Notifiable Medical Conditions Amended Regulations: Minister's briefing

Meeting report

The Chairperson welcomed Health Minister, Zweli Mkhize, noting that the meeting was scheduled at short notice and the Portfolio Committee had been informed about the meeting earlier that day. He thanked Members for agreeing to meet and asked the Minister who was accompanying him.

The Minister responded that his delegation included Deputy Minister, Dr Joe Phaahla, DDG: Communicable and Non-Communicable Diseases, Prevention, Treatment and Rehabilitation: Dr Yogan Pillay, and Minister's Chief of Staff, Ms Sibusisiwe Ngubane. An apology was made on behalf of the Director-General who was in another meeting.

Introduction by Minister
The Minister expressed gratitude on behalf of DoH that Members joined the meeting at short notice. A consultative process had begun. This included a discussion at the National Health Council the previous day, following a consideration that an update was required to National Health Act regulations for purposes of assisting DoH with managing the COVID-19 pandemic going forward. DoH shared the conviction that when the regulations were ready, at some point they would be one of DoH’s major “ammunition” to deal with the pandemic. This necessitated DoH to share their thinking with the Committee and consult other departments before tabling the matter in Cabinet. Out of this process, DoH would gain an understanding on at which point they should utilise the National Health Act regulations. This matter had to go through the National Health Council. All provincial leaders had been consulted on the matter, as well as various departments and the Office of the Chief State Law Advisor, who had initially stated that they were comfortable with the proposed amendments, pending consultation with the Portfolio Committee before laying out the way forward. DoH stated that the nature of COVID-19 overwhelmed South Africa and the world. This necessitated a huge, immediate response among various departments and the President. Ordinarily, a manageable epidemic would have relied on the National Health Act (NHA) to deal with various provisions to contain the infection. DoH believed that at a certain point, it would be more appropriate to use the NHA regulations for notifiable medical conditions, which would allow the executive certain activities and restrictions in an effort to contain the situation. The Minister confirmed that all had received the documentation.

National Health Act Regulations: briefing on proposed amendments
Ms Sibusisiwe Ngubane, Minister's Chief of Staff, proposed amendments to the current regulations on behalf of DoH. The NHA Regulations on Surveillance and Control of Notifiable Medical Conditions were gazetted in December 2017). With these regulations, DoH had ascertained that COVID-19 fell within the criteria of a Notifiable Medical Condition as mentioned in the schedule in the NHA.

Regulation 12 Surveillance and Control of Notifiable Medical Conditions
The existing Regulation 12 described the process to declare a Notifiable Medical Condition, as had been the case with COVID-19. The Minister was required to take into account that this medical condition posed a public health risk to a population of a particular community/district/ municipality/province/country or have the potential for regional and international spread – as was the case with COVID-19. Regulation 12 emphasised a medical condition which might require immediate, appropriate and specific action to be taken by the National Department, one or more provincial Departments or one or more municipalities. In these regulations, there was an emphasis on the urgency of public health risk which required immediate and specific action. It was interesting to note that, as a parallel to Regulation 12, Regulation 15 stated that if an individual was unwilling to be voluntarily isolated or quarantined, this could be done mandatorily, including detention until a court order was obtained. Essentially, the critical element was that it enabled DoH to implement measures to contain the spread of this virus.

Previously repealed regulations – matter of oversight
Ms Ngubane said it was necessary to explain why the amendments were being proposed. The regulations prior to 2017 were last updated in 1987. Those 1987 repealed regulations emphasised putting measures in place when there was a public health risk. It was noted with interest that within the repealed regulations, Regulation 2 stipulated the prevention, restriction and control over communicable diseases – which was the same concept as a notifiable medical condition. With this, Regulation 12(c) stated that the Minister should take immediate action. Here, it went further to state that there could be an imposition of restrictions, which included the closure of teaching institutions, places of entertainment, places of public reception, recreation or amusement as per Regulation 2(b) of the same document. The document went on to state that attendance could be regulated, restricted or prohibited at any meeting, reception or other public gathering – as well as quarantine.

