Vaccine acquisition, roll-out & new Delta variant; with Acting Minister


30 June 2021


Meeting Summary

Video: Portfolio Committee on Health, 30 June 2021

The Acting Health Minister, Deputy Minister and the Department of Health (DoH) explained that vaccines can only be considered for procurement after registration by the South African Health Products Regulatory Authority (SAHPRA). It is currently reviewing the data for the Sinovac, Sinopharm and Sputnik vaccines with the view to registering the vaccines. The Delta variant, which was first sampled in India in October 2020, is now detected in 85 countries and is rapidly becoming the dominant variant in many countries including South Africa. There is now good evidence that Delta is more transmissible than previously circulating variants of concern.
Members expressed concern over the slow pace of the vaccine roll-out. There was the suggestion that the private sector needs to be allowed to procure and distribute vaccines to speed up vaccinations. They asked why not open up to all who want to be vaccinated. Members asked about vaccinations for people with co-morbidities and with disabilities. They asked if efforts were being made to source the AstraZeneca vaccine again as it is efficacious for the Delta variant. Will that be fast-tracked given SAHPRA had approved it before.  Members commended the Limpopo Department of Health on its good work in going out to rural areas to ensure the elderly are vaccinated. Members asked what DoH wants to achieve with the two-week lockdown. They asked about field hospitals; alternative treatments; not stopping travel from India; and about the community service and intern doctors sitting idle.

The Acting Minister answered that the Department is concerned with how it has fared in the vaccine roll-out with the over-60 population and is looking at what has caused it not to reach its target. As of 1 July, the vaccination roll-out is opening up to people over 50-years-old and to people in the active economy, hence the multi-phase approach to vaccination. She was adamant in her reply about the alleged SAPHRA conflict of interest.

Meeting report

Opening remarks
The Chairperson said the purpose of the meeting was to receive a report from DoH, led by Acting Minister of Health, on the acquisition of other vaccines, the vaccine roll-out programme, and on the new Delta variant. He reminded Members that this virtual meeting was deemed to be in the precinct of Parliament, and therefore constitutes a meeting of a Committee of the National Assembly for official purposes. In addition to the rules for virtual sittings, the rules of the National Assembly, including the rules of debate, apply. Members enjoy the same powers and privileges that apply in Parliament. Members should equally note that anything said in the virtual platform is deemed to have been said in the House and may be ruled upon.

The Committee wanted to get an update on the acquisition of vaccines and especially other vaccines, to improve the pool of vaccines that DoH has. The Committee acknowledged that DoH might not have all the information; this might mean the Committee asking SAHPRA to update it.

Mr T Munyai (ANC) proposed that in that SAPHRA meeting, the Committee have an item about the independence of the regulator based on science, not politics – and the Chairperson asked him to remind him.

Acting Minister overview
Acting Minister of Health, Ms Mmamoloko Kubayi-Ngubane, apologised that the Director General who would be unable to join the meeting due to a meeting with the Auditor General which could not be moved. Other team members were present and Dr Anban Pillay would present. Members would have noted that DoH had already given a briefing to the public on the presence of the Delta variant in the country. That led to the President announcing Alert Level Four restrictions.

When the risks are higher, it will place more restrictions, and when the risks are lower, it would lessen the restrictions. This is to assist in managing the pandemic across the country. Members would see in the presentation that although the Delta variant has not completely taken over and replaced the other variant, it has continued to increase its dominance. This will be explained so DoH is able to clarify for those who said, for example, that perhaps it should not have stopped buying the AstraZeneca vaccine. At the time, the Beta variant was dominant in the country, and DoH had been advised that the AstraZeneca would not assist in protecting the nation. DoH continues to follow evidence-based interventions. That is reflected when DoH comes to talk about the currently-available vaccines in the country; all those have been approved based on the information DoH receives through the regulator that is there to do its work independently.

Covid-19 Response: Department of Health briefing
Dr Anban Pillay, DoH Deputy Director General: Health Regulation and Compliance, showed a graph of the SARS-Cov-2 cases in first, second and third waves in SA. It showed the seven-day moving average cases per 100 000 people. The third wave of COVID-19 is threatening to reach the levels of the 2nd wave or potentially even pass it. The increase in cases was low initially. There was then a much more rapid increase in cases across the country.

African COVID-19 epidemic
• 5.2 million cumulative cases (2.9% of global cases - up to 24 June 2021)
• 139 397 deaths (case fatality ratio: 2.6%; 3.6% of global deaths in 15% of world’s population)
• 14 (25%) countries in a 3rd wave - 64% more severe
• 53 (96%) countries had a 2nd wave - 74% more severe than 1st wave
Dr Pillay noted that most African countries have either had two or three waves.

COVID-19 in South Africa
A graph was provided and Dr Pillay added that hospital admission numbers closely mimic new cases. If South Africa wants to prevent hospital admissions, the key strategy has to be to prevent transmission of infection. There is a close correlation between deaths and hospital admissions, as well as new cases.

R number
Dr Pillay explained the graph on the R number (reproduction rate) of COVID-19 as how many people one infected person infects. If the number falls below one, then that is very good since it means that one is not able to infect other people, and it reduces the spread of infection. When the number gets above one, it means that more people are being infected.

Average daily tests & proportion of positive tests
As more people get infected, they come in to be tested, and there is an increase in testing. Linked to the increase in testing is greater levels of cases. The percentage testing positive is getting to approximately 25%, which is about one in four. In some provinces, the level of positive tests is higher than 30%, such as in Gauteng.

Confirmed cases by province
Gauteng had increased rapidly relative to the other provinces. The Northern Cape is declining; it has not decreased to an acceptable level, but it is moving in the right direction. There was a similar trend in the Free State. The other provinces are all showing increases, some more rapid.

The graph showed the seven-day moving average per province. Gauteng trends were driven by the new variant and noncompliance with mask-wearing and social distancing. As of 31 May, South Africa had two provinces that had high levels of cases: Free State and Northern Cape. Over time, the North West increased, and there was spread in the Western Cape. Now, there are four provinces with high levels of infection: Western Cape, Northern Cape, Free State, North West.

Provincial Resurgence Analysis
The graphs on page 11 were the work of the modelling consortium. Most of the provinces have passed the point of the definition of a third wave – Gauteng, Northern Cape, Free State, North West and Western Cape. KwaZulu-Natal still has a little bit of time to go before it reaches the point of a third wave. Eastern Cape is close to reaching the point of a third wave. Mpumalanga still has a little bit of breathing space.

Expected & actual all-cause deaths during COVID-19
See the graph on page 12.

Detection of Delta Variant in South Africa
The Delta variant was detected in June and over short space of time, the Delta variant (21A) has displaced the Beta variant in a number of areas. The Kappa (21B) variant is emerging in some provinces. It is another variant to watch. There are very low levels of the Alpha variant. DoH anticipates that the Delta variant will get to much higher levels, and this may explain the increase in the daily cases (shown by a dark line). DoH expects the Delta variant is playing a significant role in driving up the cases.

Western Cape: The Delta variant is increasing and displacing the Beta variant. The Eta variant was shown by a pink area on the graph. At this stage, it does not seem to be as dominant as the Delta variant, but it must be watched. The increase in the Western Cape can be attributed to the Delta variant.

Gauteng: The rapid rise in cases was shown, almost in parallel to the increase in the Delta variant. The Alpha variant still exists in Gauteng, but to a very low extent. Dr Pillay thought that in a few weeks, the entire portion of the graph would be shaded green (the colour representing the Delta variant), as DoH anticipated that the Delta variant would continue to displace the Beta variant.

Eastern Cape: The Delta variant showed a similar picture. It is not moving as fast as the other provinces. Seroprevalence seemed to be one theory, given that the Eastern Cape had such as severe second wave. There were increases in the Delta variant’s presence over the past couple of weeks, and DoH would need to keep watching to see how it progresses.

Limpopo: It showed a similar picture to the other provinces, with rises in the Delta variant, and also a rise in cases linked very closely to that.

