Vaccine procurement & roll-out programme update; Digital Vibes contract investigation
17 June 2021
- DoH: Health Facilities Readiness Update
- DoH: Covid-19 Update on Epidemiology, Surveillance and Vaccination Plan
The Committee met virtually with the Department of Health to receive updates on the investigation into the Digital Vibes contract, and on the management of the COVID-19 pandemic.
The Committee had also requested a legal opinion about the applicability of the sub judice rule. In a prior meeting, the ANC had invoked the rule to foreclose discussion about the Digital Vibes contract and to justify the Minister’s absence from the briefing. The legal opinion concluded that the Digital Vibes matter was not sub judice. The matter was under investigation but not before a court, and in any case the sub judice rule would have to be measured against the importance of parliamentary oversight.
Despite this legal opinion, the ANC remained convinced that the Committee should not interrogate the Digital Vibes matter until the Special Investigating Unit (SIU) had concluded its investigation. In addition, ANC Members claimed it would be inappropriate for the Committee to summon the Minister while he was on special leave. However, the DA, EFF, and FF+ were united in their demand that the Minister should appear before the Committee. They believed that the Minister was being shielded from accountability and that the Committee was being disabled in its oversight functions.
The Department of Health reported that the Auditor-General had suspected Digital Vibes of overcharging, and that the Department had subsequently appointed Ngubane, a private firm, to investigate. That investigation had found various irregularities. The tender and bidding process had been in contravention of the Public Finance Management Act, and there had been irregularities in the appointment process, including non-disclosure of conflicts of interest by members of the bid committees. Digital Vibes had also been paid R35 million for COVID-19-related work that had not been included in the contract at the time the work was done. The total sum paid to Digital Vibes – R150 million – was deemed irregular, and R37 million constituted fruitless and wasteful expenditure. The Department was awaiting the SIU’s final report before taking further steps in disciplinary processes and in recovering funds. Several individuals were implicated in the internal report, but the Department could not yet reveal their identities, especially because the SIU might add further charges.
The ANC expressed satisfaction with the Department’s report, but opposition parties were uniformly disappointed. Members wanted to hear details about the purported irregularities in the procurement process, and about know why the Department had outsourced communication functions that should have been handled internally. They also wanted to know whether the Minister had approved the Digital Vibes contract and whether he had benefitted from it personally. The DA, EFF, and FF+ maintained that the Minister should be required to answer these questions before the Committee.
The Chairperson decided to approach parliamentary office-bearers about meeting with the SIU in early July, when its investigation would be finalised. He also undertook to seek further advice about the legality of summoning a minister on special leave, though parliamentary legal services had assured the Committee that such a summons was within its powers and up to its discretion.
On COVID-19, the Department reported that cases had increased by 50% over the last week, for a total of 95 772 active cases. The effective reproduction rate (R) of the virus was estimated at 1.25. Four provinces had entered their third wave of infections, with Gauteng the current epicentre, but all showed a troubling rise in cases and hospitalisations. The country’s public and private hospitals accommodated a total of 114 421 hospital beds, including 5 616 ICU beds. In the current week, 6.5% of all beds and 25.9% of ICU beds were occupied by COVID-19 patients. At the same time, field hospitals in the provinces were being decommissioned, because the Department did not think they were needed. The Department was also confident that its oxygen supplies would be sufficient to cope with the third wave.
The Department said that 1.97 million people had been vaccinated to date, although most of them had received only the first dose of the two-dose Pfizer vaccine. The Department was unlikely to vaccinate more than 60% of persons older than 60 before the end of June, well below its target. The vaccination roll-out had primarily been hampered by delays in vaccine procurement. However, another concern was a decline in the pace of registrations. The Department was therefore reviewing the protocols for walk-ins at its 576 vaccination sites. 31 million doses of the Johnson & Johnson vaccine and 31.39 million doses of the Pfizer vaccine had been secured, including 1.39 million through COVAX. Deliveries of the first batches were expected to begin the next day. Johnson & Johnson vaccines arriving over the next week would be used for an ambitious programme in the basic education sector, which would target half a million persons in that sector over a period of ten days.
Members raised several matters arising from their oversight visits, including the continued closure of Charlotte Maxeke Academic Hospital and water shortages at health care facilities. They asked about the provision of oxygen to day hospitals and district hospitals, especially in rural areas. Also of concern was the decommissioning of field hospitals and the renewed spread of COVID-19 at schools.
However, the vaccination roll-out dominated the discussion about COVID-19. Though the Department claimed that the roll-out would accelerate rapidly when vaccines began arriving, Members remained concerned about its pace. They criticised the Department’s failure to meet its vaccination targets and urged the Department to admit such failures to the Committee and to the public. They pushed the Department to provide new and realistic targets, taking into account the delays thus far and the loss of two million contaminated vaccines. Members also wanted more detailed updates about the Sputnik and Sinovac vaccines, which they thought should be a crucial part of the vaccination plan. Finally, they raised problems with the electronic vaccination data system (EVDS), which experienced delays and which they said assigned people to inaccessible vaccination sites, especially in rural areas. Given these problems with EVDS, they were concerned that the approach to walk-ins was inconsistent across vaccination sites.
Ms E Wilson (DA), Ms M Hlengwa (IFP), and Ms M Sukers (ACDP) sent apologies. The acting Minister had also communicated a request to be excused after an hour, to attend a meeting with the President.
The Chairperson reminded Members that the Committee meeting constituted a meeting of the National Assembly (NA) for official purposes. Thus NA rules, including the rules of debate, and as well as the rules for virtual sittings, applied. Members enjoyed the same powers and privileges as in a sitting of the NA. Anything said during the meeting was considered to have been said before the NA and could be ruled upon accordingly. All Members should mute their microphones unless recognised by the Chairperson, and should refrain from making unnecessary points of order or interjections.
Legal opinion: Application of the sub judice rule in the Digital Vibes matter
The Chairperson reminded Members of the context in which a legal opinion had been sought. Dr Zweli Mkhize, Minister of Health, had declined to attend the Committee’s last meeting with the national Department of Health (NDOH), on 4 June. The night before that meeting, Minister Mkhize had told the Chairperson over telephone that he had received legal advice not to appear before the Committee in connection with the Digital Vibes matter. The Chairperson had accepted this explanation and had communicated it to the Committee. He had not been able to seek legal advice prior to the meeting, because it had begun at 8 a.m. Some Members had “reluctantly accepted” Minister Mkhize’s explanation. During that meeting, the sub judice rule had been raised. The sub judice issue, however, was an “add-on” – it had not been the reason for Minister Mkhize’s absence. During the meeting, the Committee had decided to seek a legal opinion to clarify its powers. The legal opinion had subsequently been sent in writing to all Members.
Adv Siviwe Njikela, Senior Legal Advisor: Office of Constitutional and Legal Services, Parliament, presented the legal opinion. The legal services unit had been given a narrow brief. The Committee had asked for advice on whether the sub judice rule applied to a matter under investigation by the South African Police Service (SAPS) or by the Special Investigating Unit (SIU). He could not comment on the legal advice received by Minister Mkhize, because he had not been privy to it.
Adv Njikela said that the sub judice rule had a long history in law, but had generally been used under jury systems, to promote the administration of justice. The rule had been established in response to the concern that laypersons in juries – who had to make findings of fact on matters before a court – should be protected from external influence. However, South Africa had abandoned the jury system long ago. Justice was now administered by judges, who were trained in the law and in adjudication. The Constitution and other laws guaranteed the independence and impartiality of judges.
In Midi Television Ltd v Director of Public Prosecutions, the Supreme Court of Appeal (SCA) had considered the interpretation of the sub judice rule in the post-Apartheid constitutional dispensation. Midi Television concerned an eTV television programme which discussed a specific case that was pending before court at the time. The SCA’s judgement provided guidelines on the application of the sub judice rule. First, the rule applied only if there was a demonstrable and substantial risk of prejudice to the administration of justice. Mere conjecture or speculation that prejudice might occur was not sufficient – substantive evidence had to be provided. Moreover, a court had to determine whether the disadvantage of curtailing the free flow of information outweighed its advantages. In this context, Parliament would have to make the same assessment, balancing its oversight functions with the possible disadvantages of public disclosure. Parliamentary oversight could not simply be eliminated on the basis of an appeal to the sub judice rule.
Adv Njikela referred Members to NA rule 89. The rule stated, “No member may reflect upon the merits of any matter on which a judicial decision in a court of law is pending.” Therefore, even the NA rules set out specific requirements for an application of the sub judice rule. A judicial decision had to be pending – that is, the matter had to have gone past the stage of mere investigation – and the relevant discussion had to pertain to the merits of the matter.
Adv Njikela concluded that a mere investigation by SAPS or by the SIU was not sufficient to invoke the application of the sub judice rule. Moreover, Parliament had a constitutional obligation to hold executive functionaries to account. Even if a matter was pending before a court, the sub judice rule could not be applied such that it compromised or “trumped” this oversight mandate. Under the Midi Television standard, there had to be a careful balancing exercise, so that each arm of government would have the space to fulfil its obligations. It was difficult to establish a firm rule that would apply generally, since the circumstances of each case differed. Each Committee had to make its own assessment, in respect of the relevant facts, in any case in which the sub judice rule was invoked.
The Chairperson reminded Members that the Committee had planned, on the basis of the written legal opinion, to override his initial decision to accept Minister Mkhize’s absence. Last Wednesday, the Committee had planned a meeting with Minister Mkhize the next day. However, on that very day, Members had received the news that Minister Mkhize was taking special leave and that an acting minister had been appointed. Thursday’s meeting had therefore been postponed, for two reasons. First, the Committee could not meet with Minister Mkhize once he was on leave. The Chairperson had heard that it was “unprecedented” for a Committee to summon a minister who was on special leave, when there was an acting minister who had been assigned the relevant executive powers. Second, the Committee had not been able to meet with the newly appointed acting minister, because she had not been in the portfolio long enough to provide a briefing. The meeting had therefore been rescheduled to today.
Mr P Van Staden (FF+) said that Minister Mkhize should not be shielded from having to appear before the Committee. His special leave should not become a “back door” through which he could avoid appearing before the Committee. The Committee had a constitutional duty to hold Minister Mkhize accountable in the Digital Vibes matter. Moreover, there was a lot of “confusion” that only Minister Mkhize could clear up. For example, in a statement the previous week, Minister Mkhize had said that he took full responsibility and apologised unreservedly, but that he had not signed the Digital Vibes contract, only a memo. That statement had caused a lot of confusion. Although Minister Mkhize had not offered to resign, there was clearly “more to this matter than meets the eye.” Mr Van Staden felt strongly that Minister Mkhize should appear before the Committee to be held to account and to answer Members’ questions. What was Adv Njikela’s view? Could the Committee require Minister Mkhize to appear?
The Chairperson joked that Mr Van Staden had, like a politician, used many words to ask a simple question.
Mr A Shaik Emam (NFP) fully agreed with the legal opinion. The matter was not sub judice – no charges had been laid, and no judicial decision was pending. However, the Chairperson had alluded to the fact that it was unprecedented for a Committee to summon a functionary who was on special leave. Yet there were mitigating factors. First, the Committee’s initial request had been made before Minister Mkhize had gone on special leave. Second, although Minister Mkhize was on special leave in his capacity as Minister, this was not tantamount to a resignation, and he remained a member of Cabinet. Under these circumstances, could the Committee summon him? His own understanding was that the Committee could not, but he would like clarification from Mr Njikela.
Ms S Gwarube (DA) said that the Committee’s meeting on 4 June had been interrupted by Members who had invoked an inapplicable rule. The legal opinion confirmed this. Those Members evidently did not understand their roles and did not understand the parliamentary rules. In fact, Parliament had, on several occasions, been very clear about the scope of the sub judice rule. The 4 June meeting had been “stalled” by Members invoking a rule that they had known was inapplicable. The resulting “chaos” had been “a complete waste of time.” That previous meeting with NDOH had been requested, scheduled, and held before Minister Mkhize had gone on leave. The Committee should therefore have the opportunity to reschedule it. If Members were allowed to stall meetings in this way, it would create a “really dangerous” precedent. Essentially, Members would be able to filibuster meetings to shield individuals from accountability. Moreover, it made “no sense” for the Committee to discuss the Digital Vibes matter with the acting minister unless the acting minister could fully answer Members’ questions. Parliament had to determine exactly what had gone on at NDOH. She therefore requested that the Digital Vibes meeting be rescheduled.
The Chairperson replied that Ms Gwarube should not “put the cart before the horse.” A briefing on the Digital Vibes contract was on that day’s agenda. Members did not yet know whether the acting minister could answer their questions to their satisfaction.
