Minister of Health on roll out strategy for the Covid-19 vaccines


05 February 2021


Meeting Summary

Video: Portfolio Committee on Health,5 February 2021

Audio: Minister of Health on roll out strategy for the Covid-19 vaccines

As previous Committee sessions had not afforded sufficient opportunity for discussion, it was decided that the session would be centered primary around discussion and less on set presentations.

Members raised questions about the late procurement of vaccines, their cost, factors used in selecting suppliers, the efficacy of vaccines on the virus variant found in South Africa, and vaccine scepticism; Ivermectin and if politicians ought to receive vaccines first to dispel public fears about vaccine safety. Questions were particularly pointed about the specifics of negotiations, which the Minister said were confidential but that this did not imply a lack of transparency. He said that misinformation was stoked, at least in part, by the media peddling in "gossip" and that this could have deleterious effects on public trust.

Members asked if the rollout strategy intended the vaccination target of 40 million people to be reached by the end of 2021. They were sceptical due to a lack of healthcare workers, lack of guaranteed supply of vaccines, and almost a month had passed since the rollout plan without a single person vaccinated.

A topic prevalent in the session was the lack of access to vital information or poor timing in its release. Some members wanted the official information before its release to the public so they could field queries from their concerned constituents. Other members said that the scientific community did not support the information on the different phases of the rollout strategy. There was also a lack of clear and measurable timelines. Members requested the Finance Minister join the Health Minister to answer questions on funding, particularly for provincial rollout. They said the briefings by provinces on their rollout plans showed that the provinces were not ready to implement mass vaccinations. Members also wondered how healthcare workers who lacked internet access would register to be vaccinated. The Minister indicated that the Department would look into these "gaps" and assist provinces to prepare. He advised that many healthcare workers had already registered for Phase 1 vaccinations and their institutions would assist with digital registration.

Meeting report

The Chairperson noted the Members had received the presentation two days ago. Due to time constraints, the oral presentation should be 15 minutes to give more time for discussion. The Minister had requested to be released 15 minutes before the meeting ended. 

Mr van Staden (FF+) asked if they could proceed directly to the discussion. The Committee already had the opportunity to go over the report and would rather the Minister answered all the questions that Committee members had. 

The Chairperson agreed. However he would give the Minister the opportunity to make opening remarks with the Director General to provide context for the presentation and discussion. He hoped that the Committee would be able to have a second round of questions. 

Mr van Staden reiterated that his concern was that if the presentation went on for too long the Committee would not have sufficient time to have their questions asked and answered.

The Chairperson told the Minister that he had been seeing media reports of PPE scandals and he hoped the Minister would see to it that this would not reoccur with the vaccine rollout. 

He was grateful that the Committee had received the presentation two days prior and that therefore the Committee would proceed straight to discussion after short introductory remarks. He asked members to send through their questions so that they could be answered by the Minister.

Health Minister opening remarks
Health Minister Zweli Mkhize said he would keep his opening remarks short. Monday 1 February was an exciting day when the country had received its first consignment of vaccines. The Ministry of Health has made it clear that for this pandemic the major resource for prevention was the successful provision of vaccines to create herd immunity against the virus which was quite virulent” in some instances. This would alleviate pressure on the country’s healthcare system.

The Minister said that it was very difficult to manage the distribution of vaccines as the global demand was similar for every country. The demand was happening at the same time for every country which created its own difficult dynamics. Nevertheless, South Africa was still on course and had not lost any time. The country could expect to receive vaccines during the next 10 to 14 days and thereafter it would proceed with its vaccination rollout programme. He reminded the Committee that not all the vaccines results were out yet. For this reason the government had to tread carefully in how they proceed with the rollout of the vaccine programme. The government was still committed to vaccinating 40 million South Africans. The government would do everything to ensure that vaccinations took place despite the difficulties inherent in global supply. Even countries who paid far more for vaccines were still waiting for them due to blockages in global supply. South Africa had seen an increase in the incidence of vaccine nationalism where countries such as the US and UK had barred the export of vaccines. Nations barring the export of vaccines was a worrying concern as they were holding onto vaccines until their populations needs were met first. 

The President had constituted and inter-ministerial structure headed up by the Deputy President to oversee the vaccine rollout. This inter-ministerial structure would be constituted by various subcommittees which would be involved at various points of the process. 

Linked to this inter-ministerial committee, the Director General would set up another governance structure which would bring together the private sector, civil society and labour to coordinate in assisting with the implementation of the vaccine rollout plan. 

The current vaccines were stored at BioVac. The Department of Health (DoH) would identify certain centres around the country where future vaccines could be stored in the requisite cold chain storage facilities to ensure adequate preservation and security. 

All provinces had produced their rollout plan ready to vaccinate people. In the course of all of this there are a number of health workers which had been trained for this purpose. They were also engaging stakeholders such as religious leaders, traditional leaders and civil society to explain to them the role which the department wished for them to play.