The 1987 repealed regulations went into the kind of detail that could be imposed as part of the measures to contain the spread of a notifiable medical condition. When DoH looked into why these provisions from the repealed 1987 regulations did not appear in the 2017 updated regulations, it was apparent to DoH that this was a “pure oversight”. In fact, one sub regulation attempted to summarise all the repealed regulations. NCID being the responsible institution looking into communicable diseases had indicated that the repealed regulations were part of normal procedure – proving that it was a matter of oversight that they did not appear in the 2017 regulations. There was thus a need to ensure those measures could be implemented to control the spread of a public health risk.

Proposed amendments
Given this need (including possible oversight), DoH proposed amendments to explore the options of putting restrictions in place. Five key changes were proposed:
• The definition of gatherings
• The inclusion of the definition of point of entry, as taken directly from the International Health Regulations of the World Health Organization (WHO)
• The introduction of new regulations for intergovernmental co-operation, consultation co-ordination at provincial, national and international levels
• The Minister may publish further regulations with notice to prevent the notifiable medical conditions, with regulation in the government gazette.
• The Minister may put measures in place (by regulation in government gazette) to impose necessary restrictions relating to notifiable medical conditions.

DoH acknowledged its understanding of the critical fact that when considering regulations which would be imposed, there may be implications for the constitutional rights of individuals. Therefore, it was key to ensure that these regulations were published and considered by the public – who were sensitised to the restrictions being a response to the COVID-19 pandemic. Outside of the actual notifiable medical condition regulations, DoH asserted that further restrictions which were being considered, needed to be detailed. This was not just a matter of restrictions, but also the health protocols that could be determined as critical, as part of the response to the virus. For example, as was the case with COVID-19, the washing of hands, wearing of masks and social distance had played a role, which DoH wanted to remain. All citizens needed to be aware that, as part of mitigating risk, they needed to adhere to these regulations. Further, the intergovernmental principles of co-operation, consultation, co-ordination echoed the impact of COVID-19 on all sectors and departments, bringing about a need for co-ordination at all levels. The proposed regulations, therefore, needed to be done in consultation with the Minister whose portfolio was directly impacted.

The repealed amendments had included the complete or partial closing of any public place, as well as the prohibition regulating the inter-district or inter-provincial movement of persons, movement from points of entry and regulations requiring individuals to remain indoors in certain hours, as well as the closure of educational institutions. This clearly comes from the repealed regulations, but was silently couched under the current regulations (2017) where it says that the Minister must take immediate action to implement measures responding to the public health risk. DoH’s view was that this did not only respond to COVID-19, but that, in future if there was another condition which was designated a notifiable medical condition, there would still need to be provisions dealing with these matters. These provisions needed to include the adherence to specific health protocols and restrictions which might need to be enforced to ensure containment of such a notifiable medical condition. Following consultation with the state law advisors, internal staff and provinces – a particular point was raised about consultation between departments. This allowed for a situation where, if a department or sector was not able to impose certain restrictions, but they deemed them critical, these restrictions formed containment measures which could be enforced with legal instruments.

Discussion
The Chairperson appreciated the presentation, noting that normally DoH did not approach the Portfolio Committee about regulations. The Committee would typically come in at the law-making stage, though the regulations were usually the Department's responsibility. While the consultation from DoH was appreciated, the Chairperson asked for insight on DoH’s thinking on this. In addition, since DoH was still consulting various groups, clarity was sought on how much of a public document these proposed amendments were and how far members should circulate them further.

Mr P Van Staden (FF+) said it seemed to him and likely many other South Africans, that the proposed amendments were no different to the regulations under the Disaster Management Act and gave the Minister of Health additional power to enforce a lockdown without the Disaster Management Act and sections of the Constitution. Mr van Staden quoted a top WHO official that had reportedly made a statement on lockdowns during the previous weekend. This official, Dr David Nabarro, had told countries to stop with lockdowns and restrictions under COVID-19. Dr Nabarro had said that WHO members did not agree with these measures to control COVID-19. According to them, lockdowns and restrictions increase poverty and malnutrition, which makes it a horrible catastrophe. As a result, people are getting poorer. Research by the University of Edinburgh had also taken the stance that lockdowns had caused more COVID-19 deaths than COVID-19 itself.

