Department of Health update on vaccine rollout; with Deputy Minister

Health

05 March 2021

Chairperson: Mr S Dhlomo (ANC)

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Meeting Summary

Video: Portfolio Committee on Health, 5 March 2021

Minister on rollout strategy of Covid-19 Vaccine & status of healthcare services in provinces in relation to COVID - 7 January 2021
Minister of Health on roll out strategy for the Covid-19 vaccines - 05 February 2021

In this virtual meeting, the Department of Health updated the Portfolio Committee on Health on the vaccine rollout programme.

Before commencing with the Department’s presentation, the Committee discussed the Minister’s absence and whether it could proceed with the meeting. Some Members expressed disappointment about this and pointed out that the Department had not provided an adequate explanation, that the Minister had held a media interview during the meeting and only he could answer certain questions. The Committee eventually decided to proceed, noting that the Deputy Minister and officials were able to engage, this was an important matter that the Committee needed to be updated on and whatever might be outstanding will be noted and the Committee could always have a chance to get the Minister to respond later.

The Department reported that the current vaccine rollout programme was an expanded study done by Johnson & Johnson. The Johnson & Johnson vaccine was shown to be effective against the 501Y.V2 variant. The Department had received approval from the South African Health Products Regulatory Authority (SAHPRA) to expand the study and this was what constituted the first phase of South Africa’s vaccine rollout. The phase one of the rollout was legally regarded as an expanded study. The Department said that this was the only option left available after reports were released that the AstraZeneca vaccine would not be effective against the 501Y.V2 variant. The Department discussed the Digital Vibes contract. The Department and the Special Investigating unit were currently probing the matter. Once the investigation was completed the results would be made public. The presentation provided an update on the Sisonke vaccination programme. It detailed the vaccine acquisition pipeline and provided a way forward on the AstraZeneca vaccines. The Johnson & Johnson vaccine (Ad26.COV2.S) was tested on 43 783 people from four continents. The vaccine provided 64% protection against moderate Covid. The vaccine provided 85% protection against severe Covid. The vaccine provided 100% protection against death. The vaccine was safe and efficacious. There were no safety concerns from the trial.

Members sought clarity about whether the Department was busy with a vaccine rollout or a trial. The EFF said that the Department is rolling out a vaccine that is still being researched but it was speaking about evidence-based strategies and fighting Covid with facts. It accused the Department of misleading the public and engaging in unethical and dangerous behaviour.

The Committee asked that considering the delays of the vaccine rollout did that mean the Department had to readjust its timelines in terms of vaccinating 40 million South Africans which was the target set by the Department? Was the money allocated by Treasury going to be enough for that acquisition of vaccines and for the rollout to be done by year end?

Members asked about excess deaths, preparedness for the third wave, the ration of healthcare workers vaccinated in private versus public hospitals, the validitiy of the COVID-related data and who was ultimately responsible for administering the vaccine.

Meeting report

The Chairperson welcomed the Deputy Minister, the Director General and the delegation from the Department of Health. He had received a call from the Minister the previous day indicating that he had challenges attending this meeting. The Deputy Minister would lead the delegation and if time allowed the Minister would join the meeting later.

Dr S Thembekwayo (EFF) said that the Committee needed the presence of the Minister today. That was why the Committee had these special meetings. Certain questions needed to be answered by him. He needed to respond to the questions that was directed at him. She said that there was a problem here.

The Chairperson said he did indicate that the delegation would be led by the Deputy Minister. There would be time for the Deputy Minister to speak on that matter when he introduced the delegation. He asked the Deputy Minister to introduce the delegation and give the Committee an update on when it could expect the Minister. He said it would not be possible to engage the Minister with questions.

Dr Joe Phaahla, Deputy Minister of Health, said that the Minister had to attend engagements in KwaZulu-Natal. There were urgent matters that he needed to address in the province and he was unable to attend the meeting. The Minister had asked him to lead the delegation.

Dr Sandile Buthelezi, Director General, DoH, introduced the delegation from the Department. He said that he would be leading the presentation.

The Chairperson requested that the Committee support the meeting proceeding without the Minister being presented. It would not be the first time the Minister would join the meeting later and answered questions. Even if questions were not answered by the Minister the leadership of the Deputy Minister would be present. The purpose of this meeting was for an update. Whatever might be outstanding will be noted and the Committee could always have a chance to get the Minister to respond later. He really wanted the Committee to support the meeting going on. He said that the Deputy Minister and officials were present to engage the Committee on the presentation. He asked the members if the meeting could proceed with the Department led by the Deputy Minister.

Ms E Wilson (DA) said that it was very disappointing that the Minister was not in the meeting. She said the Committee did need to be kept up to date about the vaccine rollout. This was a meeting that the Committee requested and because of the importance of the situation of vaccines, the meeting should continue.

Ms A Gela (ANC) agreed and said the Committee should continue with the meeting.

The Chairperson noted the concerns but said the meeting should continue so long. He wanted the Deputy Minister, in his opening remarks, to make a reflection on the concerns of the members. The Committee was going to get a vaccine rollout update. The Committee wanted to know, with regards to this matter, if it was an extended clinical trial. The Committee needed to be aware of what it was talking about. He wanted the Deputy Minister to provide further clarity on this matter to the members. He needed to understand why it was difficult for the Department to indicate what the nondisclosure agreements were about? The Department might not be able to indicate that information publicly but the members should be given that information. He wanted those issues to be attended to by the Deputy Minister as they were probably unlikely to be dealt with in the presentation. He also wanted the Department to brief the Committee on the Cuban doctors programme. There were very diverse views on the programme. He wanted to hear more about it and said that the Committee was the owner of that programme.

Mr A Shaik Emam (NFP) asked if the Deputy Minister could provide the Committee with the latest developments on the AstraZeneca vaccines? Were they still in the country because he heard that they were about to expire? Were they sold? Have they left the country? He wanted to know what was the position in terms of that?

Dr Thembekwayo asked if the Committee could receive information on the Digital Vibes communication company and their R82 million contract? Was the Minister, as being mentioned, having a relationship with the company? It was a matter that needed to be communicated to the Committee. It was something that was worrying.

The Chairperson said that the Deputy Minister may or may not be able to answer her last question as it related to the Minister. The Committee would be taking up that matter.

Dr Thembekwayo said that was why earlier she said the presence of the Minister was very important. The matter directly involved the Minister and not the Deputy Minister. However, the Deputy Minister was standing in the Minister’s place and would have to give the Committee the status of the matter.

The Chairperson said that it was not the first time that when the Committee was being briefed by a Department some questions would not be answered. The Committee would wait for a response in the event that it did not get an answer from the Department. The Committee was concerned that the Minister was not here, however, the presentation needed to go on nevertheless. The Deputy Minister will cover what he can and whatever was outstanding the Committee would follow up.

Deputy Minister Phaahla appreciated the opportunity for the Department to interact with the Committee on this important engagement. He said that there had been previous briefings where the Minister and the team had updated the Committee on the vaccine rollout. He provided some context. The process of acquiring vaccines had been going on for quite some time. The Department had held engagements with virtually all the manufacturers that came to the fore and made their findings public. These findings included information on the vaccines, the three-phased trials from the laboratory, animal trails and the outcome of the human trials. The Department had engaged with all of those in the market that had made public their findings. The first block of vaccines was the Pfizer vaccine and then subsequent to that, others followed. The AstraZeneca vaccine came next and then there was the Moderna vaccine. There was the Sputnik vaccine from Russian and Sinopharm and Sinovac from China. The Cubans had also been working on a vaccine. As the Department had been negotiating with the various manufacturers it concluded an agreement with AstraZeneca which had delegated the Serum Institute of India as its production company.

The Department was directed by AstraZeneca to conclude negotiations with the Serum Institute which was what happened. The Department purchased a million doses of the AstraZeneca through the Serum Institute of India. That product was delivered into South Africa. AstraZeneca had done part of its phase three human trials in South Africa. Unfortunately, a few days after the vaccine was delivered into South Africa the results of the human trials were released. The results showed that while internationally the vaccine was shown to be effective upwards of 76% in various parts of the world, when the vaccine was tested against the 501Y.V2 variant, which was dominant in South Africa, it was not very effective. It had an efficacy rate of 22%. That was when the problem arose. As a result of that the Department had to either abandon the vaccination programme completely or look at what else was possible. Looking at what was possible the only other vaccine which had been tested in phase three in South Africa and had shown to be effective against the 501Y.V2 variant was the Johnson & Johnson vaccine. AstraZeneca and Johnson & Johnson had done part of their human trials in South Africa. The J & J vaccine was found to have more than 57% effectiveness with the 501Y.V2 variant. The Department immediately entered into discussions with Johnson & Johnson. It was the only other vaccine that had done human trials in South Africa and had shown results with the mutations. It was the only vaccine tested in South Africa during November and December, as part of the trials, when the 501Y.V2 variant was becoming dominant in South Africa. Once the Department had that information it opened negotiations with Johnson & Johnson. It had been submitted to regulatory authorities. It had been peer reviewed and the results were not being questioned. The Department entered into discussions with them to as if it had any stock of the vaccine which was shown to be effective, including against the 501Y.V2 variant. Johnson & Johnson indicated that it had very little stock remaining in South Africa which they used for their human trials. Johnson & Johnson had much more stock remaining in different parts of the world where the majority of these trials were also being done. Johnson & Johnson said that it would be able to, if South Africa was interested, bring in that stock to be used in South Africa while South Africa was waiting for full registration and orders that were being made. The only order South Africa had concluded was for the AstraZeneca. The agreement with Johnson & Johnson was that all those doses which were remaining all over the world, as part of its trials, would be collected and then be brought into South Africa so that it could be used in the meantime while the Department waited for further orders of registered vaccines. That was the context of the vaccines.