The Department wishes to continue to get support from the Ministerial Advisory Committee. In terms of further steps and also of any new information which might become available. The distribution plan was not going to be a smooth process and mistakes and missteps were to be expected, along with challenges and unforeseen obstacles. This should be taken in stride as they continue to implement the rollout. When DoH comes across a challenge, they were not going to announce that the plan was a failure but rather address the challenge and move on. Examples of such challenges could be observed in other countries where there were reports of breakdowns of the freezers or vehicles transporting the vaccines. 

DoH was still committed to vaccinating healthcare workers in the first phase. The term 'healthcare worker' would cover everyone who deals with sick people including hospitals as well as those working in universities, research bodies, traditional healers, clinics and the like.

DoH had launched the electronic vaccination registration system which has already seen the registration of about 68 000 healthcare workers. This meant that the uptake was quite good”. He deduced that from a healthcare worker point of view, the uptake would be very successful. 

The second phase included all those who were in the front line”. This group included teachers, police and all those servicing communities. This group also includes those with co-morbidities. These two phases worked out to about 16.5 million people. The first phase would take about three months and the second phase about six months. The last phase should take about three or more months depending on supply at that time. 

DoH had engaged a number of platforms and manufacturers to get the vaccines and the 1.5 million vaccines that had been received from the Serum Institute of India had already been paid for.

Final agreements were in the process of being finalized with specific delivery dates and amounts per batch. In terms of the agreements there was another 9 million vaccines expected from Johnson & Johnson, 20 million from Pfizer, and 12 million expected from the COVAX facility. Altogether no less than 26 million people's vaccines were already assured”.

Over and above this, DoH had already identified a source for further vaccines which would be announced once the appropriate agreements were finalized. The presentation may have referred to a shortfall but in reality sufficient supply was dependent on the finalisation of agreements. This is in process. Thus it is not as if DoH is unaware of from where they will source further vaccines; negotiations are ongoing at present. 

DoH was already in discussions with a few other suppliers including SinoVac and SinoPharm in China; they had been very supportive and wanted to offer their help. South African scientists were currently working with them, along with other potential suppliers. DoH was already engaging with Moderna and other major suppliers but have not signed any agreements with them. He reiterated that where no concrete agreements have been signed, DoH would not comment on these until the appropriate time.

DoH had been engaging with medical researchers who had the facility to store vaccines to -70 degrees. The private sector had also indicated they are interested in assisting where possible. DoH would put out an open bid which would come out either today or tomorrow for future purposes. The 1 million AstraZeneca vaccines stored by BioVac did not require such facilities. He reiterated that DoH was still on course and the current vaccines had gone out for testing and quality control and the results should be back in the next few days. 

Each province has got its own areas where they would store their vaccine supply. Maps in the presentation indicated from where they would be distributing the vaccines. These maps go right down to district hospitals and clinics. There is a lot of coordination going on in the private sector. DoH is working very well with the private sector. For the purposes of the national rollout plan government was doing central procurement and then supplying both the private and the public sector for distribution. Another form of support from the private sector was from Business South Africa as well as expertise through Nedlac. 

There was a focus within the inter-ministerial committee on South Africa's capacity to manufacture vaccines locally. There are a number of countries who have indicated their willingness to work with South Africa on this. 

The main focus was on the limitation of potential risks. On the procurement side, the risks were much less because only National Treasury and the Health Department would be procuring. DoH was aware that there were a number of vaccine offers but if it does not come from the original manufacturer, DoH was still willing to see what was on offer and called suppliers to come forward. DoH would then validate these supplies and verify the authenticity of what they were offering. He stressed that it was essential to ensure that the quality and safety of vaccines are not in doubt.

The Minister said the area of logistics needed attention since it is the area with the greatest risk of fraud since it involves contractual matters. DoH is also working with the Auditor-General who had provided some ideas on how to prevent such misconduct. There had been some interest from other bodies such as Corruption Watch on what was occurring and DoH was committed to a transparent process.

There was a risk assessment analysis process under the direction of the inter-ministerial committee. DoH was working with various organs of state to intervene and assist DoH should it suspect or acquire evidence of malfeasance. Theft on the ground also had to be taken into account. Since vaccines are going to be free to the recipient as medical aids and the government are paying for them, there should not be anyone selling vaccines. The fact of there being no payment for the vaccine by the recipient means the black market would be less likely to get involved. Security for the vaccine was going to be a major focus of the Department. 

The Minister hoped Members would also give some ideas of what they think ought to be done. One interesting debate was whether parliamentary leaders should be vaccinated as part of the first phase. There were lots of myths and misinformation and it might be useful to boost public confidence if political leaders stepping forward to be vaccinated first thereby setting an example.

The Chairperson thanked the Minister. Since his last update the Committee had been receiving briefings from each province on readiness to roll out the vaccine. The Committee had been briefed by Western Cape, Eastern Cape, KZN, Gauteng and Limpopo. The Northern Cape would make their presentation on 10 February. The provinces whose plans came later were stronger than those who presented their plans earlier. 