Mr van Staden said herd immunity needed to be developed and, with a constant lockdown, this immunity could never happen. Currently, South Africa was at a 90% recovery rate. He shared his opinion which he believed was shared by many South Africans, that lockdowns had no use anymore, but just to destroy South Africa completely. There was a need for smarter management of the COVID-19 pandemic (including wearing face masks, social distancing, sanitising hands) as well as improved testing of communities. If this had been done from the onset of COVID-19 in South Africa, there would not have had to be a harsh lockdown for several months. The virus must be hunted down, instead of trying to keep everyone away from it. What had worked for other countries was not necessarily going to work for South Africa. The damage was clear in the lives of the elderly, children, and the South African economy. To go back to lockdown, would destroy South Africa completely and will lead to civil unrest across all communities in the county. Civil society has lost confidence in the government already under Level Four Lockdown. It was important to listen to the scientists, medical experts, and other experts such as not to be scared of the Coronavirus and to chase people into their homes again for several months at a time – South Africans could simply not afford this. The proposed amendments of the NHA regulations was just another way to not use the Disaster Management Act, giving power to the Health Minister and DoH which would cause a catastrophe that Members would regret.

Mr van Staden ended by expressing his sincerity, trusting that his input would be earnestly considered by the Chairperson, and his opinion was shared with the good will of South Africans in mind.

Dr K Jacobs (ANC) thanked DoH and the Coronavirus Command Council for the good work they had done saving South Africa from a catastrophe. As a medically trained person and a scientist, Dr Jacobs responded to Mr van Staden that he was not sure where the member got his science from, and members needed to be very careful of what they said and quoted on national television. It was important to assess what was being articulated by scientists within South Africa.

Dr Jacobs reminded the Committee that these regulations had existed in the first place. "Notifiable" medical diseases had the intention to curb the spread of a pathogen or harmful agent that might cause harm to communities, people and South Africans. The Department had the realisation that there was something amiss with Regulation 12 and this needed to be corrected. Members should be thankful that this was picked up and that the Minister felt that he should raise it with the Portfolio Committee. Dr Jacobs expressed his gratitude, on behalf of the African National Congress (ANC) in the meeting, that this was the opportunity to engage and explore the regulations that were being put in place. The wording - in particular “necessary and reasonable measures” - indicated that certain restrictions which were initially within the Regulations of the Act, which stemmed from 1977 and was updated in 1987, 2003 and 2017. Reinserting the proposed paragraphs was essential to the county and its people. It was possible that any notifiable medical condition could occur in future, and it was thus necessary to prepare for such an event. The world was not prepared for COVID-19. Since then, the understanding arose that it was important to be prepared for any necessary interventions that needed to be taken. As such, he supported the measures.

Ms S Grwarube (DA) had a number of clarity-seeking questions. While she was aware that the passing of regulations attached to legislation was at the discretion of the Minister, while the bulk of the legislation itself was the duty and role of Parliament – she asked why the urgency on the matter. The meeting had been deemed very urgent – an explanation on this was requested from the Minister, such that it could frame why members were called to an extraordinary meeting to consider amendments just two days before the Disaster Management Act was due to expire. Did the work need to be done that evening, was it something urgent and why the urgency?