It was a matter of public debate as to whether this was a rollout or whether it was research. Technically, and legally, it was an expanded research in terms of human trials because the doses that were being used were the remaining doses from the human trials all over the world. Those were the doses that the Department was utilising. At the time Johnson & Johnson had just concluded its studies which had shown that its vaccines were effective against the 501Y.V2 variant it had not yet required registration with the regulatory authorities including the Department’s regulatory authority which was SAHPRA. Having concluded these studies, it was submitting all the documents for registration. The Department approached the regulatory authority in the country in conjunction with Johnson & Johnson. The agreement was that as long as the expansion of vaccination, which had already started with the phase three trials, would be part of an expanded study, using that same product, then legally SAHPRA would be able to approve that. That was the context of the current rollout programme. It provides protection to frontline healthcare workers because the vaccine was proven to be safe and effective. It was legally regarded as an expanded study because the vaccine was not registered and the application for registration has been submitted to SAHPRA and other regulatory authorities.

The Deputy Minister provided an example of the United States of America where Johnson & Johnson was given the necessary regulatory approval. In South Africa the documentation was with SAHPRA and it was reviewing it. The Department hoped that SAHPRA would give the necessary approval soon. There was no doubt about the safety or the efficacy. The Department had now entered into negotiations for formal procurement from Johnson & Johnson because it was proven to be effective against the variant. The Department had also been finalising other agreements with other manufacturers including Pfizer. The Department was also in agreements with Sinopharm, Sinovac, Sputnik and other manufacturers. That was the context of the rollout programme.

The Deputy Minister said that he would answer questions if the members had any questions on the matter. He then discussed the nondisclosure agreements.

He reminded Members that the Department was dealing with private companies. These manufacturers were private pharmaceutical companies so as much as they were providing an essential vaccine, which would protect people, they were also in business. In buying the vaccines the Department had to enter into a transaction. It was a business negotiation. During a business negotiation it was a common practice that while the discussions had not been concluded the company wanted to enter into an agreement to say that until the two parties agree the Department could not disclose what was being discussed. That was a common practice of a nondisclosure agreement. Government was aware, that as a public institution, using public funds that this issue became a difficulty. Government had to navigate that the parties being dealt with were not public institutions. These were private companies that did business with whoever they wanted to business with. That was the fine line that Government needed to traverse. He said that the Director General would expand on that matter. There were some difficulties that were beyond what was envisaged. Some of the companies demanded that even when the agreement has been finalised that certain aspects of those agreements should not be made public. Government had a difficulty with that and told the companies that was an area which would not be agreed to. Once the commitment has been signed and once there was a commitment to public funds then Government was obliged to report on it. Government made it clear that it would be difficult to agree to certain aspects once an agreement had been signed.

He then discussed the issue of the AstraZeneca vaccines. The Department was at an advanced stage of selling the stock that it had through the African Union. The arrangements were at an advanced stage. The stock of vaccines could be used in many other countries, including on the African continent, especially in the North of Africa where there was no variant. The difficulty was selling the stock to South Africa’s neighbours in southern African where the variant had already been found. The stock would be moving very soon, not as a donation, but as a sale to the neighbouring countries in the continent. The Director General would expand a bit more on that matter.

He discussed the matter of Digital Vibes. The Department was working with the Auditor-General and the SIU. The Director General was in contact with those institutions and was providing any information that they required. The Director General would be able to expand on this matter.

Briefing by the Department of Health on the vaccine roll-out

Dr Buthelezi briefed the Committee on Covid-19 vaccines update. He began his presentation by discussing the matter of Digital Vibes. There were a few contracts that were flagged by the Auditor-General and the Department commissioned a forensic investigation into those contracts. The Digital Vibes contract was one of them. There were another two contracts. The Department would be doing a full report at a later stage on these matters. Digital Vibes was not the only contract that the Department had been probing. The Department shared the work it had done with the SIU. The Department linked the SIU with the specific auditing firm that dealt with Digital Vibes. He was in constant contact with the auditing firm and they were in consultation with the SIU. The Department did not want to pre-empt the investigation. When the SIU together with the forensic auditing firm finalised the work it would be made public. The results of the other contracts that the Department was probing would also be made public. The presentation provided an update on the Sisonke vaccination programme. It detailed the vaccine acquisition pipeline and provided a way forward on the AstraZeneca vaccines.

Ad26.COV2.S Johnson & Johnson Vaccine

The Johnson & Johnson vaccine (Ad26.COV2.S) was tested on 43 783 people from four continents. It was tested on 6576 people in South Africa. The Johnson & Johnson vaccine provided 64% protection against moderate Covid. The vaccine provided 85% protection against severe Covid. The vaccine provided 100% protection against death. The vaccine was safe. No safety concerns from the trial, past trials or rollout programmes. The vaccine was efficacious. It provided excellent protection against severe disease. It was easy to rollout. The vaccine had a shelf life of up to two years at -20°C. It could be stored at fridge temperature for 3 months. It was administered in a single shot. However, the vaccine was not yet licensed.

COVID-19 Vaccinations

According to the latest information 91228 individuals were vaccinated to date.

Negotiations on Vaccine Pipeline

Contracts have been signed with the following:

• The COVAX Facility: 12 million doses (Delivery to be advised)
• Janssen Pharmaceuticals (aka Johnson and Johnson) for 11 million doses starting February 2021.

The Department was in advanced stages of discussion with Pfizer Pharmaceuticals for 20 million doses. Potential cover for 10 million people. Discussions were also being held with African Union Platform to supply vaccines to cover 10 million people. Discussions with other vaccine manufacturers (Sinovac; Sinopharm; Gamaleya-Sputnik V; Cuban Vaccines) was ongoing and dependent on the publication of phase 3 trial data. Janssen Pharmaceutical and Pfizer required indemnification and the establishment of a no-fault compensation scheme as a condition precedent to the contract.

Conclusion

There has been a strong uptake among HCWs on the Sisonke Programme. The vaccination programme has achieved the goal set of 80,000 vaccinations over 2 weeks. EVDS enrolment on target.

There is a steady increase in number of vaccine sites in the country. There will be an expansion of sites to include private sector.

Government has engaged with various vaccine suppliers such as Pfizer and J&J who have made commitments to supply the vaccine over the next 12 months with clear quarterly deliverables.

Negotiations with other vaccine suppliers to diversify vaccine supply and pipeline such as Sinopharm, Sinovac, Gamleya-Sputnik and Cuba amongst others to ensure sustainable, equitable access for all.

Discussion

Ms H Ismail (DA) asked where the local production component of Johnson & Johnson was.

She noted that Aspen pushed a local production line agreement yet South African Airways flew to Brussels and the US to bring in these vaccines at a huge cost. She wanted that matter to be unpacked.

She asked what happened to the Department of Science’s 2013 plan to start a national pharmaceutical company? Why had there been no progress? She wanted the Committee to be updated on that matter.

Ms Ismail asked why the Department did not clarify to the public that the vaccine programme was a trial conducted by the SAMRC. In the presentation it was stated as a process but when the Department spoke to the public it kept on speaking about vaccinations.

In the case of serious reactions to the current Johnson & Johnson trial who would be liable? How much had the Department set aside for such in case it did happen? Could the Deputy Minister provide a list of all stakeholders who originally started with the Johnson & Johnson ensemble trials in the country? She was talking about previously. Which hospitals participated? Has there been any reports of corruption with these Johnson & Johnson trials? She remembered in the Free State it was alleged that ensemble trials were being sold by doctors. Who was administering the current Johnson & Johnson trials in the provinces? Who was ultimately in charge of it? Was it the National Department of Health? Was it SAMRC? Who was ultimately responsible? How was the data from the Johnson & Johnson trials monitored by the Department? How much did this actually cost the Department? Was it possible for the Committee to have access to the electronic vaccination data system for monitoring? The Committee heard that in Germiston there had been allegations of people getting onto the system in the wrong manner. On social media platforms, there are claims that people were able to get on the system even if one was not a healthcare worker. When would the actual vaccination commence given the status of Johnson & Johnson? She was talking about the actual vaccine and not the trials. Has there been any faults or damage with the Johnson & Johnson doses thus far? When would the country access the actual vaccines? How long would the Johnson & Johnson trial going to take? She wanted to know when the special vaccinations would be done. Or was the Department going to say that the trials were actually the vaccines? When would the country know the results of the trial of the Johnson & Johnson vaccine? What was being done to address the South African medical students studying in Cuba?

Ms N Chirwa (EFF) registered discontent with the Minister of Health not attending today’s meeting. The reason was not sufficient enough. Just to state that he was in KwaZulu-Natal because an urgent matter arose was not a sufficient reason. The Department should have provided more detail as to why it was an emergency unless it was a personal emergency. If it was related to the Health Department then the Department could indulge the Committee in much more detail instead of just telling the members it was an urgent matter in KwaZulu-Natal. She said that he was on television a few moments before the meeting doing an interview with Morning Live. If he could show up for Morning Live, then surely he could show up for the Committee? This was the primary reason that was raised at the beginning of the meeting. The Minister was too available for the media and not for the Portfolio Committee on Health. That was why the Committee decided to have fortnightly meetings. It was because of this very conversation. The Minister could not attend a Morning Live interview and not attend a Committee meeting because an urgent emergency arose and then not explain what the emergency was?

