Minister on rollout strategy of Covid-19 Vaccine & status of healthcare services in provinces in relation to COVID
7 January 2021
Chairperson: Dr S Dhlomo (ANC)
Meeting livestream https://www.youtube.com/watch?v=jTZfp__pykY
Documents: COVID19 Response
The Portfolio Committee on Health convened an online video conference to be briefed by the Minister and Department of Health about the COVID-19 vaccine rollout strategy as well as other healthcare issues related to the pandemic.
The Minister of Health announced that South Africa would receive 1 million vaccine doses from the Serum Institute of India in January 2021 and a further 500 000 doses in February 2021.
The Minister took the Committee through considerations around the vaccine rollout. The plan is for 40 million people to be vaccinated over 12 months – 6 300 full-time vaccinators, injecting up to 50 people per day. The Minister said the only measure of protection [against Covid-19] is going to come from the vaccination programme, with a minimum of 67% of the South African population needing to receive a Covid-19 vaccine in order for the cycle of transmission to be broken. It was highlighted that government would be sole procurer of the vaccine. SA is expected to receive its Covax allocation of vaccines in April but there are also discussions with vaccine manufacturers. Although Treasury is going to carry the “major burden” of procuring the vaccine, two other financing measures will be investigated: asking private medical schemes to cross-subsidise the vaccines and asking donors and business to make contributions.
The presentation outlined issues related to the epidemiology and surveillance of candidate vaccines; trends in new cases, hospitalisations and deaths; the framework for the vaccine implementation; key principles of the rollout; the identification and prioritisation of certain target populations; the phased approach for vaccine introduction; regulatory matters; vaccine distribution and security issues; resource requirements; safety, effectiveness, uptake, and the second dose; public communication, stakeholder guidance and training; the respective roles and responsibilities for the National Department of Health and for the provinces; and finally the indicative budget for the rollout strategy.
With regard to the second surge of Covid-19 in South Africa, the Minister reported that there is a huge demand for hospital beds and oxygen, necessitating the “reactivation” of beds that had previously been decommissioned.
In provinces such as the Eastern Cape and the Western Cape, infection numbers have now exceeded what they were at the peak of the first wave in 2020, while in KwaZulu-Natal almost twice the number of patients are being admitted to hospital as in 2020
Members of the Committee posed sharp questions about, among other things, discrepancies in, and in perceived inaccuracy of, official statistics especially between the provinces.
Members voiced extreme concern regarding whether the necessary treatment is being provided to all patients in order to increase the survival rate. There was also concern about the high death rate of patients not infected with COVID19 – it was said “there are people dying that should not be dying”. Members said that they were “desperately disturbed” by the situation which was at crisis level. Members asked about the availability of beds and oxygen. The Minister was asked to explain why South Africa’s hospitals were still not prepared despite it being day 287 of lockdown and why the field hospitals were decommissioned given the anticipation of further waves. It was said that while the SA government was wasting its time with the regulations under level five, other countries were getting their health sectors ready and were acquiring vaccines. Members objected to government emphasising the role of citizens taking preventive measures (wearing masks, sanitising, and the like) when the emphasis should be on acquiring vaccines. Thus while citizens where holding their end of the bargain, the state has not secured the vaccine and the National Department of Health was “regressing”.
Members expressed in unison their concern about misinformation and the lack of information provided to the public. The Department was urged to reconsider its communication strategies regarding not only the vaccine but to ensure people make their way to hospitals on time and have the information on how to take care of themselves after being discharged. There was also concern that some Members found it difficult to get hold of the Minister, Deputy Minister and salient entities of the Department which were accountable to the Committee. Members expressed concern around the opportunity for corruption around the procurement and rollout of the vaccine.
Members appealed for clarity on how the situation on the ground would be addressed, and how optimal treatment will be provided in the coming weeks
Concern was also expressed that it seemed some vaccines were simply unaffordable for SA yet government prioritised the bailing out of SA Airways. Further worries were aired whether the central procurement of the vaccines would result in a “sluggish” process especially has government does not have this experience and the centrality prevents other actors from participating in the rollout. It was stressed there must be a codified and comprehensive plan for the vaccine which can be made public.
Members questioned what was happening t the border posts, whether vaccines were compulsory, how the vaccines fared in light of the new strain of the virus identified, the role of private medical aids, detail around when the bilateral engagements with vaccine manufacturers occurred, the placement of interns and retired physicians to assist with staff shortages, the role of provinces in the rollout of the vaccine, palliative care and collaboration with universities.
There were questions around the use of ivermectin and its efficacy in reducing morality and whether the SA Health Products Regulatory Authority had done enough research on this.
Some Members called for a meeting with the Minister of Finance to explain certain financial particulars relating to the rollout plan, without whose input the details remained murky.
The Committee and the Minister agreed on the need to regulrise meetings between the parties in order to ensure Members were regularly updated to ensure everyone was on the same page especially as the Committee was a partner in the process.
The Chairperson welcomed everyone present in the meeting. He apologised for his being late and explained that he had been consulting with the House Chairperson.
He advised Members that a new item was to be added to the agenda, namely correspondence from Mr Shivambu (EFF), whose contents, he said, might have a bearing on the Committee’s discussions.
He said that 2021 was going to be a busy year and that the Committee might be calling on Members at odd hours. He said that this would occur much earlier than anticipated and would involve much more work than was initially expected.
There was an apology from the office of the Deputy Minister of Health who was in another meeting and therefore unable to attend the current proceeding. A second apology was received from the Western Cape MEC, who requested to be released from the meeting at 11:30am, a half hour earlier. The Committee had also received an apology from the MEC representing the Eastern Cape who was absent due to illness.
The Chairperson told Members that the Minister of Health, Dr Zweli Mkhize, would be briefing the Committee on the status of COVID-19 in the country and the strategy concerning the rollout of the vaccine. He said that the Committee invited four MECs from the Northern Cape, Kwazulu-Natal, the Eastern Cape and the Western Cape (which latter two tendered apologies) so that if the Minister required any specific assistance relevant to their respective provinces, they could be there to aid him.
The Chairperson then brought to Members’ attention the passing of fellow Committee Member, Dr P Dyantyi (ANC), and reflected on her dedication as a public servant of South Africans. The Chairperson gave his condolences to Dr Dyantyi’s family and afforded Members the opportunity to do the same during the Committee meeting.
He then read aloud a letter from the Speaker regarding a “request for the urgent convening of Portfolio Committee on Health regarding vaccine rollout plan,” which stated:
“Dear Mr Frolick. My office has received correspondence from the Chief Whip of the Opposition [Democratic Alliance] dated 30 and 31 December 2020, requesting that I reconvene the National Assembly in order to debate, as a matter of urgent national importance, the rollout of Covid-19 vaccine plan (sic). On 4 January 2021, she submitted another request to reconvene the House in order to establish an ad hoc committee on the government’s Covid-19 vaccine rollout plan.
“The issue of government’s Covid-19 vaccine rollout plan is an important matter to which our Parliament should pay particular attention in its oversight function. However, I do not believe that it is necessary either to hold a special sitting or to establish an ad hoc committee in order to do that at this stage. This is a matter that falls within the scope of the Portfolio Committee on Health.
“Accordingly, may you please ensure that the Portfolio Committee on Health is convened on an urgent basis to attend to the matter of the government’s Covid-19 vaccine rollout programme. As the Committee is currently also attending to matters pertaining to the National Health Insurance, I request that an assessment be done of its ability to pay the necessary attention to both issues. I will appreciate regular updates on these matters.”
The Chairperson told Members that he was reading this letter to them because he is aware of the Minister’s plan in relation to how he would assist the National Assembly in this process. He said the letter sought not to delay anything, but rather to follow the process of going through the Committee on Health before moving any further with an ad hoc committee. This gives the Speaker the ability to say that the issue of the vaccine rollout plan had first gone through the Portfolio Committee on Health whose Members have been directly working on it and that therefore they would be debating from an informed point of view. The letter, he said, does not preclude debate but merely indicates that there is no debate “at this stage.”