Delta Global Distribution
- First sampled in India in October 2020
- Now detected in 85 countries, including several in Africa, rapidly becoming dominant in many. Dr In a number of African countries, the Delta variant remains endemic, as well as in South and North America, Europe, Southeast Asia and Australia.

Vaccine registrations
• Vaccines can only be considered for procurement after registration by SAHPRA.
• The Ministerial Advisory Committee on Vaccines also advises the Minister on selection of vaccines, procurement and use of the vaccines.
• SAHPRA has to date approved the Pfizer, Johnson & Johnson and AstraZeneca vaccines. The Pfizer and Johnson & Johnson vaccines are currently being rolled out.
• SAHPRA is currently reviewing the data on Sinovac, Sinopharm and Sputnik vaccines with the view of registering the vaccines (if the data on safety and efficacy is considered to be acceptable in terms of scientific standards).

• Delta is now rapidly becoming the dominant SARS-CoV-2 variant in many countries around the world, including SA
• There is now good evidence that Delta is more transmissible than previously circulating viruses
• There is some reduction in neutralization with convalescent serum collected post-Beta infection, raising concerns about potential for re-infection in SA
• Vaccine effectiveness data from UK suggest good protection against symptomatic disease, and very high levels of protection against hospitalization, after two doses of Pfizer or AstraZeneca vaccine (no data for J&J). DoH would anticipate that the J&J vaccine will perform similar to the AstraZeneca vaccine, but it will await the studies on that. It anticipates that the J&J vaccine will be as effective as the AstraZeneca vaccine against the Delta variant.

The Chairperson said that the Acting Minister in her opening remarks spoke about AstraZeneca. What type of debate is there? The Committee was aware that when AstraZeneca landed in South Africa, government was advised by scientists that it would not be effective against the Beta variant in the country. Government did ensure that that vaccine was sold to countries that needed it. One cannot say that government should not have sold the AstraZeneca vaccine as it was expiring in April. What would have been the use of AstraZeneca if South Africa kept it. Now that it knows that there is a Delta variant and AstraZeneca is effective, so be it. However, South Africa could not have used the AstraZeneca that came in February, because it had an expiry date. If government had left it, it would have been accused of wasting taxpayers’ money.

Mr A Shaik Emam (NFP) said that he sent correspondence to the Acting Minister with questions; could she indicate when he would get a response? In the last meeting he noted the success rate of Dr Shankara Chetty, who is now being recognised more and more worldwide. Together with that, if one looks at what Minister Nkosazana Dlamini-Zuma has said, South Africa needs to simultaneously deal with vaccines and look at alternative solutions. This is one of the solutions, and his understanding was that to date, DoH had not contacted Dr Chetty. If there are solutions to problems facing the country a solution should be hastily considered, or at least have a discussion with those with the solution. He was told that vaccines were being distributed to many sites. Some of these sites have vaccines still available because there is a slow uptake; people are not coming in to have the vaccine. What process has DoH in place to redirect those vaccines so they do not expire or get wasted?

Mr Shaik Emam said that Dr Pillay spoke about the independence of the regulator and that only after registration will South Africa be able to procure. He reminded Dr Pillay and DoH that that is not true. When South Africa ordered the AstraZeneca vaccine, it was already on its way when an application was not even done at that stage, and yet Dr Pillay talked about independence. The SAHPRA board chairperson is a director in a procurement company. Can we get independence when the SAHPRA CEO came from McKinsey? McKinsey, together with Aspen Pharmaceuticals and Johnson & Johnson, have been involved in corruption and also mass deaths in cancer-related products they manufactured; there has also been upscaling in pricing. Don’t you think we have reason to be suspicious and concerned about what is actually going on?

The Committee asked a long time ago for measures to be put in place to stop travel from India, because of what was going on in India with the Delta variant. But once again, DoH failed to take timely action. Some of the most ridiculous responses came from DoH. It told the Committee that there was no direct flight from India, but people who tested negative in India then tested positive when they landed here, because they even went as far as buying their COVID-19 test results.

A death has been reported of an Eastern Cape hospital worker after having taken the vaccine. What is the position on this or is the Department going to refute these claims and not compensate people? Can it tell the Committee what it has established about this?

Mr Shaik Emam said that Johnson & Johnson released a statement on 28 May that there is a plausible connection between its product and clotting, plus thrombocytopenia. Despite that, neither DoH or SAHPRA made a statement advising the public about this danger. The World Health Organisation (WHO) called for an immediate halt on youth vaccination based on myocarditis reported in young people in the USA after taking the Pfizer vaccine. Are the parties aware of the preliminary report by Dr Tess Lawrie where over 800 000 adverse events have been reported? How many people have tested positive after taking the vaccine and how many of them have died? Why is the Committee not getting these reports? DoH is giving the Committee reports every day, which are unreliable anyway, but why is DoH not giving the Committee the reports it needs. What has happened to Ivermectin? Where is the report from SAHPRA, which he asked for in the last meeting? DoH had assured him that it would look into that. Why is DoH not giving the Committee the report on the settlement agreement on what SAHPRA agreed to in court?

Mr P van Staden (FF+) said that since only 2.7 million people have been vaccinated and the new variants are getting people infected in large numbers, Gauteng is now lockdown. Would it not be better to open registrations for vaccinations to everyone over 18, and people who want vaccination can be helped on a first-come-first-served basis? Otherwise, South Africa will take a very, very long time to get the population vaccinated who want to be vaccinated. In his view, South Africa must speed up the process. He is currently aware of a 29-year-old who has Down’s syndrome and is autistic, and is in urgent need of a vaccine. This person cannot be helped because of the registration system that is open only for ages 60 and above. This week, it opens for 50-year-olds. What measures are in place to help disabled people who want a vaccine?

No one can be forced to take the vaccine. He had received complaints from educators whose choice it was not to be vaccinated. They must now hand in sworn affidavits at their school that stipulate why it was their choice not to take the vaccination. Can the Acting Minister please consult with the other ministers and bring to their attention that no one can be forced to have a vaccination? On 25 June, a circular was issued to provincial health departments, heads of pharmaceutical services, district managers, vaccine programme managers, vaccination site managers and COVID-19 vaccinators. It stipulated that pregnant women were excluded from COVID-19 vaccines as the data to guide vaccine decision-making is lacking. It states that clinical trials on pregnant women are now under way. It stated that certain vaccines should be offered to all pregnant and breastfeeding women who are eligible to be vaccinated. How can healthcare workers have discussions with pregnant women about vaccination it states: These discussions should include the fact that safety data for vaccines in pregnancy and breastfeeding women are currently inadequate. Does DoH think this is the correct path to go with pregnant women, as no clinical trials have been done on them before? How does one know if their unborn babies will be safe on receiving these vaccines?

He had received complaints from people who were eligible to be vaccinated, but had been turned away from certain clinics in Gauteng even though they had registered and received an SMS and a vaccination date. Why is this happening, and how will this be addressed?

It is important to explain the difference in the variants for South Africans to understand because many people are watching the Committee meetings with DoH. Does the Minister not think that the time has come to allow the private sector and provincial governments to procure, store, and distribute vaccines, so that the vaccines can be administered at a much faster pace? South Africa is running at a very slow pace at the moment. Now it looks like it will take us forever to get everybody vaccinated who wants to be vaccinated.

Ms H Ismail (DA) said that Gauteng cases are significantly higher than other provinces – why is this the case? What has Gauteng done differently, or what has it not done? Has a cost-benefit analysis been done by government on the impact of further restrictions? Does a lockdown save more lives than it destroys? Is there evidence to back lockdown restrictions? If not, why not? What studies are being conducted on J&J’s efficacy for the Delta variant? How long will it be before the results of these studies are released? Will J&J vaccines need a booster shot, as stated in some reports?

Ms S Gwarube (DA) said that the Committee can understand the issue of AstraZeneca, and how that vaccine was not effective against the variant South Africa had at the time. What is the process to source the supply of AstraZeneca again? Will SAPHRA look at the scientific evidence it had before so if South Africa sources AstraZeneca again, it will not need the regulator to approve it again? She did not expect DoH to speak on behalf of the regulator, but it would be interesting to know if this is something South Africa can source quickly.