Ms Grwarube appreciated the detail provided by Ms Ngubane, particularly on the history of notifiable medical conditions, and why regulations pertaining to this were critical. She agreed that the NHA regulations as they stood did not define issues well, and did not give clarity in some instances. Despite this, she raised concerns about the proposed amendments. Regulation 12(2) was mentioned – stating how the Minister could declare a medical condition as notifiable in his or her opinion, provided it adhered to the three requirements. The Minister was also permitted, according to this regulation, to publish a national gazette to impose certain restrictions to curb the spread. There were many unintended consequences during the previous seven months of COVID-19 lockdown. There were inconsistencies in the applications of regulations across departments even though COGTA was mostly in charge of regulations. The proposals on co-ordination and co-operation between departments were thus welcomed. However, she felt it amiss if it was simply a throwaway comment to say that these regulations do not have far reaching consequences which can impact on the civil liberties of citizens, as the presenter had done. This was not to say that Minister may not (with the urgency needed) declare a notifiable medical condition that required urgent action. However, it was not possible to have legislation that allowed any given Member of the Executive to have unfettered powers, to simply, by the power of a government gazette essentially implement wide-ranging prohibitions.

Ms Grwarube prompted the Minister to re-think this because the constitutionality of the Disaster Management Act had been raised previously, particularly since citizens could not make input as decisions were made with the urgency required. To put these urgent amendments, however, into an existing piece of legislation, almost as a normal course of action was something she deemed unwise. It was considered that perhaps this was a matter of drafting and that, the regulation as it stood might have been drafted too broadly. This was particularly Regulation 12 where there was seemingly no other input besides that of the Minister on the prohibitions to be declared. She was not opposed to tightening up the regulations on this. She agreed that COVID-19 was likely not the only global health crisis that would be faced and so these matters needed to be tightened, while being careful about how laws were drafted, especially where en masse power were given to Members of the Executive, with no powers for oversight roles. Laws were not made by Members of the Executive, but by rationality and this had to be considered carefully.

Ms N Chirwa (EFF) felt it important to note the lack of political will in addressing similar matters more efficiently from the get go. This rendered the meeting a disingenuous and futile effort, in response to handling the pandemic, which was procedural. The process was disingenuous because as she had made numerous recommendations to the Minister, which he had either responded to too late, or not at all. For instance, after making the proposal on the regional-based information centres, DoH responded three months after this. There were countries at large and African countries that were working towards prioritising prevention – including Rwanda, Australia, Barbados, Burkina Faso, Fiji, Cambodia and others. As such, she found DoH’s handling and response to COVID-19 disingenuous.

Ms Chirwa brought up that a request had been made for race demographics for COVID-19 infections because there was an incomplete picture of what COVID-19 looked like in South Africa. KwaZulu Natal, for example, in its provincial report to the Portfolio Committee had included race demographics. This was important as officials could not declare that they prioritised prevention and primary healthcare but reserve such information. It was a deep lie that this information was not collected because, by virtue of going to a hospital, demographics were collected. At the time of this meeting, these demographics were not made available to the public. Which meant it was uncertain what exactly COVID-19 looked like for most South Africans, and who was impacted the most – knowing the inequality, as well as the wage gap between gender, race and class and how it impacted the COVID-19 response. A parallel was drawn with the HIV/AIDS epidemic where at the time civil society organisations had to organise amongst themselves. Such information, which worked in favour of DoH was another red flag that required attention.

Ms Chirwa continued by describing the poor co-ordination in leading provinces, particularly of human resources and finances. There were severe concerns about how the pandemic was handled within Gauteng and the Eastern Cape especially. A recommendation had been given to the Minister to place Eastern Cape under management, however the response from DoH was negative. Since these recommendations made to DoH had been taken lightly, they watched the predicted outcomes unfold. As such, it was disingenuous of DoH to call a meeting, when recommendations had been made previously. Had DoH intended to put proper intervention strategies in place from the get go, South Africa would not be where it was, expecting a second wave and losing as many as the country had.