Ms H Ismail (DA) asked the Minister why vaccines were procured so late. South Africa was expected to reach the third wave by June or July 2021. She asked how the country was going to reach herd immunity by then. It was sad that South Africa was going to lose more lives due to government delays in procuring vaccines. She asked for the total amount paid for the procurement of all the vaccines mentioned. She asked if South Africans from all walks of life were included in the vaccine trial programme. On what basis were the suppliers of vaccines chosen and the factors used for selecting suppliers such as price and availability.

She asked how effective the vaccines are against the variant of the virus in South Africa. She asked for a full report on the donors of the vaccines. Many South Africans were sceptical about the safety of the vaccines – how sure is the government that the vaccines were all safe? The Serum Institute of India was a private company and the government had paid more than double the price for vaccines. She asked if there was not an alternative, more cost-effective option. She asked why the vaccines could not be sourced from Aspen directly. How far was South Africa in developing its own vaccines locally? Now that SAHPRA has agreed to the controlled use of Ivermectin, where would government source the product and if there would be a single exit price for Ivermectin. She asked if DoH would consider setting a fixed price for it to prevent an influx of different prices. She asked if all vaccine sites were adequately equipped for cold storage. This was important because of the power outages prevalent in the country. 

The Chairperson said Members had to be considerate of others wanting to ask questions. 

Ms Ismail asked if there were to be clinical trials for the use of Ivermectin in the country. There were social media reports indicating that vaccines were not safe and had adverse effects on people living with HIV. She asked what the Minister was doing about this. 

The Chairperson said he wished to have a second round of questions and therefore they needed to be considerate of others. 

Mr A Shaik Emam (NFP) said as a community leader he had no problem with taking the vaccine if that would mean reducing the level of doubt about its safety. He asked if it was not more appropriate to advise the Committee on developments first before statements were released to the public. He asked why DoH was procuring vaccines from suppliers before SAHPRA had issued an authorisation for purchase. No authorisation had been granted for the purchase of any vaccines. He asked what was the rationale for purchasing from Aspen and Johnson & Johnson whose vaccines had a lower efficacy rate. Whilst the Minister was providing plans, various provinces were still querying how the implementation would be funded. The Western Cape, for example, was looking for R1.7 billion and did not know from where it would get this. Given the agreements between government and the suppliers were confidential and the development and rollout of the vaccine was brand-new, who would be liable if something went wrong with the vaccine in terms of its safety?

On the tracking system, he asked if government would track those who had received the vaccine to monitor if they experienced major side effects. What processes were in place to ensure people could access Ivermectin which had been proved to have no side effects over the years elsewhere?

He asked if the vaccination would be an annual vaccination after everyone had received it initially, like the flu vaccine. There were reports that the AstraZeneca vaccine was not safe for use for persons older than 60 years and that countries like Germany had banned its use for senior citizens. He asked the Minister for assurances that the vaccines were effective and safe so that political leaders could go out to their communities and tell them that the vaccine was undoubtedly safe. 

Mr P Van Staden (FF+) asked if there would be sufficient healthcare workers to administer vaccines and if a full report could be made available to the Committee on this including the number of healthcare workers available in each province to administer vaccines. The presentation referred to a shortfall in healthcare workers to administer vaccines and asked the Minister to explain how this would affect the rollout plan to vaccinate 40 million people by the end of year. DoH was already running behind with the 1.5 million vaccines from the Serum Institute of India which could be used to vaccinate only 750 000 people. 

He asked the Minister for assurances there would be no corruption in the tender process for the distribution and administration of vaccines. He was glad to hear that the tender process would be open and hoped that it would stay that way. 

He asked how government would monitor those citizens who could not register for vaccines online since most South Africans did not have access to internet. As of October 2020 only one million citizens had accessed the Covid-19 app out of 60 million citizens. 

He asked if it was safe for citizens to receive different vaccine types for the first and second doses. If it is not safe how is government going to ensure that each citizen who received one vaccine from one supplier received a second vaccine from the same supplier. 

Some scientists had said the vaccine would not be successful while other scientists intimated that the vaccine would be successful. He asked the Minister what his point of view was on this matter. He asked the Minister what assurances could be given that the Covid-19 vaccines were safe. If they were not efficacious, would the Minister himself approach SAHPRA to legalise the use of Ivermectin? 

Mr van Staden asked again if it was reasonable for government to have a goal of vaccinating 40 million people by the end of the year given the new dates from DoH and the Presidency. The Minister had previously said 316 000 vaccinations would have to be administered daily to reach 40 million people by year-end. This target had already been missed by 29 days given current delays. He asked when exactly each province would start administering vaccinations and if they would start on the same day.

What safety precautions were being taken to prevent the theft of vaccines? If this could not be provided in this forum, then the Minister should provide a written report with specifics. 34 000 healthcare workers had already registered for the vaccine but how many healthcare workers had yet to register for Phase 1. He asked how DoH would help healthcare workers who did not have the time or internet access to register for the vaccine. He requested specific dates for the start of phases 1, 2 and 3 of the rollout plan. 