On the pace of vaccinations, 121 000 vaccinations were done on Tuesday, 29 June. This is a recurring question Members have asked consistently about the commitment from DoH. The initial target was between 250 000 to 300 000 people per day. Now, the categories for vaccination have expanded: over-60s, healthcare workers, teachers, and those on the frontlines. One would assume, considering that a lot more people can be vaccinated and the Committee was told the supply is fairly consistent, why is South Africa still not meeting its targets? 121 000 vaccinations per day is dismal for a country that is in the throes of a devastating third wave.

South Africa is nowhere near where it needs to be. What is the throttling factor? The Committee is told at these meetings that DoH will ramp it up and will open more sites and ensure more people are vaccinated daily, but it is not happening. The target for vaccinating 5 million over-60s was meant to be today, 30 June 2021. She did not know how many over-60s had been vaccinated, but there have been delays and South Africa is nowhere near where it should be. What is the DoH view on allowing the private sector - professional bodies and other players - to be able to distribute vaccines under strict regulations?

Ms Gwarube understood that there may be limitations on the DoH obligation for how vaccinations can be distributed. Now we are under the gun, we are chasing a deadline, and we are completely underperforming. Surely other players can come on board? Various companies and other players in the country have come forward to say they are ready to vaccinate. Why is there reluctance to do that. When can people with co-morbidities expect to be able to register on the system? There was a lot of talk on how after over-60s, the system would be opening up to those over 40 with co-morbidities. That kind of language has fallen away. There have been calls from people saying, I am 39, and I have hectic co-morbidities, when will I be able to register? There now seems to be a segue into looking at teachers and other frontline workers. What is the thinking of DoH? What is the sequence? Who is next, and what it the rationale behind who will be next?

What is DoH seeking to get during this lockdown other than building up healthcare system capacity? Balancing livelihoods and lives is a more urgent question than it was during the first lockdown. South Africa is now in a third lockdown, and it is a lot more urgent to open up industry. What is the DoH goal for the two-week shutdown? What kind of indicators can the Committee as an oversight body look at to see if DoH has achieved the goal? In the first lockdown last year, DoH said that it wanted 21 days to build health system capacity. Those 21 days came and went. More lockdowns came and went, there was no tangible system capacity the Committee could point to. She asked if the Committee could get tangibles so it could judge DoH at the end of the lockdown.

Ms E Wilson (DA) said a lot of information is circulating about vaccines. South Africa does have the anti-vaxxer communities who are constantly talking about the number of people who have had bad reactions to vaccines and had heart attacks or embolisms and died. It is very important that an assessment is done and the Committee get figures on how many people have had severe reactions or deathly reactions and from which vaccines. This information is important, particularly for those who are trying to defend vaccines and encourage people to have vaccinations. If 1% of one million are having a bad reaction, that is to be expected, as it is known that people have reactions to vaccines for a lot of different reasons. The known percentage will assist Members in discussing vaccinations with people so that Members can calm the situation down. This information is critical and needs to be communicated. She requested this information.

She heard what the Chairperson said about AstraZeneca, and South Africa sold it on because it could not use it. The reason given was that it had a low efficacy rate against the Beta variant that South Africa was dealing with at that time. This is understandable, but only to a point. A low efficacy rate is better than not having any vaccine protection whatsoever. She found that very concerning, because she believes that having some protection is better than no protection. The end result was that South Africa sold on a vaccine that could have potentially saved a lot of lives.

She echoed Ms Gwarube in asking: is South Africa getting the AstraZeneca vaccine again, how quickly is it getting it, and how quickly can it start distributing it? We are seeing very different symptoms in the Delta variant. The symptoms are very different to the variants in the first two waves. Not enough was being done to communicate the changing symptoms. The most prominent symptom from friends and relatives who had it was the severe headaches. People were not aware that the symptoms for the new variant have changed considerably, and they should be watching out for something different. The symptoms are similar to flu symptoms accompanied by a severe headache. In that case, people should go and get this checked. People are ignoring it because they are telling us that they have flu; but they have COVID.

In the slides, Limpopo was the one area that had quite a significant rise in the Kappa variant. She asked him to give the Committee more information on that, and potentially why Limpopo versus the others has a higher occurrence of that variant. The Committee needed to know the difference between transmission rate versus deaths of the variants. Are there higher morbidity rates in the Alpha variant, or in the Delta variant?

The slow vaccine roll-out is unacceptable. When people are not prepared to take the vaccine, due to misinformation or no information, what will be done? The week before last, Ms Wilson went to have a vaccine with her husband and Anna, a woman who lives at the house and has been working for her for close to 30 years. The three of them were queueing at Clicks. The staff ended up turning away two or three people, saying they could not open another vial as there were not enough people to be able to finish the vial. They should come back the next day.

Ms Wilson’s husband and Anna were turned away because they did not have medical aid – after they had sat waiting for nearly four hours. She did not think that that was acceptable. There are people waiting, who are desperate for the vaccine and are prepared to take the vaccine. Given the growing numbers and the fact that South Africa is on a 14-day lockdown, but it is seeing numbers that are exceptionally high, further lockdowns are a likelihood. South Africa is missing the mark on this completely. If it is not vaccinating, and people are not taking the vaccines, and government is not effectively communicating very important information, it is going to continue with the lockdown. That is something that this country simply cannot afford.

Mr M Sokatsha (ANC) noted Dr Pillay said that numbers were dropping in the Free State and the Northern Cape. As a layman, his assumption might be that the number of tests were dropping as people are not coming forward to test. Or it could be that people are adhering to the COVID-19 regulations. He was happy Dr Pillay said that vaccination can only be considered for procurement after SAHPRA registered the vaccination. Dr Pillay mentioned that vaccination has advantages: It protects people from a high level of symptomatic disease and high hospital admissions. This is especially true if one has had a second dose of Pfizer or AstraZeneca.

Mr Sokatsha had a question about the good example set by Limpopo. People reached out to people in villages and remote areas, particularly elderly people, who might not be able to come to the town centres. Is DoH advising other provinces, particularly Northern Cape, KwaZulu-Natal and Eastern Cape, where there are a lot of remote areas to follow the good example of Limpopo?

Ms M Sukers (ACDP) said the Delta variant, which virtually collapsed the India's healthcare sector, is now driving South Africa’s third wave. The previous Minister was asked by this Committee why travel from India had not been immediately stopped, with tracking and tracing of persons who had travelled from India. Does the Acting Minister know why these questions were not taken seriously? DoH should give the Committee an account of why it was not done. If South Africa had done that, countless lives would have been saved. What practical steps is the Acting Minister going to take to avoid a repeat, and ensure that questions asked by this Committee are taken seriously?

Ms Sukers asked about the field hospitals. The Delta variant, which seems to be the dominant strain, is propelling a dramatic increase in hospital admissions, and an acute shortage of intensive care unit (ICU) beds. Are any field hospitals still open? What arrangements are being made to reopen field hospitals or provide suitable alternatives in provinces such as the Western Cape where the third wave will shortly strike?

On the question of vaccines, both Pfizer and J&J have used stem cells from aborted foetuses in their development, either in their production or testing. This could be a factor driving vaccine hesitancy among people who have moral objections. When the previous Minister seemed unaware of this, Ms Sukers offered to facilitate giving the biological information, which she did. The Minister’s spokesperson had asked for the information, which she assumed was in preparation for meetings with the faith and religious communities that coming week. She asked if there was research on the reasons for vaccine hesitancy. From her encounters with her constituency, there are religious objections on this basis. Will the Ministry consider acquiring ethical vaccines that do not use that method?

Last year, a study conducted among patients visiting clinics for TB or HIV treatment, and for neonatal visits showed some 40% had developed antibodies to COVID-19. A survey was also conducted among blood donors. What is the current level of herd immunity or if unknown, what studies are underway to measure this? Members are receiving regular reports of vaccine supply constraints, and warnings of possible future constraints.