Mr T Munyai (ANC) asked that the acting minister be allowed to present her report. If the report was not satisfactory, then the Committee could make another determination. The ANC wanted the executive to account to the public. The ANC did not support corruption, and corruption had to be dealt with decisively, with individuals accounting for any responsibility they might have. However, it was “practically impossible” for someone who was on leave to account to the Committee. Such a person was not “in the space of governance,” and could only account if and when he returned from leave. Yet Members should not make premature decisions – they should listen to NDOH’s report.
Dr K Jacobs (ANC) agreed with Mr Munyai and Mr Shaik Emam. The acting minister should present her report, and then the Committee could decide the way forward based on what they heard. He believed it was not possible for Minister Mkhize to be summoned before the Committee “at this time.” Therefore, the Committee should proceed with the briefings and deliberate afterwards.
Dr S Thembekwayo (EFF) said that the Digital Vibes matter was “sensitive.” The acting minister should be allowed to make her report – provided that the report was not a repetition of what the Committee had already heard from NDOH. As long as the report did not again appeal to non-disclosure issues, there would be no complaints from Members and they would engage. In addition, Members were convened as a Committee responsible for oversight, not as individual politicians. It was not the correct platform for ANC Members to refer continually to their party’s positions. Members formed a Committee and should act in unity when it came to accountability.
Adv Njikela said that he would answer Mr Van Staden and Mr Emam Shaik’s question by reference to the law alone. Section 56 of the Constitution gave Parliament and its committees the power to summon persons, and it did so in very general terms. Any person who had information relevant to the Committee could be summoned. The Committee’s power in this regard did not depend on the present or past portfolio of the person it wanted to summon. An individual could be summoned before the Committee even if he had resigned from public service entirely. On the other hand, there was the question of whether Minister Mkhize was in a position to provide information about NDOH’s current activities. The acting minister would probably answer that question. However, that was a separate question. An individual’s current portfolio did not necessarily bear on the information that the Committee required from him. In principle, one’s current portfolio did not matter. The Committee would have to determine what information it required from Minister Mkhize, and whether that information could be ascertained from NDOH instead of from him. But it was within the Committee’s discretion to summon Minister Mkhize.
The Chairperson asked whether it would be appropriate to summon someone while he was on special leave, or whether the Committee was required to wait.
Adv Njikela replied that this was a difficult question. No rule required the Committee to wait for the leave to end – the Committee could summon anybody. However, he understood where the Chairperson’s question came from. There was a certain “awkwardness” to the situation. When a minister went on special leave, he vacated his position – even if only temporarily. Constitutionally, the executive authority for the department vested in the acting minister. There could not be two ministers exercising executive authority over the same portfolio. So whether the Committee should summon Minister Mkhize depended on what questions it wanted to ask. It might be that the acting minister would be able to answer some or all of those questions from within NDOH. If she could not, the Committee might have to summon the person who led NDOH at the relevant time. It was up to the Committee’s discretion.
The Chairperson concluded that the Committee should not put the cart before the horse. The acting minister now led NDOH and had the relevant executive authority. The Committee should allow her to make her report, especially since she had to leave the meeting shortly.
Ms Mmamoloko Kubayi-Ngubane, Acting Minister of Health, said that she was rearranging her schedule so that the meeting could proceed. She would be able to stay for ninety minutes longer than she had thought.
Opening remarks by the Acting Minister
Minister Kubayi-Ngubane said that the debate among Members about the legal opinion was interesting for her, as a former committee chairperson and former whip. She did not think her opinion was relevant – Parliament had sufficient institutional capacity to support the Committee in determining what was right and appropriate. However, she confirmed that she was accounting to the Committee in line with the constitutional powers given to her as acting Minister. While Minister Mkhize was on special leave, he could not speak publicly on behalf of the portfolio. She held the executive authority and political responsibility.
She advised the Committee to reach out to the SIU, who were in a better position than NDOH to provide the answers that Members were looking for about Digital Vibes. There were constraints on what NDOH could discuss. For example, the briefings would not identify the names of individuals implicated, because the investigation had not yet been concluded. The matter was not sub judice – but it was often the case that when the government lost cases, it was because the process had been “compromised.” In her discussions with the Director-General (DG), she had highlighted that NDOH had to fully support and cooperate with the SIU investigation, including by providing investigators with whatever information they needed. She could assure Members and the public that NDOH would do the same if it was approached by any other law enforcement agencies. However, she and the DG – as the minister currently responsible for the portfolio and the accounting officer – had a responsibility not to compromise or “tamper with” the process, possibly endangering its success. She had noted Members’ concerns, and the briefing would provide the opportunity for Members to engage on some issues.
NDOH’s central focus, however, was managing the COVID-19 pandemic. Technically, South Africa had entered its third wave of infections. The situation was “worrying.” Gauteng was NDOH’s biggest concern – “the fires [were] burning” in Gauteng. Moreover, as Members might have seen on television or social media, there had been mass gatherings in Gauteng the day before, even though level three lockdown had begun. NDOH was hoping that law enforcement would assist in securing compliance with regulations. When people gathered in this way, they did not know the majority of the people with whom they gathered – some might have COVID-19. They endangered not just themselves but also their families, loved ones, and communities. Political parties had been involved in the gatherings, and she believed those parties had acted “irresponsibly.” As leaders, politicians had a responsibility to protect the people who had put them in leadership and who gave their leadership meaning. When the government said that the country was “in trouble” and that there was a need to escalate the lockdown, she hoped that South Africans would eschew “conspiracy theories.” They should understand that such decisions were based on scientific analysis. The government had looked at the statistics, models, and projections, and had decided on that basis that interventions were needed.
Non-pharmaceutical interventions – wearing masks, social distancing, and washing hands – remained important. Clinical methods also remained critical. At a meeting with provincial members of the executive council (MECs), NDOH had again emphasised the importance of testing, tracing, isolating, and treatment. In terms of treatment, and as the briefings would detail, NDOH monitored the availability of hospital beds, equipment, oxygen, and so on. NDOH would also be implementing mass testing in communities, for example in Gauteng. This was based on lessons learned during the first and second waves. Another lesson, regarding field hospitals, had emerged in NDOH’s engagements with MECs. MECs and the provinces felt that the field hospitals were not used to full capacity during the first and second waves, and that therefore maintaining field hospitals might be “premature” or unnecessary. NDOH would continue to build capacity in hospitals and redirect capacity as necessary, paying attention to both public and private hospitals.
Minister Kubayi-Ngubane said that there were several “concerning” issues with the vaccine roll-out. Since she had been appointed, she had heard a concern – from the provinces and from those “on the ground” – that vaccinations should not debilitate capacity in other areas. For example, when nurses were taken from clinics to vaccination sites, that affected the quality of primary healthcare services. NDOH was paying attention to this concern. It had asked all the provinces to detail their needs in terms of personnel and other interventions, and those would be attended to urgently.
There were two issues to raise with the electronic vaccination data system (EVDS). The first arose when an individual registered on EVDS but found that there was a delay before he received an SMS notifying him of his vaccination date and site. NDOH was attending to this, and she had met with the team who worked on EVDS. One official had registered himself on EVDS to investigate the process. The delay partially arose because there was a limited number of vaccination sites, and as NDOH continued to upgrade sites, people were redirected from one site to another. NDOH was working on addressing the “anxiety” these delays caused for older persons. It would have to address it through its communications strategy, which it was looking to improve. The delays had also caused walk-ins – when people registered online but did not receive a notification, they decided to go to a vaccination site themselves. Walk-ins had not been turned away from vaccination sites. However, NDOH was looking at the coordinated approach used in Limpopo. Based on this example, it would recommend new walk-in protocols to the inter-ministerial committee (IMC) on vaccines, which was chaired by the Deputy President. Walk-in protocols were necessary to prevent vaccination sites from themselves facilitating the spread of COVID-19. Without control measures, 100 people might walk into a site at the same time, looking to be vaccinated.
The second issue with EVDS had probably been raised with Members by their constituents. When a person was vaccinated using the Pfizer vaccine, he received a card specifying a date for his second jab. However, sometimes, he would later receive an SMS specifying a different date. This happened because the global protocols for Pfizer had shifted – whereas the recommendation had previously been for 21 days between the jabs, it was now 42 days. People should disregard the date on the written card and instead follow the SMS notification. NDOH was encouraging members of the public to spread this information to older people, especially illiterate older people, so that they would return to the vaccination site on the right date.
Minister Kubayi-Ngubane said that the ministerial advisory committee (MAC) on Social Behavioural Change had met the day before, and had discussed the slow progress of registration on EVDS. According to statistics, around 5.5 million people in the country were older than 60. Less than 60% of this group had registered. A researcher at the University of Johannesburg had produced a report, which she had received the night before, analysing the reasons for low registration. Two key issues were coming through. First, there was a “fear” of vaccination in the public, informed by fake news and misinformation. NDOH had to intensify its communications with the public to ensure that people received serious and truthful information. Second, EVDS was not always accessible to older persons. Older persons were often registered by younger relatives. So NDOH was now ensuring that community healthcare workers visited residential areas to register older persons.
Dr Sandile Buthelezi, DG, NDOH, introduced the NDOH delegation. He said that NDOH would present three briefings: an update on COVID-19 epidemiology, vaccine procurement, and the vaccination roll-out; an update on the state of preparedness for the COVID-19 third wave; and an update on the Digital Vibes contract and investigation.
Briefing: Update on COVID-19 and vaccination roll-out
Dr Aquina Thulare, Technical Advisor, NDOH, provided a detailed update on the spread of COVID-19 (see slides). Over the last seven days, cases had increased by 50% and fatalities had increased by 47.85%. As of 16 June, there were 95 772 active cases in the country, an increase of 13 246 (10.72%) from the day before. Gauteng accounted for 7 859 new cases, 59.3% of the increase. However, all provinces were “in trouble,” with all showing rising new cases. Over the last 14 days, cases had more than doubled in three provinces, with the percentage increase in new cases at 124.8% in Limpopo, 118.9% in Gauteng, and 100.4% in KwaZulu-Natal. Both total testing and the average test positivity rate had increased, with the latter at 18.5%. The effective reproduction rate (R) of the virus was estimated at 1.25.
South Africa had crossed the new wave threshold on 10 June. Gauteng, the Free State, the North West, and the Northern Cape had crossed the same threshold; the Western Cape was expected to enter its third wave very soon. The Northern Cape had reached a peak in new cases that exceeded the peak of its last two waves, and it had the highest number of active cases per capita, at 661 cases per 100 000 people.
Hospitalisations for COVID-19 were increasing in all provinces. The most highly burdened provinces in that regard were Gauteng, the Western Cape, KwaZulu-Natal, and the Eastern Cape, in that order. Total hospital admissions, both public and private, were 8 727. It was the first time since February that hospitalisations had breached the 8 000 mark.
On the vaccination programme, Dr Thulare said that there were supply-side constraints – in the procurement of vaccines – and, on the demand side, a decline in registrations. The vaccination roll-out was in its second phase, which targeted the population over the age of 60. This phase would run until 16 July, and it would overlap with the commencement of vaccinations of workers over the age of 40 through occupational health services (OHS). After 70% of the relevant population group had been vaccinated, NDOH would move onto the next phase and the next population group.
She provided a detailed update on registration and vaccination figures (see slides). As of 16 June, 3 574 318 people were registered on EVDS, 951 279 of whom were health care workers. Registration per capita was highest in Gauteng, the Eastern Cape, the Western Cape, and KwaZulu-Natal. Limpopo was an interesting case – although it was largely rural, residents over 60 had shown “marked enthusiasm” in registering. NDOH thought that there could be a lesson to learn from Limpopo. Nationally, 2 623 039 people over the age of 60 had registered, out of a total population of about 5.5 million – as Minister Kubayi-Ngubane had said, further efforts needed to be made to increase that figure, including through community health care workers and a “whole of government” approach.
1 973 074 people had been vaccinated – 479 768 through the Sisonke programme, and others with the first dose of the Pfizer vaccine. The graph of vaccinations over time showed distinct troughs where vaccinations decreased on weekends. NDOH was in discussion with the provinces and other stakeholders to ensure that vaccinations on weekends increased. This would require other measures – for example paying overtime to health care workers. Vaccinations in all provinces were “ramping up” (see slides).
Ms N Chirwa (EFF) interrupted with a point of order. She said that Members had been raising comments and concerns in the Committee’s WhatsApp group, and the Chairperson was not acknowledging them. Members wanted the opportunity to ask certain relevant questions now, since Minister Kubayi-Ngubane was going to leave the meeting soon. After that, NDOH could continue with its presentations.
The Chairperson replied that Minister Kubayi-Ngubane had said that she was able to remain in the meeting longer. He therefore wanted to continue with the NDOH presentation.