She moved onto her question from the presentation. According to the presentation South Africa had received doses meant for research collected around the world. How many Johnson & Johnson vaccine trials did the country have so far? She wanted information if it was 160 000 dosages or if it was more? Were the research dosages paid for by Government? If yes, how much was paid for these dosages? Were they donated? It was concerning that the Department subverted the ethical process of a trial in regard to firstly informing the healthcare workers that were participating in this trial in administrating the application process of participators in the trial. The Department needed to inform the nation that this was a trial. It was concerning that the Department had not done that in the way in which it explained it to the Committee today. In a meeting two weeks ago, the Department told the Committee that it was starting phase one of the rollout of the vaccine. The Department did not cite the issue that it was a phase three trial. The Department did not address this grave ethical issue within the Committee and this was very concerning.

There were many other issues. There were issues following the human based research of the AstraZeneca in South Africa. It was negligent of the leadership of the Department to not liaise with SAHPRA properly and inform the provinces as well that this was a trial. She rose the issue of provinces because yesterday Free State was before the Committee and was waffling about the issue of the phase 3b trial even citing that the FDA approved the vaccine when the FDA was not a South African body. It was stated that SAHPRA came secondary to the FDA. These were the things that the MECs were saying to the Portfolio Committee of Health. She had kept quite because she was dumbfounded by the responses. The MEC and HOD were speaking about the FDA approval when she was asking about SAHPRA approval. It was because the leadership in the Department was complicit in not trickling down information as it should have.

The ration of healthcare workers vaccinated in private versus public hospitals was not reflective of the 15:85 ratio of the people that they cater for. She was curious on what the criteria was for determining how many vaccines were sent to the private sector and how many were sent to the public sector. She noted that the public sector had to care for 85% of South Africa’s population and the private sector only tend to 15%.

The Minister had made a bold declaration in the third week of April 2020. He said that ‘we will only fight coronavirus with facts and evidence-based strategies’. However, this has not been the case. The members were refused race-based demographics despite the fact that they were proven to be a vital aspect of creating response strategies and measuring the real impact of the pandemic. It was enshrined in the Constitution that information held by the State should be accessible to everyone but the Department denied the Committee the information to date. The Department was freely giving the Committee information about the immunity of African people as compared to white people in South Africa but the Department was not able to give the Committee the impact of Covid that was race based. That information was very important as was learned from other pandemics. The Department refused to give this information having had the information. There was no patient who was administered to a hospital or a clinic that does not identify their race.

She raised concern with the collection of data that was reported by the Minister daily of new infections, number of deaths and other information. She mentioned the Eastern Cape debacle where over 400 deaths having been recorded incorrectly over a few months. However, the SAMRC released a statement stating that of the 138 000 excess deaths 85-95% of those deaths could be linked to Covid-19. Yet, the Department’s daily statistics have been updated with that information. That was misinformation. It was fake news. The matter needed to be resolved because the Committee could not have an entire Department coming every two weeks coming and lying. The Department was lying about stats and lying about excess deaths. These were questions the Committee raised because they were important and it saw what was going on. The Department was not giving the Committee truthful information. The Department was not providing truthful information to society as well. The Department provided slides to the public on Twitter but the Department did not make a declaration that there were 138 000 excess deaths of which SAMRC has linked 95% of those to Covid-19.

She said the Minister of Health and Department lied about the Johnson & Johnson phase 3b trial being reported as an actual vaccine programme. These were the assertions of the National Department of Health and provincial Departments of Health. These actions had been deeply dangerous for everyone. She said the interest was never in fighting Covid with facts and evidence-based strategies. The Department rolled out a vaccine that was still being researched but it was speaking about evidence-based strategies and fighting Covid with facts. The Department had not divulged this information publicly. Ordinary citizens had been arrested for fake news but yet there was an entire Ministry doing the same thing. How was the Department going to make sure that facts and a science-based response was the primary focus throughout the process and answer the Committee’s questions fully and factually? The Department should not do PR exercises. Whenever the Department was caught out it would come to the Committee and clarify. The Committee asked the Department these questions a long time ago. The Committee had asked the Department about the nondisclosure agreements but now because it was exposed the Department said once the contracts were signed then it could disclose the information. This had not been the case for the past two months. For the past two months the Department had refused to disclose because it had signed NDAs. Today the Department was managing the situation because it had been caught in a web of lies. The Department had been citing the NDAs as an immunity for its own lies. These were lies. It was fake news. What could the Committee do with an Executive that lies? The Department lied to the Portfolio Committee. The Department lied in the news. It lied in its statements. She called the Department liars. What must the Committee do with the fact that the Department kept coming to the Committee to lie on important issues? It was unacceptable. She believed that was why the Minister could not provide a valid reason as to why he was not in the meeting today.

She then discussed the Department saying it was well on its way with regards to the plan to rollout the vaccine. This was not the case.

Dr K Jacobs (ANC) raised a point of order. He was very concerned about the choice of words used by Ms Chirwa in calling the Minister, Deputy Minister and the Department liars. He was really concerned with what was being portrayed to the public. He could answer the points that she had raised. He said that Ms Chirwa should look at the presentation of SAHPRA of 3 February before bringing up unrealistic and wrongful debates into the public space.

Ms Chirwa asked the Chairperson to rule on the point of order because Dr Jacobs was disturbing her. What was the point of order?

Dr Jacobs responded that the point of order was about the choice of words used by a member of Parliament.

The Chairperson noted the point raised by Dr Jacobs. Ms Chirwa could not generalise and call the Department liars. She was being too general. He asked her to not use that word.

Deputy Minister Phaahla raised a point of order. He assumed the sitting of the Portfolio Committee had the same status as Parliament. The member could not just accuse the Department of lying and get away with it. He wanted the Committee and Chairperson to take up this matter with the presiding officers. This member was carrying on. If the sitting of this Committee had the same status as the main chamber, then this matter had to be dealt with. The Department could not be subjected this kind of vitriol without protection from the Chairperson and the presiding officers of Parliament.

The Chairperson said that Ms Chirwa was generalising using the statement that the Department was lying. He asked her to not use that word and withdraw that statement.

Ms Chirwa said she would withdraw the statement but would replace lying with misleading information or fake news. It was fake news. It was misleading information and it was not the truth. She took back the word lying but she said that the Department did not tell the Committee the truth. It was the same thing really but she understood the problematisation of using the word liars. She would say not telling the truth. She asked if she could continue.

The Chairperson said that she must withdraw lying without conditions. Dr Jacobs was correct to say that maybe the choice of her words was incorrect. She could still make her point but the choice of words calling the Department liars was too general.

Ms Chirwa said it was fine. She still asserted that the Department had not been truthful. The Department, the DG and the Minister have been coming to this Committee and were being untruthful on issues that the Committee had asked questions on. The Department stated that it was well on its plan but this was not the case. The plan was to have vaccinated 1.5 million healthcare workers by the end of March. The current rate was vaccinating less than 10 000 healthcare workers a day. How did the Department progress from 4000 vaccinations a day to 1.5 million by the end of March? The Department needed to clarify the fact that phase one had not yet started. It had not started because the Department was still doing phase 3b of the vaccine trial. It was in the best interests of those participating in the vaccine trial. It was in the best interest of the country. It could not be that the Department was not truthful about such information and presenting information as otherwise on public platforms stating that it started phase one of rolling out the vaccine. The Department knew that it was in phase 3b of the vaccine trial. The Department admitted this to the Committee. Why did the Department cite it as phase one of the rollout programme? The Department needed to update the nation that phase one had not yet started. The Department was still in phase 3b of the vaccine trial and phase one would start at a later stage. It would not be a train smash even after SAHPRA approved the vaccine from Johnson & Johnson. The Department did not need to create impunity from its PR stunts with information that it was supposed to share to the nation. The Department could not be untruthful about such important information. How was the Department going to reach 1.5 million vaccines by the end of March if it was receiving 80 000 doses of the Johnson & Johnson vaccine every two weeks? The mathematics did not make sense. She asked the Department to explain that.

The Chairperson requested that Ms Chirwa start rounding up her questions.

Ms Chirwa wanted to know what happened when people experience adverse consequences to the Johnson & Johnson vaccine trial. What would the response of the Department be? How many traditional healers were participating in the Johnson & Johnson vaccine trial phase 3b? She raised a concern that the private sector was testing more than the public sector. This should be concerning for the Department noting that there had been research done on the fact that poor communities in South Africa who were majority black people were the ones that were getting infected the most. This spoke to a larger issue. Healthcare was still inaccessible. The Department was not doing the work it should be doing in rural and township areas of testing people. People were being put in danger because the Department did not want to release the race-based demographics. The SAMRC had written reports on excess deaths and other matters. The Department needed to fix the issue of testing in the public sector noting that the third wave had also been pre-empted.

Mr Shaik Emam said that it was his understanding that what the Department and SAHPRA had done was unethical. Normally in a trial people were called to participate in the trial. The individual’s consent was asked for in a trial. In this instance the Department had failed to do that. He said that this matter needed to be escalated and if necessary some measures needed to be put in place to hold the Department accountable for this. Many of the people who had taken these vaccines were of the opinion that this was a rollout and that healthcare workers would be protected first. However, the Department did not tell these individuals that they were on a trial. He said what the Department had done was totally unacceptable. The Department had misled the people into believing that this was a rollout of vaccines. He was not surprised that SAHPRA had not even approved this as a rollout but as a trial. SAHPRA failed, neglected or deliberately withheld this information from the South African public by not having told them that this was part of a trial. He said that there were a lot more question marks over the legitimacy and objectivity of an institution like SAHPRA. The Committee was still waiting to hear from that institution who funded it. Who did SAHPRA really account to? Clearly SAHPRA was not as independent as the Committee though it was?

