPs were at the mall next to the vaccination sites, with a visible “Ask a doctor” sign to direct people to come and ask their questions regarding taking the vaccines.
In the Central Karoo region, for example, there was talk about the vaccine being evil. These views were not limited to older people; even the younger ones made such claims and when asked where they got their information from, they said it was from their pastors. One of the pastors helped with bringing many of his colleagues to an enlightenment session on vaccines organised by the Department and, so far, progress had been made in terms of vaccination rates.
There were two million young people at the universities, colleges, TVET colleges and community colleges. For this group, the Department worked with the Department of Higher Education (DHE). Plans were in place to include enlightenment sessions on vaccines during varsity open days come January 2022. There would also be enlightenment sessions on GBV, HIV/AIDS, substance abuse and drugs.
The interventions would be in bits but the Department was doing its best to customize its messaging according to the target area.
On the issue of vaccination targets, she explained that the first thing the Department did before going to a place to set up a vaccination site or a pop-up station was to determine the exact target on the dashboard, which was accessible to the public. This dashboard contained information on the number of registrations and vaccinations done for each age group. It was through this dashboard that the Department would identify places that needed more pop-ups and other forms of interventions. An intervention could start with a pop-up at a community hall, and then change into another pop-up at a church; then to a vaccine taxi where “Aunty Sara” could be hosting a stokvel that would bring all the church women to come to be vaccinated outside her house. In essence, the targets on the dashboard helped the Department to determine what form of intervention would be helpful for each area. Interventions were customized according to the target age group and area. For instance, the Department brought music tracks for older people who loved to dance.
She recalled that the Department initially had a target of 30 000 vaccinations a day for the whole province based on the capacity and target set to be achieved by the end of the year. So far 4.97 million people had been vaccinated, of which 1.4 million were over 50s. Of this figure, 733 000 were over 60s. All of this showed that the Department already had its targets, and it was based on this that the Department could say it had the capacity for 40 to 60 000 vaccinations in order to achieve the vaccination target of 85 percent for the over 50s by the end of the year, and 65 percent for age groups below 50.
In responding to Ms Philander, she said that the Department was trying different approaches. Interventions had been made for farm workers through the use of a wellness bus that did a ‘stop and go’ on every farm. The farm owners and employers assisted with transporting.
The Department also worked closely with the taxi industry, and not only through the Red Dot taxi service. Sometimes, people were fetched from their houses and excuses of being in pyjamas or not having documentation were dismissed. Before June, the Department had covered homelands and communities. It had also organised pop-ups at churches, and plans were in place to do more. The Department continued to rely on the community leaders, church leaders and other influencers to reach its vaccination targets.
Mr Marias raised a point of order to state that the Minister had taken up so much time answering questions while Members still had other questions to ask.
The Chairperson replied that Members had posed a lot of questions, and the Minister should be afforded sufficient time to respond.
The Minister continued by responding to the question on equitable access and accessibility. Availability did not necessarily translate to accessibility. There could be numerous vaccination sites and pop-up sites, but the question remained if they were accessible to everyone. The Department’s statistics showed that 94 percent of the over-50s that had been vaccinated were from the insured population while the 40 percent remainder were from the uninsured population. This meant that the 40 percent would end up clogging the health system should a severe fourth wave emerge. Initially, when vaccinations were going to commence in the country, more access was granted to those who could use the apps; those who had fancy phones and could use the Electronic Vaccination Data System (EVDS), while there were people in the communities with no such access. This explained the Department’s stance that while there might be some people out there that the health system might not be able to reach, other people might be aware of them. They should then assist by pointing the Department in the direction of people who had not been reached.
Dr Cloete addressed the questions about mandatory vaccinations. A vaccine mandate could be described as a mandatory policy implemented by an employer that required people who wanted to work or function at the organisation to first be vaccinated. A few organisations like Discovery Health and the University of Cape Town had implemented the policy. However, the President had called for a task team to look into this policy. The position of the WCDH was of support for clarity and finality on the development of the vaccine mandate so that everyone could be aware of the processes involved; the implications of the mandate; and how it would be implemented.