Dr Thulare said that 576 vaccination sites had been identified and accredited – 130 in the private sector and 446 in the public sector. NDOH had acquired vaccines sufficient to vaccinate about 46.7 million people. These were broken down as follows:
- 31 million Johnson & Johnson (J&J) vaccines;
- 30 million doses of the two-dose Pfizer vaccines; and
- An additional 1.39 million doses of Pfizer through COVAX.
In the short-term, NDOH expected to receive the following deliveries:
- The next day, 300 000 from J&J and 636 000 from Pfizer;
- In the week of 21 June, 1.2 million from J&J and 1.27 million from Pfizer;
- In the week of 28 June, 1.39 million from Pfizer through COVAX; and
- In the week of 5 July, 190 000 from Pfizer.
NDOH was still in discussions with Pfizer about the weekly scheduling of deliveries. It would report back to the Committee once the schedule was finalised. Discussions were also ongoing with J&J.
Dr Thulare provided an update on the vaccination of public sector and private sector workers, which was part of the second phase of the roll-out (see slides). In the private sector, 145 workplace vaccination sites were planned, with 58 in the mining sector – these sites would cover approximately 400 000 workers over the age of 40. Pilot workplace sites had been identified, and two were already active (see slides).
A related initiative was the vaccination of basic educators, which was being fast-tracked. This whole-sector initiative would target 499 000 persons in basic education, irrespective of their age. 300 000 J&J vaccines would arrive on 18 June, and the remainder would be sourced from the 1.2 million J&J vaccines arriving the following week. The first vaccines would be distributed to provincial health departments on 22 June, and the vaccines would be administered thereafter over ten days, in collaboration with the Department of Basic Education (DBE). Once this initiative was complete, the vaccination of the security cluster could proceed.
Order of outstanding agenda items
The Chairperson said that he had not been aware that Members had been having a discussion in the Committee’s Whatsapp group. They were concerned that Minister Kubayi-Ngubane was going to be leaving in an hour.
Minister Kubayi-Ngubane said that NDOH was not finished with its presentations.
The Chairperson reviewed the agenda. He said that Members wanted to be briefed on Digital Vibes, so he suggested NDOH should provide that briefing first. He asked whether NDOH had presented on the state of preparedness for the third wave.
Dr Buthelezi said that it had not. That presentation flowed on from the presentation Dr Thulare had just given, but the NDOH delegation would present in the order that the Committee preferred.
The Chairperson said that the Digital Vibes briefing should be next. Members could then ask questions of Minister Kubayi-Ngubane. NDOH could provide its briefing on the state of preparedness for the third wave later, since Dr Buthelezi and other NDOH officials would be able to answer questions about the COVID-19-related briefings.
Briefing: Digital Vibes contract and investigation
Mr Van Staden said that Members had not received a copy of the Digital Vibes presentation.
Dr Buthelezi said that NDOH would send a copy to Members.
Dr Buthelezi said that he had already shared the background of the matter with the Committee in the 4 June meeting. On 20 December 2020, he had received a final report from the Auditor-General (AG). In relation to the Digital Vibes contract, the AG had concluded that it was possible that NDOH was being overcharged. The AG had therefore recommended that NDOH should interrogate Digital Vibes’s rates and benchmark them against other service providers. NDOH had appointed Ngubane to investigate the awarding of the contract, the change in the contract’s scope from National Health Insurance (NHI) to COVID-19, and whether NDOH had received value for money.
Dr Buthelezi had received Ngubane’s final report on 24 May. The findings included:
- The tender/bidding process followed was in contravention of the Public Finance Management Act (PFMA);
- The process of appointing Digital Vibes was irregular, including due to “inconsistencies” in the bid committees and non-disclosure of conflicts of interest by members of the bid committees; and
- R37 million of the sum paid to Digital Vibes constituted fruitless and wasteful expenditure.
Moreover, NDOH had requested Digital Vibes to carry out COVID-19-related work before the Digital Vibes contract had officially been expanded to include COVID-19. This had resulted in an additional commitment of R35 million, which NDOH had paid after the expansion of the contract was approved. The report found that this expenditure – and any amount paid to Digital Vibes for work done before the expansion was approved – was irregular, because it contravened Treasury regulations. The report concluded that due to the irregularity of the appointment, the total sum paid to Digital Vibes (R150 million) was irregular and should be reported in terms of the PFMA.
In the last week of February, the SIU had informed Dr Buthelezi that it would be investigating the Digital Vibes contract, insofar as the contract related to the presidential proclamation on allegations of COVID-19-related corruption. NDOH, through Dr Buthelezi’s office, had cooperated fully with the SIU investigation. It had provided documents, access to officials’ IT equipment, affidavits, and consultations with various officials, including with Dr Buthelezi. Dr Buthelezi had last consulted with the SIU on Monday. The SIU process and report had not yet been concluded. NDOH expected to receive the report soon, and the report would include referrals for disciplinary processes.
To date, NDOH had:
- In February, suspended the Digital Vibes contract;
- Reported the irregular expenditure to the Treasury, in terms of the PFMA;
- Commenced consequence management processes in relation to officials identified in the report; and
- Commenced discussions with counsel regarding the recovery of funds due to the Department from Digital Vibes, as recommended in the report.
Dr Buthelezi emphasised that NDOH had to await the SIU’s report to supplement these processes, as the report might disclose new information. Therefore, NDOH asked not to disclose, at this stage, the identity of individuals implicated in the investigation. This was to avoid compromising the SIU investigation and the ongoing departmental consequence management processes. The SIU might add additional charges, so it was preferable for the NDOH to work from a comprehensive and final charge sheet. Moreover, it was preferable for NDOH to work with the SIU in recovering funds.
Discussion: Digital Vibes and COVID-19
The Chairperson said that Members wanted to ask Minister Kubayi-Ngubane questions, particularly about Digital Vibes, before she left the meeting. The more technical briefings could be discussed with NDOH officials later.
Mr Shaik Emam said that he thought his hands were tied in asking about Digital Vibes, because NDOH had been advised not to identify individuals. He had planned to ask which officials had been responsible for the tender process and contract. He still believed that this was not privileged information and that the Committee was entitled to know.
Mr Shaik Emam said that he had concerns about the vaccine roll-out. In particular, he was concerned that law enforcement would only be vaccinated after educators and so on – but law enforcement officers were also “on the frontlines” and many had died.
Mr Shaik Emam said that many health care workers had also died of COVID-19. Had any health care workers died or been infected with COVID-19 after taking the vaccine? That is, were there any cases in which the vaccine had either harmed a worker or failed to prevent infection?
Mr Shaik Emam said that there was clearly a supply problem in the vaccine programme – the doses acquired by NDOH were not going to be sufficient. So why had NDOH not been concentrating on the Sinovac and Sputnik vaccines? Some had been offered to South Africa for free, so he was not sure why South Africa did not have any.
Mr Shaik Emam said that Dr Shankara Chetty was a doctor in Port Edwards. Had Minister Kubayi-Ngubane met him? He knew that Minister Kubayi-Ngubane had just been appointed and had been put in “the hot seat,” but she should meet Dr Chetty. None of his 4 000 COVID-19 patients had required oxygen or hospitalisation, and none had died. He had a simple and very successful treatment method. He had received international recognition – only South Africa had not recognised his achievements. Another report had come in from an Indian doctor yesterday, and that doctor’s methods were very close to Dr Chetty’s, and were also saving lives. Since South Africa had problems with compliance and vaccination, such treatment methods might be one solution.
Mr Shaik Emam said that NDOH emphasised regulations, like wearing masks and social distancing, and Minister Kubayi-Ngubane would be meeting with the National Coronavirus Command Council (NCCC) and with the President himself. Yet, the previous day, the EFF and Minister Kubayi-Ngubane’s own party, the ANC, had broken those regulations. He did not blame the EFF. The government had said that the elections must proceed, but also that gatherings were not allowed. The EFF had met yesterday because it needed to campaign. But how many people had been infected and would die as a result? How would NDOH handle this? He suggested to the Chairperson that the Minister of Police should be invited to the Committee’s next meeting with NDOH, because SAPS could help.
Mr Shaik Emam said that Minister Kubayi-Ngubane might be correct that there were a lot of conspiracy theories around the COVID-19 vaccines, but he was not sure whether they were really conspiracy theories, since the underlying issues had not really been investigated. In any case, it was disturbing that – given the NDOH’s budget for communications – South Africans were being “psychologically drained” by all the negative publicity around vaccines. At the last moment, people changed their minds and refused to be vaccinated, because of fears arising from false or dubious information on social media.
Mr Shaik Emam said that the health Ministry and the South African Health Products Regulatory Authority (SAHPRA) were required, in terms of a recent court settlement, to provide regular reports on Ivermectin. More evidence was coming out about Ivermectin’s effectiveness, but SAHPRA had not been making the required reports. What was happening?
Mr Shaik Emam said that he had “a serious problem” with NDOH’s COVID-19 statistics. For example, the other day, NDOH had reported 153 in-hospital deaths but only 114 total deaths; the next day, it reported 78 in-hospital deaths and 59 total deaths. The statistics were clearly inaccurate and unreliable.
Mr Shaik Emam said that he would leave remaining questions to other Members. However, he urged the Minister to speak to the National Coronavirus Command Council (NCCC) – along with SAPS and other stakeholders – about ensuring compliance with COVID-19 regulations. Currently, the country was in an “absolute crisis” as a result of the pandemic. There was an “unbelievable” number of hospitalisations and deaths among teachers over the last couple weeks. These issues were being “suppressed” and the relevant information was not really shared. Minister Kubayi-Ngubane should look into his suggestions, especially his suggestion to meet with Dr Chetty, and should report back to the Committee.
Mr Van Staden said that he did not think Minister Kubayi-Ngubane would be able to answer the Committee’s questions about Digital Vibes. He thought he had been misunderstood in the Committee. His position had always been that Minister Mkhize, regardless of whether he was on special leave, should be required to report to the Committee and answer its questions. Dr Buthelezi’s briefing on Digital Vibes had been “disappointing.” It did not provide the information the Committee needed. So Minister Mkhize must be called to the Committee.
Mr Van Staden said that under section 55(2) of the Constitution, and as cited in the legal opinion, the NA “must provide for mechanisms to ensure that all executive organs of state in the national sphere of government are accountable to it; and to maintain oversight of the exercise of national executive authority.” According to section 92(2), ministers were accountable to Parliament. Moreover, NA rule 167(a) said, “For the purposes of performing its functions a committee may… summon any person to appear before it to give evidence on oath or affirmation, or to produce documents.” Therefore, he suggested that the Committee should submit a report to the Speaker, who would consult with all party whips. If the whips reached agreement, they could communicate with Minister Mkhize to call him before the Committee.
Mr Van Staden said that although NDOH had mentioned mass testing, it should not forget about mass screening. At the beginning of the pandemic, in level-five lockdown, NDOH had gone home-to-home conducting community screenings in the provinces. As he had said last year, this programme had to continue. The virus had to be “hunted down.”
Mr Van Staden said that the President had announced an escalation to level-three lockdown to curb the spread of COVID-19. However, on Friday, the Committee had visited Kopanong Hospital in Vereeniging, and had seen equipment worth millions of rands standing unused. On Friday, he had asked the Gauteng MEC for health whether that equipment could not be put to better use. Underuse of equipment could exacerbate problems with bed capacity and so on. He reminded the Chairperson that the Gauteng MEC was supposed to deliver a report on the matter to the Committee, and he encouraged Minister Kubayi-Ngubane to look into the matter herself.
Mr Van Staden said he had received a complaint regarding a municipal clinic in Parys in the Free State. When people registered on EVDS at that clinic, they did not receive any SMS notification or reference number afterwards, so it appeared that their data was not being captured in the system.
Mr Van Staden said that NDOH was currently facing “big problems” with vaccine procurement. At this rate, it would take 30 years to vaccinate the population. He suggested that NDOH should open registration to everybody, allowing everybody to be vaccinated on a first-come, first-served basis.
Ms Gwarube told the Chairperson that she was concerned that Members were raising questions about both of the NDOH briefings. Though the meeting was scheduled to continue for another hour, Minister Kubayi-Ngubane had to leave in half an hour. It would take a lot of time for all Members to ask all their questions and to receive responses. Could the Chairperson clarify what the Committee was dealing with in the current discussion? Would it return to COVID-19 later? If the various issues were mixed together in the discussion, Minister Kubayi-Ngubane would never get through all the questions in time.
Ms Gwarube said that she was “incredibly disappointed” with Dr Buthelezi’s report on Digital Vibes, which had merely repeated information that had been in the public domain for several weeks. It had not provided the Committee with any clarity about the relevant events and the contents of the investigation. Essentially, it had been “a waste of time.” She would ask Minister Kubayi-Ngubane and Dr Buthelezi further questions about Digital Vibes, and she hoped they could be answered.