The Chairperson then moved on to the correspondence received from Mr Shivambu, which was distributed by email on 6 January 2021 and which was addressed to the Chairperson. In essence, it asked the Committee to invite the Minister of Finance to the Committee to explain and answer questions concerning the funding of the vaccine acquisition, distribution and funding strategy. The letter said:
“We write as the EFF to request that the Portfolio Committee on Health must invite the Minister of Finance, Mr Tito Mboweni, for the upcoming meeting scheduled for Thursday…”—the Chairperson pointed out an apparent typo in which Mr Shivambu wrote “7 November” instead of 7 January 2021—“for the briefing with the Minister of Health, Dr Zweli Mkhize, on the status of healthcare services in relation to COVID-19 and [the] rollout of the COVID-19 vaccine. The scheduled meeting is very important, and many of the lives of our people during the COVID-19 pandemic will depend on the strength of the public representative through Committee where we are able to interrogate the work of the executive and ensure the rollout of [the] COVID-19 vaccine is accessible to all in an efficient manner (sic).
“Over the past months, particularly recently as governments all over the world are making efforts to secure vaccines for their residents, it has become more apparent that one of the key issues of securing the vaccine is [the] availability of funding. We made notes of reports that South Africa’s payment to secure [the] vaccine was late and the payment made was through [the] Solidarity Fund and non-governmental initiatives. […] It will be beneficial for the Portfolio Committee to have the Minister of Finance present to engage all questions pertaining to the funding.
“We hope you will find our request in order and will urgently engage the Minister of Finance to avail himself.” The letter was signed “EFF Deputy President and Chief Whip, Hon Shivambu.”
The Chairperson said he received the letter yesterday (6 January 2020) but was not able to fulfill what Mr Shivambu had requested. He said that he hoped today’s presentation with Dr Mkhize would reveal any gaps in relation to which the Committee might have reason to invite Minister Mboweni. This is because the Committee’s direct link is with the Ministry of Health, not Finance. He said that he was reading this letter for Dr Mkhize’s information, so that he might refer to it in his remarks to the Committee. He said he also had yet to respond to the leadership of the EFF which he had not yet had a chance to do.
The Chairperson remarked that he had received queries from teachers as to why they are not prioritised with regard to the vaccine. He said he was unable to answer the query because he was not aware that the Department of Health had been looking into that matter.
The Chairperson invited the Minister to give his presentation. Initially Dr Anban Pillay, Deputy Director-General: Health Regulation and Compliance, DOH, was planned to give the presentation, but as he was not yet present in the meeting, Dr Mkhize briefed the Committee instead.
Dr Mkhize thanked the Chairperson and conveyed his season’s greetings to the Members present. He also conveyed the apologies of the Deputy Minister of Health, who was currently engaged in a meeting with the President. He also said that the Director-General was involved in issues of South Africa’s vaccine acquisition and other urgent matters with which he was now dealing.
He then offered his condolences for the passing of Dr Dyantyi.
Dr Mkhize then addressed Mr Shivambu’s letter and said that he, Dr Mkhize, was aware that the Minister Mboweni would have been unable to attend the Committee meeting due to a family bereavement with which he was presently occupied. Nevertheless, Dr Mkhize said that some of the issues raised regarding the financing of the vaccine rollout he himself would cover in the current briefing.
He then said he would take Members through the history of the Department’s “engagement on this matter.” Firstly, the nature of the pandemic has been devastating the world over, and a number of countries have faced a second wave and South Africa is no exception. In this case, he said that we have seen the “country’s figures going beyond 1 120 000.” We have also seen a rise in fatality rates beyond 30 000. We have also seen a number of hospitals filled to capacity, particularly in the private sector which has been under comparatively more pressure. This state of affairs has now also spread to the public sector. Issues of concern include the “huge” demand for beds, oxygen and additional staffing. For this reason the Department has asked for the “reactivation” of the beds which have been “decommissioned.” Records show that in all the affected provinces, including the Western and Eastern Cape, Gauteng and also KZN, “the numbers” for the second wave have exceeded that of the first. In the Western Cape and KZN, for instance, the number of admitted patients has approximately doubled from the first wave.
He said the Department has also faced pressures in the area of staffing, where officials have been constantly fighting COVID-19. Ideally, the Department wants to ensure that staff get sufficient rest to prevent exhaustion which is now quite noticeable given the onslaught of the second wave. In addition to this, the festive season has necessitated the “stringent” measures which were put in place. He said that during the festive season there has been complacency in the use of masks, and that people were under the impression that during the level one lockdown, the problem was not as concerning.
Dr Mkhize said that what has compounded this situation is the presence of a new variant of the virus, known as “501.V2.” This variation indicates a “slight change in the structure of the virus.” This phenomenon is not exclusively South African, as can be seen from its presence in the UK, Brazil and Australia. The respective variants in each of these countries are different, and therefore South Africa’s variant differs from that of the UK. However, both South Africa and the UK’s variant seem “equally highly transmissible”. The challenge therefore is to research the impact of these novel variants, particularly the question of the extent to which it is more virulent, for which there is currently no evidence, nor is the any clear evidence of its resistance to the vaccine. This research is now underway with a “huge” number of experts and international partners.
To deal with this issue, the only major source of protection is going to come from the vaccination. In South Africa, he said he believed everyone should have the vaccine but in terms of current calculations the country needed a minimum of 67-70 per cent of the population to be immunised to break the cycle of transmission. This is what is called herd immunity as scientifically calculated given several factors, including the rate of transmissibility and the number of persons to whom each infected individual is potentially capable of transmitting the virus on average.
He said that a programme has been embarked upon to collaborate with various partners around the world in relation to the availability of vaccines. At the time of the commencement of these discussions, the issue concerned two approaches. The first approach was to pool a number of countries to create a degree of safety by ensuring that we are part of a large bloc of countries which can more effectively negotiate; and also enrolling in the COVAX facility which looked at approximately nine vaccine candidates.
The second approach involves bilateral agreements, which involves making immediate financial contributions and therefore binding the country to the “fate of that particular vaccine.” The financial contribution would be non-refunding and therefore there would be a degree of risk involved. Dr Mkhize said that the risk associated with the bilateral approach was too high. He said it was more viable for South Africa to work with countries to ascertain which vaccines were effective and then attempt to procure it from there.
South Africa has opted for the former COVAX approach, and has committed to purchase sufficient vaccines for 10 per cent of the population [approximately 6 million people].
Dr Mkhize said there were “a few delays” in the payment for the vaccine. He said they were not major issues that would warrant the degree of anxiety which could have been generated when the payment process was “a bit slow.” What actually happened in this case was that Treasury had advised that what needed to be done was to “raise the money” so that there would be no need to immediately “tamper with the budget framework” that had already been tabled.
He said that the Global Alliance on Vaccine Initiative (GAVI) was negotiating the terms of the agreements, and that in the process, those terms meant that “they were to be guaranteed,” so that there was much discussion between the legal teams on both sides. He said this is what really caused the delay in determining what was the best way in assuring said guarantees. Between GAVI and Treasury, it “took a while to resolve.” However, it was acknowledged that there was no risk to the South African participation in that process, and so the above issues were “ultimately resolved.” As it stands, “that amount of money was paid, and guarantees were signed.” The amount that is guaranteed, he said, is actually in the budget as determined by the Department of Health and Treasury. The issue of COVAX was sorted. So the President announced that in terms of the COVAX platform “we were going to have the first vaccine into the country around April,” which was the timeline given to government by the COVAX facility.
He added that by the time government had gotten to this point a number of results were released to indicate the progress of various vaccine candidates, and there had been many announcements. On that basis, it gave government sufficient confidence “to be able to start engaging with various manufacturers.” So there have been engagements on a bilateral basis with various manufacturers. There was another platform where President Ramaphosa established a task team to look at the continental access to the vaccine using the “volumes of the continent to actually leverage better prices.” This process provided much insight in terms of what the various manufacturers were offering. High income countries (e.g. the US and the UK) had committed funds on a “risk hedge basis” much earlier; a luxury which South Africa was “unable to afford because of our limited resources.” These high earning countries purchased each of the several vaccine candidates long before their efficacy was determined. South Africa considered this and determined that this approach would be too risky. However, once the efficacy was established for the various vaccine candidates, South Africa started to engage.