The government had demonstrated time and again that it was too incompetent to manage the administration of a task of this magnitude. Government had to include the private sector in the administration of the vaccine to ensure that people do not have to wait to get vaccinated. 

He asked why government would not permit provinces such as the Western Cape to procure vaccines themselves to allow people to exercise their right to be vaccinated.

Dr K Jacobs (ANC) wished to register a point of order to take exception to what Mr van Staden had just been saying about the provinces. 

Mr van Staden said he was merely asking the question which was on the mind of the public given there had been rampant corruption during the PPE procurement and other reports of corruption which were already in the media. It was important that the public should know the answer to questions such as these.

The Chairperson indicated that Members had each been asking a large number of questions. He did not want to stop Members from asking questions but wanted to afford the opportunity to others who had yet to ask their questions. If there was to be a second round, those who had already asked questions would be placed at the bottom of the list in the second round.

Ms E Wilson (DA) asked her first question [which was inaudible due to poor connectivity]. She asked for the cost per dose from AstraZeneca. Belgium, Switzerland and Norway had banned the use of AstraZeneca vaccines for a myriad of reasons.

Given the details in the presentation, the South African government would vaccinate only 36.2 million people by January 2022 which is well below the required level for herd immunity in the country. On the current trend the country would run into a problem since the number of people to be vaccinated each month would be unacceptably low. She asked why the bulk of vaccines was coming from Pfizer which was the most expensive provider.

There seemed to be a lot of purchases from COVAX and asked which vaccines specifically would be procured from them.

The Committee had received presentations by the provinces which were wholly unprepared, especially as regards distribution, storage and data management. The government could not hope to achieve their goals when these systems were not first in place. 

She had concerns that the tender processes underway would not be properly managed. 

She requested that reports be made available how far government was in vaccinating the population in the same manner reports were made about infections, deaths and recovery rates.

She was concerned that the Committee had not received the data and reports which the Minister had been using in his webinars to the public. The Committee should have access to such data before such public webinars occurred. One of the reasons it is important is because the public contacts their parliamentary leaders about reports. Members are not in a position to provide answers to their constituents as they do not received the webinar documents used by the Minister.

Ms N Chirwa (EFF) said there was insufficient scientific support for the rollout strategy, especially for phases two and three of the plan. The strategy was not cognisant of the social circumstances of the country such as senior using private transport versus seniors who use public transport who are more at risk. DoH should devise a strategy which recognises these differences. The rollout strategy for people living in rural communities cannot be the same as those living in urban communities. 

She said insufficient information was being communicated to the public and even Members of Parliament. Public concerns about vaccine safety are due to lack of official information. One of the pillars of DoH is to educate the public to prevent the transmission of disease. The health education of the public was not being done effectively and that this should be looked into.

The government had not taken international patents into account especially as there was discussion to localise the production of vaccines. She asked for the position of the South African government on patents. She wanted specific dates of when government planned to initiate the local production of South African-made vaccines. 

She suggested that government was neglecting the public production of vaccines by instead focusing on its partnerships with the private sector. In June 2020 the Minister had said he was dedicated to helping the public sector manufacture vaccines but had since been more focused on the partnership with BioVac, a relationship which has been in operation since 2003. The government was not doing enough to ensure that state capacity was being built. 

Ms S Gwarube (DA) said that while presentations and webinars were welcomed this does not replace the need for a tabled codified strategy for the vaccination rollout. DoH was obligated to provide a formal plan which indicates clear timelines, cost of vaccines, manufacturers approached, instead of drip-feeding” the information and saying that government is unable to provide detailed information for various reasons. One reason clear and concrete information is essential is so Parliament can hold government to account. This lack of information also fuels misinformation in the public sphere. 

She asked, given the second tranche of the AstraZeneca vaccine would arrive only in March 2021, if those healthcare workers who received their first dose would be able to receive the second dose within the prescribed time frame. 

On the Pfizer vaccines having stringent requirements for their storage, did the provinces have adequate cold storage facilities?

The rollout of the vaccine in the first phase appears to be more manageable than it would be in the later phases. Gauteng was not ready to roll out to the general public due to challenges such as IT infrastructure and cold storage facilities. She asked if there was a risk mitigation plan in place to deal with such issues.

While DoH indicated that they were on track to meet the rollout strategy goals, a letter issued by Treasury indicated that DoH applied for the procurement of vaccines only on 6 January 2021, a process which should have started already last year. In light of this, was government still confident that it would meet its goals by the end of 2021?

Dr S Thembekwayo (EFF) said that there had been a request by the EFF Chief Whip that the Minister of Finance accompany the Minister of Health to this meeting. However, this request had not been honoured. She asked why as there were many questions on the rollout strategy costing. She asked the Minister for the estimated cost of each phase of the vaccination rollout and how each phase would be funded. If the Finance Minister had been present, he could have assisted him in answering these questions.