He explained further that every employer had the right under the Department of Labour Regulations to draw up a vaccine mandate on the basis of consultation, following a fair process. An employer could then say employees could only work at an organisation after being vaccinated based on an outlined process that was followed. The Western Cape government on the other hand, was composed of public servants. It had no delegated authority to implement the vaccine mandate on employees of the Western Cape in isolation from the National Department of Public Service and Administration (DPSA). The DPSA had a process which the Western Cape government had to follow. There would also be a process for Parliament to follow as an entity and an employer itself.
Adding to what the Minister had said regarding targets, he said that every area, outreach, or place had targets that were aggregated to the lowest level, and daily functions were carried out based on these targets.
Regarding vaccine hesitancy, Dr Cloete said he could not speak for the Premier. However, a lot of the issues being dealt with by the Department were in relation to access. It was for this reason that a differentiated module was adopted in order to take the vaccines as close as possible to the people. A weekly survey was done by a company that interviewed people to ask why they had not been vaccinated. Based on the result of the survey, about 30 percent said they had just not gotten around to it; about 20 to 30 percent of people said they were not sure about getting the vaccine but would reconsider if there was a trusted person they could speak to; and another 20 to 30 percent said they would not get vaccinated. The issue at hand was not just vaccine hesitancy, but also the issue of people who had not gotten around to getting vaccines from a logistics point of view.
On the question of other prevention measures besides vaccinations, mask wearing and ventilation, he noted that all these recommended prevention measures were based on science and evidence. The available science and evidence were inconclusive on immune boosters and Ivermectin. If it became clear that they could be used as prevention measures, they would be added to the evidence-based interventions.
On the symptoms of Omicron, he said it was still early days. There were suggestions that some people had milder symptoms. There was still a need for the Department to monitor the symptoms as more people got infected, before making a statement on what the exact symptom profile for the new variant was.
A booster dose, as the Minister had explained, was mainly to boost immunity because the antibodies meant to protect the body were bound to wane after a period of time.
He disagreed with Mr Marais’s claim that the virus was engineered. He said that the virus was real, based on science. It was not an engineered virus, neither was it produced in a laboratory. It behaved like other viruses; and vaccines were developed according to the strictest rules of vaccine development that were internationally observed. This was why there were regulatory bodies in every country to regulate the content of medicines. These regulatory bodies were there to safeguard everyone. As for the content of the vaccine, vaccine contents were based on evidence investigated by regulatory bodies to protect citizens.
He clarified that a spike protein was an element on the virus itself. This spike protein attached itself to human cells and caused the infection and symptoms being referred to by Mr Brinkhuis. The spike protein was purely a piece of the virus itself that existed and attached itself to the human cell, infected it and made people ill.
An upstream in cases and hospitalisations had started in Gauteng and would soon start in the Western Cape. As shown in the presentation, the Department was expecting an increase in hospitalisations over the next 10 to 14 days. By that time, the Department would be able to respond to the question around symptoms of the new variant. Nevertheless, there was no expectation for the variant to be much different from the previous variants. In all, the Department was certain that the virus was real; Omicron was real and would be infecting people; some people would be ill and even hospitalised; but the evidence available to the Department showed that vaccinations would help a lot. Based on this, he urged that more people should get vaccinated.
Mr A Van der Westhuizen (DA) highlighted the interesting trend with infection rates, which had led to talks of ‘waves’. He sought clarity on why the virus behaved in waves; and if it had anything to do with the imposition of lockdowns and clamping down on movement at the start of a new wave. Or were there other reasons for this trend in waves?
It was common knowledge that people had to wait for 15 minutes after getting vaccinated to be sure that there was no allergic reaction. He asked if the Department had seen any allergic reactions or anaphylactic reactions to the injections.
The Chairperson said she had seen some reports that pediatric COVID wards in Gauteng were full. With other variants, children were largely unaffected. She sought clarity on whether the new variant might change its target profile and if this was something that the DoH would need to keep a close eye on. Mothers of small children would find this to be a worrying indicator, hence the need to know more about this variant.