He said that South Africa was party to nondisclosure agreements (NDAs) which were signed from September/October 2020. The purpose of these NDAs was to allow the manufacturers to share certain sensitive information with government which they otherwise could not have done.
Dr Mkhize added that the Department of Health had had many discussions with Minister Mboweni to inform him that the fiscus would have to “carry the major burden of having to procure the vaccines.” He said the Department would look at other means of raising additional funds, such as approaching medical aid schemes for contributions on the basis of social solidarity, whereby the schemes could “cross-subsidise the members of the public.” Another way was to solicit donations from businesses. In combination with the Solidarity Fund, there are many avenues to ensure the success of adequate procurement. He said the Ministerial Advisory Committee (MAC) had provided an “outline of a framework” of what needed to be done in this respect; this framework would be shared with the Committee.
He said that among the important issues was the question of prioritisation of different sectors of society, starting with the most vulnerable to eventually reaching every citizen.
He reiterated that the Ministry has “engaged a number of manufacturers,” and that they are at the stage where discussions are “fairly sensitive and we believe that we will be able to conclude as much as possible” (sic).
He said the Department was pushing to access vaccines as early as February 2021: “We should be able to get to that point,” he added.
He acknowledged that there was quite a lot of anxiety in the society which he attributed to the “resurgence of COVID-19 which has created a lot of panic” with regard to the number of persons being infected and getting sick; the fact that hospitals are reaching capacity; and the number of resultant deaths. “It is actually natural that we should all be anxious at this point.” He said that the situation would be managed to the best of the Department’s ability and “also we will be making sure that we bring the vaccines as quickly as possible into South Africa.”
He also acknowledged the criticism and comments from different parts of the public. He said that whilst the pandemic had to be defeated, government is on course and the matter will be handled. “There will be vaccines available; they will be available in stages.” He appealed to the public that their anxiety should not cause them to believe that government has got the country into a worse situation than it otherwise would have been in. He said the situation in South Africa is commensurate with that of other parts of the world. “Some countries have started with vaccinations; we will also be starting with vaccinations soon.” He added that “the whole of next year, we’ll do our best to vaccinate as many people as soon as possible, our target being the 40 million people to achieve heard immunity.”
He thanked the Chairperson and asked to hand over to Dr Pillay for the presentation.
The Chairperson thanked the Minister and added that his remarks had been “extremely helpful”, “detailed” and “of great assistance”.
The Chairperson then recognised Dr Pillay, but as he was not yet present in the meeting, Dr Mkhize said he himself would take the Committee through the presentation.
Epidemiology and Surveillance (Slides 3 and 4)
As of 6 January 2020, the total cumulative cases amounted to 1 149 591. The case fatality rate was 2.7% (31 368 deaths). Total recoveries amount to 929 238 (80.32%). This shows an increase of late which indicates the severity of the second wave. He said the Eastern Cape is already starting to plateau. He said that there were many reports that the Department was still correcting to ensure accuracy in the rate of fatality. The cumulative cases in the Western Cape has already reached double the rate of the first wave. The Western Cape has run out of oxygen and had to be provided emergency support. This is mainly due to the increased number of cases. KZN showed “exactly the same” trend. The trend in Gauteng is rising steeply. The number of cases is expected to increase still as people return home after the holidays. As it stands, the case numbers are already two-thirds of the first wave. He said other provinces are experiencing similar trends.
Trends: National New Cases, Hospitalisations & Deaths (Slide 5)
The Minister said that deaths (as well as hospital admissions) in the country are already higher than what was experienced in the first wave.
Framework for Vaccine Implementation (Slide 7)
He said the framework for the rollout of the vaccine involves government structures; communication, stakeholder guidance and training. The Department would be looking to prioritise certain segments of the population; the allocation of vaccines; the distribution; administration; safety, effectiveness, uptake and the second dose. There are other related issues including the data monitoring and tracking of the supply of vaccines; vaccine uptake, use and coverage; adverse events following immunisation (AEFI); and vaccine effectiveness monitoring and reporting. There are also the issues of regulatory considerations, and budgeting and finance.
Why are Vaccines Important (Slide 8)
He briefly reiterated that the aim is to prevent morbidity and mortality, and to achieve herd immunity and prevent ongoing transmission.
Key principles (Slide 9)
He then outlined the key principles of the plan: government will be the sole purchaser of the vaccine for the country. There would be multiple vaccines in the programme (which are not interchangeable in two dose vaccine schedule). The allocation of vaccines would be guided by the MAC on vaccines. The rollout would be based on pre-vaccination registration and appointment. All vaccinated persons should be on a national register and will be provided a vaccination card. A national rollout committee would overseas the rollout (in both the private and public sectors).
Leadership and Coordination (Slide 10)
A national vaccine coordinating committee will oversee the rollout. He outlined the leadership and members of this committee, which would be chaired by the Director-General of the National Department of Health, and co-chaired by Dr Lesley Bamford.
He also elaborated on the stakeholders involved which included the MAC, organised labour, civil society organisations (see slide 11), the private health sector (including medical aid schemes) as well as other parts of the business sector (see slide 12).
Identification and prioritisation of target population (Slide 13)
He reiterated that this process would be guided by the MAC. Vaccines would not be available for everyone immediately, and a prioritisation system will be utilised. Priority will be given to parts of society which are essential for societal functioning, and those most at risk of infection and of transmitting the disease.
There would be three phases: In phase 1, limited doses would be available; in phase 2 a larger number of doses are expected to be available, and in phase 3 there would be continued vaccination and a shift toward a more routine approach. (See slide 14 for more details on the key factors and likely administrative strategies for all three phases).
Phased approach for vaccine introduction (Slides 15 to 17)
Phase 1 will involve predominantly healthcare workers; phase 2 will include essential workers, persons in congregate settings, persons older than 60 years, and persons older than 18 with co-morbidities; phase 3 will include all other persons in the target population which is estimated to be 22.5 million people.
Unresolved issues on which the MAC is still working include whether pregnant women and children should receive the vaccine, and whether people who are known to have had the disease should be vaccinated (see slide 18).
Vaccine selection (Slide 19)
There are six key criteria for the selection of the approximately 200 candidate vaccines: they are (1) vaccine supply and sustainability (i.e. supplier capacity); (2) safety, efficacy and immunogenicity; (3) ease of use; (4) storage and distribution; (5) the cost; and (6) SAHPRA approval (for full licensure or emergency use authorisation).
Vaccines at advanced stages of study (Slides 20 and 21)
Government is looking at many candidate vaccines (which all come with their respective issues and characteristics). These include vaccines from Pfizer/BioNTech (2 doses), AstraZeneca/University of Oxford (2 doses), Johnson and Johnson (part of which is being prepared in South Africa alongside Aspen; regulatory approval is pending), Moderna, and Sinopharm (China).
Regulatory matters (Slides 22 and 23)
Vaccines must of course be safe and effective. To expedite the approval of vaccines the following measures must be met:
● Agreements with EMA, ESFDA, MHRA, and TGA
● SAHPRA has adopted a priority review approach for all COVID-19 vaccine applications
● Flexibility in relation to labelling and packaging requirements
● Authorisation in terms of section 21 of the Medicines Act
● Vaccine products based on new technology must have effective vaccine safety surveillance and causality assessment systems
● There must be active and passive surveillance (SAHPRA)
● The use of electronic supporting systems for assessment by NISEC
● The availability of reporting tools and coordinated reporting lines
● There must be adequate surveillance to allow for data sharing (NDOH, WHO, SAHPRA)
Vaccine Distribution and Security (Slides 24 and 25)
In terms of distribution, the following factors need to be considered and are being worked on:
● Distribution security: Vehicle tracking and monitoring (central distributor/contract distributors)
● Safety and security at administration sites: Security deployment and presence
● Track and traceability of vaccines using barcode scanning
● Safe and secure disposal of all vaccine packaging and vials
● Data verification of volumes distributed versus volumes administered
● Monitoring of vaccine wastage
The Minister then went through the administration process of each phase, reading these from the slides verbatim. (Slides 27 to 32).