She asked the Minister what safety guarantees were in place for healthcare workers living with HIV. She asked what measures were in place to detect side effects and inefficacy of the vaccine.

Security measures were important. She asked what extra measures were put in place to prevent fraudulent vaccines” from entering and leaving South Africa.

She told the Minister that while she accepted that DoH was ready for the vaccine rollout, it was nevertheless evident that individual provinces were not ready.

There were reports that South Africa was paying more than other African countries as well as European countries for vaccines. She asked why this was the case and what assurances the Minister could give that South Africa would pay less for vaccines in the future.

The Chairperson noted that he had received a letter from the EFF Chief Whip requesting that the Finance Minister be present at the next meeting. 

Dr Thembekwayo interjected saying the Chairperson should inform the Committee of this later due to the limited time available for the Minister to answer questions. 

The Chairperson said he just wanted to indicate that he wished to invite the Minister of Finance to appear before the Committee alone as it needed time to ask the Minister pertinent questions.

Dr K Jacobs (ANC) expressed his general satisfaction with the presentation and the work of the DoH. Most questions asked by his colleagues were answerable by referring to that presentation. 

He wished to emphasise how the disposal of waste products would be undertaken in South Africa, especially used vials. Used vials were being fraudulently filled with saline and issued to unwitting members of the public in countries such as China. 

Although the vaccine had arrived in South Africa, the public should still be made aware that the country is still in the midst of the second wave and that measures should be maintained to prevent the spread of the virus.

Mr M Sokatsha (ANC) asked the Minister where public representatives stood in terms of being vaccinated. He agreed with the Minister that public representatives should come forward to be vaccinated first to show the public that the vaccines are safe. He asked where South Africa was in its research capacity for the production of vaccines locally.

Ms A Gela (ANC) thanked the Minister and expressed her general satisfaction with the work of the Minister and DoH. She asked how South Africa was doing in the global competition for the procurement of vaccines given the high international demand. She acknowledged that everybody in the country should be included in the plan to be vaccinated. She did however want to confirm with the Minister whether children—especially those with co-morbidities—would be vaccinated. 

Ministers response 
Minister Mkhize said questions which were answered one way today could be answered another way tomorrow. This was due to the continually changing variables about the pandemic. He wanted to be upfront with Members, telling them that he did not expect the plan to run smoothly. There would always be areas where the targets needed to be revised and this is mainly for two reasons: variability in the delivery of vaccines and logistical challenges which Members had indicated had been raised by the provinces. It was a very large implementation programme and to think that every part of the plan would be followed without any challenges would be very misleading.

On how South Africa was dealing with global competition, the matter was very difficult because if no contract was signed with the manufacturers there was no guarantee that you would get a vaccine consignment even though it may have been set aside for delivery to the country initially.

On South Africa producing its own vaccines, this was going to be a long process but government was "eyeing” both Aspen (a South African company) and BioVac as partners of government. The inter-ministerial committee would look into other initiatives government will have to enter into to produce its own vaccines. South Africa has in the past been able to manufacture its own vaccines albeit not necessarily for humans but for animals. He believed that the expertise does exist in the country for local vaccine production. It was important that government focus on building this capacity. That very morning the country had been looking at offers from other countries who were looking into this. Building capacity for vaccine development would happen over a long period and if there were developments in this area, he would communicate these.

On data registration and management, there were quite a number of healthcare workers who had already submitted their registration. About 160 000 people had already registered. Obviously this was a trial run for government to have a sense of how many people wanted to get onto the system. Those who are unable to access the internet to register themselves, their institutions would be able to account for them and assist in registration. 

On South Africa paying more for vaccines, many manufacturers look at different countries on the basis of whether they are low or high income countries. On this basis they determine what price to charge. The second criterion they look at is if the country was involved in the investment into the development and manufacture of vaccines early on. So the manufacturers will look at how much the country contributed to the manufacture of vaccines in the development stage. This is what has happened in the US and in Europe. Another factor is bargaining based on economies of scale. Still other countries depend on donor finance to finance the purchase of vaccines. South Africa may be able to take advantage of a pricing structure that is available through the African Union platform.

When DoH receives questions on why South Africa did not engage in bilateral negotiations, the answer is that South Africa would have paid more on this basis. Platforms are being utilised. Where South Africa can make use of bilateral arrangements, we would make use of it. The price South Africa paid for the AstraZeneca vaccine is the same price that Brazil paid. In other countries prices will vary depending on how much investment they made. In the case of Pfizer, we could enter into negotiations with them on the basis that they had undertaken research in South Africa. On this basis they had to acknowledge that South Africa had made some contribution to research and development of the vaccine. Most discussions have to be kept confidential until the arrangement has been concluded. 

On the readiness of provinces, the National Department of Health would be engaging with each province to assess where the gaps are. 

There is a process called the detection of adverse effects after immunization as part of the monitoring process. Everyone who has taken the vaccine can report if they are experiencing adverse effects. This would help DoH to deal with any untoward effects which arise. 