Ms Sukers said Ms Gwarube had spoken about strategic sourcing, and she wanted to emphasise this. Countries that have been successful in vaccine roll-out have been ready for contingencies. South Africa appears to be shocked by every setback. The Committee repeatedly questioned DoH about its capacity to conduct strategic sourcing or procurement. It had urged the previous Minister to draw extensively on the private sector. Will the Acting Minister act to implement a comprehensive sourcing strategy?

Why does DoH and SAHPRA continue with double-talk on Ivermectin? Both are under court judgement to make Ivermectin available. What are the numbers under the compassionate programme for access to Ivermectin? How many section 21 applications have been made, and how many have been granted?

Ms Sukers said the Committee must take very seriously the impact of government communication of daily statistics of deaths and infections. The nation has no strong psychosocial or mental support for people in trauma. Our people are experiencing collective trauma. Members of Parliament are suffering greatly because of the pressures that they are under. Is there a different way in which it can communicate? COVID-19 can be overcome. It has more than a 90% recovery rate. That needs to be communicated, because South Africans are gripped with fear. Government needs to tell people that they can survive COVID-19. DoH must take an approach that is much more positive in addressing this. There is a direct correlation between adherence and compliance, and trust in government. This Committee cannot afford lip service from DoH or death by PowerPoint. She emphasised that all questions asked by Members are in the best interests of the people they serve. DoH must do better to act on the questions the Committee has consistently asked since last December.

Dr K Jacobs (ANC) said that he keeps asking himself what is most important thing right now for any person in South Africa? The answer simple: It is what is good for that person and that person’s family. He wanted to know why what people talked about in the first wave is not being talked about anymore. Then MPs were actively going out to support people, promoting non pharmaceutical interventions (NPIs) and having communication strategies. WhatsApp groups were formed and other platforms on which people would find interventions. He did not see that anymore. He did not see the kind of reporting South Africa used to have where people could go onto a platform and easily find what is happening in their immediate vicinity. South Africa knew that the third wave was coming. It is here now. How does it impact on South Africa’s hospitals, how does it impact on people who are patients, on those needing operations, on those who receive chronic medicines, on district services, and on healthcare worker themselves? It is not being talked about anymore. How does it impact on hospital levels?

He had also asked constantly about the field hospitals. He understood that such things cost money, and the challenge of the current economic situation in South Africa. He requested that Members keep on speaking about admissions, bed occupancy rates, oxygen needs, medication needs, informing people where to go to. South Africa learned so much from the first and second waves, and it beat the first and second waves.

Now it has the Delta variant, and it is going to learn from this new variant. Let South Africa continue with the vaccinations, and let it have a vaccination drive, and move fast to get all of the vaccines approved, and South Africa make certain that it saves its people in that way, because it needs to reach population immunity. But on the other hand, South Africa needs to speak up on what it has learned before; let it start with community awareness programmes, its screening and testing sites, quick screening sites, quick testing sites, and sites where people can go to be hospitalised. The mainstay of treatment is a supply of oxygen. That saves lives. As soon as oxygen in the blood drops below 92%, a person is in trouble. Government needs to drive those messages home, and get communication strategies right, which it used to have in place before.

In the same way, South Africa needs to protect its healthcare workers. He had noticed that there is no data for the J&J vaccine, so he had a concern for healthcare workers who were vaccinated with the J&J vaccine. He would hope there is a study looking at the immunity of those who were vaccinated with the J&J vaccine. What impact would that have on the health of South Africa’s healthcare workers, so they would be able to continue to deliver their services?

Dr S Thembekwayo (EFF) referred to the Sisonke trial findings released in April. Out of the [unclear 1:10:31.9] South African healthcare workers who were vaccinated with the J&J vaccine, 50 had severe or serious side effects. That number was not mentioned in the DoH briefings. There was only mention of "very few". The number 50 cannot be comparable to the term "very few". What happened to those 50? Can the Committee have a report on that, if there is any report? If there is no report, she asked why not.

This new information on AstraZeneca is indicative of the Department's confusion and a lack of consistency is the order of the day. South Africans would like to receive information that is consistent, especially health matters. What is the Minister’s take on the SAHPRA association with pharmaceutical companies led by the Bill & Melinda Gates Foundation, and the conflict of interest, where SAHPRA received R27.6 million in 2019 and R45 million in 2020 from the Gates Foundation? This is the same Bill Gates who has shares in Johnson & Johnson. That is why Members say vaccines from other countries are needed.

Members have asked if South Africa can get vaccines from Russia, China and Cuba. This would indicate a move away from American vaccines, and she thought that South Africans would be satisfied to hear of such an announcement from DoH. Why are people who are on medical aid and who register on the Electronic Vaccine Database System (EVDS), allocated to receive vaccines that are very far from their residence. She was making reference to non-Discovery medical aid holders. Could the Minister check on the contact number that people call to find out about the availability of vaccines and the sites, because the responses people get from that line are not professional. That line serves South Africans, but Members are not satisfied with the responses from that line. The DoH roll-out plan is not clear enough. There needs to be an open and solid plan that can be applauded by all South Africans. When can Members expect to have that from DoH?

Mr T Munyai (ANC) welcomed the report on the current state of vaccines and on the Delta variant. The Committee should adopt that as a very important progress report. There is no doubt that COVID-19 vaccines can provide protection against many dangerous variants, such as Delta. It is very important to demand universal global access to vaccines, for South Africa, Africa and the rest of the developing countries. It is within South Africa’s national interest that all people are vaccinated as urgently as possible.

The vaccination numbers have declined – is this to do with the lack of vaccine supply, or lack of human resource capacity? The United Nations (UN) Chief Economist Elliot Harris argued the following: "The timely and universal access to COVID-19 vaccinations will make the difference between promptly ending the pandemic and placing the global economy on a resilient recovery trajectory, or losing more years of growth and development opportunities". All that Members are trying to plead with the Minister is that while they welcome the report, South Africa needs more supply of the vaccine. Regardless of socioeconomic status, whether people are in Tsitsikamma in the Eastern Cape, or Springbok in the Northern Cape, or in a distant village in Limpopo, people should have access to vaccines at equal rates.

Members know that this is not an easy intervention, because it has to do with the logistics and the cold-chain needed to keep vaccines at a particular temperature. The rest of the continent and developing countries should have access to vaccines, especially South Africa. He requested that the military assists in the deployment of the vaccine to needy areas. Members already know that the business sector is receiving nearly a billion rand to roll out vaccines. But Members are saying there is a need to strengthen the capacity of the developmental state – by making sure that the military, like any other country, is allowed to vaccinate people.

Ms Ismail added to her questions – after having network connectivity difficulties. What mechanisms does South Africa have to ensure people coming through the airports are not bringing in fake tests results? How sure is government that these test results are true? What test verification methods are in place? Is there data on the long-term effects of each vaccine? This is very important as Members are getting some reports that people are dying the next day after receiving the vaccine. Communication to citizens is important. Sometimes people hear of this and they start panicking, and then refuse the vaccination. Communication of the symptoms and vaccine efficacy are very important, and enough of this is not being done.

By now, DoH should be aware that South Africa is in a third wave; it should have been sourcing vaccines from more than one source. Ms Ismail had been called by many healthcare workers who were having problems registering on EVDS. She pointed to the efficacy of the J&J vaccine, as most healthcare workers got the J&J vaccine. How sure is DoH that one jab is enough? South Africa is losing lives rapidly. The vaccine roll-out is extremely slow. Why are vaccinations not taking place on weekends as well? There is the budget constraint – but compared to lives – this is something that needs to be dealt with.

How prepared are South Africa’s healthcare facilities? It had the first lockdown, and people were told the lockdown is taking place to prepare the health system. South Africa is now in a third wave, and it still has not enough beds, not enough ventilators, not enough vaccine supply, and not enough oxygen supply. This cannot go on. South Africa is facing a pandemic that is taking lives at a rapid speed. It needs as many hands as possible to assist, yet community service doctors are not getting placements. This is unacceptable and it is unfair. They are dependent on their placements. Such people’s lives are put on hold simply because DoH has not planned effectively. Some have already wasted six months of their lives; how are they expected to get on with their lives and careers?