Ms Gwarube asked what the Digital Vibes contract had originally been for. The contract had shifted from its initial brief, around NHI, to COVID-19-related work. But what was the initial need that NDOH had been trying to fill? What was the brief for the tender? What was the total value of the Digital Vibes contract? How many contractors had been short-listed for the tender, and on what basis had Digital Vibes been chosen over the others? What was the Committee to make of reports that Digital Vibes had been contracted to handle simple functions that should have been performed internally at NDOH? Such reports were in the public domain and, in the absence of clarity from NDOH, were presumed true. Had simple functions of NDOH’s communications department been outsourced to Digital Vibes? This circled back to the initial question of what the contract was for.
Ms Gwarube asked for an explanation of the normal process taken by NDOH in awarding a procurement contract. Was the DG the last person to sign off on a contract? In what circumstances did the executive authority see or sign off on a contract? In the case of Digital Vibes, had the executive authority done so? That is, had the executive authority seen the contract or had any say in its award? How had the awarding of this contract deviated from the normal process?
Ms Gwarube asked what the AG’s key findings had been about the Digital Vibes contract and the process leading to its award. What had the AG flagged? She had asked Dr Buthelezi the same question in the 4 June meeting and he had directed her to the AG’s report, but she still wanted to know.
Ms Gwarube said that she still held that Minister Kubayi-Ngubane could not be expected to answer these questions about Digital Vibes, but Members were expected to ask them of her anyway. Did Minister Mkhize sign off on the Digital Vibes contract? Was he aware that the contract was allocated to his close associates? At what point did he become aware of this? Had any money exchanged hands between Minister Mkhize or his family and Digital Vibes or its owners? She would have preferred to ask Minister Mkhize, but he was not present and Minister Kubayi-Ngubane had indicated that she was present on his behalf.
Ms Gwarube said that, as Adv Njikela had said, section 56 of the Constitution did not limit the Committee’s powers to summon persons. It made “absolutely no sense” that the Committee would not use its powers to get to the bottom of the Digital Vibes matter. If the NDOH delegation present in the meeting could not answer her questions, the Committee had a “serious problem” – it was being “rendered useless” and was shielding people from accountability. Members should acquaint themselves with the Constitution and the parliamentary rules.
To Ms Gwarube’s question about the Committee’s process, the Chairperson said that the Committee would have a second round of discussion for questions about COVID-19 and the vaccination roll-out, including about NDOH’s third briefing. He asked Members to wait for that second round where possible. For now, Members should raise questions that they wanted Minister Kubayi-Ngubane to respond to. For example, Ms Gwarube had raised specific questions that Minister Kubayi-Ngubane would have to answer.
Ms H Ismail (DA) said in her view the Committee had to receive a report from Minister Mkhize. When the Committee had requested the 4 June meeting, and at that meeting in which the sub judice rule had come up, Minister Mkhize had not yet been on special leave. As Adv Njikela had said, the Committee could summon anybody to answer its questions. The Committee would not ask Minister Mkhize about anything that had happened after he had gone on special leave – it was interested in events that took place while he was still responsible for the health portfolio.
Ms Ismail said that she would repeat the questions she had asked at the 4 June meeting, though Ms Gwarube had already raised some of them. Who had signed the Digital Vibes contracts – who had scrutinised them, and who had approved them? The Committee needed transparency and accountability on that question. Moreover, NDOH often directed Members to the AG’s report – but when would the Committee be able to consider the full AG report, and discuss it thoroughly with NDOH? Had NDOH paid millions of rands for Digital Vibes to schedule Minister Mkhize’s media briefings, interviews, and other COVID-19-related public engagements? Finally, as Ms Gwarube had asked, had any family member of Minister Mkhize benefited from the Digital Vibes contracts?
Dr Thembekwayo said that there was another problem with the EVDS system that Minister Kubayi-Ngubane had not mentioned. It particularly affected those on medical aid. A person registered with their residential address on EVDS, but sometimes received an SMS notification telling them to visit a vaccination site very far away from their residence. Moreover, there was no way to call the NDOH 08-something number to have this changed to a location that suited you. She believed that people should be vaccinated in sites close to where they lived, and that was not happening, especially for people on medical aid. She asked Minister Kubayi-Ngubane to investigate this further. Minister Kubayi-Ngubane should also check on the “attitude” of the staff who responded to queries from the public about EVDS.
Dr Thembekwayo said that the findings of the Sisonke programme had been released.
The Chairperson interrupted to ask whether Dr Thembekwayo’s point could wait until the second round of discussion.
Dr Thembekwayo replied that it could not. It was an important point relating to the J&J vaccine, and Minister Kubayi-Ngubane had not commented on it during her opening remarks. The vaccine was bought with taxpayers’ money. She wanted to know about the finding that 50 or so health care workers had suffered serious side effects from the J&J vaccine, and that one person had died.
Dr Thembekwayo agreed with other Members that no matter how many times NDOH reported to the Committee on Digital Vibes, only Minister Mkhize could provide the correct and relevant information. She was not satisfied with Dr Buthelezi’s report on Digital Vibes, and it had not changed her mind.
Mr Munyai said that he was happy with the legal opinion. Although section 56 of the Constitution allowed the Committee to invite anybody to account before Parliament, Adv Njikela had said that he was not sure how this should be handled in a situation where a minister was on leave. If the legal advisers were unsure about how the situation should be handled, they should consult further and come back with a conclusive view. Ultimately, the SIU investigation was not complete. Regardless of whether he was on special leave, Minister Mkhize was not going to account on an incomplete report. He urged the Committee to wait for the SIU to finalise its report, to avoid compromising the process, as cautioned by Minister Kubayi-Ngubane. Demanding accountability “prematurely” could compromise the process. Another key issue had been raised by Dr Jacobs in the 4 June meeting, about the relevance of section 35 of the Constitution in a situation in which a matter had been reported to SAPS. The legal advisers should also present their view on that issue, and should not provide “selective” advice. Minister Kubayi-Ngubane and Dr Buthelezi had addressed all the key issues “without ambiguity.” So the Committee should allow law enforcement agencies to conclude their investigations, so as not to endanger the success of the case in the courts.
Ms Chirwa said that during Dr Thulare’s presentation, she had raised a point of order, and had unfortunately been “shut down” by the Chairperson. Her point had been that Minister Kubayi-Ngubane had to answer Members’ questions. Since this point had been ignored, Minister Kubayi-Ngubane should stay in the meeting to answer all of Members’ questions. This was not a favour but an obligation – Minister Kubayi-Ngubane had to account to the Committee, not the other way around. She had raised the point of order to remind the Chairperson that Minister Kubayi-Ngubane had to leave early – 15 minutes from now, in fact. If she did indeed leave early, the Committee would not have enough time to ask all its questions and to receive answers from her. She was obligated to stay.
Ms Chirwa said that NDOH’s plans, as reported to the Committee earlier in the year, had not been fulfilled. How would NDOH ensure that it followed its plans in the future? The NDOH had presented various targets to the Committee that year, and none of them had been achieved. This was particularly important as it related to targets for vaccinations and for capacitating public health care facilities. Effectively, NDOH and its executive tended to “mislead” the Committee and the public by providing targets and deadlines that it did not achieve. It did this because it knew there would be no accountability. How would this “crisis” be handled? NDOH had given the Committee incorrect and misleading numbers on vaccinations and health care capacity. Initially, NDOH had planned for 800 vaccination sites – now, in June, it reported that there were 576 vaccination sites. The failures of NDOH and the provinces should not be “taken lightly.” What exactly was NDOH’s plan, going forward, to address its failures at the national and provincial level?
Ms Chirwa asked for a precise date by which all health care workers and people over the age of 60 would be vaccinated. The official date was 16 July, but the current vaccination rate was not consistent with that deadline. The dates given by NDOH were never “truthful,” and this was a problem with NDOH’s presentations. It could not reach the targets that it set for itself, and there was no accountability. Through slow vaccine roll-out, NDOH had created a “crisis” for South Africa. All health care workers should have been vaccinated in April, and now – in June – there were still less than 500 000 vaccinated. This was not enough and the Committee should no longer tolerate it. NDOH sent out public statements with the inaccurate vaccination timelines. In the same way, it should send out a public statement to correct those inaccurate timelines. It should tell the Committee and the public that it would not be able to meet its target because it had “failed.”
Ms Chirwa said it was a “crisis” that there were only 576 vaccination sites. There were more than 8 000 public health care facilities in South Africa. 576 sites were absolutely insufficient. This related to inclusivity. People were being excluded from the vaccination programme, especially as walk-ins. But there were walk-ins because there was also a “crisis” in the online registration system. Only 13 million people in South Africa had consistent internet access. People did not have access to EVDS, and NDOH was not addressing that – it had not set up proper channels for those people. In some municipalities, there had been no vaccinations – neither by registration nor of walk-ins. How would NDOH address the problems with registration and walk-ins? It was perpetuating the lie that South Africa had universal health care coverage. Vaccinations fell under primary health care, and they should be available at every clinic and hospital. 576 sites were “a blatant failure.” NDOH had promised 800 sites by March, and it was now July. During elections, the government had door-to-door visits – why was this not implemented to advance registration and vaccination? Why was the NDOH not prioritising access to primary health care? Precisely that was the primary mandate and obligation of NDOH.
Ms Chirwa asked for clarification about media reports that Russia had offered to donate 15 million doses of the Sputnik vaccine to South Africa. Was this true, and was it true that the government had rejected the donation? The government had accepted a donation from J&J for basic educators even before SAHPRA had approved it. Why were other companies not being accommodated in the same way as J&J? The EFF had previously argued that the government was biased in favour of certain manufacturing companies, and the government had to account for this. It cost lives. Hundreds of people were dying every day in South Africa because the government was biased in favour of J&J and Pfizer.
Ms Chirwa noted that prior NDOH presentations had said that Pfizer was being prioritised in urban areas, and J&J in rural areas. Why was this the case?
On Digital Vibes, Ms Chirwa asked why NDOH was outsourcing functions that should be handled by its own communications department. Apparently, it had paid R150 000 to get an opinion piece printed in a newspaper – something that anybody could achieve for free. Why was there a tender on such functions? Did NDOH not have a communications department, and did its communications department not have adequate capacity? Why was it not able to deal internally with such a small thing as an opinion piece?
Ms Chirwa said that Digital Vibes could not be discussed without Minister Mkhize. At NDOH, there was “financial mismanagement” and a “blatant disregard” of the law. The problem did not start with Digital Vibes. The Committee was only so interested in Digital Vibes because an investigation had been conducted. Billions of Rands were lost to irregularities every year, yet NDOH could not even help the Committee get to the bottom of a R150 million contract. Minister Mkhize had to stop “hiding” and report to the Committee, which had the power to summon him. He had to “answer for his crimes” and for the actions of the Ministry he led. The Committee could not hold Minister Kubayi-Ngubane accountable because she had not been at the Ministry during the relevant period and did not know anything. That would be used as an excuse for a lack of accountability. If Minister Kubayi-Ngubane could not answer Members’ questions, the Committee should simply close the meeting and call Minister Mkhize.
The Chairperson told Ms Chirwa that in Parliament she should properly refer to allegations, not to facts. She should say that Minister Mkhize had to come and answer to the allegations of criminal activity, not to answer for criminal activity itself.
Ms Chirwa replied that her point was that Minister Mkhize had to come before the Committee – the Chairperson was digressing. She wanted their discussions to be cordial, but the Chairperson was doing the same thing that she accused him of doing at every meeting. “Don’t police my expressions,” she told him.
The Chairperson repeated that in parliamentary language, Ms Chirwa was saying that Minister Mkhize had to come and account on allegations. She had not phrased the point that way.
Ms Chirwa replied that she had said that Minister Mkhize had to account for Digital Vibes. Where should she insert “allegations” into that sentence? He had to come before the Committee and account for Digital Vibes.
Mr M Sokatsha (ANC) said that he would limit his questions, given that there would be a second round of discussion – he did not want to be “all over the show” and “like a headless chicken.” He was “very happy” with Dr Buthelezi’s report on the steps that NDOH was taking in the Digital Vibes matter. He was also happy that NDOH was cooperating fully with the SIU. He did not want to “put the cart before the horse,” as other Members had. Other Members had said that they were disappointed and dissatisfied, and that they did not think that Minister Kubayi-Ngubane would be able to answer their questions – before they had even asked their questions. This seemed “malicious.” NDOH had a capable Ministry which would be able to answer the questions. Minister Kubayi-Ngubane had been clear that she could take responsibility for NDOH. So the Committee should give the Ministry the opportunity to answer its questions, and afterwards could pinpoint any answers it was not satisfied with.