On the reports supplied to the Committee, DoH takes the point and sit down and determine what additional information was required. However he would refrain from referring to these reports as “drip-feeding”. One reason is that DoH comes before the Committee only upon invitation. Members of the media often pose questions to DoH. For this reason sometimes the demand for information cannot wait until DoH has already informed the Portfolio Committee. If there was a way of closing this gap, DoH would be happy to deal with it. 

On the timelines for administration of vaccine doses, more doses are expected but this information cannot be made available until the agreements are finalized. He assured the Committee that the second doses will be administered within the required time. Initially the second dose had to be administered within 21 days of the first dose. Upon correspondence with UK counterparts, it has been determined through research that doses may be administered 42 days after the initial dose. In some cases they have stretched the administration of the second dose to three months after the initial dose. It is important that a person who received a vaccination from one brand receive the second vaccination from the same brand. 

DoH was not worried that South Africa does not have adequate facilities to store Pfizer vaccines as it has determined there are adequate facilities and capacity. All DoH needed to do was to build its capacity as it goes along. 

It was important to raise behavioral change and acceptance of the vaccines. There are cultural issues, concerns, fears, the difference between urban and rural and so on.

The question of patents was being handled at the level of the World Health Organisation. However, patents will not stop South Africa from investing in its capacity to develop vaccines locally. South Africa would work with the rest of the African continent to develop local capacity. 

On the cost of the AstraZeneca vaccine, he noted the transport cost was incorporated into the price. The primary reason DoH was buying the way it was is due to availability which is the primary criterion. There will be no need to worry about the availability of vaccines in December 2021 due to the expected level of production at that point. Another 500 000 AstraZeneca vaccines arrive during February 2021. They were expecting other vaccines to arrive but he will make more information available when those agreements have been concluded. As vaccines become more available, they would not wait for three months to start the next phase but would start with the next phase concurrently. For this reason some of the phases in the plan may start earlier. The Committee needed to understand that there is no reason that government would slow the vaccination process down on its own account. 

On the high cost of Pfizer vaccines, government had negotiated the price down. However, as Pfizer was offering greater availability this meant a higher price. On this basis, government had to think very clearly about what it was able to do. The question was "should we avoid getting a vaccine consignment because it is expensive when it is in fact available? This question must be asked in the context of vaccine efficacy which in the case of Pfizer is acceptable. The answer was “no”. 

COVAX would let DoH know which particular vaccines they have available. They were the ones who determine what is available and it is based on what they have ordered and if the countries in question would be able to manage the conditions under which the vaccines have to be stored and transported. COVAX had said to DoH that they would be able to procure about a billion vaccines. This bodes well for other countries which are more dependent on donor vaccines than South Africa. DoH has approached COVAX to find out what vaccines are available to South Africa but COVAX is also constrained by exigent factors. 

On regular vaccination reports similar to the reports on statistics for Covid cases and fatalities, the Minister replied that DoH was working on such reports.

On allowing the Western Cape to go ahead and purchase its own vaccines, if this question was posed in the context of suggesting that the ANC was procuring through corrupt practices then the question was out of order. However, to address why a province might not be successful in procuring, the Minister replied that the procurement process is quite complicated such that it would be difficult for a province to procure vaccines unilaterally. If a province is asking to procure vaccines on its own, what they are inadvertently requesting is for Treasury to allocate from the budget to each province individually – this would be more conducive to corruption. Also, manufacturers would have to deal with nine separate procurement offices rather than just one central procurement office which makes the availability of the vaccine precarious. A third problem for provincial procurement is some of the provisions required in the agreements with manufacturers are such that only the national government can assent to them. There are certain forms of authority that the Constitution does not permit provinces to exercise. A manufacturer will be reluctant to agree with a party within a country without first consulting the national government. These are the practical problems which prevent successful provincial procurement. 

He told the Committee that the original dates assigned to each phase would undoubtedly change and that the Committee ought to give DoH sufficient time to get back to them once final dates have been established in accordance with changing variables. 

The Minister said he will leave the questions on Ivermectin to the Deputy Director-General.

On the safety of the vaccines, the Minister said in any such situation a few things should be expected of therapeutics. Firstly they have undergone rigorous scientific analysis to establish the level of safety. In this case the scientific analysis had established safety. There would not be any procurement if safety was not established. Secondly, there is the question of efficacy which will become very important as there is a high degree of efficacy variation found in different vaccines. Even the same vaccine may show different levels of efficacy under various conditions. DoH would therefore look very closely into this. 

On corruption, he invited Members to report corruption when and where they detect it. 

The Minister welcomed Members’ offers to come forward to take the vaccine first as an example to their constituencies.

On why one would procure a vaccine with lower efficacy rather than another, the Minister replied that as long as the efficacy is acceptable as established by the World Health Organisation, then availability should take precedence over efficacy. There is a limit to how far this can be taken.