The Chairperson said that the information about no serious side effects is important, as it will allay the fears people have. Healthcare workers do communicate at vaccination sites that if one gets a mild headache, take a Panado; if one is feeling unwell, lie down. DoH needs to educate people on the serious side effects, and to report them. Continued reporting will help to say that there are no serious side effects that have been recorded to date, or there is one after injecting two million South Africans. Such things will assist MPs. However, it will depend how quickly the clinicians and hospitals are providing DoH with that information. Again, it must still be the population that must report that they have developed this or that side effect. DoH can only report on what information people bring to them.

The good story from Limpopo needs to spread quickly because Limpopo is one of the provinces that is very rural. But for it to have a significant number of people from uninsured populations registered for vaccines is commendable. Yesterday, the Chairperson was listening to Prof Salim Abdool Karim talking about how the Delta variant is very transmissible. He was not commenting how dangerous it is, but it could possibly make people flood hospitals once they are infected, and therefore the professor cautioned people. Is South Africa getting admissions into general wards, or are most of the ICUs filled up? He agreed with Ms Gwarube and asked if there is a consideration by DoH of getting the AstraZeneca vaccine now that South Africa has the Delta variant.

Mr Munyai wrote in the chat box: The developed countries are enjoying more access to vaccine whilst the developing countries are in the valley of despair; the rich countries should stop the greed and illegal ban of other vaccines to access the global market especially the developing countries. In South Africa, we are very happy about the progress our government in combating….

Department response
Dr Pillay replied that DoH had been planning that it may have a third wave after the second wave. DoH has been working with its provincial colleagues; it has been working on what it calls the resurgence plan, which outlines the lessons learned from the second wave around hospital beds, oxygen, personal protective equipment (PPE), human resources, medicines, and what needs to happen at a particular time in each provincial department to be ready. All provinces have the planning tools. DoH tries to assist them as best it can. This does require information from provinces to say they are having a problem in a particular area. DoH monitors bed occupancy.

DoH had a meeting with the provincial health heads of department (HODs). The DG called that meeting this week, and DoH had a discussion with the HODs about planning for additional beds. All have already plans in place aligned with their resurgence plans. Most of the provinces have closed their field hospitals, and are using current facilities or expansion of current facilities and alternative building technologies because of some of the challenges to ensure that this is something that can be sustained. If one used a field hospital, one would probably have to close it after a while, or some of the resources become lost; but if one has it in one’s own facility, one can keep that for a longer period, and the investment is more cost-effective in that context. Most, if not all provinces, have taken that decision after initially procuring field hospitals.

Free State and Northern Cape testing is continuing at the usual rate. There is the adherence to COVID-19 regulations and advice. Some scientists say that when people see many others getting ill around them such as family members and friends landing in hospital or passing on, then that initiates a behaviour change. The problem is that that behaviour change is sometimes short-lived, and consequently people forget to wear a mask and social-distance. That is what drives the next wave, and people learn again, and forget again. People need consistently to apply the NPIs, because that is the most effective mechanism.

On comparing the Alpha, Beta and Delta variants: The Alpha variant was the initial variant. It was not as transmissible as the Beta variant, and had fewer mutations. The Beta variant was far more effective in transmission and was much more virulent. Now South Africa has the Delta variant. DoH knows that the Delta variant is capable of being more transmissible than the Alpha and Beta variant, and it does not know yet if it is going to cause more severe disease than the Beta variant. What is clear is that if one has a virus that is more transmissible, it does mean more people will be infected than with the Beta variant. As that happens, those who are more susceptible will certainly need hospitalisation.

That is the approach DoH has been taking. In Gauteng, that is largely what has been happening; many more people are getting infected far more easily than if they were infected with the Alpha or Beta variant. Being extra cautious is probably the most critical factor to ensure that transmission does not happen. With transmission itself, this seems to happen in a shorter timeframe. Studies are being done globally since 85 countries were affected. These studies are predicting that virus transmission occurs in a much shorter period of time than the Beta variant.

One of the key objectives DoH wants to achieve with the lockdown is to ensure that it can reduce transmission, which will then reduce hospitalisations, and will have the knock-on effect of a reduction in mortality as well.

On the use of general or ICU beds in hospitals: DoH is seeing many more people infected, and some are going into the ICU. If more people are infected in a particular population, one will certainly see many more people going into the ICU as a result of that.

Dr Pillay showed two slides on the DoH rationale for selecting age groups for vaccination. This comes from the DoH database on mortality. It is what it calls the case fatality ratio, and it is from the Daily Hospital Surveillance (DATCOV) system which the National Institute for Communicable Diseases (NICD) develops. In the graph, the NICD looked at age and sex for the period 5 March 2020 to 5 June 2021. What was most notable was that as age increases, the case fatality ratio increases significantly. If one looks at an age group above the age of 60, one can see that that group is sitting with a case fatality ratio just above 30%; in the case of those 80 and above, the ratio goes above 50%. In a hypothetical scenario where one opened up vaccinations for anybody above the age of 18, one can see, for example in the ages between 30 and 39, that there is a massive difference in the risk and the likelihood of mortality is far lower.

The objective with vaccination at this stage is predominantly to protect high-risk individuals to avoid severe effects that lead to hospitalisation, as well as mortality. The graph on the second slide showed the odds ratio linked to the risk of hospital mortality in South Africa. When there are odds of one, it means that one’s chance of mortality is equal, whether one had that condition or not. As age increases, the mortality risk increases phenomenally. He then pointed to co-morbidities. The graph showed an equivalent point, where one’s odds ratio is equivalent (shown by a vertical red line). Whether one had hypertension, diabetes, chronic cardiac conditions, kidney disease, one’s risk is much lower than the older age groups. If one looks at which provincial health system one is in whether there is any difference there; there is no significant differences with that. The key issue remains age, and that is why DoH is using age as the key variable in determining vaccination.

Dr Nicholas Crisp, DoH DDG: National Vaccine Rollout, replied about numbers. As of yesterday, South Africa had registered just under 4 million people on the EVDS. Today, 30 June, South Africa crossed the 3 million mark for vaccinations. About 480 000 of those were done during the Sisonke trial with the J&J vaccine, and the rest have been done since 17 May 2021. What DoH is currently tracking and tracing is where it is registering and vaccinating, and building on its targeting of the population.

At the moment, registration coverage is about 53% for the target population. It varies a lot from province to province, and DoH has lessons to learn from that. It is the highest in Limpopo which is at 74%. The second highest is Eastern Cape. It means that it is not necessarily the urban areas, that are performing well; in fact, is the rural areas are performing the highest. The low performance is in urban areas. Vaccination coverage is about 47% to 50% in KwaZulu-Natal and Limpopo of this target population. Whereas in some other provinces it is still below 25%. There are specific problems from one province to the other that DoH is trying to understand at district level, and to assist them. It is very different between the insured and uninsured populations. In the insured population, whose numbers are significantly smaller, the lowest coverage is in the rural populations, where a relatively small proportion of insured people have registered.

In the uninsured population, the rural provinces are doing better than the urban provinces, and are getting above 50% of the uninsured target population as of this week. DoH is trying at this stage, district by district, to establish which district services are doing well or poorly. DoH has identified that a significant portion of the challenges of those not performing well is because they do not have a lot of vaccination sites, and the vaccination sites are hampered primarily by geography and also due to the concentration of private sites in the metropolitan areas. For example, [unclear 1:38:17.1] has the highest vaccination coverage of all districts in the country with over 70% of the target population reached, and [unclear 1:38:26.1] being the second highest. With the districts in the Northern Cape, where the distances are very far, and the districts were to rely on the J&J vaccine, which has only just arrived and is not being used in the population programme yet, they are struggling to get their rates above 20%. There are some districts where DoH is identifying that the gap between registrations and vaccinations is very wide, and in others where it is very small.