She also wanted to know the number of days for symptom onset in the new variant. As would be recalled, the symptom onset in the Beta variant was an average of six days, while that of the Delta variant was an average of four days. Was there any anecdotal evidence to show that Omicron symptom onset was even quicker, perhaps two days as some people had attested, or was it too early to know this?
She concluded by acknowledging the strain that the DoH was going through seeing that a fourth wave was imminent and would mount incredible pressure on the physical and mental capabilities of the Department. She therefore wanted to know how the Department was preparing and motivating itself and its team members to face the upcoming wave and get through it in the same way they had previously done for other waves.
Ms R Windvogel (ANC) asked if there were any vaccinated persons who had been reinfected and hospitalised with the new variant.
Mr Herron revisited the issue of vaccine hesitancy and slow rate of vaccination. The previous day, the Committee had received the latest Labour Force Quarterly Report which showed a massive job loss partially attributed to the lockdowns that the country had gone through over the past almost two years. The Committee had heard from both the Minister and the Head of Department that vaccinations were key to overcoming this pandemic and probably regaining normalcy of some sort, as well as achieving immunity within communities. He expressed concern about what he picked as a lack of urgency by the Department and government on vaccine mandates. Government should not be plotting participation in task teams when in actual fact, vaccine mandates should be implemented where possible.
The Minister had spoken about supporting the vaccine mandate for healthcare workers but she had not stated whether the mandate had been implemented for healthcare workers in the Western Cape. He asked for the steps being taken by the Department in this regard.
The Western Cape had large employers like Old Mutual, who had implemented the vaccine mandate. It was therefore puzzling that government was just observing other employers as they implemented the mandate, rather than leading with implementation.
With regard to Dr Cloete’s description of what a vaccine mandate was, he said that the mandate could take as many forms as possible. Some countries had made it compulsory for all adults to be vaccinated. Others had made venues require proof of vaccination in order for people to access them. Neither the Minister nor the Head of Department had responded to his initial question about the Provincial Government’s move to implement a mandate for places like restaurants and bars where liquor licences and policy on consumption of liquor were already implemented. He asked if the government would move forward with a vaccine mandate or whether participation in a task team would be the way forward. He concluded by asking why the vaccine mandate could not be implemented seeing that employers and HEIs in the Western Cape like the University of the Western Cape and the University of Cape Town had already implemented mandates.
Mr Christians asked for confirmation of the recovery rate of children in the age group of 12 to 17, as the information he had was that their recovery rate was 100 percent. He wanted to know why SAHPRA had approved that this age group be vaccinated.
On the issue of vaccine mandates, he expressed confusion about why some political parties were bent on having the vaccine mandate implemented, when in actual fact the President had already stated that no one would be forced to be vaccinated, nor would people be forbidden to travel. However, there were media reports on public sector unions in support of mandatory vaccinations. In his opinion, neither the Department nor the Government should be blamed for responses to vaccinations, as there were people out there who did not want to be vaccinated. The ACDP as a political party had taken the Government to court about vaccinations for those aged 12 to 17 and would still take the Government to court about mandatory vaccinations, because the party believed in freedom of choice.
People should not be forced to get vaccinated. Instead, other ways of getting over this virus should be explored. Ivermectin for instance, had worked for more than 40 years; 10 billion people had used Ivermectin in the past, and there were statistics to prove this. The hesitancy with the current vaccines was because they were experimental, which made people uncomfortable. The ACDP would continue to push people’s right to freedom of choice over mandatory vaccinations.
Mr Marias informed the Minister that the ingredients contained in his pain tablets were clearly written on the box and in the pamphlet accompanying the medicine.
His stance remained the same on the need for more attention on addressing the humanitarian crisis of hunger and starvation. Around the world, 155 million people were currently experiencing chronic levels of hunger, with COVID contributing to this crisis through its impact on the economy and businesses. Businesses were shutting down, leaving more people unemployed and with no income, but the vaccine mandate was receiving more attention. There were other lifestyles that should be prohibited or for which mandatory policy should be developed. An example was the spread of HIV/AIDS, which was an even bigger killer than COVID. Yet, no talks had been had regarding banning interpersonal activities that lead to the spread of HIV.