Phase 1 would involve work-base vaccination programmes in hospitals, the model being to provide vaccinations to all staff working in the public and private hospitals. Outreach teams would vaccinate workers in smaller health facilities. There will also be the establishment of vaccination centres in which additional sites for vaccinations are created and may be linked to a health facility/pharmacy or be standalone (see slides 27 to 30 for more detail).
For phases 2 and 3 (see slides 31 and 32) there is a need to balance vaccine rollout with ongoing provision of essential services. Health facilities and outreach teams will shift to providing services to other target groups. Vaccination centres will play a larger role, so additional sites will be established. For example, pharmacies (independent or pharmacy groups), mass vaccination centres in urban areas (for individuals and groups, for instance essential workers) and other settings such as community halls, churches and schools could be used. Registration and accreditation process of non-facility sites will be in place.
Resource requirements (Slide 33)
The following figures are indicative figures for what it would mean to vaccinate 40 million people over a twelve month period (with two doses). This would involve:
● 316 000 vaccinations per day
● Each vaccinator can vaccinate 50 people per day
● Approximately 6 300 full-time vaccinators
Additional vaccinators may be recruited from, amongst others: clinical associates, post-community service nurses and doctors, contract nurses (already part of the HPV vaccination campaign), final year medical and nursing students, other cadres (may require changes to scope of practice), and so on.
All provinces would be advised to appoint a full-time, dedicated cold chain manager along with supervisors and/or accreditors.
Safety, effectiveness, uptake, second dose (Slide 34)
Perceived vaccine safety is an essential component of acceptability of the vaccine. Vaccine confidence increases through transparent and effective vaccine safety surveillance and causality assessment. The use of electronic reporting system to collect core variables required for AEFI causality assessment is important. SAHPRA will implement Yellow Vaccine Card System, to be adapted for RSA for active surveillance. SAHPRA will implement the MedSafety app for electronic reporting of all AEFI for passive surveillance. The availability of reporting tools and reporting lines which facilitate causality assessment of cases from the private and public sector (case reporting and case investigation forms) must be ensured. Surveillance enables data sharing (per NDOH, WHO, SAHPRA). AEFI surveillance for Covid vaccine will be finalised and vaccinators trained.
Communication, stakeholder guidance and training (Slides 35 and 36)
Communication and training are essential components of the vaccine rollout plan. Communication will involve targeted stakeholder engagements with a clear rollout plan. These would include community leadership (political, traditional and religious leaders), the media, labour unions and civil society. (See slide 35).
Training will involve the development training material (virtual and in person where allowed), the development of training plans, the development of supervision methods, criteria and tools, the development of vaccination field guides and ensuring the availability of IEC material. (See slide 36). The Minister stressed the importance of aligning messaging surrounding the vaccines’ rollout.
Data for vaccine management and surveillance (Slides 37 to 39)
The Minister said there was a need for a strong data system which is centralised, the details for which are delineated on slides 37 and 38. All this information would need to be accessible from a National Data Dashboard which will show daily vaccination numbers (See slide 39).
Roles and responsibilities for the National Department of Health (Slide 40)
The Minister then outlined the responsibilities assigned to the Department of Health, a list for which can be found on slide 40.
Roles and responsibilities for provinces (Slide 41)
He then laid out the responsibilities of the provinces, a list for which can be found on slide 41.
Indicative Total Budget for Vaccinations (Slide 42)
The Minister gave an example of the budget for the vaccine rollout plan. He emphasised that this was just an example, to give the Committee a sense of how the budgeting would work.
The Minister said that Treasury has allocated provisional amounts for the rollout plan (he did not elaborate on specific values, since they were subject to change). The National Health Department and Treasury are currently in discussion to streamline the process for acquisition and distribution.
The Chairperson thanked the Minister and opened the floor for discussion in a first round of questioning. He reminded Members to turn on their cameras when speaking.
After extending his condolences for the passing of Dr Dyantyi, Dr K Jacobs (ANC) acknowledged the Speaker’s letter to the Chairperson as well as its contents. He also conveyed his appreciation of the Chairperson’s answer to the letter, particularly about the creation of an ad hoc committee. He said it would not do justice to Committee Members to not fulfill their mandate, which is to have oversight over processes and procedures.
Turning to Mr Shivambu’s letter, Dr Jacobs said that the Committee accepts the Chairperson’s explanations and noted the content of the letter.
Turning to the pandemic, he noted that there had been a great increase in the number of infections and the rate of transmission given the new variant of the virus. However, he said he was concerned about the discrepancy between the number of infections and the fatality rate as shown in slide 3, especially between the provinces. He said that if one looked at the number of infections in Gauteng (304 447) with a fatality rate of 1.9% compared to the Western Cape infections (223 888) with a fatality rate of 3.4%, it tends to make one very worried about the accuracy of the numbers when this discrepancy is observed. And similarly for other provinces. He asked the Minister what was the contributing factors which caused these discrepancies. In other words, for instance, Gauteng has a high cumulative case total with a low fatality rate, whereas the Western Cape has a comparatively lower cumulative case total with a high fatality rate. He said he noted what the Minister had said about the number of beds, the number of increased admissions, the increase in the new cases, the difficulties with oxygen and staffing supply, and so on, but he said this discrepancy still needs to be addressed.
He said that as much as we are waiting on the acquisition of the vaccines, something of more immediate importance is the clinical situation in terms of whether the necessary treatment is being provided to all patients in order to increase the survival rate. This is worrisome considering the data just provided. He conceded, however, that increased deaths follows increased infections, but he remains worried. He said that a challenge which will have to be faced later is the increase in the number of individuals with chronic diseases post-COVID infection, for instance lung problems. He said this needed to be prevented.
Turning to the vaccines, Dr Jacobs said that he was concerned about misinformation. He said that a programme was needed to be able to answer the concerns of the public. He likened the problem to that of smallpox, polio and TB, and stressed that the right message needed to be communicated to the public. He said that the role of the media present in the Committee was essential, since they would have to convey to the public that the vaccines are important and needed, and they should not contribute to the spread of misinformation.
He also noted that the Western Cape had intimated that it would be procuring a vaccine as a province, and he said this was a problem since acquisitions were to be rolled out by the National Department of Health, aligned with the Ministry. He asked the Minister to speak on this issue of the direct opposition to the national plan for central procurement.
Lastly, he said that the Health Department had to continue with its message of preventative measures, especially regarding clinical treatment. On the other hand, the public has the responsibility to save lives themselves. He said that he thought government had been faltering on its messaging concerning non-pharmaceutical interventions.
Before stating her query, Ms E Wilson (DA) extended her condolences to the family of the late Dr Dyantyi and reflected on her dedication as a public servant. She also conveyed her sympathies to the Chairperson who had recently lost his brother to COVID-19.
In response to the letter received from the Speaker (namely, that there will not be a special sitting to debate the issue at hand but that it should rather go to the present Portfolio Committee first), Ms Wilson said that “we” had been asking the Portfolio Committee for a meeting for more than two weeks. She said that she has been “desperately disturbed” by the situation; and that there has been a lack of access to information unless it was via the media which she remarked was not always reliable. She said that there has been a call for unity, but there can be no unity when there is no participation: “we are not all on the same page.”
She recalled that with the first update concerning COVID-19, there were regular updates and meetings with all parties about what the situation was and what was happening, and everyone was given an opportunity to participate. But that, she said, has stopped. She wondered why. She told the Committee that no information leads to misinformation and “fake news.” She added that this is what was happening at the moment. She said that as a representative she was unable to satisfactorily answer her constituents’ questions due to lack of information. “It does not create a good impression.” She expressed her umbrage at the fact that it had to go as far as the Speaker requesting a Portfolio Committee meeting for the meeting to eventually happen, despite Members’ previous requests as early as a fortnight ago. She said it showed “a lot of disrespect to” Members and that it was “unacceptable.”