Mr Sokatsha asked for an update on the progress of the SIU investigation and report. When was the final report expected? The best approach would be for the Committee to debate the merits of the report.
Dr Jacobs said that everything he wanted to raise had been raised by other Members, which was a problem with being the last Member to speak. Minister Kubayi-Ngubane should be allowed to give her account and to try to answer Members’ questions, and thereafter the Committee could decide its way forward.
To Mr Sokatsha’s question, Minister Kubayi-Ngubane replied that the SIU had said – both publicly and to NDOH – that its investigation should be completed by the end of June. The report would be released thereafter.
To Mr Shaik Emam’s question about Digital Vibes, Minister Kubayi-Ngubane replied that several officials were involved, not just one person. NDOH could not publicly identify those officials, because they had not yet had an opportunity to respond to the allegations. If NDOH compromised any step of the process, as clearly outlined in the Labour Relations Act, it could result in any subsequent court case being thrown out. The SIU had asked NDOH not to identify individuals until it finalised its report. The SIU seemed to believe that additional charges would be laid.
To Mr Shaik Emam’s question about the involvement of law enforcement, Minister Kubayi-Ngubane replied that the issue was continuously raised in the NCCC. She had even raised it in her capacity as Minister of Tourism.
To Mr Shaik Emam’s question about the Sinovac and Sputnik vaccines, Minister Kubayi-Ngubane replied that both vaccines were under consideration at SAHPRA. Progress had been made with the Sinovac application. SAHPRA had done extensive work on it and she had seen a report. An entity had lodged an application for Sinovac and had submitted the requisite report; it had thereafter received feedback from SAHPRA and had fixed relevant issues. It looked as though the process was close to complete. On the other hand, there had not been much progress with the Sputnik vaccine. All vaccines had to meet the regulatory requirements.
To Mr Shaik Emam’s question about Dr Chetty, Minister Kubayi-Ngubane replied that she had not met Dr Chetty and would look into whether such a meeting was necessary.
Minister Kubayi-Ngubane said that NDOH agreed with Mr Van Staden about the usefulness of mass screening, especially in Gauteng, given the many cases there.
Minister Kubayi-Ngubane said that NDOH would note Mr Van Staden’s comment about equipment at Kopanong Hospital. It would also look at the Committee’s oversight report, which provided guidance for NDOH.
To Mr Van Staden’s suggestion about first-come, first-served vaccination, Minister Kubayi-Ngubane replied that NDOH would not currently support such an approach. The vaccine roll-out was based on tranches, and NDOH had decided to protect the most vulnerable groups first. It thought that the current approach was working well.
To Ms Gwarube and Ms Ismail’s questions about Digital Vibes, Minister Kubayi-Ngubane said that Dr Buthelezi would provide more information about the value of the contract and the process followed. The appointment had followed the normal process, but there had been “compromises” in that process.
On the question of whether Minister Mkhize had benefitted from the contract, Minister Kubayi-Ngubane deferred to the remarks Minister Mkhize had made publicly on the subject.
Minister Kubayi-Ngubane suggested again that that the Committee should allow the SIU to do its investigation, and should thereafter invite the SIU to brief the Committee. The SIU was the most suitable entity to report because it was investigating and “drilling down” the details. NDOH was also waiting for the details in the SIU report. For example, NDOH did not know “what money went where, how” – it was relying on the SIU for that information. She acknowledged Members’ frustration, but said that only the SIU could say conclusively what had happened and what the evidence was. For example, the SIU, and not NDOH, had the power to review officials’ bank accounts. She urged Members to wait for the conclusion of the SIU investigation, which would not take long. The SIU had recently reported to Parliament on other investigations, so it should be able to report on the Digital Vibes matter too.
To Dr Thembekwayo’s concern about the distance of vaccination sites from people’s residences, Minister Kubayi-Ngubane said that NDOH would follow up and check with its private sector partners. It would send a written response through the Chairperson.
To Dr Thembekwayo’s concern about the J&J vaccine used during the Sisonke programme, Minister Kubayi-Ngubane said that J&J would be part of the continued vaccine roll-out. As the President had announced, the two million contaminated doses would not be used and had been replaced.
To Ms Chirwa’s accusation that NDOH had misled the Committee by giving it false information, Minister Kubayi-Ngubane asked Ms Chirwa to provide precise details of the false claims and the dates on which they were made.
Ms Chirwa raised a point of order.
The Chairperson did not respond.
Mr Sokatsha said that if the Chairperson was not present, Ms Chirwa should allow Minister Kubayi-Ngubane to continue speaking.
Ms Chirwa asked why, in that case, Mr Sokatsha was speaking – who had made him acting chairperson?
Mr Sokatsha and Ms Chirwa argued.
Mr Shaik Emam asked Dr Jacobs to step in as acting chairperson.
Dr Jacobs recognised Ms Chirwa’s point of order.
Ms Chirwa said that in her question, she had specifically stated that all NDOH presentations to the Committee regarding the vaccine roll-out had been “misleading” and “mistruthful [sic].” In simple terms, they had been “lies.” None of the targets regarding dates or figures had ever been honest. Minister Kubayi-Ngubane had said that she was able to respond to Members’ questions, and she should do so.
Mr Sokatsha interrupted to say that Ms Chirwa was making a new point, not a point of order. She should allow Minister Kubayi-Ngubane to continue.
Ms Chirwa replied that she was not making a new point, and Mr Sokatsha should not speak while a Member was making a point of order. All Members should be respectful to one another. She was clarifying that in her initial question she had said that all NDOH presentations about the vaccine roll-out had been “lies.” Minister Kubayi-Ngubane had to respond to her question: what were the new targets, and what implementation strategies would NDOH use to correct its past “failures?”
The Chairperson apologised for his absence – he had had technical difficulties. He asked Ms Chirwa to nevertheless write down, and forward to NDOH, the claims to which she was referring. Her accusation could not be so general as to apply to every part of every NDOH report.
Ms Chirwa interrupted to ask whether the Chairperson could not “grasp” what she was saying. In her question, she had even given specific examples, such as the dates for the vaccination of all health care workers and of all persons over the age of 60.
The Chairperson interrupted to ask Ms Chirwa to allow Minister Kubayi-Ngubane to continue.
Minister Kubayi-Ngubane said that she was “getting used to” the Committee. She said that, as a former deputy chief whip, her request to Ms Chirwa was made in line with the rules of Parliament. It was a serious matter for a Member to claim that a department had misled Parliament.
To Ms Chirwa’s question about the vaccination of health care workers, Minister Kubayi-Ngubane said that such vaccinations continued and had been ongoing. When the Sisonke programme had ended, NDOH had begun vaccinating health care workers using the Pfizer vaccine. So it was not that NDOH had stopped vaccinating health care workers. If a given health care worker was not vaccinated, this was “for one reason or another” – it was not because vaccines were not available.
Ms Chirwa interrupted to ask Minister Kubayi-Ngubane to explain the reasons to which she was alluding. Minister Kubayi-Ngubane was “blaming” health care workers for not being vaccinated, when it was NDOH which had failed to vaccinate them.
The Chairperson told Ms Chirwa not to interrupt while Minister Kubayi-Ngubane was answering questions. There would be another round of discussion later.
Ms Chirwa said that she merely wanted Minister Kubayi-Ngubane to respect her, and she would respect the Minister in return. Minister Kubayi-Ngubane must provide specific reasons for the fact that the 1.5 million health care workers had not been vaccinated.
Mr Sokatsha interrupted with a point of order. Everyone present was an adult, and nobody had interrupted Ms Chirwa while she was speaking. He asked the Chairperson to maintain order in the meeting. This was not the first time there had been disorder in a Committee meeting – every meeting, Ms Chirwa was “like a headless chicken.” Members were trying to listen to Minister Kubayi-Ngubane.
Ms Chirwa interrupted and angrily repeated Mr Sokatsha’s claim that she was “a headless chicken.” It was simple – Minister Kubayi-Ngubane had to answer her questions. Why had only 400 000 health care workers been vaccinated? What were the reasons?
The Chairperson told Ms Chirwa that she would not speak unless he had recognised her to speak. If she felt that her questions were not answered to her satisfaction, there was a way of dealing with that – it was not necessarily to interject while somebody else was speaking.
Minister Kubayi-Ngubane said that the Committee was “interesting” and she was learning how it worked. She would now address other Members’ questions.
Ms Chirwa interrupted with another point of order.
Minister Kubayi-Ngubane said that she now had to register that she had “a serious issue” with Ms Chirwa’s conduct.
The Chairperson asked the secretariat to remove Ms Chirwa from the meeting. She had been warned about her conduct.
Ms Chirwa said that Minister Kubayi-Ngubane simply had to answer her question. She could not skip her question.
The Chairperson repeated his request to have Ms Chirwa removed.
Ms Chirwa was removed from the virtual platform.
Minister Kubayi-Ngubane said that Dr Buthelezi could provide more factual details about the Digital Vibes contract. She recommended that the Committee should invite the SIU, who could provide better and more intensive assistance than NDOH could. NDOH did not want to compromise the investigation in any way. It was trying its best to comply with Parliament, but equally it did not want the SIU to find that NDOH had obstructed justice or otherwise inhibited the investigation. NDOH would appreciate the Committee’s assistance in that regard.
The Chairperson suggested that the Committee should hear the final briefing from NDOH before moving on to further discussion. He excused Minister Kubayi-Ngubane from the meeting.
Mr Shaik Emam said that two of his questions, about the effect of vaccines on health care workers and about Ivermectin, had not been answered.
The Chairperson replied that Dr Buthelezi could follow up on those questions.
Ms Gwarube suggested that, before the final presentation, Dr Buthelezi should reply to the questions about Digital Vibes, as Minister Kubayi-Ngubane had suggested he could.
The Chairperson agreed. He had also noted Minister Kubayi-Ngubane’s suggestion that the SIU should be invited before the Committee, and Mr Van Staden’s suggestion that the Committee should write to the Speaker, who could consult the whips.
To Ms Gwarube’s question about the AG’s report, Dr Buthelezi replied that he had quoted from the AG’s findings in his presentation. The AG had concluded that it was possible that NDOH was being overcharged by Digital Vibes, and had recommended that NDOH should interrogate Digital Vibes’s rates and benchmark them against other service providers. There were about eight pages in the AG’s report where the AG analysed the services provided and raised various issues.
To Ms Gwarube’s question about the normal process for awarding a contract, Dr Buthelezi said that the process usually began when a need for external capacity was identified. A particular unit identified a demand for a particular service that could not be provided internally using existing resources. The budget for the tender was identified and went through the committee that dealt with budgets. Once the budget was approved, a submission was made, which went through a process and reached the accounting officer, the DG. That submission covered everything, including the budget, and suggested the people who should be appointed to serve on the committees. NDOH had a specification committee, which worked on the bid specification; an evaluation committee, which was appointed by the DG; and an adjudication committee, which was chaired by the chief financial officer (CFO). Once those committees had done their work – going through the process of advertising, evaluation, and so on – then the final submission went to the DG. In terms of the PFMA, it was the DG who signed off on, and had final approval over, the contract.
Dr Buthelezi said that this was a description of the generic process followed at NDOH. He could not provide specific details about the Digital Vibes process, because parts of that process were subject to SIU investigation. The CFO, who chaired the award committee, could confirm the value of the contract.
Mr Ian Van der Merwe, CFO, NDOH, confirmed that Dr Buthelezi’s description of the process was correct. To Ms Gwarube’s question, he said that the total initial award to Digital Vibes was R140 million. However, NDOH had recognised that its budgets had needed extensive repositioning and reprioritising. So the initial award had been made with the understanding that budgets would be reconsidered going forward.
Dr Buthelezi said that some of Ms Gwarube’s questions – for example about the shortlist and selection criteria – were part of the SIU’s investigations. The SIU could probably provide more detail. As Minister Kubayi-Ngubane had said, NDOH did not want to compromise the SIU’s work.
The Chairperson asked whether NDOH would attend a meeting between the Committee and the SIU.
Dr Buthelezi did not respond.
The Chairperson said that the current meeting would be extended an hour beyond its scheduled time.
At Mr Shaik Emam’s urging, the Chairperson reminded Dr Buthelezi about Mr Shaik Emam’s two unanswered questions.
To Mr Shaik Emam’s question about whether any vaccinated health care workers had died or been infected with COVID-19, Dr Buthelezi said that there was an existing process for following up on adverse effects after immunisation. NDOH had received some reports of individuals who had developed serious adverse effects, and it was following up on those cases. There was a team of experts, the National Immunisation Safety Expert Committee (NISEC), which did the relevant analysis. There were also some reported cases of breakthrough infections – cases where a vaccinated individual was infected with COVID-19. NDOH was also following up on those. It had spoken to SAHPRA to put together a proper study on breakthrough infections. However, being vaccinated generally did not make one immune to infection; instead, it limited the severity of the infection, reducing hospitalisation and mortality rates. NDOH would probably be able to report back to the Committee in the next meeting on both adverse effects and breakthrough infections.