Ms Chirwa noted a previous point by Ms Grwarube was made that DoH was a “law unto themselves” whereby recommendations were not taken seriously until tipping point. There were other instances she could recall although she would not raise them in the meeting. If, indeed, prevention was a priority to DoH’s COVID-19 response, it was urged that the demographics including race, gender and even sexual orientation should have been of primary consideration and given to the public, as it was key to prevention strategies. For example, one could not implement prevention strategies in the same way for OR Tambo Airport as for a taxi rank. Currently, there was no strategy for contact tracing in a taxi. This was raised even before the first case of COVID-19 was reported – how contact tracing and prevention would be co-ordinated in townships and rural areas? DoH had not yet responded to such nuances. This was particularly concerning because South Africa was a country with one of the highest rates of inequality and unemployment. There was little political will enacted by the Minster and DoH, even during corruption and nepotism allegations, indicating a failure to address the opportunity of primary health care and prevention. The meeting was thus “regressive” as the Minister was not seeking to hear the thoughts of Members, but was simply following procedure. Despite this, Members would give recommendations even though the Minister would go back and do as he pleased.

Mr A Shaik Emam (NFP) articulated his interpretation and understanding of what was happening in the meeting – that the discussion was in anticipation of doing away with the national state of disaster. There was an intention to give more powers to the Minister, so that should the need arise at district or local level, he might be able to enforce strict regulations in terms of this. There had been a previous commitment that the phasing in of a lockdown would be done through the district model, though this was not followed and that was of concern to him. This was due to happen based on hotspots and infections rates, but it did not happen this way. He was unconvinced that in practice, the proposed amendments would work especially because inter-provincial and inter-district challenges might have hindered this. The previous regulations did not give enough power to the Minister, according to him, to be able to deal with these problems, should they arise. As such, he did not have a problem with the proposed amendments. What he did have problems with was how these amendments would be effected, given the low level of compliance.

Mr Shaik Emam said the other important matter was that the National Coronavirus Command Council took decisions without accepting the recommendations made by other spheres and structures of government. For this reason, many regulations were ineffective, as witnessed by low compliance levels. Compliance had been low with no measures in place to deal with this. The danger persisted up to Level 1, which made the regulations “useless” as there was no compliance.

There was another problem as there was no oversight mechanisms for Members of Parliament to hold the National Coronavirus Command Council to account, as it seemed to become an authority on its own. He supported the move if it entailed that the National State of Disaster would be done away with and, should it be necessary, the Health Minister would be able to impose strict regulations where there was risk of hotspots or high infection rates. An example of ineffective regulations was school pupils were instructed by government to travel in a full taxi, but to socially distance in schools. This was the same with aeroplanes. His fear was that the Minister might be replaced by a new Minister, yet the amended regulations would still stand with so much power vested in one person. By virtue of no engagement with other authorities, including Members of Parliament, was it not dangerous? However, if the intention was to move away from the National State of Disaster and deal with it if there was a pandemic or particular hotspot, then he felt they were moving in the right direction.

Dr P Dyantyi (ANC) thanked the Minister and DoH for the sterling job during trying times. It was clear that the loss of the repealed regulations was an oversight. An analysis of disaster regulations showed that most issues supposed to be dealt with by DoH were dealt with by other departments. What was particularly pleasing about the presentation was the emphasis on collaboration with other affected departments. She commended DoH on its sterling job, adding that South Africa would not be at a 90% recovery rate if South Africa had not done what it did. She supported the amendments to the regulations.

Ms A Gela (ANC) thanked the Minister for calling the Portfolio Committee for consultation, which showed that the Minister was indeed very transparent. The good work DoH was doing for the people of South Africa was appreciated. COVID-19 had taught Members much, particularly the gaps which could be traced back even to the Apartheid-era where healthcare facilities were not the same for all. As the ruling party, an effort had been made to correct the mistakes of the past, which would include ensuring all South Africans received the same standard of healthcare. The Minister had been appointed only during 2017, and as such he was acknowledging the gaps in the regulations, which was appreciated, along with the good work being done. Though others did not see the positive work and outcomes, such as with opposition parties like the EFF – the Minister had stood firm to ensure that mistakes were corrected and gaps were addressed. As such, Ms Gela expressed her firm support for the Minister and his department.