Ms Wilson informed the Committee that she was part of a certain emergency services (EMS) group who advised her that 50 per cent of their incoming calls are all COVID related. She said she had just visited a local Netcare Hospital in Polokwane that morning and saw a queue of 29 ambulances waiting to gain access to that hospital. Some of the ambulances had been there for up to three hours. She said that when these ambulances—which are carrying very sick patients—are parked outside the hospital for this duration, they are not attending to other people who might require their aid. She remarked that this has become a “huge, huge crisis.” There are also reports of a diminishing supply of oxygen; the EMS system is severely under strain. Outside the aforesaid hospital (and others nearby), tents had been erected. This situation is not unique to Polokwane, and there is evidence of it occurring the country over. There are videos of ambulances arriving in underground garages at hospitals where tents have also been erected. Despite this, “we’re hearing from provinces that there is no crisis.” “There is a crisis,” she said to the contrary. She appealed to what Dr Jacobs had just said regarding the number of deaths. She added there are people who are dying who should not be dying. She was not referring to COVID patients, but rather the more ordinary cases such as stroke and heart attack victims. These people, who would ordinarily be admitted and treated now cannot gain access to these hospitals as they usually would and thus are dying otherwise avoidance deaths. This happens particularly when they are referred to another hospital, sometimes hundreds of kilometers away and dying en route because they could not initially be admitted to a hospital under emergency circumstances. “That is unacceptable. These are issues that really need to be dealt with.” She said she was aware that several Committee Members, including herself, have been attempting to get hold of the Medical Research Council (MRC), the Minister’s office, the Deputy Minister’s office and the South African Clinical Research Association (SACRA). All of these entities, she said, falls within the Committee’s oversight remit but are nevertheless uncontactable.
She then asked the Minister to give some clarity as to what is happening at the border posts. She said there are “literally thousands of people waiting to get back into South Africa,” many of them not wearing masks and are climbing over fences and over each other to enter the country. She said this was an issue and wanted to know what measures were being taken to test them at the border. There are other borders, she added, where people enter regularly to conduct business and to take their children to and from school. Initially this coming-and-going was permitted for 14 days subject to a negative COVID test. That time limit has been reduced from 14 days to 72 hours. This has caused a backlog of up to 15km of people waiting to get children back to school, universities, colleges, and the like. While this backlog occurs people start “milling around” and begin to infect each other.
She also wanted an update on the oxygen supply in the country, since she was receiving word from EMS groups about its shortage. “So is there or is the not” enough oxygen supply, she asked.
Ms S Gwarube (DA) said that Members had already had a conversation about the function of the Portfolio Committee in relation to the pandemic when COVID-19 first became salient; that it was not just an “annoying stakeholder” but rather a partner in the process, and needed to be treated as such. She then made the call to formalise and regularise the updating of the Committee for future purposes, whether once per week or once every two weeks. She said that the Committee could not simply rely on the media for what is happening around the country, but needed official information in order to truly understand what was occurring.
She said she wanted to pose a critical question to the Minister: “By your own admission, you have stated that South Africa was gun-shy of starting bilateral negotiations with vaccine manufacturers” and that you relied almost solely on the COVAX facility for a long time while other countries all over the world had started negotiating with manufactures all over the world and that South Africa had not started that process because of the risk that the Minister had outlined (namely, the risk that a vaccine candidate for which funds would be guaranteed might turn out to be inefficacious thereby wasting those limited resources). She asked when the bilateral engagements started. She said she wanted specific and not evasive answers. She says it was unacceptable that the Minister’s line was that these were sensitive negotiations and that the Department would get back to us.
She said that it is often said that some vaccines are simply unaffordable for South Africa, but said that surely it should be South Africa’s main priority to secure vaccines. She said she cannot conceive why the South African government should consider any other priority, such as bailing out SAA, over the acquisition of vaccines where the financing of the former may be diverted to the latter.
She then questioned the wisdom of central vaccination procurement where the process would be sluggish and slow. This prevents other actors from participating and rolling out the vaccine as quickly as possible; this has been done in many countries around the world. Moreover, the South African government does not have experience of the mass vaccination of 40 million people, making the policy of central procurement and rollout audacious.
Lastly, she said that COVAX has made it clear that they will look at two main issues when considering the distribution of vaccines. The first is regulatory approval, which the Minister had indicated SAHPRA is ready to expedite. The second is country readiness. This means that South Africa has to ensure that it has the capacity to deliver over 40 million vaccines in a twelve month period, which seems “impractical.” There are issues of logistics, storage, transportation, distribution and allocation of the vaccine. For this reason she is calling again, as has already been done, for a codified and comprehensive plan for the vaccine which can be made public. She said that if this could be submitted to COVAX, it can surely be made available to the South African public.
Ms H Ismail (DA) said she had a question on the various views of ivermectin. She said she read reports where the World Health Organisation (WHO) sponsored a preliminary review of the effectiveness of ivermectin. She said the review concluded that there was an 83% reduction in COVID-19 mortality. She said that SAHPRA had conducted its own review and was refusing the use of said medication. She asked whether SAHPRA has done enough on this issue when the WHO has already provided a preliminary review.
She asked why government denied Discovery’s plan to acquire the vaccine to vaccinate 2 million of its members through the former’s policy of central procurement. She asked the Minister to explain why government wants to be the sole purchaser of vaccines considering the fact that the country needs to have “all hands on deck” in the vaccine rollout.
She asked whether the vaccines in the long-run would be mandatory.
She asked if government sought to obtain the assistance of interns and other viable personnel to assist with staffing shortages. This was to be done by early January 2021.
She asked whether the vaccine would be extended to critically ill children given that the presentation suggested that minors would not be prioritised.
She queried if the Minister could provide a full report of all provinces, whether there are sufficient beds, oxygen and other equipment given the upsurge of case numbers.
Mr P Van Staden (FF+) also extended his condolences to the Chairperson and the family of Dr Dyantyi.
He stated that the Committee needed to be informed of decisions before it is taken to the Command Council, since it was the Committee’s function to hold the Minister to account. He said the FF+ was concerned about the possible “chaos” which may ensue (as reported in the media) in government’s attempt to roll out the vaccine.
He observed that there was a developing trust gap between government and reputable experts. An open letter alleging mismanagement of the rollout and an associated cover-up was published in the media the preceding day (6 January 2021) signed by various experts including medical experts. He cautioned against cover-ups and lack of communication. There was also misinformation on social media due to lack of information, which is why access to information was imperative to the Committee, which he said was “in the dark.”
He also noted the issue of the lack of oxygen supplies in private hospitals as well as that of personal protective equipment (PPE) and healthcare personnel.
He emphasised that regular updates are required in light of the fact that the country was amid its second and more serious wave of the virus.
He asked the Minister to explain why South Africa’s hospitals were still not prepared despite it being day 287 of lockdown with regulations still in place which make no sense.
He wanted a briefing on how interns will be utilised to assist in the pandemic, and more specifically their placement.
He asked when the Minister would be calling upon retired physicians to assist doctors and nurses as already gazetted.
He wanted the Minister to clarify whether the vaccine will or will not be effective against the new variant of the virus.
He requested that the Minister state clearly and unequivocally the exact dates government had its first meetings with pharmaceutical companies and why they had cancelled a meeting with one which had reach out to government. This is essential given previous corruption during COVID-19.
He asked what guarantees the Minister could give that corruption will not take place again.
He told the Minister to stop complaining in the media that other countries had acquired vaccines early and that they should be shared with South Africa. He said that whilst government was wasting time making senseless regulations in lockdown level five, and instead of getting the health sector ready, other countries moved quickly to acquire vaccines for their citizens.
He also threw doubt on the capacity of government to vaccinate 40 million people in 12 months, and appealed to the statements of an expert to corroborate his doubts. He asked the Minister to explain exactly how government plans to go about doing this. If the Minister fails to answer how this it to happen, the Institute of Race Relations (IRR) would approach the courts for relief in this regard.
He asked the Minister to please answer all these questions, and that he should do so today.
He reminded the Minister that he had cautioned that field hospitals should not be decommissioned, but should be kept for a second and third possible wave. He asked how much would it cost to re-erect these field hospitals and why they were demolished in the first place.
Ms N Chirwa (EFF) conveyed her condolences. However, Ms Chirwa had technical difficulties which rendered her questions largely inaudible. She stressed the need for the Committee to invite the Minister of Finance to explain certain financial particulars relating to the rollout plan, without whose input the details remained murky.