He then discussed the accuracy of the statistics that the South African public was getting. The excess deaths could have run to over 130 000 in South Africa. The matter that concerned him was that some institutions like Discovery who indicated that South Africa could expect another 92 500 Covid-19 from now until December 2021. This was indicated as a result of relaxing the regulations, restrictions and going down to level one. There were super spreaders coming like Easter and other events.

He discussed the rollout of vaccines. The Department was optimistic. It needed to be clear that no one was expecting miracles from the Department of Health. The Department had not performed optimally before Covid-19. It had been in crisis. The Department was not able to rollout 40 million doses of vaccines. The Department needed to give the Committee and indication of what it could actually handle because there was a third wave coming and it was anticipated to be a different variant. This particular Johnson & Johnson vaccine only had a 57% efficacy rate. What would happen if any of these vaccines that was already ordered and would be arriving during that peak period do not work? It seemed as if the Department was treading on very thin ice. It was a very dangerous point.

He then discussed the issue of AstraZeneca. He wanted the Department to be honest because the Committee received conflicting reports from within the Department. When did the Department first realise that these vaccines were going to expire? Did the Department negotiate the expiry date when it procured the vaccines? He heard that these vaccines still could have been used in South Africa particularly with those who had severe Covid. Why did the Department not consider using it for those particular people while it continued with the Johnson & Johnson trial? He understood that the expiry dates still applied to whichever countries the vaccine goes to. It needed to be given in two doses so there needed to be a gap between one and two. Was it going to be effective for those countries as well?

He heard SAHPRA talking about the vaccine being used by the WHO and the FDA. Why was SAHPRA not consistent in that argument? Why has the Department not been in the forefront of looking and reviewing the data of Ivermectin which could also help with the vaccine? SAHPRA had said it would allow it on compassionate grounds. SAHPRA did not have the capacity to deal with the application. A group of pharmacists was taking it to court. What was the reason for the Department showing no interest in the lives of the South African people to want to actually put some pressure to review the data on Ivermectin? Daily there was worldwide evidence that Ivermectin was working. Only South Africa was in absolutely no hurry.

He said that the Department was nowhere near giving out 1.5 million doses by 31 March. Some experts were estimating that it would take 20 years to rollout these vaccines. What advice and guidance was the Department giving the National Coronavirus Command Council in what would be expected in April and May? From what he was hearing there was a crisis looming in a couple of months. South Africa went to level one and looked like it would move to level five shortly because of how serious the problem was going to be in a short space of time.

He discussed indemnity. He knew the Department did not want to disclose all the negotiations taking place. What had the Department agreed to if there were adverse side effects in the rolling out of this trial? What protection was offered to those particular people in South Africa who have been at the mercy of the Department? 

Dr Thembekwayo asked specifically about the Digital Vibes company’s relationship to the Minister. She thought that the Minister was the one who could give the Committee the appropriate information because of his connection to the company. The Committee did not ask about the other two companies and was not interested in them because he was not mentioned there. He was specifically mentioned in this company and she wanted the response from him. That would satisfy her. She asked the question because that matter was a problem. Because he was a Minister and because he was involved there he should have been immediately suspended while the investigation was going on. Why was the Minister not suspended?

When the provinces came and presented to the Committee they complained about the shortages of healthcare workers. How would the Department ensure that this problem was solved? How would the Department ensure that all temporary healthcare workers were employed on a permanent basis to strengthen the system and prepare for the NHI? She received a letter of complaint to say that the Eastern Cape Province have sent out letters to nursing personnel, Cuban professionals and community healthcare workers to say that their contract was expiring on 31 March 2021. It was stated that there would be no further extensions. It was Covid and healthcare workers are playing an important role. She asked the Department to intervene on this matter. The previous day, the House discussed appreciating the important role that was played by the Cuban doctors. It was also mentioned that their contracts were ending on 31 March in the Eastern Cape. They were a brigade of 217 doctors. She asked the Department to intervene and provide a possible plan to address this situation. KwaZulu-Natal Province had extended the contract of healthcare workers by one year. Why could the Eastern Cape Province not do the same? She asked for the Department to provide an answer because she also needed to respond to the public who sent this concern.

She said that there was a possibility of a third wave. What was the Department’s plan for providing the correct vaccine that would be able to counter act the third wave? What were the Department’s plan on the lockdown regulations? There was a possibility of the third wave and what was the Department’s plan for it? It was by time that the Department worked in conjunction with SAHPRA. SAHPRA said one thing and the Department said another. The Department needed to sit down and reflect on what it was doing. It should not rush things. Right now it was not phase one of the rollout it was expanded research. The next thing it would not be expanded research it would be another name that was taken from the WHO. The Department was confusing the country. The Committee was confused so what about the public? The Committee usually did not have the correct answers to answer the public’s questions because the Department was confusing.

How much has the Department spent on the Cuban doctors thus far? Has there been any joint plans with the Department of Education given the reopening of schools? Every year the hospitals around the country receive internships. Some hospitals will give their interns a stipend while some hospitals do not give their interns a stipend. Why did the Department not create a balance and set a fixed stipend for interns in all the hospitals? All these students come from the same institutions. Tambo Memorial Hospital did not pay any stipends for their orthotists and prosthetists doctors. How could the Department help on this matter so that a balance could be created? The same stipend should be received by the doctors there. 

Ms Wilson said she wanted some clarity on the Cuban brigade. The new cases of Covid-19 have been below 1500 cases per day nationally. In light of this what was the situation with the Cuban brigade? Were they going home? Was the Department going to keep them on? What would the Cuban doctors be doing now that the country was in this situation? What were the Cuban doctors costing the Department on a monthly basis?

She had a concern with the vaccine rollout of healthcare workers in far off areas. In Limpopo the vaccines had been delivered to Polokwane. There were areas in Limpopo like Phalaborwa and areas in the Waterberg that were over two hours away from any hospital. Vaccinating those healthcare workers has become a serious issue. Those healthcare workers wanted the protection of the vaccines. Hospitals were unable to transport them to a vaccine centre. All the frontline workers could not be taken at the same time to get the vaccine. It was a concern and she wanted clarity on how the Department was dealing with that.

There was news of fake vaccines being picked up in Gauteng. There was a quick response to that. There were fake vials of vaccine and fake masks. The perpetrators were arrested very quickly. This highlighted her concerns about the disposal of the vials. In her understanding once every vial had been used it would be broken and properly disposed of. Could the Department give the Committee clarity on this because it was going to be an issue in South Africa? People were desperate for the vaccines.

People had been scared of Covid and wanted to get vaccinated and carry on with their lives. She was sure that this would be one case of many. How was the Department going to stay on top of this? How was it going to ensure of the vaccine vials that were used? She brought up the matter of field hospitals. She knew that some of the field hospitals were being taken down. Were all the field hospitals being taken down? If they were not being taken down already then why not?

She thanked the Deputy Minister and Dr Buthelezi for availing themselves for today’s meeting. She was sorry that the Minister was not here but the update given was appreciated.

Dr Jacobs said that the Committee was in a bad situation. Members of the Committee received presentations and did not re-read those presentations. When the members did not understand those presentations they raise the type of questions which they do. Members worded the questions as if they were new worries and concerns. Members also misconstrued what they said on this platform. It was important for this matter to be addressed because it was quite dangerous for members to put their opinions out there that there was a form of misguidance by the Department. That was not true. If members did not reread what was presented before then this meeting should not be the platform to display their ignorance. That was a big concern because the ignorance displayed here was being shown to the public as the truth. It was far from the truth. The Committee had many presentations in the past year on the same topic. That was how long Covid had been around. All the members present had been in presentations by the Minister, the Department, SAHPRA and many other entities which by now should have given them a better understanding of what these matters were all about.

He referred to two presentations made to the Committee. A presentation was given by SAHPRA on 3 February, just a month ago. SAHPRA spoke about the guide to the Covid vaccine. There was a slide on the approved Covid-19 studies. There was a slide on the pharmacal vigilance reporting requirements. That discussed certain vaccines which had been approved and certain vaccines which had not yet been approved. Would it have been proper for the Department to do absolutely nothing after having discovered the 501Y.V2 variant in the country because the Johnson & Johnson vaccine had not yet been approved by SAHPRA? It had been shown to be efficacious. It was shown to be safe. It was shown to be effective against mild to moderate disease. It was 100% effective to prevent death and admission to ICU. In that case what would have the members have said then if the Minister and the Department had done nothing to bring some vaccine to South Africa? The uptake of 80 000 healthcare workers is that there was consent. Does that not mean that there was approval? At the point of receiving the vaccinations there would have been a consent document. There were also the documents given to people explaining the adverse side effects that they might experience and where they should go to have that treated. He was concerned when members came to the meeting and misconstrue things. He raised concern with the types of questions that had been raised in the meeting.

Dr Thembekwayo raised a point of order. She said that Dr Jacobs did not have to respond to what she and other members had said. Dr Jacobs was not part of the Department. Dr Jacobs was a Committee member like the rest of them. Dr Jacobs needed to let the Department answer for itself.

Dr Jacobs said that members had misconstrued certain information.

Dr Thembekwayo said that he should ask his questions.

The Chairperson said that Dr Jacobs should be allowed to speak. He did not hear Dr Jacobs list specific names of members. Dr Jacobs did not mention any names.

Dr Thembekwayo said that Dr Jacobs was reacting to her questions.

