Vaccine roll-out programme & acquisition, with Minister
09 September 2021
In this virtual meeting the Portfolio Committee received an update from the Deputy Minister and Department of Health about the COVID-19 vaccine roll-out programme across the country.
The Department of Health presented the progress of the COVID-19 vaccination roll-out programme. The presentation covered vaccine security, vaccination progress and demand generation. A number of statistics and graphs were presented to this effect. The number of COVID-19 patients in hospitals was highlighted and it was noted that a higher number of non-vaccinated persons were admitted to hospital. A breakdown of the number of vaccines administered per province was outlined. It was noted that a high number of vaccines were administered in Gauteng, however given the population size in the province, it was hoped that this would be higher. It was noted that there was still a higher number of females vaccinated than males. A number of demand generation strategies were outlined, this included increased programme visibility, provision of information and use of local media, amongst others.
Members raised concerns about mandatory vaccinations and government’s stance on the matter, particularly given that companies were said to intend applying a mandatory vaccination policy from the beginning of 2022. Clarity was requested about the number of vaccines spoilt due to inadequate storage/transport. An update was requested about when persons under the age of 18 years would be able to get vaccinated. Clarity was requested about the number of harmful/adverse events reported to the National Department of Health on the vaccines. Members asked for greater clarity about the vaccination targets and how vaccine hesitancy would be addressed.
Clarity was sought about statements that access to public facilities would be limited to unvaccinated persons. There was a request for clarity about the processes followed and officials implicated by the Digital Vibes matter, and why some officials had been suspended and others not. Clarity was requested about the delays in addressing the needs of the women who had endured forced sterilisations.
Opening Remarks by the Deputy Minister
Deputy Minister Dr Sibongiseni Dhlomo gave brief opening remarks and introduced the presentation. He highlighted the number of vaccinations that needed to be reached by the end of year, in line with the target set by the President.
COVID-19 Vaccination Progress Presentation
Dr Nicholas Crisp, Acting Director General, National Department of Health, presented to the Committee. The presentation covered vaccine security, vaccination progress and demand generation. A number of statistics and graphs were presented.
Vaccination status of patients currently in hospital
-Currently in hospital: 11 205
-Vaccinated: 1 956
-Not vaccinated: 9 249
-Percentage vaccinated: 17 percent
-Percentage not vaccinated: 83 percent
-Johnson & Johnson vaccines: 3 103 658
-Pfizer vaccines: 10 961 708
-Total administered: 14 065 366
Vaccines administered per province
Eastern Cape: 910 621
Free State: 362 306
Gauteng: 1 641 452
KwaZulu Natal: 1 227 376
Limpopo: 774 360
Mpumalanga: 377 471
North West: 387 219
Northern Cape: 156 570
Western Cape: 1 021 209
Individuals vaccinated per sex
Females: 57.77 percent of individuals vaccinated
Males: 42.23 percent of individuals vaccinated
Key demand generation strategies
High programme visibility:
-posters in community and retail outlets
Information in people’s hands:
-What to expect in vaccination process
-Where to go, what to do
Use of local media:
-Use of community radio
-Engagement with other local media
Local mobilisation and canvassing:
-Activation of local leadership
-Engagement with NGOs
-Other local networks
The Chairperson noted that with increased vaccination of the population, it would result in decongestion of the hospitals. It was clear from the figures shown that people who were vaccinated, even after receiving only one dose, had a lesser chance of landing up in the Intensive Care Unit (ICU). He noted the importance of the statistics shown and emphasised the importance of communicating this information to the public.
Ms A Gela (ANC) appreciated the updates from the Ministry on the vaccination programme. She asked if it was true that most companies will apply a mandatory vaccination policy, starting from 2022. The President had said that people had a choice and a right to choose to be vaccinated or not. What was government’s official position on mandatory vaccination? She asked how many harmful events had been reported to the National Department of Health about the vaccines. How were the harmful events being resolved or handled by the Department? She asked when persons under 18 years would be vaccinated, like in other countries. She noted that the country had opened up to other age groups. What were the most pressing vaccination challenges experienced by the Department and how were they being addressed? Slide 11 showed that over 10 million people were already vaccinated. There was still a target of 40 million. What was the budget put aside for the vaccination campaign?
Mr T Munyai (ANC) appreciated the interventions being implemented to increase vaccinations, including using local radio stations. The key issue was that the vaccine could not only be championed via the Department of Health and Ministry. All leaders on the ground, including traditional leaders, community leaders and faith-based leaders should mobilise and organise people to get vaccinated and counter the false media propaganda. He congratulated the Department and Ministry on the work they had done. He suggested that leaders in communities needed to encourage people to get vaccinated. Vaccinations would protect people against severe illness, hospitalisation and death. This point had been made on numerous occasions and was based on science. A strong programme was required to reach out to people. The campaign that was being implemented in KwaZulu Natal (KZN), was ‘going to the people.’ The majority of people were unemployed and in abject poverty; it was important that mechanisms be found to reach out to the people so as to meet the target set.