She asked if a vaccine has not yet been identified for rollout, how the Minister can explain the acquisition of vaccines in February 2021. She wanted to know from whom, or from which manufacturer, South Africa had been allocated a vaccine.
She also asked what the roll of provinces were in the distribution of vaccines. She said she was asking this because of the lack, and inaccuracy, of information, which seemed to be a recurring theme.
She also objected to the fact that government has been pressuring citizens to take preventative measures (wearing masks, sanitising, and the like) and behaving as if this pressuring was the primary objective of the state, which in reality should be the acquisition of vaccines. Thus while citizens where holding their end of the bargain, the state has not secured the vaccine and the National Department of Health was “regressing.” She alleged that government, and particularly the Ministry of Health, has not secured vaccines because it does not have the funds: “the money was looted; the money was misappropriated.” She stressed that government must take accountability for its actions because it is affecting peoples’ healthcare.
Lastly, she said the Minister of Finance needed to come before the Committee to explain why there are no funds, and how much is needed for the rollout of vaccines.
The Chairperson clarified (contrary to Ms Wilson’s claim) that the meeting was not called at the behest of the Speaker. The Chairperson said he was personally contacting the Minister to ascertain a date on which a meeting could be held. However, there was a bereavement in the Chairperson’s family which was a contributing factor to the two week delay.
Ms M Sukers (ACDP) asked the Chairperson if it was possible to extend the duration of the meeting to afford the Minister sufficient time to answer all questions posed.
The Chairperson said the Minister had other obligations beyond twelve o’clock (and therefore the meeting could not be extended).
Ms Sukers extended, as other Members had, her condolences.
She said she wanted to support the call for more effective communication and more regular updates between the Committee and the Department of Health.
She said the urgent situation on the ground, and the growing number of deaths, was why many Members had been calling for this meeting for more than two weeks. For this reason, also, she wanted to ask that MECs be present in these meetings, in order to update the Committee.
She echoed that people were dying because ambulances were unavailable. She had personally driven an infected constituent to the hospital to attempt to save their life. “The situation is traumatic.”
She said Members needed clarity on how the situation on the ground would be addressed, and how optimal treatment will be provided in the coming weeks.
Her first question was how people who resided in shacks were to get to quarantine sites.
Two critical issues affected the number of untimely and unnecessary deaths. Firstly, people do not know when to go to hospital in time, ignoring symptoms until the last minute. People are unable to monitor their symptoms and wait until they are in respiratory distress. A comprehensive community communication campaign needs to be started. She wanted to know from the Minister what plans were place in this regard. Second, when patients are sent home after being hospitalised, they lack sufficient information in order to adequately take care of themselves after a COVID-19 diagnosis. She said many people had died in her constituency. She asked what information packages the Department of Health has designed that patients can take home to be more informed. She asked the Minister if he considered podcasts.
In terms of palliative care, she said she had senior constituents (in their seventies and nineties) dying at home. Elderly people with co-morbidities are being collected last by EMS services. She asked what plans had been made for community-based care.
She wanted to know where most deaths occurred within the hospital system (whether in the district hospitals or main hospitals), and how many deaths were due to co-morbidities and not directly COVID.
She said that a number of clinicians and patients would like to make use of ivermectin. She asked if the Department was aware of trials being conducted in the country for this drug, and if not why not. She asked if the Minister would liaise with SAPHRA in order to obtain emergency use authorisation.
She asked how many South Africans have been exposed to COVID-19 and what percentage of the population has already been exposed, and which programmes were in place to determine this.
She also asked how effective the current vaccine candidates would be against the new variant of COVID-19. She asked which studies were in place to determine this.
She said there were moral and religious concerns about the uptake of vaccines, and therefore wanted to know if vaccines were going to be compulsory.
She asked if the contents of the vaccines be made public, and whether the Department would avoid using vaccines which used aborted stem cells in any stage of its development.
Dr S Thembekwayo (EFF) also conveyed her condolences.
In response to Mr Shivambu’s letter requesting the presence of Minister Mboweni before the Committee, she reiterated that his appearance was important because they needed to engage on questions pertaining to the funding of the vaccine rollout.
She said that different people responded differently to vaccines and therefore wanted to know, in additional to pregnant women, which other factors were being investigated.
Referring to the negotiations with vaccine manufacturers, she wanted to know the status of negotiations with Johnson & Johnson which developed a vaccine where only a single dose is required, thereby providing an avenue for greater cost effectiveness.
She asked if there was any interest in the Department engaging with universities (for instance the University of Pretoria) which have undertaken studies concerning COVID-19.
While the vaccine was pending, she wanted to know why the Department was not advising the “poor public” to supplement non-pharmaceutical interventions with the intake of immune boosters to stimulate the immune system against the virus.
She said that there was a form in circulation disclaiming that the vaccine may cause death; she wanted to know if this could be made available to the public.
She said the healthcare system was not designed to deal with such large-scale crises, and that there was physical and mental exhaustion among healthcare workers in addition to worn out hospital infrastructure. She wanted to know how the Minister was addressing this.
She said the President had indicated that funds were paid for the vaccine, but that it was only paid in April. She wanted to know who the money was paid to and why the Minister had indicated February when the President had indicated April. She wanted to know who to believe.
Ms A Gela (ANC) also extended her condolences.
She said that there was an invitation for the Committee to go to the Eastern Cape, a hotspot, to perform oversight, but that no Member had availed themself. She reminded Members that this was their duty.
She repeated the need for the Department to assist exhausted healthcare workers, some of whom were in isolation due to exposure.
She asked what would be done to absorb community workers who wish to work in the public sector in order to assist with the pandemic.
She said that the country needed urgent intervention with the dwindling supply of oxygen.
Mr A Shaik Emam (NFP) said he was “extremely disappointed” with the Minister because he had failed to address the various legal challenges taken against the Department in respect of ivermectin.
He asked what the Minister’s plan was if India banned the export of vaccines (as its government had suggested) and how this would affect the rollout, especially in light of the fact that the Department had no other procurement agreement in place.
He wanted the Minister to comment on recent reports on the “lack of effectiveness of the Pfizer vaccine.”
He remarked that “I am not wanting to sell drugs, I don’t manufacture drugs, so your Department asking me whether I would put an application to register a particular drug I think is totally unacceptable. My job is to do oversight as a public representative.”
He said there is a drug called ivermectin, and disclaimed that he was in no way suggesting that people should take ivermectin and stop everything else, but, he said, there is evidence unfolding internationally on an almost hourly basis by several experts, that the success rate of the drug was 100%. In light of this, he asked why the Department was not engaging with SAHPRA to review ivermectin.
He echoed a complaint that the Department and other salient organisations were not contactable.
He wanted to know who was funding SAHPRA, given that it has adopted the curious attitude that it did not want to even review the efficacy of other potential alternative drugs such as ivermectin (which, after all, is an old drug that has been approved by the WHO and whose developers had received a Nobel Prize). He said it is suspicious that SAHPRA wants to criminalise the drug. He suggested that the low cost of the drug (and therefore its low profitability) was the reason behind SAHPRA not wanting to look into it.
Ms M Hlengwa (IFP) also expressed her condolences.
She said recent reports suggested the inefficacy of the UK vaccine against the new variant of COVID-19 and wanted the Minister’s input on the accuracy of these reports and the possible effects of these reports on the rollout of the vaccine in South Africa.
She asked the Minister what was being done about infected persons being turned away from hospitals and clinics which at times resulted in death.
Mr M Sokatsha (ANC) joined his colleagues in communicating his condolences.
He expressed his concern that the communication campaign concerning the vaccination rollout was very poor, and that constituents were "very scared” of the vaccination. He wanted to know what the communication strategy was.
His next question concerned the drug known as Sputnik 5. He wanted to know what the Department’s position was on this drug given its purported high efficacy rate.
He said a hospital in his community of Richmond was not operating 24 hours a day as it used to do due to the lack of staff, many of whom had been infected with the virus. The nearest hospital was more than 100km away, and asked the Minister what the Department was doing to assist in this regard.