The Chairperson said that a member of Dr Thembekwayo’s party was raising a point of order and she was still speaking. He wanted to listen to Ms Chirwa. He asked her what was her point of order?

Ms Chirwa said that her point of order was that Dr Jacobs should retract the statement that members had presented misconstrued information. The Department should not have said there was a vaccine rollout when it was a trial. Dr Jacobs could not say she and other members were misconstruing information. That was not true.

The Chairperson said that that was not a point of order. That was a different view that she held and not a point of order.

Ms Chirwa said that it was not a view. The Department said it was a phase 3b trial today but they did not say that two weeks ago. It was not a view it was a fact.

The Chairperson said that Dr Jacobs should be left to continue what he was saying. She had her own view. Dr Jacobs was bringing in another view and the Committee should listen to him.

Ms Chirwa said that it was not a view. It was a fact. The Department admitted this today. It was a trial and not a vaccine rollout.

The Chairperson said that Dr Jacobs should be given the platform to continue his point without interruptions.

Dr Jacobs said that members did not understand the difference between a phase one rollout and a phase 3b study. These were running concurrently according to his understanding. It had purely to do with the fact that phase 3 studies had been done in South Africa. The vaccine had been shown to be effective against the 501Y.V2 variant. It was important to note this because the facts that the members put out there needed to be correct. He was trying to correct some members with regards to the information that they were sharing. He said the healthcare workers were willing to participate. There would be results from this trial but it would only add to what was already known in terms of the efficacy and the safety of the vaccine within South Africa against the variant in South Africa. It was important to note that SAHPRA told the Committee that it did different types of investigations. One of those was to look at what was already approved in other countries and use that data in order for them to do their studies and approve certain vaccines. The FDA approval was really of great importance to South Africa and for the use of the vaccine within South Africa. There should be no question about that. The AstraZeneca vaccine was also studied in South Africa. It was found that there were challenges with the efficacy of the AstraZeneca vaccine with the new variant. Then it was withdrawn. He applauded the Minister and the Department for having taken this matter forward and brought a vaccine to South Africa that, according to studies, will work and help South Africa fight this challenge. He just wanted to clarify those matters. He said that there were 34 million people to be vaccinated in the near future. There was still a shortfall of about six million doses. What were the Department’s plans going forward to address that shortfall? He hoped that the Department would be able to acquire all of those doses within the near future.

Ms S Gwarube (DA) said that there was great confusion with the difference between the trial, the actual rollout and the various phases of the rollout. She said that instead of throwing jabs at each other as members perhaps this was an opportunity for the Department to clarify. If members of the Committee were slightly confused about which was which, whether the first phase of the rollout in its entirety was a trial and if so, were the healthcare workers aware? What would be made of the second and the third phase of the rollout? When will there be a differentiation between the trial and the actual rollout of the vaccine? It was important that the Department not blame people who did not understand its argument but rather improve the argument itself. She asked the DG and the Deputy Minister to clarify the matter. The Committee was also getting questions from the members of the public on exactly what the rollout was. If the members were equipped to deal with those questions, then they would be able to squash any misinformation that there might be out there as Dr Jacobs had stated. In the presentation there was a clear differentiation between the rollout and the Sisonke study. If the Committee could get clarity on that then that would be useful. She said that there had been varying reports on the rollout of phase two and the third phase of the vaccine. It was good to note some of the agreements which have been signed and the doses that would be coming through in the next couple of months.

The last the Committee heard of a timeline was that some of these vaccines would come into stream in the second quarter of the year. What was the Department’s preparation around the possible third wave which was possible going to be happening around May or June? How would this coincide with the second and the third vaccine rollout? The first vaccine rollout was relatively simple considering that the Department was targeting healthcare workers. The second and the third phase of the rollout was a lot more difficult. The Department needed to make sure that its infrastructure was well and good. The Department needed to reach people as much as possible. What was the timeline considerations of the third wave that was anticipated? How would the Department ensure that it would reach people quickly for the second phase of the rollout? It was good to see that the distribution sites had been added to but ultimately how was the Department getting the primary healthcare system ready to be distribution nodes in the second and the third phases? She wanted to get a sense of the preparedness of the rest of the health system, in a very much localised fashion, on how it would be rolling that out.

She had a question of clarity on the contingency fund which was announced by the Minister of Finance during the budget speech. He announced that there would be a R9 million allocated for the vaccine rollout and the acquisition of the vaccine. There would be R1 million allocated for marketing and allocations. There was an announcement of a contingency amount which would be there to cover any mishaps or adverse events in the vaccination process. How was this being managed?

[The budget speech says: “We are allocating more than R10 billion for the purchase and delivery of vaccines over the next two years. We increase the contingency reserve from R5 billion to R12 billion to make provision for the further purchase of vaccines and to cater for other emergencies”.]

Who was funding it? Was it being funding through the Department? Was this something that was being funded through Treasury? Where were these funds being sourced? What kind of adverse events was the Department anticipating? She then discussed the 9 million and 10 million in total. Did this then mean that the Department had to recalibrate and readjust its target of vaccinating 40 million South Africans by year end? Considering the delays of the vaccine rollout did it mean the Department had to readjust its timelines in terms of the 40 million South Africans target which was set by the Department? Was the money allocated by Treasury going to be enough for that acquisition of vaccines and rollout to be done by year end? She wanted clarity on those questions.

Ms Gela welcomed the report from the Department and the Deputy Minister. She was happy that the Committee had this session of getting feedback from the Minister. The Minister was always briefing the Committee so that the members knew the status of Covid-19 in the country. She was very disappointed with the behaviour that the members, particularly from the EFF, were showing South Africans. She said the Committee would continue to serve the people of South Africa.

Ms Chirwa said that Ms Gela should be concerned that the Minister of Health was involved in corruption and not that the EFF were questioning corruption. Ms Gela should be concerned about that as a Portfolio Committee member.

Ms Gela said that the platform was hers to speak.

Dr Thembekwayo said that Ms Gela should continue asking her questions and should not talk about the EFF.

Ms Gela applauded the good work that the Department was doing to save South Africans. Healthcare workers and doctors were very happy. She believed that the Department would continue with the good work that it was doing to save the lives of South Africans. The Department had procured additional vaccine doses which was to be brought into the country on a specific date. She welcomed the report. She looked forward to the Department reaching the target of 67% of the population as had been promised. She said that the Minister had been transparent with the Committee. She agreed with what Dr Jacobs had said. She said that the members needed to be more educated because time and again the Committee received briefings. The Department had given the Committee reports for the members to go through. She was surprised that today it seemed as if these reports were a new thing. She was surprised that the members said the Department was misleading the country. The Department of Health and the Portfolio Committee was not misleading the country. That needed to be noted. It was those members who were misleading the country because they did not understand the issues that were being faced. The Minister did brief the Committee on the Johnson & Johnson vaccine and what was going to happen with the rollout. She said she would move on from those members because they did not understand issues.

Dr Thembekwayo said that Ms Gela should stop saying that.

Ms Chirwa asked if the EFF members could be respected in this Portfolio Committee meeting.

The Chairperson said that Ms Gela should make her point now.

Ms Chirwa said that there was no point and that was why Ms Gela was not making a point. She added that Ms Gela did not have any points because she did not prepare for meetings. 

The Chairperson said that the members should allow her to finish her point. He asked Ms Gela to make her point.

Ms Gela asked how the Department monitored the current Johnson & Johnson vaccine trial. She also raised the concern of healthcare workers and staff shortages. What was the Government’s agreement with Johnson & Johnson on the vaccine trial? So far the Department was doing very well and responding well. She believed that the Department was going to reach the target of making sure that all the healthcare workers are vaccinated. She was happy with the work the Department was doing despite the criticism that it was getting from other people who were negative. She thanked the Department for the good work it was doing. She appreciated the good work that the Minister was doing. The Minister had forwarded an apology and the Deputy Minister was in the meeting to respond to the issues. The Minister and Deputy Minister were working together and respected the people of South Africa. The Committee could not blame the Minister because he was doing very well. He was doing a good job. He had been at the forefront, with the President, to save the lives of South Africans. She noted the negativity coming from the EFF.

Ms M Sukers (ACDP) said it was evident that the country was wrong-footed on the vaccine rollout. There had been an interchanging of the use of words between vaccine rollout or a vaccine trial. The Committee could not ignore the impact of the lack of clarity at the beginning of giving out the Johnson & Johnson vaccine to healthcare workers. She even struggled to find the right word to use if it was a rollout or trial. She had received messages where healthcare workers were uncertain if they were part of a vaccine trial. The matter needed to be addressed and the concerns of South Africans needed to be depoliticised. The Department and the Committed needed to provide the type of guidance that was needed. The Department needed to acknowledge where the message to South Africans, and specifically frontline workers, had not been clear. This situation could not be politicised. The Department needed to show the kind of moral integrity that was required in this time. The Department needed to own this issue. It needed to be acknowledged that there was a strategic manoeuvring that took place. The Committee needed to say thank you to the people who were working hard to ensure that the bottom does not fall through. She said that the South African Council of Churches had submitted a request that pastors and ministers be considered frontline workers so that they were able to receive the Johnson & Johnson vaccine. Pastors and ministers also wanted to be prioritised for vaccination. Was consideration being given to that request? Ministers of the Gospel were central to addressing the impact of Covid-19 and were continually exposed in communities to people who were sick. She wanted the Department to response to that matter.