Ms M Sukers (ACDP) was appalled that Members were listening to the proposals which she deemed undermining of constitutional democracy. She joined her two colleagues in saying that the meeting was a “tick box exercise” which undermined the oversight function that, in the previous six months, had been lacking in Parliament. Ms Sukers stressed that there was “no way” that Members could support the proposal. The government had lost “all credibility and trust” with the people of South Africa. The concern that the restrictions would be met by resistance from a large portion of South African people was echoed. South Africa had a 90% recovery rate not because of the government, but because of the men and women working under difficult circumstances in hospitals. There were doctors and nurses working at the forefront of the pandemic. People had died, not just of COVID-19 but because of other diseases. Many elderly people died alone, with family unable to visit them in hospitals. She had witnessed this within her constituency and within her family. The South African nation had gone through six months of difficulty and this could not be undermined. Recovery rates were not because of restrictions or regulations, as evidenced in communities where no regulations were adhered to.

Ms Sukers, along with her party, was very concerned about the restrictions proposed because they extended an abnormal situation, giving the Minster power to exercise authority beyond what is stipulated in the Constitution. A National State of Disaster was an extraordinary event which warranted extraordinary powers circumscribed by the relevant Act and which had a time limit. The powers contemplated in these regulations were in fact emergency powers. Without these powers being of limited duration, it would create an indefinite state of emergency at the discretion of the Minister. It was further challenged that the documents and notice of the meeting had been given in the afternoon, with the expectation that support was to be given by Members in the evening. Rather, the matter needed to be debated by the full house of Parliament. Members were effectively sustaining and undermining the abnormality by entertaining the proposal. Essentially, people were being asked to give up their civil liberties to a government that had not performed at all. There had been corruption at the highest level, for example, which broke the trust of South Africans. As such, she requested the Chairperson take the matter to be debated by the full house of Parliament. Members could not be expected to agree with restrictions in the name of COVID-19, especially if there were many pandemics being faced, including HIV/AIDS and the pandemic of violence against women and children. Medical conditions were not defined beyond COVID-19. She found the proposal unacceptable, including the manner in which the proposal was done.

Ms E Wilson (DA) articulated that it had become clear that the Minister intended to use the NHA to circumvent the Disaster Management Act. This in itself raised concerns. The Minister was a member of the Cabinet, which mean that he understood where South Africa was in terms of the Disaster Management Act, which was to come to an end. The first of her concerns was that there were no legal opinion on the matter, which was already lacking at proposal level. Executive powers were particularly “dicey” at the best of times. There needed to be some kind of participation by all spheres of government, as South Africa was a democracy. The matter thus needed to be taken for debate in the House, as civil liberties could not be infringed on. From the onset of COVID-19 in South Africa and the world, it had been clear that the virus was not going to go away quickly. With the support of South Africans, the situation of dealing with the pandemic was improved – not the effort of the Minister or DoH.

Ms Wilson was concerned that if the matter was of importance, it was only brought up two days before the National State of Disaster was due to expire. Why was this occurring as an emergency meeting, if the lockdown was already six months down the line and there was time for DoH to prepare and plan ahead. The was very concerning. She had a severe problem with the executive being given so much power. She speculated that the proposal was part of a “face saving exercise”, especially because provincial departments of health were in total disarray as evidenced in provinces such the Eastern Cape where patients were treated in garages. This indicated that DoH was shambolic, unequipped, understaffed and short of everything needed for a proper healthcare facility, yet the Minister was requesting support from Members to give further power in a situation that was not going to help anyway. There was added concern because the matter seemed to be rushed through. She could not see Members supporting the proposal.

Mr T Munyai (ANC) commented on behalf of the ANC as the responsible governing party – adding that they truly considered the proposal from the Minister would be helpful to the country and its people. As such, he supported the proposal 100%, so that it could be enacted as a matter of urgency. One could not tell when the unprecedented novel COVID-19 would re-emerge. It was in fact better if the approach was handled by DoH as opposed to any other department. When the material conditions of the country where assessed, it was clear that the proposed amendments should be adopted for future similar situations, as detailed in the proposal. Mr Munyai urged the Members to approve the proposal, as it would help the country. It was important to be preventative instead of running amuck when disaster hit. He fully supported the proposal.