The Chairperson thanked Members for their questions.
He said that regarding Mr Shivambu’s letter: this would be processed in due course because it contains substantive content which cannot be ignored. However, it was sent at the “eleventh hour.”
He expressed to the Minister the pervasive concern among Members was that there was rampant misinformation due to a lack of official information, and wanted his comments on how this would be remedied.
He said the Committee needed to up its game and perform oversight on the ground, not merely in the Committee. He said certain Members had queried whether they could have access to certain sites, but were told that it was not advisable and so the Committee “left it at that.” The Committee needed to improve in this respect.
He then recognised the Minister for his answers to Members’ questions.
With less than 20 minutes remaining in which to respond to the various queries raised by Members, Dr Mkhize indicated that he had a prior commitment to attend to and thus could not stay any longer than initially planned.
He asked Dr Pillay to take the first few minutes to respond to Members’ questions.
Dr Pillay first addressed the questions concerning the bilateral meetings. He said the Department had bilateral meetings with “all of the manufacturers that are currently having vaccines available” (sic). In most cases these meetings started in September 2020. He said there were “one or two meetings before that” but that they were not formal because there was “nothing concrete to talk about in terms of the vaccine.” He said the article published on News24 was “wholly inaccurate.” He said he contacted Johnson & Johnson regarding whether there was a misunderstanding between them and the Department, and that they had advised him that they were not aware of any meeting which was cancelled, nor were they aware of any disputes between themselves and the Department. He said there had been "fruitful discussions” the details for which would “probably” be able to be communicated at a later date. But there is “no veracity in the claims that [the Department] had cancelled meetings.” He said Johnson & Johnson had also responded to journalists claims which were not reported.
On the question of the vaccine being unaffordable, he said he checked with his colleagues in the Presidency concerning this. He said there seemed to be a misunderstanding. What was said was that the vaccine was expensive: “there is quite a big difference between the two.” The Pfizer vaccine was quoted as being $10; there are vaccines at much lower prices, which is in the public domain. So the response, he said, was about the vaccine being expensive but not unaffordable. “Certainly when we do procurement we will look at the cost effectiveness of the vaccine.”
On the question of intern placements, he said that “all of the medical interns have been placed, so have the community service doctors”. There are about 1 800 interns which have been placed and around 2 355 community service doctors which have been placed. There are no outstanding issues in this regard.
On the question of access to beds, there has been “severe pressure” on access to beds, particularly in private hospitals across a number of cities in the country and that the National Department of Health has been working very closely with provincial departments to try to assist with additional beds. The provincial departments would be able to confirm the details of patients being transferred. But the Department continues to monitor the situation, and to cooperate with colleagues in the private hospital sector to ensure that sufficient beds are available in the public sector where there is pressure in the private sector.
On queries relating to oxygen, he said the country had three oxygen suppliers, one of whom (for a time) had difficulty supplying the full quantity of oxygen to the Western Cape. This was remedied and “things are much better now.” However, as the demand for oxygen and hospitalisations increase, “this will place a strain on oxygen supplies.” He said “there isn’t a shortage, but if there is a breakdown in oxygen equipment et cetera, this will cause challenges.”
On questions about communication, “we have quite an extensive communication strategy, including [inaudible], production of posters electronically as well as short videos” to provide information about the pandemic. However, he said “we’ll certainly have to deepen the extent to which people are accessing this information because it’s critical that people know well in advance the need to go into facilities early; delaying going in obviously has catastrophic consequences.”
On the question regarding cooperation with universities, specifically the University of Pretoria (UP), “each of our provincial health departments have a close relationship with a number of universities that are supporting them in the COVID response, particularly in research, analysis and the like.” He intimated that UP has a close relationship with the Gauteng Department of Health and is part of the latter’s response team and advises that department on analytics.
On the question of ivermectin, Dr Pillay explained that this “is a mandate of SAHPRA—not the Department. We have looked at the trials and I think it’s fair to say there is much academic debate about its effectiveness or not. In my engagements with SAHPRA to try and find some solution to this problem, the discussions that we’ve had suggest that maybe a solution is to have a phase four clinical trial structure which would allow patients to access the drug, but there to be (sic) a controlled reporting of the experience of patients both in terms of the effectiveness as well as safety—we’d get a better handle on whether this product works, how well it works and if there are any safety issues around it (sic).” He said he hoped that this would be resolved with SAHPRA.
Dr Mkhize then said “I do accept there’s a need for regular updates between the Ministry, the Department and the Portfolio Committee. You will find that we are ready to come in whenever arrangements can be made.” He added that “I do accept that Members feel that there’s been a gap; too many things have been happening, that we need to find a way to close that gap and I therefore want to give support to that suggestion” (sic).
On questions of Members’ “specific complains that are relating to specific hospitals,” he said “most of the MECs are on the line; we would ask them to actually follow up on those issues, but where it’s necessary we could pick those issues up with the Member directly so that we could share—where we’ve got specific issues—don’t be uncomfortable to send us direct communication, either to the MEC or to the Minister. We’ll try and address those because we do understand the situation is pretty difficult at this stage; there’s lots of pressure in the community amongst our health workers; everyone can feel the pressure of the resurgence, and therefore you’ll not be blamed for raising the issues where you are coming across individuals, because all of us now are having, you know, specific personal experiences where we have to deal with individuals, friends, relatives, neighbours, with the public who are all complaining—or who are raising issues—out of the fact that the number of peoples (sic) who are testing positive, the numbers who are getting to hospitals, the challenges in hospitals—all of that is higher. We have to acknowledge that upfront and say that what you feel is what we are all feeling. We have to just try and work together to try and help our country through this difficult situation. We did say—yes—we were ready, and of course we have just communicated that the surge that we are showing now (sic) is much bigger than what we have seen before and therefore strains are going to be felt somewhere along the line, and we have to really continue doing whatever we can to make sure that we can save the lives of our people. Any life that might be lost—mainly because it’s unavoidable—it really is regrettable that at any one time that we should lose any life that could have been saved, so we would really continue to express our commitment. Particularly, our health workers are very much under pressure, but their commitment and dedication is still appreciated [inaudible]. So we would want to just plead for cooperation, working together to try and resolve some of the problems; where we can find information we will share” (sic).
On the issue of the Premier of the Western Cape wanting to procure vaccines, “I did raise the issue with them that in fact they indicated they were ready to deal with the vaccine, but we have actually since convened the whole national health council with all the provinces, and agreed on the approach that we are going to be securing the procurement centrally. And that is mainly because most of the manufacturing companies would rather deal with governments. I think maybe in another few months that might be a bit more open, but that is our impression at this point. So we will be doing central procurement and we shall cover really the country as it were, and most [other] countries are doing almost the same thing: they procure for the country, and then of course the internal mechanism of distribution are tailored to the various countries” (sic).
On questions relating to the border, he said “There are issues and challenges at the border; we are getting lots of reports—I don’t have any update right now—but we have asked that there should be a review on the whole approach to port health authorities at that level, in particular the question of testing. We are actually going through that issues (sic), so when we got a decision made we’ll make a public statement at that point. But are aware that there’s quite a lot of challenge[s] here, at that level” (sic).
On the question of which vaccines are being looked at, he said “We have indicated that we have dealt with Moderna, Pfizer, AstraZeneca, [Johnson & Johnson] and Sinopharm—and those are the main ones that we’ve actually been looking at.”
On the question of a national mandate for the vaccine, he said “The vaccine will be voluntary; we’ll try an urge as many people to take the vaccine, but vaccines are actually not mandatory. We just need the community to understand that it’s for their benefit, and therefore they need to participate at that level. So where there are issues related to moral, ethical or religious objections and those kinds of issues, we can deal with those at the time when we meet those situations, but where we are, the vaccines are going to be offered really more for the common good of all, and therefore […] they are not going to be mandatory to anyone, but we will actually like to see everyone taking up the vaccine” (sic).
On the query concerning whether the vaccine will work, he said “Actually the vaccines do work, and there is not the only one on COVID (sic), we dealt with that on polio, on tetanus, on measles, et cetera. And so all of this actually help to save the community from infection (sic).”