She said that the South African private sector was a world leader in strategic sourcing. Other countries had sourced vaccines early and effectively. Did the Department use a strategic sourcing approach? Who in the Department, in terms of profile function, was responsible for strategic sourcing strategies and negotiations with pharmaceutical companies? Were these people strategic sourcing practitioners? In view of the fact that a mass vaccination rollout has not yet begun and that South African would be facing a third wave according to some scientists SAHPRA and the DOH must focus on treatment and care. Despite the initial evidence of the efficacy of Ivermectin, SAHPRA had to be sued to be allow the use of Ivermectin. What steps will be taken by the Department to ensure that potential treatments receive the same priority as the approval of vaccines? It was possible that there would be another wave. The Committee needed to know whether the Department was open for other treatments to receive approval. She discussed people with comorbidities such as people with diabetes and hypertension. Was the Department prepared for the winter months? Was communication upscaled to get people into treatment and to get those comorbidities under control?

The Chairperson said that this Committee was made up of some scientists. Some of the members were medical scientists. He did not doubt the Department’s explanation. He requested that, so that this matter was buried once and for all, in the next meeting when the Department provided an update to bring along Professor Glenda Gray who was the principal investigator on the Johnson & Johnson clinical trial. She was independent and could answer the Committee’s questions. Some of the questions the Department was answering on her behalf. Her presence in the meeting could add value as she was the President of the SAMRC and the principal investigator of the clinical trial. He asked the Department to consider bringing her along the next time the Department briefed the Committee. He wanted to know if general practitioners lined up to get vaccinated was there anything that they needed to pay? How were they contributing to the pool or resources to buy these vaccines?

He said that mine workers were important and would need to be vaccinated. Were the mine owners contributing to the buying of the vaccines? He said that the healthcare workers getting the vaccine were signing their consent. The healthcare workers were comfortable and happy with the consent that they were signing. The consent explained everything on this matter.

The Committee heard about the third wave. He could not remember when the Department anticipated that this third wave would begin. He wanted the Department to take him through the timeline of the vaccination process especially with healthcare workers, people with comorbidities and those above 60. When someone got vaccinated when did it start protecting the person? Was it after a week or after two days or after two hours? How many South Africans did the Department want to vaccinate before the third wave began? He imagined that the Department wanted to protect people from getting severe Covid-19 and from death. Did the Department think it was on track with those critical pool of South Africans who must be vaccinated before the third wave started? By the time they were vaccinated would there be sufficient protection in their bloodstream so that they received a mild strain of Covid-19?

He asked the Deputy Minister and Director General to take the Committee through their responses.

Deputy Minister Phaahla thanked the Committee for the questions that had been asked. He discussed the matter of the vaccine trial and tried to provide some clarity. The Department’s original plan, as the members were familiar, was that by this time it should have been rolling out vaccines which were properly ordered, procured and delivered to South Africa. The vaccines should have been ready to rollout according to the Department’s plans. Phase one was for the 1.2 to 1.5 million healthcare workers. Phase two would be for all frontline workers including people with comorbidities. Phase three was for everyone above the age of 18 would be vaccinated. That was the Department’s original masterplan. Then the million doses of AstraZeneca vaccines were delivered. The Department then got the news that everyone knows as a result of a phase three study done in South Africa led by Professor Shabir Madhi on the AstraZeneca vaccine. It added to other studies that were being done in other parts of the world. The results were released to say that the vaccine which had been delivered was not effective against the 501Y.V2 variant of the Covid-19 virus. The Department could not proceed despite this setback. It could not just ignore the results and go ahead with the rollout. The vaccine was not above the minimum scientific requirement of 50%. It did not meet that requirement of at least above 50% in terms of efficacy. How could the Department proceed when it was not effective against severe illness, ICU and death? The Department had to take a decision in terms of that. It decided to err on the side of caution and not proceed with that vaccine. The Department, at the same time, received another report from the manufacturer Johnson & Johnson of a study that also had trials in South Africa. This trial had a different outcome which stated that this vaccine was more than 50% effective against the variant which the other vaccine was not shown to be effective against. The Department saw that there was a window of opportunity as this other vaccine was shown to be effective in its studies. The Department had to immediately start having discussions with Johnson & Johnson who were the owners of the vaccine and the SAMRC which was responsible for doing the trials in South Africa. The reason that the Department could bring in AstraZeneca, at that time, was because it had already been registered with various authorities and was at an advanced stage of approval. By that time they had submitted all the documents and SAHPRA approved the Department bringing the stock into the country. Johnson & Johnson was nowhere near that process at that time. The only option that was open to the Department to implement phase one, in making sure the frontline healthcare workers were protected, was through the expansion of what already had been approved by SAHPRA. The Committee needed to remember that for AstraZeneca and Johnson & Johnson to do human trials in South Africa they had to apply to SAHPRA to get approval to undertake these human trials. Johnson & Johnson already had their approval for human trials.

He discussed the normal clinical trials that had been done with regards to AstraZeneca and Johnson & Johnson. In the report that the Department received the Johnson & Johnson vaccine was tested on South Africans and it was proven to be effective. This was the only option available to the Department. All that needed to be done was for the Department to approach SAHPRA and expand what had already been approved. SAHPRA already approved for this vaccine to be tested on South Africans and it had been shown to be safe. It was shown to be effective. The only way the Department could expand that protection was through expanding on what already had been approved which was the research trial. The Department had been very open on this matter. Those who were really listening would know that the Department had been very open in this regard. He was not blaming members who were confused because the situation was unusual. The Department took a very unusual direction in order to make sure that a product which has been proven to be safe and effective in the country could be used to expand the protection to frontline healthcare workers. The legally available route was the expansion of the study. Most of the manufacturers would not have done more 50 000 cumulative human trials. What was unusual about the expansion of the trial was that the Department was targeting to reach more than 500 000 South Africans. That meant that more than 500 000 frontline workers would have been protected. It would be unusual because when Johnson & Johnson looked at its study of human trials it would be able to quote a figure of more than half a million. Whereas most other companies would have a figure of between 40 000 to 50 000. The expansion was allowed at the time when the safety and efficacy of the vaccine was no longer in doubt. As the Department moved to the vaccines which were procured as a result of final approval by various authorities even during the actual, normal, rollout of the vaccines the information of those who received the vaccine would be collated. That was why the Department was rolling out the Electronic Vaccination Data System (EVDS). Any side effects would be reported. In a way there was going to be a continuous study even at the time that these vaccines would have been registered. He said that the expansion of the provision of this vaccine to more than half a million people, which was unusual in terms of a study, but this was the only way protection could be provided. Anyone who wanted to call that a rollout or a study was not wrong either way. In normal human studies the trial would not even go up to 100 000 individuals.

When the figure was close to 500 000 would that be regarded as a rollout or would it be regarded as a study? In his opinion both answers were correct. The message might not have been loud and clear. He assured the members that the people who received the vaccine understood it very clearly. It was fortunate that at this stage the Department was not going out to members of the general public. There were healthcare workers many of whom understand this situation on a daily basis. The process was slow and very thorough. When the vaccine was administered the administrators asked questions and people understood that they were part of a study, part of the Sisonke trials. By the time the injection was given to the individual they would have been thoroughly taken through all the information so that they understood what they were going through. He assured members that the more than 91 000 people who had received their vaccination went through all the relevant steps and that there were no shortcuts. He disagreed with those who believed that there was any unethical behaviour. The South African Medical Research Council was fully responsible. The Department of Health was a beneficiary partner according to the agreement that had been reached with Johnson & Johnson. The SAMRC was fully in charge of the expanded study. The Department did the best it could. South Africa was governed by the law and the Constitution. If there were members who believed that there was unethical conduct, then they knew where to go. The Department fell under the Constitution and the law. If there were members who were convinced that the Department of Health, Johnson & Johnson and the SAMRC were conducting an illegal, unethical business then they had the right to approach the various legal authorities of the country to challenge that. He was very confident that the Department would not be found to have violated any law and any ethical conduct. Research and medicine were regulated by various laws and ethical conduct. He was certain that no fault would be found with the Department. He agreed with the Chairperson that the Department should bring in Professor Glenda Gray, who was the President of the SAMRC, under whose auspices this trial was happening. He understood that the members of this platform were all politicians and that there was a lack of trust among politicians. The Department could bring in the specialists and the heads of these institutions. The Committee could question them and they would tell the Committee that no chances were taken with the rollout of this vaccine.

He discussed whether Aspen was doing local production. He explained that the vaccine was not yet in production. Once SAHPRA approved the documents Aspen, representing Johnson & Johnson, will start production in South Africa. The 11 million vaccines that had been agreed to once the approvals had been in place would be produced locally by Aspen. For the current trial period there was around 500 000 Johnson & Johnson vaccine doses would be made available. The Department was in the process of procuring 11 million doses. He said it was very unfortunate language that a certain member of the Committee used. The Department stood by what it had said. It relied on science. The allegations that the Department was peddling fake news was completely unfair and unfounded.