The Minister said that confidentiality is standard in any commercial transaction. When transparency is spoken about it should not be “conflated” with non-confidentiality. Transparency means government is able to explain why it made certain decisions and under what conditions. That does not entail that government should go out in public explaining every detail of the negotiations. That is the nature of negotiations and that is why it is confidential. But there's nothing devious about confidentiality. Government may not wish to enter into an indemnity agreement, for instance, but due to the fact that every other country is doing it, not to do so would be put obstacles in obtaining the vaccine order. Lots of agreements are preceded by much negotiation which does not come out into the public. However once a decision has been settled upon, government may explain why a certain agreement was entered into. 

It is important that where people die after taking the vaccine, one must take note of the tests administered to establish the cause of death. It does not entail that the vaccine was the cause. Association does not mean causation.

When power shortages occur, hospitals have generators which we expect to kick in when there is an interruption of electricity. Some of the packages for storing the vaccines have battery packs which maintain the cold chain for a particular period of time. Certain vaccines which require very low temperatures may be stored for a few days before they go bad. 

On buying from Aspen directly, there is a difference between Aspen and the Serum Institute of India. AstraZeneca has given the Serum Institute of India the licence to manufacture. Aspen does not have a licence; it is a contractor to Johnson & Johnson. However DoH is still engaging with Aspen as it is happy that Aspen is building capacity inside South Africa. DoH thinks that Aspen can go further and that they can manufacture the entire value chain. As to the Johnson & Johnson vaccines which are being manufactured in South Africa, the entire continent is looking to that manufacturing to determine what proportion of that comes to the rest of Africa. You cannot buy directly from Aspen but government is dealing with Johnson &Johnson directly and in fact deals with them every second day. Procurement is based first on safety, then on efficacy, then on availability and only thereafter does cost come into consideration. 

Dr Anban Pillay, DoH Deputy Director-General: Health Regulation and Compliance, replied about Ivermectin that it was important to state that SAHPRA was mandated to deal with Ivermectin. DoH does not have a specific role in the registration or evaluation of the product. He had been talking to SAHPRA and there would be licensing of good manufacturing practices (GMP) facilities to store and supply Ivermectin. There were about three suppliers who could potentially supply the drug. 

On a fixed price for Ivermectin, this would be determined when they engage with suppliers after they determined who the suppliers in question were. 

On vaccine efficacy, he thought it was important to appreciate that the percentage one sees for a vaccine relates to the efficacy in mild-to-moderate infection. What should be very important is if the vaccine can prevent hospitalisation and death. If you look at all the vaccines, they are more or less equally effective on that score. The goal is to prevent hospitalisation and death at the end of the day. Whether there are more or fewer symptoms is not the big issue. 

The IT system put into place to track vaccines requires the batch number and other product details. These details are captured on the system. This will enable DoH to track the vaccine and ensure that a vaccine administered to a patient is one that was approved by government. 

Using two different brands of vaccine on the same person would be practically difficult because the IT system would capture the details of the vaccine which was initially administered to the patient. The patient would receive a reminder to return and receive their second dose and the correct dose would be delivered to the facility the patient attends. 

On which vaccines COVAX would supply, it currently has deals with Pfizer and AstraZeneca. COVAX is also talking to Johnson & Johnson. It is anticipated that later on in the year Johnson & Johnson will also supply their vaccines through the COVAX facility. 

It was important to note vaccine delivery date from commencement of vaccination date. The arrival date of the remaining 500 000 AstraZeneca vaccines from SII was anticipated in March because DoH is not too certain of the date. As the arrival date was uncertain DoH felt it prudent to allocate arrival date as March rather than February because there is no delivery date at this stage. 

Further questions
Ms Wilson said there appeared to be the perception that Members were suggesting that challenges faced by DoH were by design. She wanted to assure the Minister that this was not the case.

She asked how realistic the figures were for how many vaccines DoH has already secured.  She asked if these agreements were finalised or if these were still in process. She wanted clarity whether these figures were thumb-sucked” or final. 

Mr Shaik Emam asked again how DoH was able to procure vaccines without first getting authorisation from SAHPRA, according to whom there was no section 21 application even up until now. 

Various organisations had indicated that they had attempted to negotiate with DoH for the sale of vaccines but had not heard back from DoH until January 2021. He asked if this was due to financial constraints or, if not, what factors were the cause of these delays. 

He was not satisfied with the response about Ivermectin. There appeared to be miscommunication between SAHPRA and DoH on who was the custodian of the health of the public. He wanted clarity as to the use and registration of Ivermectin. 

Mr van Staden said that according to recent reports there were about 40 000 frozen” posts for experienced doctors and specialists due to a lack of funding and the impact of this had been seen over the past few months at state hospitals due to a lack of doctors and nurses. 