To Mr Shaik Emam’s question about Ivermectin, Dr Buthelezi said that it was SAHPRA which was obligated to make regular reports on Ivermectin. NDOH would consult with SAHPRA and provide a written response, probably within the next 24 hours.
Briefing: State of preparedness for the COVID-19 third wave
The Chairperson warned the NDOH delegation that the Committee was constrained for time.
Mr Ramphelane Morewane, Chief Director: District Health Services, NDOH, reported on the readiness of health facilities for the COVID-19 third wave. He provided a detailed breakdown of the trend in COVID-19 hospital admissions (see slides). There was a total of 114 421 hospital beds, including 5 616 ICU beds, across the public and private sectors. In the current week, COVID-19 patients occupied 6.5% of total beds and 25.9% of ICU beds. A major concern was the Northern Cape, in which 119% of ICU beds were occupied by COVID-19 patients. On hospitalisation, there were serious data quality problems, especially since some hospitals did not make use of the Daily Hospital Surveillance (DatCov) system.
Mr Morewane also provided a detailed breakdown of trends in oxygen supply and utilisation (see slides). Oxygen utilisation was increasing nationally and in most provinces. Consumption in some provinces was being monitored closely. In the North West, for example, it was concerning that oxygen consumption at this stage, early in the third wave, was already close to where it had been in the second wave. Mr Morewane also explained NDOH’s oxygen readiness plan and the system used, in conjunction with the supplier, Afrox, to monitor oxygen supplies in the country (see slides). NDOH believed its oxygen capacities were sufficient to cope with the third wave.
In 2021, 9 000 new oxygen cylinders had been added in preparation for the third wave, and there was a pool of standby equipment available to be deployed at short notice. An addition 700 tons in oxygen stock was now available in the Eastern Cape and Western Cape. These provinces had been prioritised because of their distance from Gauteng, where the bulk of the industry was located and from which the stock had to be transported. To facilitate the transport of oxygen tanks, there was also a need to improve hospital access roads, particularly in provinces like the Eastern Cape. Finally, he indicated the distribution of donated respiratory support devices across the provinces (see slides).
Discussion: COVID-19 vaccines and preparedness for third-wave
Dr Jacobs compared the current situation with the situation during the first and second waves of the pandemic. He said that during the first wave, the government had been “inexperienced”; during the second wave, it had been 60% or 70% experienced. There should be a focus now on reflecting on the initial challenges faced, or the initial “fright” that COVID-19 had elicited. He did not get the sense that this kind of reflection was happening, but perhaps that was because the Committee had given NDOH a narrow brief for its presentations.
Dr Jacobs said that NDOH and the Committee needed to “take a few steps back.” For example, the basics of public health care were critical. Were the dashboards functioning? Was NDOH looking at community spread? Was there screening or testing? What kind of testing was there – where did NDOH stand on antigen tests and PCR tests? There was also isolating, in a facility, and quarantining, at home. There should be an awareness programme to “wake up” South Africans to the very serious position the country was in – the third wave could potentially be worse than the others. He saw that NDOH had made great progress in increasing the number of hospital beds and ICU beds, and in augmenting oxygen supply. Since the beginning of the pandemic, he had been pushing for oxygen consumption, and measuring oxygen saturation, as mainstays of COVID-19 treatment. In sum, he would like to have another meeting at some stage, to allow a more comprehensive discussion about where NDOH was generally in regard to the pandemic, and how it was going to revisit public health initiatives to stop the spread of COVID-19 in communities.
Mr Morewane replied that towards the end of the second wave, NDOH had assessed the lessons learned during the first two waves. That assessment had been used to work with the provinces on writing resurgence plans for the third wave. Provinces had written their resurgences plans under NDOH’s guidance, with NDOH spending two days in each province helping to identify areas where the government had not done well. His presentation to the Committee was based on such reflections about the lessons learned from earlier waves, as well as on its preparations for the third wave.
Ms Ismail reminded the Chairperson that the Committee had agreed to meet with SAHPRA regularly, at least on a monthly basis. However, SAHPRA had not attended the Committee in a long time. The Committee also needed reports from the South African Medical Research Council (SAMRC). There had been reports of deaths after vaccinations, and there were clinical trials taking place in the country. The Committee needed reports on these issues so that it had proper scientific evidence.
Ms Ismail noted the NDOH’s concern about low registration on EVDS of people over the age of 60. This was delaying the vaccine roll-out. She also knew that it was important for vaccination sites to observe COVID-19 protocols, but why could walk-ins not be allowed at vaccination sites? The vaccination targets were not being met, and at the current rate it would take several years to reach population immunity.
The Chairperson said that walk-ins to vaccination sites were only allowed in Gauteng. Some might say that this was because Gauteng was at the “deep end” of the third wave. Why were walk-ins not allowed elsewhere, especially in rural provinces like KwaZulu-Natal and the Eastern Cape?
Dr Nicholas Crisp, Deputy Director-General: NHI, NDOH, replied to Ms Ismail’s point about low registrations. He said that, in fact, the opposite was the problem. Even if NDOH had not reached its target for registrations, more than enough people were registered on EVDS. More than two million people were registered and waiting to be vaccinated. Because of the issues with J&J, there had been only Pfizer vaccines available, so it had not been possible to vaccinate people fast enough to keep up with the demand, as reflected by registrations. In a vaccination programme, there were two challenges: to create demand, by registering people, and to match that demand with the government’s ability to supply vaccinations. Ideally, those two factors should be in balance, so that NDOH did not unnecessarily raise expectations.
Dr Crisp said that currently, just over 3.6 million people were registered on EVDS. The total number of vaccinations to date was nearly two million – NDOH should reach the two million mark that day – or, on average, about 85 000 daily. That included just under a million health care workers who had been vaccinated. The challenge was to match the number of registrations with the number of available vaccines. There were about two million people who had registered but had not yet been vaccinated – mostly people over the age of 60, but also some health care workers. Those people were waiting in a virtual queue, until such time as there was a vaccine dose and a vaccination site available for them.
On walk-ins, Dr Joe Phaahla, Deputy Minister of Health, said that other members of the NDOH delegation had already alluded to Limpopo’s high number of registrations and vaccinations. Limpopo’s success was due to pro-active community mobilisation. Community leaders organised people to visit vaccination sites to be registered and immediately vaccinated. That was a suitable approach, especially in rural areas. NDOH would be discussing it further with the provinces. As the stock of vaccines improved, NDOH would be able to “recoup the lost ground” and increase its vaccine coverage, especially in rural areas. It would begin to encourage more pro-active mobilisation campaigns. These were also helpful in avoiding stampedes. A vaccination site could be made aware that community leaders were arranging for 100 people to come to the site from a particular area on a particular day, and it could then make the necessary preparations.
However, Deputy Minister Phaahla had visited Gugulethu in the Western Cape the day before. He had been assured that when people experienced delays after registering on EVDS – even if they had registered in a different province – they were not turned away if they walked into vaccination sites without being scheduled. Across the country, NDOH had been emphasising that people who came to vaccination sites should be accommodated, especially if they had registered and even if they had not received an SMS from EVDS. This had been happening.
In addition to low registration numbers, Ms Ismail had two further concerns about EVDS. First, she had received many calls from people all over the country who said that they had registered on EVDS but had not subsequently received an SMS – or if they had received the initial SMS, they had not received a follow-up SMS notifying them about the details of their vaccination site. Second, sometimes people received both SMSs, but were assigned to a vaccination site that was in another province or that was otherwise inconvenient. They were sent to distant sites when there were alternative sites closer to their homes. For the population over the age of 60, travel was “cumbersome,” and many did not drive – the long distances created additional stress for them. That could also be delaying vaccinations.
Ms V Mente (EFF) said that there was a “huge problem” with EVDS in the Eastern Cape and KwaZulu-Natal. People registered on EVDS but did not receive notifications telling them where to go to be vaccinated. Moreover, the vaccination sites were distant. For example, in Chris Hani in the Eastern Cape, there were only three vaccination sites, and some villages were 300 kilometres away. It was likely that people would make the trip to one of those sites only to be turned away because it was full – and they could not afford to make the trip again on a different occasion. Why did NDOH not add more vaccination sites in rural areas, so that people would have easier access to them?
Dr Crisp replied that it was not surprising that people were not receiving notifications from EVDS. As he had said, there was a long virtual queue for vaccinations. If someone was number 4 000 or number 5 000 in a queue for a vaccination site which was vaccinating 200 or 300 people a day, that person would not receive a vaccination for a very long time. To shorten the queues, NDOH needed sufficient vaccines and sufficient vaccination sites. For a month now, everybody had been “frustrated” about the J&J situation. People should not expect SMS notifications for some time – in some cases, the delay would be three or four weeks.
Dr Crisp said NDOH was aware that some people were being sent to vaccination sites very far away. The situation should have improved by now, because changes had been made to the system. Vaccination sites were programmed as either rural or urban. The managers at each site controlled their own scheduling, and they designated their site as urban or rural. For urban sites, EVDS prioritised people within a ten-kilometre radius of the site. For rural sites, that increased to 30 kilometres. The problem was that there were “overlaps.” For example, a person might register with Tshwane as his address, but without specifying a suburb. In that case, EVDS searched for the nearest vaccination site from the whole perimeter of Tshwane. On the other hand, if he registered under a particular suburb, like Gezina, then EVDS would search for a site within Tshwane and close to Gezina. Perhaps NDOH needed to communicate better with the public about this. The more precisely they located their suburb or village, the more likely they were to be allocated to the correct vaccination site.
To Ms Mente’s concern, Dr Crisp said that there were parts of the country where there were no nearby vaccination sites. However, provinces had been “champing at the bit” to open additional vaccination sites. It served no purpose to open additional sites until they could be supplied with vaccines, so NDOH had been purposely preventing the provinces from opening too many sites. This was particularly the case in rural areas, given the shortage of J&J vaccines. Right from the beginning, NDOH had decided to use J&J vaccines in rural areas, because they were easier to manage from a cold chain perspective and because it was a single-dose regimen – in remote rural areas, it would be more challenging to require a two-dose regimen. But once vaccines became available, additional sites could open. So, though it was currently true that some communities had to travel long distances to be vaccinated, that did not imply that NDOH was not aware of the situation and planning for those communities.
Ms Ismail said that some vaccination sites closed at two p.m. in the afternoon. What was the NDOH protocol for vaccination sites? What time were they supposed to open and close? When residents brought such issues to her, she was unable to give an informed response because she did not know the protocols.
Ms Ismail noted that the last presentation had focused on hospital beds and oxygen supply, both of which were essential capacities. However, water was another essential commodity, and it was currently scarce in some provinces. She was “really concerned.” Water shortages at hospitals and primary health care facilities could lead to unnecessary deaths. In Gauteng, for example, where cases were rising rapidly, there were frequent water cuts. This was “shocking.” Water was essential during the pandemic, and was also needed to sanitise medical equipment and so on.
Ms Gwarube said that, during its oversight visits, the Committee had observed problems with water supply. Health care facilities said that there was nothing that they could do, and that local municipalities were responsible. Some of the affected areas were hotspots for infections, but had not had water in almost a week. What was NDOH doing to help address this? How was it intervening with local municipalities?
Ms Ismail said she was also concerned that Charlotte Maxeke Johannesburg Academic Hospital had not yet been reopened after the fire, though the building was structurally safe. In this time, all facilities had to be functional. The ICU beds were needed for COVID-19 patients. She had also received calls from cancer patients and kidney patients, who received treatment at Charlotte Maxeke and who had been severely affected by its closure. What was NDOH going to do about this?
Ms Gwarube said that the Committee would of course send its oversight report to the Ministry. However, in its oversight visit to Charlotte Maxeke Hospital, the Committee had learned that there was a sort of “impasse” between the City of Johannesburg and NDOH, particularly regarding fire compliance. Gauteng, of course, was in a “crisis,” and was the current epicentre of the third wave. Surely negotiations should be taking place so that the capacity at Charlotte Maxeke – over 1 000 beds – could be used during the current wave of infections. The country could not wait for the compliance issues to be resolved. How far was NDOH in these kinds of negotiations? Could provisions be made, perhaps using the national state of disaster, to overcome the impasse?