He discussed the number of deaths announced. This was a scientific system. Anyone in the world one would find confirmed, laboratory proven, Covid-19 deaths. All over the world there were reports of how many laboratories confirmed Covid-19 deaths there were. There were other deaths which occurred due to other causes. This did not only arise during Covid-19. Through reporting, either by Stats SA or SAMRC, annually or quarterly there would be total deaths in the country that would be reported which Home Affairs had. There would be deaths that could be ascribed to natural causes or to unnatural causes. Those natural deaths could be ascribed to specific ailments like TB, HIV or heart disease. In the total number of natural causes of deaths in the records of Home Affairs there were deaths which could not clearly be ascribed to TB, HIV or heart disease although they were deaths due to natural causes. It was not known as to what caused those deaths. That was where the studies by the SAMRC would come in with what was called excess deaths. This was over and above what could be allocated to specific causes within the natural causes of deaths. In the current situation of the pandemic all of that was an expansion of this work. It was not specific to 2020 or 2021. This record keeping was done in previous years as well. The SAMRC would look at the confirmed deaths, deaths caused by natural causes and look at the studies to say in a normal year these were the normal number of deaths due to natural causes. The SAMRC would do an assessment according to those statistics. In their own assessment, within the natural category of deaths, they found that there was a variance between what was reported as laboratory confirmed Covid-19 deaths and other deaths which were far above the normal natural deaths. The SAMRC stated that there was no other explanation. The SAMRC assumed that because there was no record of what was the cause it was of the view, in terms of scientific and mathematical extrapolation, that a certain number should be ascribed to Covid-19. It could not prove it because it had not been tested. The Department could not venture when it reported on a weekly basis. It could only report on what was laboratory confirmed. The other records of natural deaths which could not be ascribed to a particular disease was left to the researchers. It was the duty of the SAMRC to report on those deaths every year. The members should not be confused by that. The Department could not report on those deaths because it could only report on deaths which had been confirmed by a laboratory. Anything else would be left to the researchers who do mathematical extrapolations to calculate excess deaths without laboratory testing. He said if members were confused about that matter and called it fake news then they needed more understanding. If the members wanted to they could ask Prof Gray and Prof Abdool Karim more about the science. That was not the terrain of the Department. The Department’s terrain was to report what had been confirmed by the laboratory. He responded to the member who said that what the Department was doing was not approved by SAHPRA. That was not true. SAHPRA had already approved the human trials by Johnson & Johnson led by the SAMRC.

Ms Chirwa said that was what she said; that SAMRC approved the research process.

Deputy Minister Phaahla asked to be protected. Ms Chirwa was interjecting.

The Chairperson said to Ms Chirwa that that was not the way to behave in a meeting. He added that he would not allow her to raise her point of order.

Deputy Minister Phaahla discussed the third wave and the possibility for further variants. That was the invisible enemy that the Department was dealing with. The nature of viruses was for them to mutate. There might be another variant which would give the Department more challenges. There were going to be mutations. Scientists stated that as viruses mutate they got less and less virulent and less lethal. The Department hoped that when there were more mutations the variants would be less lethal and cause less severe diseases. The Department did not know when the third wave would occur. It was anticipated that as the virus mutates that would be around the time of the next winter. As the vaccine was happening all other precautions like the washing of hands, sanitising and social distancing still needed to be in place. The country could not purely rely on the vaccine. The Department was pushing to receive more and more vaccines so that by the time the May/June winter period was reached more ground would have been covered.

He discussed the Department reaching the target of vaccinating 1.5 million healthcare workers by the end of March. That was the Department’s original plan but with the challenges faced because of AstraZeneca the Department was not able to reach the 1.5 million target by the end of March. The Department’s current target was to exhaust the current doses of the Johnson & Johnson vaccine. That would be a figure of over 500 000. Hopefully by then the Department would have received some Pfizer vaccines. By the end of March, the Department was anticipating having vaccinated close to 700 000 people. As the Department was receiving more and more doses it hoped it would be able reach the original target.

Mr Shaik Emam asked the Deputy Minister if he agreed that thus far SAHPRA had given approval on the Johnson & Johnson vaccine for the purposes of trial. The Deputy Minister said that there was an application for it to be considered for a rollout as well. Would the Deputy Minister agree that with the AstraZeneca vaccine the Department did not get approval or authorisation from SAHPRA when the Department ordered it. When it was arriving in South Africa the Department made an application and then SAHPRA authorised it. Then immediately after that it was found out that AstraZeneca was not effective. Based on all of that would the Department blame ordinary South Africans for not trusting SAHPRA and the processes that the Department was following? It looked like SAHPRA was not as independent as it should be. Right now the Department was rolling out something as a trial and only approved as a trial.

Ms Gwarube said the Deputy Minister spoke about how the terms were used interchangeably, rollout or trial. She said it was quite important for the distinction to be made. She wanted clarity that the entire first phase of the rollout of the Johnson & Johnson vaccine was in effect a trial? It would only be in the second and third phase that the Department will then apply to SAHPRA for an expanded rollout of the vaccine where the country would actually start the vaccine rollout.

Deputy Minister Phaahla responded to Mr Shaik Emam’s remarks on the distrust of SAHPRA. He said that the distrust of SAHPRA was warranted. SAHPRA had already given the Department approval. The only approval the Department needed was approval to expand the trial. The expansion was asked during the time when the product was already proven to be effective. That was why it was not difficult for SAHPRA to approve that because it was only an expansion of what was already agreed upon. AstraZeneca was approved by other authorities and SAHPRA had all the documents. The Department had to apply to SAHPRA to allow the Department to bring the product into the country. The issue of the variant was not the principal issue in terms of whether any of the vaccines were effective. It was the original variant of the virus which was the determining factor amongst all the other vaccines. It was helpful that the two vaccines were tested in the country where there was a variant. That was why there was additional information which came later. It was unfair to blame SAHPRA for not having waited to see if the vaccine was effective against the variant.

He responded to Ms Gwarube’s questions. The issue was that Johnson & Johnson had submitted its documentation to SAHPRA for final regulatory approval. Johnson & Johnson would then be given the right to trade in South African and supply to any institution who wanted the product. He said the phase one of rollout was always for health workers. Whether the Department received the vaccine from Johnson & Johnson or any other manufacturer the vaccines would be added to the phase one. Those who had been vaccinated would not need another vaccination. The expanded study was ultimately contributing to the phase one even if it was under the context of a study.

Dr Buthelezi responded to whether the Department was paying for the current vaccines of the Sisonke trial. The Department was not paying for the vaccines. The vaccines were being donated. The vaccines were being strictly managed in line with protocols. Johnson & Johnson and the SAMRC had to take out insurances because that process was not yet a part of the rollout. The no fault compensation would come in once the Department dealt with the commercial vaccines starting with the 11 million that had already been signed for. According to the SAHPRA approval, the SAMRC must oversee this process. The Department trained its own vaccinators that do the final injections but the SAMRC took the overall responsibility.

He then discussed the matter of adverse events. The Department was monitoring if people experienced side effects following the vaccination. There were no serious side effects such as anaphylactic shock which was the worse form of adverse events. If there were any adverse events with the study, there were insurances that the SAMRC and Johnson & Johnson had taken. He said the issue of Ivermectin was still being reviewed. There were a number of court cases that the Department was dealing with currently so it would not want to comment much as the matter was in court. He then discussed the shortage of healthcare workers. That was a serious problem that the health sector was facing. It was not a new problem. It had been there for a long time. The Department did not think it would be able to resolve that issue very soon. The Department was taking a huge cut in compensation of employees so the Department was still seeing what it could and could not do. The Department was going back to the drawing board to try and work on these issues. He discussed the issue of the Eastern Cape that was raised by Dr Thembekwayo. He would follow this up with the Head of the Department. The Department did not currently have details on it so he was unable to comment on it. He promised that the Department would deal with the issue and communicate with the Committee. The information of the money spent on the Cuban brigade would be provided to the Committee because the Department did not come prepared for that in this meeting. He said the Department would follow up on the matter of standardising the internship stipends. The Department would get more details on the matter so that it could give a detailed response to the members. He said the issue of the far-out sites in Limpopo was a general issue in the country. The approval of the Sisonke programme was under very strict conditions. It limited the rollout geographically. The Department was trying to reach as many people as possible. As soon as the Department had the proper approvals and reverted back to its original plan then this should not be an issue. The Department hoped that this would happen quite soon. He said that most of the field hospitals had been taken down or decommissioned. The last one to be decommissioned was the Gauteng one. In the meetings with the MECs there were discussions that the Department needed to start decommissioning these hospitals. There was then the second wave and the field hospitals came in handy to deal with that. The Department would give a full response once it had checked with the provinces.

He discussed the concern raised by Ms Chirwa about the healthcare workers not being informed. The National Health Council was called and this matter was presented thoroughly. The Department had everyone in the meeting. The whole Sisonke trial was taken through by Prof Gray and questions were answered. The Department thought it had covered everything. In addition to that he had chaired the Committee of Heads of Departments. They had several meetings with the administrative heads in the provinces. The Department had meetings with all the unions in the health sector. The Department spent time going through the Sisonke programme so much so that the union leaders volunteered to take the vaccine so that they could encourage their own members. The Department arranged a special session at Steve Biko Hospital for the union leaders to go and take the vaccines. The Department would follow up with the HODs if there was still that narrative going around that they did not have information. The Department tried its best to ensure that the provinces were a part of what was supposed to happen with regards to this trial. He said the letter Ms Chirwa received from the Eastern Cape could be sent to the Department.

He said that the matter of the faith leaders had been addressed. The faith leaders would be part of phase two together with the essential workers. This had been presented in the past to the Committee.

The Department did not have concrete data on the third wave. The Department’s target was to protect as many people as soon as possible before South Africa experience the third wave. Any other additional questions could be sent directly via email.