Ms H Ismail (DA) asked what government’s official stance was on mandatory vaccinations. Had there been instances where government had compensated families or individuals that had died or had serious adverse reactions to the vaccine? She asked how many Pfizer vaccines were spoilt due to inadequate storage/transport. Would government publish an official list of medications that were known to have serious adverse reactions with Pfizer, if there was such a list?
Dr S Thembekwayo (EFF) wished the Minister had been present in the meeting to clarify the contradictory statements. She suggested that statements were made by the Minister that government was considering limiting access to public facilities to people who had not been vaccinated. The business community was being allowed to do similar. She had wanted a response from the Minister if he had said that and why he had said that. The Minister was meddling with things that would make him very ‘unpopular’ with South Africans. It was a contradictory statement to what was said by the President. She requested clarity on that.
Dr Thembekwayo asked questions on behalf of Ms N Chirwa (EFF). An update was requested on the revised programme to alleviate vaccine hesitancy, following recommendations by the Committee in previous meetings. Would the country reach its target of vaccinating 67 percent of the population by December 2021? Given that the Director General (DG) Dr Sandile Buthelezi was on suspension and the former Minister Dr Zweli Mkhize had resigned due to involvement in the Digital Vibes Matter, what was the reason Dr Anban Pillay was still around? Was the Minister and Deputy Minister aware of any report and/or investigations involving Dr Anban Pillay? What was the principle applied on DG Dr Sandile Buthelezi’s suspension, that was not applied across the board against officials involved?
The issue of the forced sterilisation of seven women and the request to Steve Biko Academic Hospital to intervene was brought up. In the past few days the Economic Freedom Fighters shared a list with the Minister, to date there had not been a commitment to assist the women with medical interventions. What was the Department waiting for? Give these women their right to quality health. Why had there not been an attempt to retain commitment to provide medical healthcare for all of them, following the first workshop with the Ministerial Committee earlier in the year?
Mr M Sokatsha (ANC) asked what the progress was on the vaccination targets set by the Department. He appreciated the work being done by the Department and Ministry to mobilise people to be vaccinated. He had seen the campaign in Gauteng and North West, both were very good programmes. He asked if the Department would be visiting rural areas. He was concerned about rural people in the villages who could not go to the centres where the vaccination sites were located. He asked that the programme be extended to the villages.
The Chairperson noted the dip in the number of vaccinations over the weekends. He acknowledged the discrepancy between provinces of the number of vaccines administered per 100 000 people. He noted the points about demand generation and addressing access etc. He asked how the issue of vaccine hesitancy would be addressed. He asked for clarity about the vaccine population targets and if there had been any changes to the percentage targets to reach herd immunity.
Deputy Minister Dhlomo thanked the Chairperson for picking up on an important point, being that even with one vaccine, one was approximately 80 percent protected. One might still be admitted to hospital but the chances of landing up in the ICU and dying were much lower. The report on the number of people who went into the ICU, vaccinated or not, and the severity of illness, would be valuable.
The President had announced that mandatory vaccinations were not being considered at this time. He was aware that there was pressure for medical students to be vaccinated, reasons were provided, such as students losing out on time, working with patients and going to wards. Medical students were similar to healthcare workers. There were certain private companies that did not want to lose productivity and wanted all their workers to be vaccinated. The government had not made any pronouncement on mandatory vaccinations. However, government was not able to stop anybody who wished to make it mandatory (i.e companies).
There was a committee that was working on adverse events that continued to advise and guide and give detailed reports. The onus was on the general population, who had been vaccinated, to report any adverse effects experienced. There had not been any indication that the country would be vaccinating South Africans under 18 years. The vaccines that were registered in South Africa were for persons 18 years old and above. There were approximately 39 million people above the age of 18 years. The country was working on vaccinating 70 percent of the population who were over the age of 18 years.
The local government elections would not impact negatively on the vaccine programme; those campaigns needed to take place in parallel to the vaccine programme. There was no strong vaccine hesitancy in the country. Many people were postponing when they would get it. There were plans to improve the vaccine hesitancy/reluctancy.
He responded to the question about compensation of people with serious adverse events. This had not taken place, as there had been no report of a case where the vaccine had caused serious adverse events. He was not aware of the statement made by the Minister, as suggested by Dr Thembekwayo. That issue would be communicated and clarified with the Minister. He reiterated that it was hoped that the country would reach its target by December 2021.