The Chairperson invited the Minister to respond. He had been checking with the legal team, as normally the Portfolio Committee was not consulted on regulations, and prompted the Minister to comment on this.

Minister's response
Minister Zweli Mkhize thanked Members for their comments. The intention of the meeting was to do a consultation to ascertain Members' view. It was true that the National Disaster Act was in place, and was due to expire a few days after the meeting, though it had been extended every month – this was out of the control of DoH. This was a matter which was considered by various Members of the Cabinet and the Coronavirus Command Council about what would be best for the country. The matter presented was being discussed through various avenues, because DoH felt the regulations had actually existed, with most of them based on international health regulations which pertained to the containment of notifiable medical conditions. Generally, dealing with highly infectious diseases meant that these needed to be dealt with quickly. At the start of the COVID-19 pandemic, a number of countries did not put up restrictions from central government, rather they were issued by the head of the health department because there provision in their legislation allowing for swift action in dealing with such outbreaks. In such circumstances, there was not time to debate regulations as the health of the people was top priority.

The Minister prompted an understanding of the proposed regulations in the context that the regulations had existed over many years, with a simple oversight from previous years – which needed to be corrected. If COVID-19 was not a global threat as it was, or was localised, it could have been managed without the declaration of the State of Disaster. There were many other conditions which required interventions. Probably by nature of these epidemics, this would require only circumscribed restrictions associated with the areas impacted. The regulations were empowering right across to be able to deal with situations as they arose. This did not stop Members of Parliament from raising the restrictions in Parliament. Restrictions put in place needed to be discussed by Parliament to ascertain that Members are comfortable that the necessary oversight had occurred.

The Minister clarified that because the Amended Regulations were being discussed elsewhere, it was a matter of courtesy to bring the matter to the Portfolio Committee and not leave the body behind. At the time of the meeting there were multiple discussions and consultations going on, and a decision had not yet been taken on whether the State of Disaster would be lifted. It would be much more useful to do so once comments were received from the Portfolio Committee and the State Law Advisor, which had been consulted on the matter.

Whether the State of Disaster continues or not, it was important to consult the Portfolio Committee, with other matters arising of which alternatives and issues needed to be kept in mind. He clarified that no malice was to be construed in the discussion of the proposed restrictions. The nature of notifiable medical conditions, particularly infectious conditions, required various restrictions. From the conduct of the COVID-19 pandemic, there was always a possibility of localised restrictions, though the spread often occurred very far between areas. Some restrictions could be contained in one area. In future, it was possible that a similar pattern could occur, and it may not be possible to apply restrictions to the entire country. For example, the Western Cape situation was discussed amongst officials, but since infections moved so quickly between provinces, it became apparent that DoH needed to look at the country as a whole.

Minister Mkhize said that it was nothing out of the ordinary for these regulations to be reintroduced, especially since these were applicable in many countries. Without the National Disaster Management Act, there was no instrument to enforce the wearing of masks, sanitising, distancing and so on which brought about the need to amend the regulations. Under the circumstances, South Africa was not “out of the woods”. When the state of disaster was lifted, there needed to be an instrument which would provide that masks and social distancing were still enforced. It would send a very wrong message if stadiums, for example, suddenly opened, without alternative legal instruments to remind individuals of the “new normal” they were expected to live by.

These regulations might not be enough to manage the situation. There might be a need for a National Disaster declaration again. The distinction between the National Disaster Management Act and the proposed regulations was that these regulations would encourage a particular conduct by society. It also gave the ability for enforcement officers to continue to do inspections and encourage South Africans to behave in a way to avoid spreading COVID-19, as the country awaited a vaccine.