He discussed how soon the vaccine worked. According to the data from the Sisonke trial the vaccine showed protection after 28 days. Currently, for the Sisonke trial everyone that had been vaccinated had not paid including people from the private sector because the Department was not paying for the vaccines. When the commercial vaccines started being distributed then the Department had a system where people paid either through their medical aids. At the point of delivery, people should not pay. There was a mechanism that the Department was putting in place. It was a reinvestment model that the Department was going to use for people to pay for the vaccines those who were on medical aids and in the private sector. He discussed the mine workers and the mining companies. The Department did have a meeting with the Minerals Council. The Mining companies did want to assist with the procurement of vaccines. The Department was working with them to see how they would be able to pay for their vaccines. Private hospitals would be paying for the commercial vaccines even though the vaccines would have been procured by Government. Currently, with the Sisonke trial that the Department was implementing with the healthcare workers in the mining sector, three of the hospitals had their people vaccinated. That matter was being taken care of.

Dr Anban Pillay, Deputy Director General: Health Regulation and Compliance, DoH, explained some terminology in healthcare research which might be useful for the members to understand. The two terms the Department used often was trial and study. These two terms were not necessarily the same. The term trial was used when an intervention was being tested. That was in the case of a vaccine. A new vaccine, where it was not known how well it worked, was being compared to a placebo. That was called an intervention or a trial. The vaccine would be compared to a placebo because it was not certain whether the vaccine worked or not or how safe it was. Once the trial was complete then there were results which would say that the vaccine was effective and safe. Once the trial was complete another trial could not be done on the same drug. A study would have to be done because it was already proven that the vaccine works. With regards to Johnson & Johnson the phase three trial was to see whether the vaccine works and whether it was safe. It was proven to be effective and safe through the global study with over 43 000 people. Once a company finished that then the product would be registered. Because the product was not registered and the Department wanted access to it the only way the Department could have access to it was through a study. Those doses Johnson & Johnson had available were the doses from the study. In a study there was no placebo because it was already known that the vaccine worked. It was unethical to give people a placebo when a product actually worked. In an observational study everyone was given a product and it was observed how effective the vaccine was in the general community. Very often a product would be rolled out and an observational study would be done at the same time so the two terms were not mutually exclusive. There were a number of examples in healthcare where a rollout and study was done at the same time.

He responded to the question of access deaths. The deaths that occurred in healthcare facilities were the ones which were identified as deaths as a result of Covid which the Department would then report on a daily basis. In additional to that there were people who died outside of healthcare facilities. What researchers, such as the ones at the SAMRC do, was ask the question: where there more people dying now than were dying previously when there was no Covid? If the answer was yes, then they ask what was the excess deaths? The researchers then postulate that these extra deaths were due to Covid. However, one could not be specific and say for sure that these were definitely deaths due to Covid. It was speculated. They were not able to say whether a specific individual had died of Covid. It was just a postulation of what the researchers thought was happening. Every country did this because not everyone died within the healthcare system. Some people died at home and died as a result of Covid without knowing. The Department could not capture those excess deaths in its reporting because they come through much later and it was not known how many were excess deaths. This was done after the reporting and was based on modelling exercises. He discussed the questions on the AstraZeneca vaccine. The AstraZeneca vaccine was only shipped to South Africa after approval from SAHPRA. The Serum Institute was very strict that they would only put the vaccine on an aircraft as soon as the Department showed them the approval from SAHPRA for the vaccine to be sent to South Africa. The AstraZeneca vaccine was not sent and then the Department obtained approval. The vaccine was still in India and the Department had to get approval, demonstrate it to the Serum Institute that that the Department had approval now and only then would they ship the vaccine to South Africa.

He discussed the private sector allocation of the vaccine. 85% of people in South Africa used the public health system and about 15% use the private health system. However, in terms of healthcare workers the picture was very different. There was a higher proportion of workers working in the private sector. In order to make sure that the allocation was fair a higher portion of the doses needed to be allocated to the private sector because that was where people were working. That was the reason for the allocation. The Department had not seen any adverse reactions to date. All of the reactions have been reactogenicity to vaccines which was part of the normal process when anyone got a vaccine. The individual might experience pain in their side, fever or a headache. Those were the main symptoms that people have experienced as a result of the vaccine. The Department had no anaphylactic experiences relating to the vaccine. The Johnson & Johnson vaccine that the Department currently had, as part of the phase 3b study, was a maximum of 500 000 doses which had been committed. The healthcare workers in phase one was clearly more than that. The healthcare workers were estimated to be 1.2 million. The balance of those vaccinations could not be done by the Johnson & Johnson vaccine. Even the commercial vaccines from Johnson & Johnson would be available a little bit later. The Department was going to have to use the Pfizer vaccine to address those gaps. Going forward in quarter two, both Pfizer and Johnson & Johnson would continue to supply vaccines. Between those two the Department believed it would be able to run an effective phase two campaign of vaccinations. Phase two would be for essential workers, the elderly and those living with comorbidities. When the Department was readying itself to rollout the AstraZeneca vaccine the provinces developed very detailed plans on how they were going to deal with this. These plans detailed the sites they were going to use, who were going to be the vaccinators and how the vaccines were going to be distributed. As soon as these Johnson & Johnson vaccines were finished and the Pfizer vaccines would be in the country the Department would revert back to that plan. The Department believed that the provinces would be able to reactivate those plans. The Department already had discussions with them in order to make sure the provinces were ready to deal with the rollout. He then discussed the no-fault compensation system. The WHO, as well as Johnson & Johnson and Pfizer, have indicated that in order to ensure that there was a good uptake of vaccines one had to provide some sort of a compensation system so that the public had confidence if they experience an adverse event that they would be protected in the healthcare system. A couple of countries have had no-fault compensation systems previously. The research suggests that the uptake for vaccines was much better because the public had greater confidence when those systems were in place. The no-fault compensation was meant to compensate for the healthcare costs that would be incurred assuming that there were some adverse effects from the vaccine. Hopefully that was not going to happen because in the trials that did not happen. The fund would then compensate for those healthcare costs as well as any other costs that may be incurred as a result of exposure to the vaccine. In order to do this there needed to be a structure that was set up with an expert panel of people who had to make a decision as to whether these adverse events were linked to the vaccine. If it was then there needed to be decisions on how reimbursement for those healthcare costs might happen and if there was disability how that would be funded. That detail will have to come out in a structured process from Government around regulations for the Department to put this in place. National Treasury would work very closely with the Department to put this fund in place.

He discussed the budget. This was the initial budget that the Department had received. Treasury had made it clear to the Department that if the pace of vaccination increases and the budget needed to increase then during the budget adjustment period there would be an adjustment. This was a priority for the country for a number of reasons so members should not be preoccupied with what the initial budget allocation was. The Department would make sure that it acquired as many vaccines as soon as possible and administer them to people so that South Africa could get over this pandemic. Treasury would make sure that the budget was available to ensure that this was a smooth process.

Dr Aquina Thulare, Technical Adviser, DoH, responded to the question of whether people in the private sector would be expected to pay for the vaccine and how the funds were going to flow. The vaccine would be administered for free at the point of care. Those who did not belong to medical schemes would be funded through the fiscus and the fiscus would ensure that the vaccine was purchased and distributed to sites that were expected to vaccinate through the entity Biovac which was partly state-owned. For those who belonged to medical schemes, Biovac would supply the vaccines to the private sector providers that would be vaccinating. There would be claims against the medical scheme that the members belong to. The schemes were going to pay for the vaccine using a mechanism called the ‘single exit price’. This would go back into the fiscus, through Biovac, to enable the fiscus to purchase more vaccines. For those who were not on medical aid and were allocated to be vaccinated on private sector sites there would be an administration fee that was paid by those vaccinating in the private sector. The cost was in line with the cost of administration and the cost of any other consumables that may be used. The price was between R50 and R60 per episode. If there were other private sector role-players such as the mining sector that wished to vaccinate then they would also purchase the vaccine from Biovac into their facilities. They would reimburse the fiscus through paying Biovac. Should they wish to put in additional funding into the purchase of vaccines there was currently a process that was underway between the Department of Health, National Treasury and Business for South Africa. There would be a final determination of how the private sector would put in funding to augment the fiscus in purchasing the vaccines. The discussions were at an advanced stage and National Treasury would also be guiding the process on how these funds could be deposited into a pot that the fiscus would be using to purchase vaccines on behalf of the entire population. The most important was that even in those activities the Department would want to see the prioritisation of who got vaccinated in phase one, two and three. Those who were more prioritised would not be left behind. The Department would use its Electronic Vaccination Data System to implement the prioritisation. It was important to ensure that as the Department implemented the EVDS that certain information was collected and that included whether the individual belonged to a medical aid or not. This would be captured in the vaccination process and that would be matched with the database from the medical schemes.

The Chairperson thanked the Department and the members.

Deputy Minister Phaahla thanked the Committee for the opportunity to provide the update. He assured all the members that the Department valued their contributions. The Department did the best it could to respond to the points the members raised. If there were any further matters they could be submitted to the Parliamentary Liaison Officer. The Department would do its best to respond to those matters that were not fully covered.

The Chairperson said that in the next update in two weeks’ time the Department should bring along Prof Gray to the meeting to provide additional information and additional legitimacy to what the Department was presenting.

The Chairperson confirmed with the Committee that he was in liaison with the House Chairperson. The Committee meetings were an extension of the National Assembly sitting. Therefore, the rules that applied there should apply here as well. Members needed to be reminded of that. The Committee Secretariat did not have the minutes of the last meeting as they were still being compiled. Next week the Committee would have two items on the agenda. The Committee would be meeting with National Health Laboratory Services (NHLS.) The second item was the Private Member’s Bill that was brought by Dr Thembekwayo. The members would deliberate on that based on the input made by Dr Thembekwayo and the report that came from the Department of Health. SAHPRA would appear before the Committee on 12 March.

The meeting was adjourned.