He responded to the question about the Digital Vibes matter and suspension of officials. The investigation in the Department and the report about officials was a ‘work in progress,’ according to the information he had.
He responded to the question raised on the forced sterilisations. Two days before, the Ministry had been briefed by the Department, the report on the findings of the forced sterilisations was ready. The Minister had started a committee that was independent of the Department and was led by a gynaecologist. Once the Ministry received that report it would be shared with the Committee.
He was encouraged by the number of vaccinations taking place per day in Gauteng. When the Ministry spoke to the Member of the Executive Council (MEC) in Gauteng, she had said that she was really pushing herself and the Department to reach 90 000 vaccines per day. If the leaders in other provinces could be motivated to do a bit more than what was given as a target, it would be beneficial. There was a report tabled by the National Coronavirus Command Council (NCCC), Gauteng had done well but it had a large population and should do better than other provinces. Certain parts of Gauteng were doing better than others.
He noted that there had been issues about identification documents (IDs) in accessing vaccinations. In the case of lost IDs, one could still put one’s ID number into the system and be vaccinated (even if the replacement had not been issued yet). Solutions needed to be established for people who did not have IDs, so that they could access the vaccine. The vaccination system was such that it was linked to the ID registration.
Dr Crisp stated that there was a process called Adverse Events Following Immunisation (AEFI). It was a global programme that had been running in South Africa for more than 15 years reporting on child vaccines. That same process was used globally for the new COVID-19 vaccines. It was a reporting structure. Any adverse events identified by a practitioner or lay person could be reported via a cellphone or email to either the National Institute of Communicable Diseases (NICD), the Department or Health or the South African Health Products Regulatory Authority (SAHPRA). Adverse events could be mild but still adverse. The harm might be temporary, transitional, serious or long-term. The worst and most serious would be death. This programme had teams of professionals that were trained in the examination and investigation of adverse events in every province. There was a national committee appointed by the Minister called the National Immunisation Safety Expert Committee (NISEC). NISEC had a standard process that was followed, a WHO global process where evaluation was done of all adverse events to determine if they were caused by the vaccine. From that system, the Country reported into the global collective of information.
South Africa’s reporting was presented two or three weeks before during one of the Minister’s Friday press briefings, which was followed by a press briefing by SAHPRA. SAHPRA had a statutory mandate to report on pharmacovigilance and report on any drug, product or biological which might cause harm for any reason. That website was in the public domain. It was a ‘mini-website.’ If one went to the SAHPRA website, the tables of all reported adverse events were listed, including deaths. After vaccination, more than 60 deaths had been reported – more than half of those had been investigated and the investigations had been concluded. None of the deaths investigated had been found to be causally linked to the vaccine. It was quite a rigorous process. If it was felt that cases were not being adequately dealt with, this could be reported to the authorities and followed up. Should a harmful event, transitory or permanent, be caused by a vaccine, there was a programme called the No Fault Compensation Fund and Scheme that could be utilised. So far there had been no adverse events that had got that far in the process. Should there be a case, it would go through to the No Fault Compensation Adjudication and the various panels associated with that. An outcome would be given and an award could be made. If the award got turned down, there would also be an appeal process.
He noted that it was mentioned by Ms Gela that other countries were vaccinating under 18 years. That was true. The countries that were vaccinating under 18 years had reached a far higher percentage of vaccination coverage than South Africa; those countries were months ahead of South Africa with their vaccination programme. He had no doubt that at some point in the future, there would be a vaccination programme that would be able to roll-out to minors in South Africa. In the countries that were vaccinating under 18 year olds, it was persons between the ages of 12 and 18 years of age. There were no vaccines for use for persons under the age of 12 years anywhere in the world currently. There were research programmes taking place to look at the efficacy and safety of vaccines between the ages of two and 12 years.
The most pressing challenge at present was to find and convince people that vaccinations were good them. He emphasized the value of providing information about the reduced severity and lesser risk of hospital admittance, due to COVID-19, following vaccination. The challenge was to get vaccines to the people and people to vaccines.
He responded to the questions about spoilt vaccines. In the normal course of any vaccination programme globally, there was planned wastage. Planned wastage included where 5 or 6 doses were contained in a vial and a vial was opened and only three vaccines were given and some needed to be thrown away, when there were no remaining people to be vaccinated on a given day. That was all part of planned wastage. There were instances where the cold chain was compromised and one could not prove that the vaccine had been refrigerated the whole way before it got to people. In such cases vaccines had to be thrown away. He was so far aware of two instances and collectively those doses were under 10 thousand doses. That was not to say there were no other smaller amounts. Some homework would be undertaken to check the number of vaccines that were destroyed due to failure of the cold chain.