Where it is very small, it means that the demand is running out, and that demand is often in areas where the registration is high. That is why DoH has taken the decision to open to another category, otherwise it will run out of the demand of the age group 60+. It has also learned from the evidence of other countries that when one introduces the 50+ population, they tend to be the children of the 70+ population, and they take the elderly people with them along the vaccination journey. DoH will monitor that and see if it makes a difference. The registration of the 50+ population starts tomorrow (1 July 2021), and at least by 15 July, it will be scheduling and seeing 50+ people being vaccinated.

On how much vaccine South Africa has: Just in this past week, South Africa received the Pfizer vaccine from the COVID-19 Vaccines Global Access Facility (COVAX). It also gets Pfizer from two separate contracts, so it has received doses in this quarter from the two contracts, and it has received J&J vaccines (announced by the Minister) in two different deliveries, in the previous week Thursday, and in this past week Thursday. South Africa now has 1.5 million doses of the short expiry vaccine, which it is using in the intensive programmes and in the essential services.

DoH has been criticised for the slow uptake and the number of people it was able to target. DoH knows that it is moving towards a target of 200 000 to 250 000 (hopefully in excess of that) vaccinations per day. South Africa is up in the past week from an 85 000 average per work day to over 110 000 at the moment. As new sites are brought online by both the public and private sectors, these numbers will start to increase. DoH is targeting specific districts that are trailing behind. There is a question on equity. That is a concern because one does not want to leave parts of the country behind.

DoH wants to ensure that the target populations in every district are being reached. At the moment, DoH has 53% of the target population registered; just under 40% of the target population has been vaccinated. Now that it has vaccines and is rolling out additional sites, DoH is confident that it will start to pick up speed very quickly. At least for July and the first week of August, it is confident of its vaccine supply. Beyond that point, it is still in the process of stabilising the vaccine supply. It is confident that it can get the supply stabilised. Ideally, DoH would want to reach 65% to 70% of the target population. Now, when it registers the 50 - 59 age group, it will continue to register the 60+ group. There is improvement in what DoH is able to do, and it is trying very hard to up these targets and to move faster. It has a multi-pronged approach to do that.

The private sector is definitely distributing vaccines, it is definitely vaccinating, it has a large number of sites, and DoH has meetings with it twice a week. DoH appreciates the way it is working together very closely with the private sector to ensure it reaches a bigger population. DoH also has agreements with the private sector that it will vaccinate the uninsured population, so the challenges referred to by some Members of uninsured people being turned away from private sites should be a thing of the past. It should now be possible for uninsured people to be vaccinated at private sites, just as insured people will be vaccinated at public sites, especially in rural areas where there are no private sites at this stage, because of economy of scale. DoH has stabilised that relationship and it is going a lot more smoothly.

Dr Crisp emphasised the point about how people must not let their guard down just because South Africa is doing better with vaccination and is improving all the time. The point by Dr Jacobs about continuing to wear masks and hand sanitise must not be forgotten as South Africa moves into a better vaccination period.

The reason for the Limpopo success story appears to be the way in which people have mobilised the community and the community leaders, rather than any particular system. People go to the communities very proactively; people have involved all the Members of the Executive Council (MECs), and all Heads of Departments extremely efficiently. That is a lesson that must be spread to all the provinces.
Ministry response
Deputy Minister of Health, Mr Joe Phaahla, replied about the Delta variant and why DoH did not stop international travel from India. Mr Shaik Emam was not happy that DoH said South Africa did not have direct flights from India. We are part of the global village. Unless one goes back to total lockdown and total grounding of movement, as long as movement is permitted, people will move from area to area. One could go the extra step of having every airline checking where people have stopped over. But the question is if what one would achieve through that would be worth the cost and the effort when one has many other areas where one can get maximum impact. It was really a balancing act, and it would be a different matter if there were planeloads of passengers coming from New Delhi and Mumbai to South Africa directly, then there would be some way of managing that. He noted some Members still remained unhappy with that.

On opening vaccine registration to everyone: Dr Pillay did show the scientific rationale for age differentiation. There is more to gain, because what has been proven is that hypertension, diabetes, heart disease, kidney disease, which are non-communicable disease (NCDs), were also shown to be the risk factors in serious illness, and have a close relationship with age. Using that as a differentiation, one is able to, at the same time, beyond just the risk factor of mortality and morbidity in terms of age, also capture other risk factors.

On why numbers had grown in Gauteng, this province is the centre of South Africa’s economy with business and travel. People travel all over the world for various purposes. Such travel is largely arriving in Gauteng. The Delta variant has been shown to have increased transmissibility, and once that arrives in Gauteng – Gauteng is the most dense of the provinces – there may be increased cases.

On AstraZeneca: One should not go back to the argument if selling it to other countries was correct due to its limited efficacy for the Beta variant. With the current information that it is efficacious when it comes to the Delta variant, there would be no need to re-register it. It is already registered. The only question at this stage is not about its safety, it is more about efficacy, specifically against a particular variant. There will be no need to seek further approval from the regulator.

The factors that determine how speedily government moves are: 1) Availability of vaccines; and 2) human resource capacity once the vaccines arrive. The stock is stocked mainly because all provinces had already identified sites, and potential human resources. But to activate, especially where DoH has to pull in additional human resources, one cannot do that until one knows that one has stock. As the reliability of stock improves, more sites are able to be activated, and more people can be brought in. As the vaccine supply stabilises, DoH can get stability with the J&J supply. With the dominance of the Delta variant, hopefully it can access further stock from AstraZeneca and from the Serum Institute, which will go a long way while DoH is looking at other sources such as the Sputnik, Sinopharm and Sinovac vaccines.

The Deputy Minister agreed with Dr Jacobs that while vaccination has shown to add to protection, it is not a panacea to dealing with this pandemic. It has been shown, not only in South Africa, which is still in the early stages of vaccination, but also in countries which are quite advanced with vaccination. In countries such as Australia, there are a number of cities under lockdown. There was also a report from Prof Abdool Karim on the Seychelles (which has fewer than 100 000 people), where having vaccinated, it had to return to a lockdown because the Delta variant was present there. The Seychelles had vaccinated almost everybody but it had to take this measure despite vaccination as it has a severe wave of COVID-19. There are those who want to whip government for everything, and want to promise the population that one just has to vaccinate, then it is uhuru. Unfortunately, in real life, that is not the fact. South Africa’s population must always be aware of that, and the NPIs must always be emphasised. If Members are not be satisfied with the roll-out plan; DoH could reiterate a full explanation with the Acting Minister on where DoH is with the execution of the roll-out.

The Deputy Minister commented on SAHPRA allegedly being captured by the Bill & Melinda Gates Foundation. That could not be further from the truth, because while there are a number of donors from time to time, especially when SAHPRA was being set up, when it had to catch up from a backlog, there were funds sourced from various sources to help SAHPRA clear the backlog. SAHPRA very much sticks to principles of the science of any medication which comes through, and it works only with if it is compliant with the requirements.

Department response
Dr Pillay said that it is important to understand the way SAHPRA operates. SAHPRA has a number of technical committees. When an application for a medicine is received, each of these technical committees evaluates an aspect. One committee will look at the chemical structure, and its stability; another will look at the way that the tablet or injection has been put together, if the process is appropriate. Another group will look at how it was manufactured. Another looks at when the drug gets into one’s blood stream, how it works. These are all different groups.

Each committee needs to come back and comment if they are supportive of registration or not. That process then gets pulled together to a point where there is a positive recommendation from all the committees. If one of the committees has a problem with a particular product, then SAHPRA will not be able to register that product. In the way SAHPRA operates, individuals do not have the power to decide to register a medicine or not. It is largely process-driven. Most of the regulators across the world are structured that way, so no one person can make a decision about it.