The vaccine mandate, in his opinion, would infringe on people’s privacy, bodily integrity and their right of choice, and the Government would be stepping on dangerous ground if it attempted to force people to be vaccinated against their religious and other beliefs. He backed the ACDP on this issue and categorically said that he would not allow anyone to push a needle into his arm in the name of vaccination. Death was inescapable, regardless of the form in which it came. More attention should be given to the nutrition of people in order to boost their immunity against this virus and any other disease.
The Chairperson noted the heated debates and varying opinions on the vaccines.
On the issue of vaccine mandates, the Minister clarified that the Department, being an employer of healthcare workers could, only make recommendations and not impose a vaccine mandate, seeing that an employer-employee relationship was in play. This was because this relationship automatically activated the Labour Laws. It was for this reason that the DPSA was responsible for developing policy frameworks to guide vaccine mandates. Outrightly imposing vaccinations would lead to labour issues and court cases. The Department would therefore not be able to impose vaccinations at this time.
Nevertheless, she opined that the DoH had a responsibility to lead by example by ensuring that healthcare workers, not only in the Western Cape, should be vaccinated. Other sectors where a vaccine mandate could be implemented without the processes that public parastatals had to go through, should consider implementing one, just like the Higher Education sector and some private companies had done. While it might be easy for the sports, entertainment, events and leisure sectors to implement a requirement for proof of vaccination before accessing certain events or shows, it might be difficult to impose vaccinations where the right to access basic services was involved. For example, it might be difficult to say that before you entered Khayelitsha Mall, you must be vaccinated because this might mean denying people access to food. However, a restaurant in Khayelitsha Mall might impose a requirement for customers to show proof of vaccination before ordering a meal. This was why the Department was working together with the DPSA, even at the level of bargaining chambers to have conversations around vaccine mandates for public servants.
It was evident that the task team suggested by the President would focus more on access to big events and Institutions, but it would be difficult to impose a vaccine mandate on the general public.
Dr Cloete told Mr Herron that the Department was taking urgent steps to ensure that many people were protected against Covid. The Department had already met with HEIs, and still met with them regularly, to discuss the implementation of vaccine mandates. However, from a workplace perspective, DoH staff were public servants, and could only articulate their position on vaccine mandate to the DPSA, who would then give effect to a mandate. As could be noticed from the comments of MPs, there were a lot of contesting views on this issue. It was necessary to have a court decide on the constitutionality of a vaccine mandate.
The infection rates and the waves were another reason why the current coronavirus was a novel one. He pointed out that this was not the first coronavirus. Multiple coronaviruses had been around for a long time. The current virus had a specific set of characteristics that made it “novel”. To put it in proper context, most of the flu viruses infecting everyone for the past 50 to 80 years were caused by coronaviruses. The current coronavirus was just novel because of a change in characteristics where no immunity had been built over a period of time. The current virus was behaving the same way other coronaviruses behaved. Like other viruses that behaved in seasonal patterns, coronavirus changed with temperature changes, changes in conditions and changes in the immunity of people.
On allergic reactions to vaccination, he noted that there was a very clear app where reports of any adverse events in relation to vaccination could be made. Of the four million vaccinations done in the province, not many, if any at all, anaphylactic responses had been recorded. The data on vaccine reactions was available to the public and was published by SAHPRA. Every detail on the number of adverse anaphylactic reactions could be accessed on SAHPRA’s website. In the Department’s view, no anaphylactic reactions had been recorded.
He cautioned people about jumping to conclusions on the pediatric wards report from Gauteng. He had been at the Red Cross Hospital the previous day and the situation was that there was currently a wave of respiratory illness in children there and in the Tygerberg Hospital which had nothing to do with Omicron or COVID. It was an ordinary flu that was currently being diagnosed and more children with respiratory symptoms had been admitted to hospital. The Department had been very careful about associating what was happening with a kind of respiratory surge linked to something called H1N1, which was the normal annual circulating flu.