In the Eastern Cape, 625 nurses are without jobs due to DoH, which does not have the money to pay for their salaries. The problems in the Eastern Cape state hospitals have been seen over the past few years. This past Wednesday doctors and other healthcare workers had been protesting in Upington in the Northern Cape due to a shortage of staff. Health care workers at this hospital were under an enormous amount of pressure. The hospital in question is a district hospital with 327 beds but it only employs 36 doctors at present. Doctors are working 40 hours a week with 20 hours overtime but are not paid if they work longer hours to fight this pandemic. There is not enough staff to assist these doctors. Hospital management must limit overtime and make use of overtime only in the event of shortage of staff. The Eastern Cape department paid tens of millions of rands for false overtime claims. How would DoH address these issues which appear to be spreading across the country. How does DoH plan to eradicate the problem of appointing interns? How does DoH plan to ensure that sufficient healthcare workers are employed across the country to help the fight the pandemic and to help the vaccine rollout? When will these appointments take place?

Ministers response: 
The Minister told Mr van Staden that he had seen these numbers published and they were very high – there was no shortage of 40 000 doctors. The real issue was that there were human resources challenges. The Department had gone around to the provinces and had employed contractor doctors and nurses. Mr van Staden had referred to unemployed doctors. The Minister had asked the SA Medical Association and Health Department to look at the list of unemployed doctors. The issue of "unemployed doctors" usually manifests in different ways. A number of interns when they have not been allocated by the end of the year start tweeting that they are unemployed. When this happens the Committee start thinking that interns are not being employed; but really it is just a matter of timing.

Secondly, certain doctors employed as community service doctors start panicking at the end of their term and ask where they are going to be employed. In a number of instances this issue becomes quite emotive. The Department saw the same occur in 2020 and he called on the MECs to declare all unfilled vacancies. Thereafter he determined that the provinces were not in the same situation.

In Gauteng for example there was a call for doctors to come in for interviews. However, there were certain posts which could not be filled since doctors had not applied in large numbers. There was no automatic translation” whereby a community service doctor would want to stay in the public service. A number of community service workers wanted to move into the private sector.

In the Northern Cape there was a different challenge, where areas were remote and away from the main cities and therefore suffered more. Doctors were unwilling to relocate to these remote areas. In smaller hospitals there tended to be fewer doctors since doctors wished to move to urban areas.

Where there are financial constraints, provinces have to pause filling posts. In the Eastern Cape for example there are very few doctor and nurse posts that are unfilled – but rather unfilled posts related to other workers such as porters and cleaners. These issues would be dealt with by formulating a futuristic” human resource strategy. This strategy would take into account current vacancies. It would also take into account population growth and some “norms” which have been discussed. 

On Ivermectin, the Minister replied the issue is there are certain divisions of responsibility. Most of the issues raised fall under the jurisdiction of the regulator who deals with registration, approval, efficacy and the analysis of available data. The regulator analyses reports to determine if the data for individual therapeutics were properly peer reviewed. SAHPRA is responsible for this and DoH cannot duplicate its work. When trials for new products happen, individual research institutions approach SAHPRA who gives them authorisation to undertake the research. The results of the trials will indicate if a particular drug is useful for a particular purpose. It is not the responsibility of any one individual researcher to go ahead and register a particular drug. The developer is the one responsible for seeking authorisation.

While there have been many questions on the Ivermectin drug, there is a need for double-blind trials. These trials have to be rigorous and scientific to prove the efficacy of Ivermectin. The results of double-blind trials for Ivermectin are not yet available. The problem with Ivermectin is that the issues surrounding the drug arose at the time when the Covid-19 surge was very high. Just because everybody was anxious about wanting a drug which could help against Covid-19 does not mean that the scientists themselves have to become emotional about the process of testing or fast-tracking the drug. It is true that scientists should fast-track the drug but only within an acceptable scientific process. The regulator has now put this process in place with doctors managing it. 

On ordering vaccines before authorisation, there was a time when there was so much uncertainty DoH could not commit much. However, over time there has been much new information. Some of the vaccines have already been tried in different countries. For some of the vaccines, DoH has already started negotiating and ordering before the efficacy results have been announced. This is because there has been a short-listing of vaccines. This involved DoH having to make an educated guess” as to what might work. DoH has been helped in this process by our scientists who have been reading a lot of relevant research papers. However, once the order has been placed, DoH has the option that if we know a given drug works, government can stand in and be the one that applies for the vaccine to be imported under the name of government. Therefore approval will be given on a conditional basis. For example, government was the one who applied for AstraZeneca to be imported. If next year, for instance, AstraZeneca wanted to import the vaccine they could apply for permission from SAPHRA to import. There was nothing wrong or untoward with the process. Some vaccines have been brought into the country under the guise of research”. 

On concerns about questions raised by the media, the Minister said the media relied on gossip”. The media tries to pitch a sale” and therefore it uses Members of Parliament to pressure DoH. Although the media will be correct in some instances, often it is mistaken, so there would be some misinformation in the public sphere. One of the problems is that the media has sources and evidence which it would not reveal, yet the story they put out will not change. 

The Chairperson thanked the Minister and adjourned the meeting.