On the issue of the council meeting having delayed the arrival of the vaccine he said, “I think it’s a ridiculous statement but because it has been responded to, we’ll not waste time on it. The point is that we’ve actually been hard at work to make sure that we secure vaccines for the country and so everything else is all part of the mechanics of managing things and so we don’t think they should be taken out of context. So we don’t believe there has been time wasted, nor do we ever believe (sic) that there’s any need to take government to court, because government is actually to the provision of the vaccines and we’ll move on in that regard because of our duty and responsibility of our Republic, and so those who have got concerns we’ll try and explain to them so that they can see that we’re all on the one side here, we don’t have two sides on the issue of COVID (sic). Some have even suggested there is denialism and of course that is completely out of context, because there’s no-one who’s denying; there’s clearly a science-like process here, and so we will deal with it from that perspective.” He added that “I think what we must accept is that there’s a lot of anxiety and uneasiness, and people are also—you know—worrying about a number of things, that’s why we have had a lot of public concern that we have noticed.”
On the questioning on financing, he said “[inaudible]… we have accepted that there will be support that will come from [the] private sector in terms of business[es] and donors, also in terms of medical aids. But government is not relying on charitable sources; we have actually got the fiscus to carry this; this would have been the response that the Minister of Finance would have given at the time if he had been here; we’re not at liberty to release any kind of figures. All I can say is that between us and Treasury, the funds we need to raise, to purchase, to procure the vaccines will be made available, and so it’s a matter of I will deal with the details (sic).”
On Ms Sukers’ question “of the challenges of having to deal with individuals who are sick,” he said “we do appreciate and understand. I think that we have indicated that all of us are going to come across that situation because we are going through a really difficult time, however we must say that we must continue to work together and share whatever information that we need. Now, there’s a lot of information that has been requested about hospitalisation numbers, beds, and ICU, and so on: That we’ll just need to prepare and give a proper presentation because we won’t be able to do justice at this point” (sic).
On Dr Thembekwayo’s question concerning the discrepancy in timeframe of the President (who indicated acquisition in April 2021) as against the Minister (who had just indicated acquisition in February 2021), the Dr Mkhize said “There were two days given; the dates that the President gave indicated that the COVAX timeframe was saying that we should have our first vaccine from [the] COVAX facility around April —that is the timing of the COVAX facility. Then—it’s only 10 per cent that we’ve committed to COVAX. We are raising the rest of the 57 per cent of the vaccines, and this is when I’d said ‘we are looking at earlier delivery’—so I’ll come back to that issue because there is nothing wrong here. We’re basically saying that we’re trying to do everything we can—I’ll come back to that just in a minute.”
On Mr Shaik Emam’s question about India’s potentially banning the export of vaccines, the Minister said, “There is no banning of exports. The matter was in the media. It has been corrected. You will understand when I come back after the next few points I want to make. The concern was worrying all of us; I think we have dealt with it.”
On the matter of ivermectin, he said, “I do want to acknowledge the letter you wrote, honourable Emam Shaik (sic); and the matter here related to the question of ivermectin. And in this case the concern…all that I understand was the response was to say…the matter we are prepared to work with you and support as far as we can, we don’t believe we need to go to court. If you give us all the information, we’ll try and follow the issue up. We have indeed taken the matter forward. We have been receiving a number of comments from a number of people on this issue—on ivermectin—I can just read briefly for you that they did issue a statement from SAHPRA indicating some of the analysis that they’ve done,” and he added that “They did a number of other analyses afterwards. Then they felt that they were not in a position to register it as it was submitted, but in fact the MAC had a huge debate about it, and so they also felt that the stance taken by SAHPRA was correct. So the latest—after review—because of the issues you raised and the fact that we had to intervene to say ‘okay relook at this issue and come back and tell us after these additional appeals have come,’ so I just want to quote briefly from SAHPRA’s response: ‘there are currently no applications either for clinical trials or for the registration of ivermectin, for the treatment or as prophylaxis for COVID-19, however SAHPRA encourages and supports all well-designed, ethically approved scientific studies designed to identify new or existing medicines that are used in the treatment and prophylaxis for COVID-19. SAHPRA reiterates its commitment to expedite the review of such studies.’ We’ll send you the statement but in reality, there’s nothing stopping a special arrangement to actually apply under the supervision and the doctor taking responsibility—that’s how they’ll have to deal with this. So I think that when you start saying that SAHPRA is captured and who’s financing… I think you’re taking it a bit far; I think you should come back from that, because it is not correct. I think what has happened here, you are dealing here with a situation where you have people who are looking at this matter; it’s not political, it’s completely clinical, and also the commercial interest get[s] put aside, we just look at the science tests. So I think I just want to assure you; no need for us to take it to that kind of extent. So I hope we can close that matter.”
In response to Ms Hlengwa, he said, “studies are being done to look at all the aspects of this particular strain; the issues of vaccine sensitivity and issues of—you know—whether it’s more virulent than the other one. There’s no evidence of that, but it [has] been seen that it’s much more transmissible, like what we have seen in other countries. So because it’s a new issue, it’s going to continue being a matter which will be focusing our scientific research attention.”
The Minister then remarked that “in line with our commitment to keep the public informed of developments relating to the vaccine rollout strategy, we will still communicate developments therefore of national importance,” and added, “when we had the press briefing on Sunday (3 January 2021) we indicated that insofar as our negotiation with individual manufacturing companies were concerned, we are bound by the nondisclosure agreements and confidentiality clauses that we’d agreed to. We accept this and we recognise that we are in negotiation with independent private companies who may not want details to be disclosed until certain, or all, items and conditions between the parties are met. At the press briefing, I as Minister of Health, gave an undertaking to [the] South African public that we would prioritise the protection of the health workers but ensuring that they receive the vaccine by February 2021. At the time I could not disclose further details.”
He said, “Today, I’m pleased to announce that the Serum Institute of India has given us permission to make public an announcement—a public announcement—and start engaging with all the relevant stakeholders in preparation for the rollout. In our presentation we also stated that as a country, we’ve estimated 1.25 million of health workers (both for the public and private sector) need to be prioritised. It is for this reason that today we announce that South Africa will be receiving [the] first 1 million of vaccine in January  and another 500 000 in February  from the Serum Institute of India. As recently as yesterday our teams at the National Department of Health and SAHPRA, we are fine-tuning and aligning all the regulations and processes to ensure that there are no unnecessary delays or regulatory impediments to activate this rollout. We are all happy that the Serum Institute of India and AstraZeneca vaccine has already been approved by various regulators and is being rolled out in other countries. Therefore, as part of expediting the regulatory process, SAHPRA is applying reliance on that regulatory framework. We also want to inform the public that the acquisition has been done directly by the Department of Health. This strengthens the credibility of the processes of negotiations and payment issues are managed directly by government with other manufacturers. The concern that we’ve had with the PPEs (sic) is basically that there were many vendors that we do procure from. This is quite direct between government and the manufacturers. We’ll now be engaging all relevant stakeholders to ensure an efficient and effective rollout of the vaccines for our health workers. Because once it’s in here we have to take care of both [the] public and private sector[s]. We are meeting with the private sector to look at finding the structures to ensure that the proper administration and allocation of the vaccine so that the relevant sectors are able to receive the vaccines accordingly. We therefore ask the public to be patient with us as we continue to engage manufacturers. Our commitment remains to save and [inaudible] the lives of our people. We will not neglect our responsibility to protect lives and also fight this pandemic. We therefore call on South Africans, members of the public and political parties, business, labour and NGOs, and community leaders and Members to work with us as we start this historic process.”
The Minister thanked the Chairperson and Members for their time.
The Chairperson thanked the Minister and welcomed the fact that the Minister wanted to bring back regular updates to the Committee. He said the final time slot would be determined. He expressed his desire to have the relevant MECs present in these future updates.
The Chairperson also clarified to Members that the discussion he had had with the Speaker did not mean there would be no special sitting in Parliament on the matter of the vaccine rollout. Rather the Portfolio Committee was meant to ascertain more details before any potential special sitting.
The Chairperson thanked all Members for their presence and their robust engagement.
The Chairperson adjourned the meeting.