He responded to the question about medications being contra-indicated to Pfizer. Information was collected globally about any contra-indications. Contra-indications might be to another medication or where someone was immune-compromised due to cancer therapy etc. When that information became available the Department published it. This was done by the technical experts in the Advisory Committee that were appointed by the Minister. The Advisory Committee would advise the Minister of such information and that would then be published in either circulars to staff or on the Department or SAHPRA’s website.
He was concerned that Dr Thembekwayo thought that the Minister had said that he wanted to ‘limit access to public facilities.’ The Minister had in fact very pointedly told him that access to public facilities would never be limited. Should there be, through statutory, legal or court processes limitations to other facilities, it would be highly inappropriate for government to limit access to public facilities. All he could say was that this was the instruction he had from the Minister when he had discussed the use of vaccine cards to limit access to places.
Many people had raised the issue of vaccine hesitancy with the Department. There seemed to be two different kinds of hesitancy, the one was about ‘laziness’ or reluctance. That group knew they needed to go, knew it was good for them but just had not gone and got it. Then there were people that were hesitant, due to engaging with negative information, being put off because they did not like needles or for whatever reason they were hesitant to go for a vaccination. There were about 6 percent that were absolutely against the vaccine. The challenge was to get the people who were not inspired to go for vaccination and provide accurate information to those that were hesitant so that they could make informed decisions before they got sick and ended up in hospital.
He responded to the question about the different targets. The first target was to get 70 percent of people over the age of 50 vaccinated. In fact, the ideal would be to have everyone over the age of 50 vaccinated, because they were the most vulnerable people in the community who were at risk of ending up in an ICU and dying. This year the target for the vaccination programme, by the time it came to December 2021, the Department of Health would like to concentrate on adults, which was the 40 million referred to. For 2021, the Department was trying to get to 70 percent of the adult population. That was not the last target. The Department would still like to get to the entire population, including children. If one had already excluded 20 million people from the target programme, one could not hope to reach them. One would never reach 100 percent of people, because there were people that were more than hesitant and would refuse to be vaccinated. Any country that vaccinated more than 65 percent of the population had done extremely well. Some of those countries had done it in more ‘forceful’ ways than that of South Africa. The Department would prefer to encourage people and provide information. The Department would like to vaccinate 70 percent of the adult population with at least one dose before Christmas. That would require the country to do in excess of 260 000 vaccinations per day till the end of the year. There was capacity across both the private and public sectors to reach 300 000 vaccinations per day, which was the target that the President had set the Department. He believed that if the country pulled together as a nation, which would be achievable.
Dr Barry Kistnasamy, Coordinator: Occupational Health & Safety (OHS) COVID-19 Workstream, National Department of Health, responded to the questions about mandatory vaccinations. Government had not mandated vaccination. The whole issue around mandatory vaccinations in the workplace was covered under the Occupational Health and Safety Act, which was covered by the Department of Employment and Labour. The Minister of Employment and Labour issued a direction notice at the end of May 2021 on a number of workplace measures on prevention and intervention on the COVID-19 response for workers. Annexure C of the direction could be made available to the Committee; it covered the issue of workplace vaccinations. It was a very regimented process. This was discussed at the National Economic Development and Labour Council (NEDLAC), where government, trade unions, business and communities were present. Based on the NEDLAC process the Minister’s office in the Department of Employment and Labour had conducted a strict process of risk profiling in the workplace to ensure which jobs would require mandatory vaccination, and thereafter consulting with the workers etc. This was specifically about transmission risk in the workplace, to consumers, clients, to the individual or other workers. There was a procedure involved about what companies needed to do, which included counselling with workers, providing support and an enabling environment. It was an employment and labour direction, under the Department of Employment of Labour and Occupation Health and Safety Act.
Deputy Minister Dhlomo noted that the following day this update would be broadcast on most television and radio stations. There would be a presentation made specifically by the MEC for Health in the North West province. The presentation would focus, among other things on what challenges North West had. There would be a short testimony by a senior political journalist, who had agreed to share her story. The login details would be forwarded to the Committee’s Secretary.
The Chairperson thanked the Deputy Minister and Department for the update on the vaccination roll-out and acquisitions. He encouraged the people of South Africa to go out and get vaccinated. The question raised by the Committee was specifically on hesitancy, and quite a bit of time had been spent trying to address the hesitancy issue. He noted the lesser risk of severe illness and hospitalisation as a result of being vaccinated and encouraged South Africans, in light of this, to get vaccinated. He noted the presentations that would take place to the Committee the following day on the National Health Insurance (NHI) Bill.
The meeting was adjourned.