On the funding from the Bill & Melinda Gates Foundation, as well as a number of other donors, when SAHPRA started out, moving from the Medicines Control Council (MCC) into SAHPRA, there was a massive backlog of applications. As a result, SAHPRA needed many more people to come on board, both from South Africa as well as internationally retired evaluators, to assist with getting through the backlog. Funds were required, and these donor organisations offered donations for that. The donations did not go directly into the SAHPRA account; they were facilitated through National Treasury. Like the DoH, many departments receive funds from donor organisations, but the funds come through Treasury in most cases, or the support is in kind.

On the J&J vaccines and thrombocytopenia, that adverse event is well reported in the literature, as well as to healthcare workers. Patients that receive the J&J vaccine are counselled about it, and advised that if they are prone to this, they should not be taking the vaccine. Doctors would advise patients who are at risk not to do so as well. There is a similar situation with myocarditis but the numbers are very small for this. Members asked for more information on the adverse events for each vaccine; DoH could probably provide that information.

Dr Pillay noted that Mr Shaik Emam posed a number of questions to the Minister in his letter, and a lot of these were for statistics. DoH needed to get that information as well as the Ivermectin report which it had promised to get.

[Ms Wilson wrote in the chat box: What is the Kappa variant, where is it from and why is it dominant in Limpopo?]
[Dr Pillay replied in the chat box: It very difficult to say from where a variant comes. The reality is variants will naturally develop. As the virus continues to replicate it will produce variants. The Delta variant now dominant may well be replaced by another variant. What we cannot predict is what will be the next variant or its characteristics.]
[Dr Thembekwayo wrote in the chat box: I am not convinced about the information shared on SAHPRA.]
[Ms Wilson wrote in the chat box: what do we know about Kappa? Are symptoms different, transmission rates (indication on Limpopo figures suggests it may be fast) etc.]
[Ms Wilson: I think that percentage of morbidity and bad reactions per vaccine is very important. We need to encourage people to vaccinate.
[Ms Ismail wrote in the chat box: Has there been a cost-benefit analysis done by government on the impacts of further restrictions? Does the lockdown save more lives than it destroys? Do we have any evidence to back lockdown restrictions?]

Ministry response
Acting Minister Kubayi-Ngubane replied about SAHPRA noting the reference to a conflict of interest that had been mentioned. The Acting Minister wanted to refute that about the SAPHRA Board Chairperson. DoH had looked at that matter. Dr Rees' partner was previously a black economic empowerment (BEE) partner but that has since lapsed, and neither he nor she are involved with Aspen or J&J products. DoH had a conversation with Dr Rees on the matter. As Members of Parliament, one needs to protect institutions and individuals in South Africa from being intimidated, because it will battle later to find professionals who are willing to serve. When people fight, they personalise matters and attack individuals. These are women who have been attacked and literally threatened by people who want to go and do a sit-in at their homes.

This is something that Members of Parliament should stand against as lawmakers who protect institutions that support South Africa. MPs talk about gender-based violence as one of the pandemics yet there are people who attack women because of the responsibility they have taken in South Africa to lead. She hoped that Members would stand with DoH and state that what happened against the SAHPRA leadership is uncalled for.

The Acting Minister said that DoH will respond to Mr Shaik Emam’s letter. In terms of the Rules of Parliament, MP Questions have a deadline and the Ministry has an obligation to respond. The Ministry will respond to the letter but it cannot put a timeframe on because that specific tool was not used of a Committee letter. It is an individual MP Question. According to the rules, the Ministry will respond within the timeframes allocated.

On international travel, we operate within a global community, and there are practical steps that can be taken. She understood that then-Minister Dr Zweli Mkhize had responded to this. The Acting Minister said that when Members ask questions, DoH responds. However, it does not mean that if Members ask a question and the Ministry answers but the response is not to the satisfaction of Members, that the question is not answered. The Ministry answers questions within the context of how it does its work, and how it operates as Members of the Executive.

There has been research on vaccine hesitancy by the University of Johannesburg (UJ), linked with the Human Sciences Research Council (HSRC). Another was done under the South African Research Chairs Initiative (SARChI), funded by the Departments of Science and Innovation (DSI) and Higher Education and Training (DHET) in Soweto, where there are multiple issues. One is around community leaders. In this context, there has been reference to traditional leaders and traditional healers, and it could be deduced from the research that because some of these community leaders did not give an indication of safety or even comfort with the vaccine, that is likely to influence those who believe and follow these leaders.

Another challenge was the distance to travel from where people were located to obtain the vaccine. That is why part of the issue is around how to respond to that. This relates to the good story from Limpopo, and bringing the vaccine to the people as the research found it was people who are not able to go where vaccine is because of being 60-plus and the cost of travel. There is also registration. DoH is looking at all of those factors. That is why there will be a multiple response for interventions from a system point of view. DoH will now call for coordinated walk-ins that need to be arranged by the leaders so that DoH can get maximum vaccinations done.

DoH will continue to do the work on acquiring a moral vaccine. It currently does not have something which it can say will bring comfort to those who believe due to religious beliefs, they cannot take the vaccine. DoH continues to advocate for this vaccine to help such people.

On the impact of communication about the pandemic, DoH is required to be transparent, honest and accountable in its reporting. The Acting Minister heard what Members were saying about how there is a lot of pressure on individuals, and they end up being depressed about the number of people dying. With statistics, one has to be accurate, and to report openly. DoH does emphasise support and taking care of social concerns. Some people talk about pastoral care. When DoH meets with church leaders and traditional leaders, it talks about providing support within communities. Members of Parliament also have a responsibility in providing that.

The Acting Minister noted that the President continues to be a champion for global access to vaccines, and making sure that access to vaccines is equitable. On various platforms, the President has been vocal about this, and has said there is a need to ensure it is not only "those who have" who get access to vaccines, but everyone – from developed to developing countries. Based on the inequalities South Africa has, it must ensure that it rolls out the vaccine to even the most remote rural areas and to the vulnerable.

Further questions
Ms Sukers asked the Chairperson if he could write down the questions so that the Committee staff could be released as it was late.

Mr van Staden said that he still did not hear what measures will be put in place to help disabled people get vaccinated faster. He did not hear the measures that would be put in place to fast-track vaccinations throughout the population. By what date will South Africa be completely vaccinated? If DoH continued at this pace, it would take the country a very, very long time.

Ms Sukers thanked the Acting Minister for her response on ethical vaccines. It was appreciated, and she trusted that it would be part of the roll-out at the soonest possible time. What Deputy Minister Phaahla said was unacceptable. The then-Minister, Dr Zweli Mkhize, said in May that DoH was urgently looking at the ports of entry. Nothing was done. It is a point that must be made by the Committee. The escalation in cases was directly to do with how South Africa managed its ports of entry. The Delta variant has escalated due to the failure of South Africa managing this process.

The practical steps of NPIs were very important, and were raised by a physician in the Committee, Dr Jacobs. South Africa needs practical information and examples. In her constituency, people are already seeing the signs of a re-run of what was seen in the second wave in January, with the health services under pressure and emergency services not responding timeously to people who are in need of oxygen. The Committee needs those practical answers given to it. Although she appreciated that DoH does respond epidemiologically, South Africa cannot afford epidemics. We need the practical output of what is being done. The Committee needs to know the status of field hospitals in all provinces, and what is being done to augment and ensure comprehensive care.

Mr Shaik Emam expressed his disappointment. He had posed many questions, but DoH had only attempted to respond to two questions. He was extremely disappointed with the response of the Deputy Minister. He was shocked at the Deputy Minister’s response on whether it was worth the cost and the exercise of putting in restrictions. For him, it was worth the cost: It is not your people, it is our people that are dying. If you had put the measures in, you could have saved some lives. We said stop the travellers from India coming into the country. But you want to do an exercise to see if it is worth the cost. He was very disappointed by the Deputy Minister’s response. He had told the Acting Minister about Dr Shankara Chetty before. He did not know why the Department believed that it was a law unto itself. Dr Chetty is recognised worldwide. Mr Shaik Emam has spoken to many doctors in the two weeks who had indicated they are all using a similar treatment, and that it is working. Why is this not being considered when DoH talks about evidence-based decision-making? He had given the Department the evidence. The WHO had stopped the roll-out of some of the vaccines. When it suits your Department, you accept evidence; when it does not suit you, you do not. Why has DoH still not contacted Dr Chetty which might save many lives here?