The Chairperson told Ms Gwarube that the situation at Charlotte Maxeke Hospital had improved since the Committee’s oversight visit. He had spoken to Minister Kubayi-Ngubane about the matter on Monday. Dr Buthelezi should probably provide further details, but the problem was not with the City of Johannesburg engineers who had to provide a compliance certificate. The starting point was the NDOH engineers in Gauteng, whose work had to be certified. In short, the work of those engineers had not been good enough for certification. Minister Kubayi-Ngubane had been working on the issue. But as far as he knew, the ball was not with the City of Johannesburg but with the NDOH engineers, who needed to prepare a good report before compliance could be certified.
Dr Buthelezi said that NDOH, led by Minister Kubayi-Ngubane, had met with the Gauteng team on Saturday to discuss Charlotte Maxeke Hospital. Present were the premier, the mayor of Johannesburg, the MEC for health, the MEC for infrastructure development, the MEC for local government, and various councillors. Ms Tasneem Motara, MEC for infrastructure development, had briefed them on the whole compliance process. The ball had been thrown back to the NDOH, who needed to ensure that the engineers could sign off.
Dr Buthelezi assured Ms Ismail that the oncology unit had been prioritised. The main delay was the installation of the fire doors as a final compliance requirement. The government had approached every manufacturer of fire doors in the country, and had found that they could not get the doors until 2 July. So the government was looking into alternative arrangements. As soon as the fire doors were installed, the engineers would be able to sign off on the oncology unit and go to the City of Johannesburg for approval. Saturday’s briefing had been comprehensive, and there was no “stand-off” among stakeholders. The City of Johannesburg was dealing with compliance issues, in line with the relevant legislation. The parties had also discussed using the Disaster Management Act. However, the MEC for local government had already communicated with its national counterpart, and had concluded that the state of disaster could not be used as a workaround.
Ms Ismail said that the government had spent millions of rands on field hospitals, but the Nasrec field hospital was not being opened for the third wave. Why were field hospitals not being used? They could be repurposed as vaccination sites – there was always a need for more vaccination sites.
Ms Gwarube said that many field hospitals had been decommissioned, and the building of others had been halted. Was there any intention to reopen them or to finish building those that had not been completed?
Mr Morewane replied that before the second wave, NDOH had guided all provinces on how to decommission field hospitals. Most provinces had rented spaces for field hospitals, and had had difficulties maintaining the rentals during off-peak periods. NDOH had realised that not all field hospitals were used to full capacity during the second wave. For example, in Gauteng, the 500 beds at the Nasrec field hospital had never been used to full capacity. So, instead, the province had built a new ward using alternative building technology – a 300-bed facility at Chris Hani Baragwanath Hospital, which could be used as overflow if the resurgence led to a high number of hospitalisations. The province did not necessarily have the funds to rent the whole of Nasrec for the duration of the pandemic.
Mr Morewane said that, similarly, the Free State field hospital had been decommissioned. There were three hospitals in Bloemfontein, and all had available space, because the province had repurposed further space at Netcare Universitas Hospital. NDOH was meeting the province again next week to get an update on where the materials from the field hospital were and how they would be used. In the North West, there had been a field hospital at Maseve. The construction of another field hospital had stopped, because the hospital at Maseve had never been used to full capacity. Moreover, the space for the hospital had been donated by the platinum mines. However, the hospital could be reactivated if needed.
Ms Ismail was “very concerned” about rapid COVID-19 testing. She had received calls from people who said that there was a discrepancy between the results of rapid tests and the results of full-blown nasal or throat tests.
Ms Gwarube, following from Dr Jacobs’s remarks, asked about the current capacity of the health system. Would NDOH say its capacity had improved since the first and second waves of the pandemic? NDOH had always said that industries needed to be closed in order to slow infections while it was building capacity in the health system. Some of those capacity-building projects had been started but not completed. Field hospitals had been closed because they were not being used. How did the country’s current situation and capacity compare to that at the start of the pandemic in 2020? Was the country now in a better position to handle a resurgence?
Ms Gwarube asked about NDOH’s current capacity in terms of ICU beds, high-flow oxygen, and other resources. Currently, there was a crisis in Gauteng, but, of course, it was clear from past experience that infections would soon start to rise across the rest of the country. How ready was NDOH for this, in terms of capacity?
On oxygen supply, Mr Morewane said that towards the end of the second wave, and knowing that the third wave was inevitable, NDOH had asked Afrox to start collaborating on a contingency plan for the third wave. Because of that, Afrox had achieved some of its targets before the third wave had even begun. So NDOH did not think there was any “major problem” with the oxygen supply.
Mr Morewane said that Dr Buthelezi could provide further detail about the availability of hospital beds in Gauteng, but he could speak to the number of repurposed beds available. He had already mentioned the 300 repurposed beds at Chris Hani Baragwanath Hospital. There were also repurposed beds at Jubilee Hospital and Bronkhorstspruit Hospital. Those beds were ready to be activated when necessary. The province had assured NDOH had there was no shortage of public beds.
On capacity in Gauteng, Dr Buthelezi said that the province had promised NDOH that it was using all available avenues to replace the beds that had been lost at Charlotte Maxeke Hospital. In that morning’s nerve centre meeting in Gauteng, NDOH had been assured that the province had been able to repurpose 1 112 beds. With the existing beds – just under 3 000 – this brought the total number of beds to almost 4 000. The province was also trying to activate an additional 727 beds across Chris Hani Baragwanath, Bronkhorstspruit, Jubilee, and AngloGold Ashanti hospitals. There was a plan in place and NDOH received a daily update from the nerve centre. According to that morning’s report, about 46% of beds in public hospitals were occupied in Gauteng. The problem was the private sector, where the occupancy rate was over 80%. In the public sector, however, NDOH was confident that it would be able to accommodate many cases. With the increasing number of repurposed beds, the province would be covered.
Dr Buthelezi said that the day before NDOH had been working with Gauteng and the Solidarity Fund to source additional nurses from nursing agencies. The documentation had been finalised and the Solidarity Found would assist in ensuring that there was staffing capacity to cover the beds. Similarly, NDOH was confident that oxygen needs in the province were “well taken care of,” based on a report from the province and on Mr Morewane’s input.
Ms Gwarube said that she understood that SAHPRA was a completely independent regulator, as it should be. But did NDOH have a way of monitoring when applications were brought to SAHPRA and how advanced those applications were? Some manufacturers had claimed that they had made applications to SAHPRA and were awaiting feedback. Minister Kubayi-Ngubane had mentioned the SAHPRA processes in the earlier discussion, but there were still “discrepancies.” How advanced were the SAHPRA processes for these manufacturers? Where were the delays in the processes? Of course, NDOH did not involve itself in SAHPRA’s work, but it received reports from SAHPRA. It would be helpful to hear specifics, instead of just that the processes were nearly complete. What was the process for applying for regulatory approval? Were there “markers” used to measure progress in this process? The Committee needed an understanding of where the processes stood and how soon other manufacturers would be able to come aboard.
Dr Thembekwayo thought that South Africa needed the Sputnik vaccine. How far was NDOH with that vaccine?
Ms Mente said that she, like Ms Gwarube and Dr Thembekwayo, was interested in the status of other vaccines. How far was NDOH in acquiring the Sputnik and Sinovac vaccines? Both of those vaccines had been cleared by the World Health Organisation, and South Africa should have access to them.
Dr Crisp replied that there had been applications to SAHPRA for the registration of both Sinovac and Sputnik. The relevant data had been submitted to varying degrees of detail, and, as always, documentation was required. In his last discussion with SAHPRA, he had heard that the processes for the adjudication of both vaccines was “in an advanced stage.” However, it was difficult to know precisely what that meant until SAHPRA had received all the required documentation. All medicines and biologicals were potentially dangerous and could have unexpected effects. NDOH therefore preferred to be patient and trust that the independent process would be concluded at the proper time.
Dr Buthelezi returned to the claim, raised in the earlier discussion session by Mr Shaik Emam and Ms Chirwa, that NDOH had declined a donation of Sputnik vaccines. NDOH had never received this offer. It had checked all over, including with the Russian development investment corporation. He was not sure where the media had gotten the story from. However, even if NDOH was offered such a donation, it would have to wait for SAHPRA to approve and register Sputnik, as per the law.
Ms Gwarube said that she did not think the J&J supply issue had been properly discussed. How was the destruction of the contaminated J&J doses going to affect NDOH’s targets? 300 000 J&J vaccines would arrive the next day, but that was “a far cry” from the two million that had been budgeted for. Would NDOH still reach its target for vaccinating the over-60 age group by the end of June, or had that goalpost been moved?
Ms Gwarube said that NDOH was still far from meetings its vaccination targets, according to which it needed to vaccinate between 250 000 to 300 000 people daily. What was the reason for the “throttling” of the vaccine roll-out? Was the problem about vaccine supply and the allocation of vaccines across provinces, or about the activation of vaccination sites? What were the key three issues that were preventing NDOH from increasing the rate of vaccination, and vaccinating at least a couple hundred thousand people weekly?
Ms Mente said that Ms Chirwa’s question to Minister Kubayi-Ngubane still stood. Ms Chirwa had been very clear and she had not been “problematic.” Her question had been about the timelines or deadlines that NDOH had given the Committee for the vaccination of various population groups – starting with health care workers, and then moving on to persons over the age of 60. Those timelines had not been met – neither all health care workers nor all older persons had been vaccinated. It was incorrect and “out of order” to require Ms Chirwa to provide specific dates and claims, when it was NDOH who was “custodian” of that information. The question was: how far was the vaccination process now, and what were the new timelines for vaccinating the relevant groups? The timelines would also have to accommodate the other population groups that had been identified by the President, including educators. Arguably, students should also be added as a priority group for vaccination. It was “silly” to vaccinate teachers without vaccinating students, who interacted both with teachers and with their parents, especially when there was evidence that vaccinated people could still be infected. In short, NDOH should give the Committee its new timelines and explain why the original timelines had not been met.
Dr Crisp replied that NDOH had intended to vaccinate the entire population over the age of 60 by the end of June. That target would have been reasonable if both Pfizer and J&J vaccines had been available as planned. The problem was that now NDOH was two million vaccines behind in the total supply chain. The J&J delivery the next day would begin to compensate for that shortfall, but that was only 300 000 out of the total two million. By now, NDOH should have been beyond that two million and into the regular supply chain of J&J vaccines. Up until now, the delay had been a supply issue, rather than a demand issue.
Dr Crisp said that everyone in the health system had been equally frustrated with the J&J situation, which was completely outside the control of NDOH and of the country. It depended instead on the American Food and Drug Administration (FDA) regulations and their application to the American plant that manufactured the active ingredient in the J&J vaccine. But everybody could “take comfort” in the fact that the vaccines used would be safe, and that the contaminated doses would be destroyed. The problem was that NDOH had lost the two million doses that were already in South Africa, in fridges, waiting to be administered. So NDOH had been working with J&J and with the two regulators, SAHPRA and the FDA, to identify vaccines that were already inside the United States and had been bottled there, and to use them in South Africa. This meant getting permission to adopt the FDA labelling inside South Africa, getting the GMO certification from the Department of Agriculture – a requirement for biological imports – and arranging for the vaccines to be tested in South Africa at the National Control Laboratory immediately upon arrival.
Dr Crisp said that the first 300 000 doses were on the way and would arrive the following day, and further batches would arrive in quick succession after that. Altogether, NDOH expected to have replaced the two million lost doses within the next ten days to two weeks. J&J would provide NDOH with the flight details as soon as the necessary international permits were finalised both in the United States and in South Africa. The problem was that the first 1.5 million doses were already thawed and therefore had a short shelf life, so NDOH had to get them into the field rapidly. After that, it could embark on the planned programme and roll vaccines out into the community programmes. He was pleased that, at last, the vaccination roll-out could start “catching up.”
Dr Crisp said that NDOH would not meet its target for vaccinating the population over the age of 60. There were two reasons for this. First, there would always be a percentage of the population who did not want to be vaccinated, and who chose not to register or receive the vaccine. Realistically, studies suggested that not everybody would register. Second, there was the delay caused by the J&J issue. If NDOH received no vaccines from J&J, it would be able to reach 52% of its target. Now that some J&J would be arriving before the end of the month, NDOH might be able to surpass that. If lucky, it might be able to achieve 60% of its target. That did not mean that NDOH would stop vaccinating older persons, but it would be delayed in its timeline for that group.
Dr Crisp said that NDOH had been “struggling” with the vaccination roll-out because of the supply of vaccine doses. It had not opened vaccination sites simply because it had not had vaccines to supply them with. However, sites in all provinces and in the private sector had been ready for some time. The roll-out would accelerate over the next week, and certainly over the next fortnight. NDOH aimed to more than double its vaccination capability in the first week, and to double it again in the third week.