As for the symptom onset in Omicron, it was too early to know, and it would be better to wait for more research before making any assumptions.
On the physical and mental preparation for the fourth wave, the Department’s teams had survived multiple waves, and the management was extremely proud of their tenacity. After the second wave, the Department implemented a programme called “intentional grilling, grieving and healing”. It was executed in an intentional way by taking the staff through the process of sharing how it felt to grieve and heal. After going through the third wave, the Department offered all staff two days of leave to rest. The staff had been incredible and were now ready to face the next wave, despite being tired and mentally exhausted, with a recognition that this was the job they were called to do. Dr Cloete mentioned that he had spent the earlier parts of the day talking to EMS personnel and forensic personnel, after he had spoken to the people at the Red Cross Hospital. He was proud of the staff in the province, especially with their approach to work and the acknowledgment of the fact that it was their purpose to serve.
On what the major driving force behind the infections was, he reiterated that it was still early days and the Department could not specifically state the number of people that have been hospitalised, vaccinated or not vaccinated. This data would become evident over the coming weeks, and the Department would then have sufficient data to answer Ms Windvogel’s question
As for the recovery rates in those aged 12 to 17, he agreed that the rates were extremely high. He also clarified that SAHPRA had made the ruling for this age group to get vaccinated based on proven evidence that there was a protective factor that would prevent them from being infected; especially for those that had comorbidities. The vaccines would be beneficial to them and protect them from infections the same way they would for people over the age of 18. Since the ACDP had gone to court to challenge this, the court would have to rule on whether vaccines for 12- to 17-year-olds were constitutional or not.
Dr Cloete refused to comment on the statements made by Mr Christians on freedom of choice and vaccine resistance, but he agreed that vaccine resistance was a real issue, with some people determined not to get vaccinated at all, based on reasons best known to them. The Department would however, continue to present everyone with all the necessary information, and offer access to doctors. But ultimately it was left for people to make the decision to be vaccinated or not
As for the comment by Mr Marias, he agreed that it was indisputable that hunger was an issue. A study conducted by a group of researchers also attested to the impact that COVID had had on society, in South Africa and the world at large. One of the biggest impacts was children going hungry; households going hungry; people not having food to feed their children. This was a humanitarian crisis that needed to be dealt with by society, especially because the statistics on malnourished children would still rise. The Government and society at large should not turn a blind eye to this humanitarian crisis. Instead, efforts should be made to assist people at the receiving end of the crisis.
In responding to Mr Herron, he explained that the distinction between a mandate for a workplace and a mandate for access to societal activities was clear. As the Minister had stated, two major issues would emanate from the task team. These were mandates for public and private workplaces and mandates for participation in certain activities and access to certain places. The dynamics would play out in the coming weeks. Either way, discussions around a vaccine mandate would be tested in court to proffer a way forward.
The Chairperson expressed appreciation for the Department’s responses, while noting that the evidence in support of vaccines was overwhelming. Based on the billions of doses that had been administered around the world and given the identification of the Omicron variant and the trends towards a fourth wave, mirrored by the projections in the Department’s presentation, parliamentarians had a duty to raise public awareness on the importance of staying safe at this time. Parliamentarians who acted as public representatives, had a duty to help residents separate fact from fiction and ensure that people followed reliable and scientific evidence through the sharing of best public health advice. It was necessary to reach a stage where the development of further variants could be prevented; the health system salvaged from further strain; and the daily lives of the citizens and the economy could begin to recover. The only way to achieve this was to encourage as many vaccinations as possible across the length and breadth of not only the Western Cape but the country in its entirety. She mentioned that she had been vaccinated and urged others to get vaccinated as well.
In closing, she thanked the Minister, the Head of Department, the entire team from the Department, as well as every healthcare worker in the province, for the remarkable work they did and prayed for strength and courage to face the next challenge.
The meeting was adjourned.
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