[Ms Ismail wrote in the chat box: Dr Pillay can you share with me the cost-benefit analysis report?]

Ministry response
On travel, the Acting Minister replied that aviation and travel and tourism will have international protocols. It will have international guidelines on how countries respond to travel and health. Government would have looked at this holistically. It looked at what was being said by the United Nations World Travel Organisation (UNWTO), and the global aviation industry on travel restrictions. The current challenge is that we should not close international borders as it impacts negatively just as the pandemic does. The country has adopted a risk-adjusted strategy. In that process, government talked about the importance of balancing lives and livelihoods. It will save lives, but it will also save livelihoods. When the Delta variant was discovered in India, part of what government put in place was that all travellers that arrive in the country need to have done a test within 72 hours before producing negative test results. If ones arrives in the country, and is screened by Port Health, and found to have symptoms, one is isolated in quarantine for not less than ten days. It is not correct and not true to say that South Africa has been reckless and that we have not put mechanisms and measures in place to protect South Africans.

The regulations are very clear: Anyone who arrives is required to produce that test. That is a mechanism to protect South Africa. South Africa was the first to complain and raise concerns when people started calling the Beta variant the 'South African variant'. Government felt that South Africa was being isolated; it felt that the country was being ostracised in the midst of a pandemic. You cannot suffer twice – both from a pandemic and from discrimination. South Africa also cannot be the one who says other nations must suffer twice. However, we are not saying that we should not protect our country. There is clear indication that protocols and mechanisms have been put in place, including within the community. There was a misunderstanding of what the Deputy Minister said, and there was a misunderstanding of what government has done to protect South Africans.

[Ms Sukers wrote in the chat box: Wrong answer - this department is accountable to the people of this nation firstly.]

Mr Shaik Emam interjected to say that the Acting Minister was misleading the Committee. Another Member expressed agreement.

The Chairperson said Mr Shaik Emam should not do that when the Minister was on the platform. If he was not happy with an answer, then he knew how to express that.

Acting Minister Kubayi-Ngubane said a conversation could be had. One participates in global platforms that deal with these matters. They could have a conversation with Mr Shaik Emam, and take him through how the decisions in countries are taken, and what is being done so that all can be informed. She was speaking from experience – she sits on the Sustainable Tourism Committee within the World Economic Forum, which deals with these matters quite regularly. Government is able to evaluate what countries are doing on travel, and it can give a clear indication why certain countries took a particular decision. Mr Shaik Emam would then understand why South Africa took a particular stance in not choosing what he said it should have done.

On fast-tracking the vaccine roll-out: One is not going to state here that one is not concerned about how we have fared with the 60+ population. We have been open about it, to say we would have loved to have finished the 60+ population by today, 30 June 2021. Out of that, the Department has had to go back and look at what caused it to not reach this target. DoH is looking at multiple processes for the implementation of its vaccination programme not only opening for other age groups such as the 50+ population, but also dealing with other sectors. DoH is opening for the security cluster as well, because these are the people who must help DoH and do the work in managing the pandemic. One also wants to keep the economy going; that is why one must vaccinate within the active economy, so that people in retail, in the taxi industry are not exposed.

DoH is ramping up and fast-tracking the multi-phased approach. It will continue to evaluate the process. When we look at our vaccine programme, there will continue to be improvements. What is important for DoH is to be able to come back to the Committee when it has changed its initial plan and say which decisions it has changed and the reasons for the change.

Initially, when DoH mentioned co-morbidities, the understanding of the population was that anyone of whatever age who has a co-morbidity will be vaccinated quickly with the 60+ group. But later, DoH opened only for 60-pluses. From a practical implementation point of view, there was the question of how to prove that a person has a co-morbidity. The category of 60+ was seen as a category that has more co-morbidities and are thus vulnerable. That is how the decision was taken. DoH will go back to look at disabilities. Part of what DoH must do is that when it takes a decision on rolling out vaccines, it must look at the practical implementation of that process.

With many disabilities, one would have a certificate or a medical report. But there are certain disabilities that would not have that. DoH would have to look into how it balances that and perhaps respond when it comes for another meeting in a fortnight to say that it looked at that, and this is what it thinks is practical about implementation. It is very important for DoH to be transparent in what it does. Every week, it reviews, and goes to the Inter-Ministerial Committee on the COVID-19 Vaccines (IMC). The IMC looks at what it has been able to achieve, and where there are bottlenecks, then gives recommendations. The technical teams also look at how DoH is rolling out vaccinations. DoH is looking into having more sites for vaccine roll-out.

On practical steps, DoH had to look at the field hospitals. For example, DoH asked Gauteng about the Nasrec site, and it said that it never even had full capacity at Nasrec. When one looked at the costs and the occupancy, it did not make sense. What Gauteng did during the first and second waves was to add bed capacity in hospitals. Many of the provinces would have done that. As provinces do away with the field hospitals, one would find within the hospitals themselves, there is additional capacity that has been brought in. In Gauteng, there are about 1 400 additional beds. What would have affected Gauteng more is the absence of the Charlotte Maxeke Johannesburg Academic Hospital due to the fire. When one looks at the buildings with alternative technology (ABT) that have been brought in, such as Jubilee, AngloGoldAshanti, Bronkhorstspruit, Baragwanath and Dr George Mukhari Academic Hospitals, then one sees that the beds add to what is needed. Currently when DoH evaluates in Gauteng, it does not have those beds at 100% capacity.

In managing the pandemic, something DoH had done is to have a team looking at what is happening, and based on the numbers, do interventions per province. When looking at Gauteng, there is pressure in the private sector. The Acting Minister is in daily contact with the Gauteng Department of Health. A meeting was held with the National Ministerial Advisory Committee (MAC) on Covid-19 to look at whether levels of government are missing each other in interventions, and close the gap so that the parties can ensure they are on the same page. Some people who sit on the MAC are clinicians who have practical experience; they are literally on the ground. Part of what was found is that the bed capacity is there. There are two areas where there is strain – the ICU and the Emergency Room. We do not have shortages of oxygen. That capacity is there. With the ICU, it is the turnaround time, and DoH looked at interventions on how to respond to that.

[Ms Ismail wrote in the chat box: Please reply on the placements of interns and community service doctors. Their lives are basically on hold.]

The other challenge picked up was the turnaround time for sourcing of human capital. To activate some of the existing beds, one needs to have the human capital to activate them. When the President made announcements, that is why he was able to say that the Solidarity Fund has provided money to be able to recruit nurses to assist DoH in Gauteng. DoH is monitoring other provinces. It does not think that it is in trouble where it is now. DoH is saying to the Committee that it has developed an action plan in response to research, together with WHO guidelines. Once it has research, that is what gets activated. All the provinces were given an indication to activate and get everything ready. There is a reporting mechanism that continually monitors what is happening with beds across the country, with oxygen supply, ICUs, and so on.

In Gauteng, a joint team has been established to look at how to transfer patients between the private and public sector, so that where there are gaps in bed availability, there is a smooth transition. The ambulance can know where to take the patient, and not go to a hospital that is full. Work is being done consistently every day to ensure that DoH responds to the pandemic. DoH believes that as it emphasises what needs to be done by the Department, it needs to again emphasise the responsibility of citizens in assisting it in being able to manage the pandemic. Gatherings have been stopped, and no one should be encouraging gatherings, especially political parties. People must see leaders speaking out, because it is not only the responsibility of DoH, and the responsibility of healthcare workers to save lives; it is everyone’s responsibility.

The Chairperson said the Committee will probably meet the Acting Minister in the next fortnight for an update. The Committee appreciated the invitations from the Health Ministry Parliamentary Liaison Officer, when the Acting Minister is to appear on other platforms. The Committee appreciates the information. He knew that some Members still wanted to ask questions, but the Committee had to be fair to the staff and to those Members who had held meetings all day.

The meeting was adjourned.