The Minister agreed and credited the work of South Africans in curbing the spread of COVID-19, which included communities, health workers, non-governmental organisations, and businesses for doing what was possible during the lockdown. South Africans had tried their best under the circumstances. This being said, going forward, much surveillance was required. This had been addressed in a plan, which enabled DoH to quickly pick up when infection rates drastically increased in a particular area and act quickly without having to bring in a state of disaster. This surveillance formed part of the support from WHO, such as not to be surprised when infections surged.

Many lessons had been considered from other countries, while taking the South African context into account. On this, the President had announced that almost all business was to resume under the state of disaster. The lockdowns were extreme measures that currently had been returned to by the United Kingdom and Spain, for example, so South Africa would need to be cautious of getting there again.

To those who had criticised government’s handling of the pandemic, the Minister shared that it was important to accept that DoH had to find a way to balance the lives and livelihoods of citizens. There were those who said that DoH was prejudicing those in poor communities by opening up and removing restrictions. Those impacted by unemployment and food insecurity were most often poor and black. There was therefore a delicate balance of health and the economy.

Along this argument was the fact that the tourism sector was opening and international flights had resumed. Tourism, business, investor movement was critical to South Africa. The mine sector, for example, saw an increase in infection rates particularly in Limpopo and Mpumalanga which needed to be managed because it was important to ensure that individuals maintained an income while curbing the spread of COVID-19. The Minister felt satisfied that his department had tried its best, along with South Africans. Though the infection rates at the time of the meeting showed a degree of stability, it was important that there were adequate tools to respond if the situation suddenly changed.

Up to 10 000 infections per week, which was the current rate, was still very high and it was not time to relax. As such, if the State of Disaster were to be removed, there needed to be some basic instrument to help DoH take action. It was still possible, despite this, that South Africa could return to a national state of disaster, but this decision was vested in collective deliberation with the Portfolio Committee and others.

On lost trust with South Africans, the Minister supposed that this referred to a specific issue. A major concern at the time of the meeting was the shrinking of the economy, which had also occurred globally as a result of the restrictions necessary to curb the virus. As such, it was understandable that South Africans had lost hope in the government due to lost hope in the economy. Any such concern was legitimate. The President would be announcing measures to rebuild South Africa’s economy a few days after the meeting. Cases of corruption that were reported were being investigated. Action was being taken, mainly because of individuals concerns and because government could not allow for such misuse, especially under a global health threat. The criticism surrounding these concerns was thus understood and deemed acceptable.

It was re-articulated that there needed to be a management strategy beyond a state of emergency. On the inputs from Members, he replied that there were various inputs which might not be seen, but all views brought forward by stakeholders were considered. Concerns around drafting would be looked at, particularly with the State Law Advisor and legal team.

It was important to the Minister to not be so negative and suspicious to the extent of disregarding an instrument to manage the risk to population health – which needed a strategy outside of COVID-19. It was not the intention to take away powers of any sphere of government. If there was any need to hold the government or Minister accountable, there would be provision for this across levels of government. All comments were noted, and Members were reassured that the regulations were not intended to increase restrictions to worse than what was seen under the state of disaster. Rather, they were preparing for a future where they may be need for a certain conduct to be maintained without reinstating the state of disaster. For this, the proposed regulations were required.

It was still possible to return and be specific, to say that as far as COVID-19 was concerned, there were particular factors that were important to contain. If there were any needs to discuss this further, then this needed to be done. The Minister reiterated the issue of oversight, and that the pre-existing regulations were not new. The Minister concluded by thanking Members for engaging, adding that they would continue to engage when the situation arose.

The Chairperson thanked the Minister. Using an example of his own experience, he cautioned Members against making general statements or impressions of South Africans based on single observations. It was noted that the inputs from Members were reflective of the varying views amongst political parties, which was not alarming, but a reflection of the national discussion. Overall, a majority of Members had supported and accepted the proposal be taken further. Since the WHO had commended the Minister for their strides, it was noted that DoH could have done better, but they performed well and this was commended. Criticism was accepted, while overall this was not unexpected.

The meeting was adjourned.