Mr Van Staden said that the Committee had seen a “huge infrastructure problem” during its oversight visits to clinics and hospitals. Officials in the provinces had said that the departments of infrastructure development were “a problem.” What was NDOH’s relationship with the departments of infrastructure development and of public works? There were issues not only with water supply but also with electricity and other aspects of the infrastructure. Clinics were not in a good state.
Mr Munyai welcomed the “fantastic” and informative presentation. It had covered the issues that had been of concern during the initial outbreak of the COVID-19 pandemic – for example, oxygen supply. He was “very excited” by the comprehensiveness of the report. The report linked to previous reports by NDOH, including Dr Thulare’s presentation earlier in the meeting. He added that, as indicated by NDOH delegates, the resurgence of COVID-19 was not confined to Gauteng. He recommended that future reports from NDOH should cover all the areas that had been covered in that day’s presentations. Together, they gave a comprehensive idea of the situation.
Dr Thembekwayo said that recently COVID-19 had been affecting schools. There were many examples of schools where cases had been reported. How did NDOH plan to include learners in the vaccination process? Moreover, was NDOH able to influence DBE and the NCCC regarding the opening of schools during the third wave?
Dr Crisp replied that, from the start, the plan had been to prioritise health care workers, then older persons. This was because comorbidities were concentrated in the older population, and international evidence showed that both comorbidities and age increased the risk for severe illness, which could overwhelm the hospitals. Beyond that, the plan prioritised various segments of public-facing essential services. This included the security sector – SAPS, correctional services, the South African Defence Force (SADF), and so on – along with educators, and certain industries where people were not able to maintain social distancing because of the nature of their work. Right from the beginning, there had been parallel planning streams for OHS sites in the security sector and for a range of public service functions, especially educators. In this context, the concern was basic education, because the aim was to get children back to school in a safe environment.
Dr Crisp said that while sourcing the short-expiry vaccine that was due to arrive shortly, NDOH had been preparing with DBE for a rapid deployment of vaccines across the basic education sector. This programme covered the whole sector – not just the public sector, and not just educators, but also private sector personnel and school governing body staff. The target population encompassed 499 000 people. However, some had already been vaccinated because they were over 60 or registered as health practitioners – psychologists, for example, were registered with health bodies. A further portion of that population would choose not to be vaccinated. So, in sum, NDOH expected to vaccinate between 405 000 and 410 000 people in the basic education sector, over a period of ten days. The programme would begin on Wednesday, when the vaccines would be distributed and all the accessories – needles and syringes – were in place. NDOH was confident that the plans would be executed quickly.
Dr Crisp added that a parallel process was evolving concurrently in other sectors. During the current Committee meeting, another NDOH team was meeting with SAPS. A lot of work had been done with SADF about vaccinating SADF staff, and NDOH was also running a programme for other public departments with the Department of Public Service and Administration (DPSA). Finally, a number of companies – up to 20 – were almost ready to roll out vaccination programmes in the workplace. He trusted that now that vaccines had been procured, the vaccination roll-out would “pick up very quickly,” especially over the next two weeks as those vaccines arrived.
Deputy Minister Phaahla said that schools had been discussed at the NCCC. NDOH held that education was critical, in the long-term as well as in the short-term. Educators had been prioritised in the vaccination roll-out to ensure that schools could stay open. Because it was the basic education sector, the learners were mostly under the age of 18, so they were at low risk for severe illness. The problem was that the learners interacted with their parents. However, once people over 60 had been vaccinated, NDOH would move on to vaccinate those over 50 and those over 40. Parents would be covered in those stages of the roll-out. Once the parents and the educators were vaccinated, the learners – who were themselves at low risk – could continue to attend school. That was NDOH’s approach, and it did not agree with those who argued that schools should close. The long-term impact of school closures would be very difficult for the country to recover from.
Dr Thembekwayo said that Mr Morewane had mentioned that rural hospitals were covered under the oxygen management plan. Could she receive a list of the specific rural hospitals covered?
Dr Thembekwayo told the Chairperson that Ms Chirwa could not be removed from the Committee’s meetings every time she tried to demand answers to her questions. Was there not some alternative to removing her from the meetings? She was a part of the Committee and had to be accommodated.
Mr Sokatsha thanked NDOH for its helpful presentations. He was pleased to hear from Mr Morewane about NDOH’s plans around oxygen supply, and to hear that NDOH was confident that no province was going to encounter oxygen shortages.
Mr Sokatsha said that he thought NDOH had a very good relationship with DBE. However, he was concerned that compliance with COVID-19 regulations at schools was becoming lax. Initially, he had seen schools implementing stringent measures – for example, people would screen and sanitise learners at the school gates. These measures seemed to have been relaxed, despite the high rate of infection at schools. NDOH should ensure that it strengthened its relationship with DBE to ensure that proper measures were implemented at schools.
Ms Mente asked whether the distribution of oxygen tanks took into consideration the day hospitals in remote areas. Those day hospitals had to refer patients to district hospitals that were 100 kilometres away or more. In remote areas like Eastern Cape and KwaZulu-Natal, it could be over five hours before an ambulance arrived and dropped the patient off at his destination. Patients in those areas did not have their own cars to get to hospitals. There were also problems with oxygen supply at the district hospitals. For example, the high-care facility at All Saints Hospital in Ngcobo, Eastern Cape did not have sufficient oxygen. Patients sat in the hallway waiting to take turns to receive oxygen. How was NDOH considering remote areas in its plans for the distribution of the necessary resources, including equipment and oxygen? Was NDOH considering distance? It should not just identify and capacitate district and provincial hospitals, assuming that everybody had access to those hospitals. People died on their way to hospital.
Mr Morewane replied that NDOH faced a challenge with oxygen in the small, medium-sized, and even large district hospitals, because oxygen was used in line with the packages of care provided at the facility. Few district hospitals had the capability to make use of oxygen. Those that could had made use of repurposed space, and had augmented their capacity in terms of devices and human resources. However, NDOH would have to look into the difficulties faced at All Saints Hospital. In the limited specialist cases that it could take on, All Saints was supported by Nelson Mandela Academic Hospital and by the University of Stellenbosch, especially its family medicine team. If All Saints had problems with oxygen even with this specialist assistance, NDOH would have to look into the matter. He knew that Afrox spent a lot of time and resources supporting facilities in the Eastern Cape – it had even expanded the oxygen supply in certain districts. So Afrox had done a lot of work in the area. NDOH would have to look into it.
Mr Morewane said that NDOH’s contract with Afrox included the smaller oxygen cylinders that were carried in ambulances. Respiratory support devices were also allocated to ambulances. So ambulances could safely transport patients between different facilities. Generally, day hospitals would only temporarily accommodate patients who required oxygen. The oxygen supplied to day hospitals and district hospitals was the kind used for general emergencies, usually in cylinders. NDOH knew that all district hospitals were adequately covered in terms of oxygen cylinders. If there was a challenge in a specific facility, he should be able to look into it and identify the problem.
Ms Mente asked whether the vaccine roll-out considered bedridden people. If a ward councillor or some other representative learned that there were bedridden people at certain addresses, could they indicate this to NDOH and request that NDOH make home visits to vaccinate those people? This was especially relevant for older persons who could not walk or were not mobile – such people even had to send relatives to fetch their social grants on their behalf.
Dr Crisp replied that all provincial departments had visited conjugate settings – old-age homes – to vaccinate all residents, including residents under the age of 60. This had happened during the first two weeks of the roll-out, and continued in some provinces. Some provinces had also conducted outreach to people who were bedridden at home. However, such outreach was not always possible, in which case the provinces tried to make a plan to get those people to a vaccination site.
The Chairperson agreed with Ms Mente that if NDOH deviated from its planned timeline for whatever reason, it should indicate the deviation to the Committee upfront. The Committee should not be given a new timeline as though it had not already received a different timeline. So NDOH should update the Committee in that way, with continual measurement against its initial targets.
The Chairperson said that Dr Thulare’s presentation had mentioned the effective reproduction rate of the virus. What was the effective reproduction rate?
The Chairperson noted Minister Kubayi-Ngubane’s concern about diverting resources and nurses to vaccination sites, and away from the clinics and hospitals that provided antenatal care and HIV and tuberculosis treatment. The Committee would be watching NDOH to ensure that it achieved the requisite balance and did not remove capacity from other important areas.
Mr Morewane returned to the question Mr Van Staden had asked in the earlier discussion session, about unused equipment at Kopanong Hospital. Since the Committee had already raised the issue with the Gauteng MEC, he would not comment until he had verified his information with the Gauteng MEC. However, NDOH was aware of the relevant issue and had already raised it with the Gauteng Department of Health.
The Chairperson told Dr Buthelezi that Mr Van Staden had another question, about the registration of health care workers for vaccination. He had sent the question to Dr Buthelezi’s Whatsapp.
In response to that written question, Dr Buthelezi said that there had been two different systems for registering health care workers for vaccinations. At the beginning of the roll-out, when the Sisonke programme was underway, there had been a registration system for health care workers that had not been stratified by age. However, when vaccination was opened to members of the public over the age of 60, NDOH had found that the original system was being “seriously abused.” People who did not qualify for vaccination were registering and pretending to be health care workers. NDOH had therefore closed that portal and opened a new portal, under Dr Crisp’s guidance, for the registration of health care workers.
Dr Buthelezi also sought to clarify comments made by Ms Chirwa in the earlier discussion session. Ms Chirwa had said that less than 500 000 health care workers had been vaccinated. This was not correct. 480 000 health care workers had been vaccinated through the Sisonke programme, but a similar amount had received the first dose of the Pfizer vaccine. Therefore, close to a million health care workers had been vaccinated. NDOH acknowledged that it should have vaccinated all health care workers by now, but it was continuing to push for the vaccinations of health care workers as a matter of priority. NDOH had been trying to correct the same misunderstanding with the National Education, Health and Allied Workers’ Union (NEHAWU) – the figure of 480 000 that was being cited did not take into account the health care workers who had received their first dose of the Pfizer vaccine.
The Chairperson suggested that when NDOH reported to the Committee in the future, it should record whether it was behind on its targets, so that the missed targets were not skated over. There were sometimes deviations from the NDOH’s plan, often for reasons beyond its control. NDOH should acknowledge and record those deviations upfront, so that the Committee could deal with them.
The Chairperson said that the Committee might invite SAHPRA again, because it had not heard an update from SAHPRA in a while. The Committee needed SAHPRA to explain what it meant for the Sinovac and Sputnik applications to be at an “advanced stage.” China and Russia were “friendly forces,” working with South Africa. Given the vaccine supply issues, it could not be that the Sinovac and Sputnik paperwork was left incomplete.
The Chairperson said that the Committee would consider approaching parliamentary office-bearers to ask to receive a report from the SIU on its Digital Vibes investigation in early July, as soon as the SIU report was complete. Members had also raised the question of whether it was legal to meet with a minister who was on special leave. He would look into that question too.
Ms Mente said that Deputy Minister Phaahla had said that vaccination sites allowed walk-ins. Could Deputy Minister Phaahla assure the Committee that NDOH would send out a standing instruction that sites should not turn away walk-ins who were eligible to be vaccinated? People who had not registered on EVDS were often turned away from the vaccination sites. Could NDOH issue an instruction for sites to accommodate anybody who came in with an ID?
The Chairperson replied that he would let Deputy Minister Phaahla respond, but he thought that everybody should register. Because of challenges faced in South Africa, not all older persons would be able to register. When such persons arrived at vaccination sites, they would be registered and vaccinated. But whenever possible, people should register themselves and help others to register.
Deputy Minister Phaahla said that it would be “reckless” for NDOH to make a general call allowing walk-ins. If people were registered and became “frustrated” with delays, NDOH encouraged people to get in touch with vaccination sites so that they could be scheduled. But NDOH preferred for people to register and await a notification. If the notification was taking too long, they could get in touch with the sites directly, through the management of the sites. If they felt that they had exhausted other routes and did come in to the vaccination sites without an appointment, they should not be turned away. But NDOH preferred for the process to remain “orderly.” In rural provinces where there was limited access to EVDS, NDOH encouraged community leaders – Members of Parliament, community health workers, traditional leaders, and councillors – to organise people and coordinate with the vaccination sites. That way, the sites could agree to accommodate a certain number of people from a certain area on a certain day. That would be orderly and was therefore preferable. In the rare event that someone registered and received no notification, he would be accommodated at the vaccination site if he came to enquire about it. But NDOH did not want to overwhelm the sites, or allow COVID-19 to spread at the sites, by communicating a general message that people should walk into vaccination sites without registering and making an effort to follow the proper process.
Mr Van Staden reminded the Chairperson that the Committee still needed to discuss his earlier suggestion, about writing to the Speaker about summoning Minister Mkhize before the Committee.
The Chairperson said that he had dealt with that. He had said that he would engage with the parliamentary office-bearers.
The meeting was adjourned.