Vaccine roll-out programme & acquisition, with Minister & Deputy

Meeting report

Opening Remarks
The Acting Chairperson made brief opening remarks. He congratulated both the Minister Dr Joe Phaahla and Deputy Minister Dr Sibongiseni Dhlomo on their new positions.

Oversight Visit to KwaZulu-Natal (KZN) and Gauteng provinces
The Acting Chairperson stated that the Portfolio Committee had conducted an oversight visit to KZN and Gauteng following the civil unrest in the provinces. The oversight visits took place to determine how health infrastructure, the vaccination programme and oxygen supply to hospitals had been impacted by the unrest. A meeting would be scheduled to adopt the oversight report. Tremendous efforts had been made to change the quality of healthcare in both provinces. The challenges would be dealt with once the report was adopted.

He highlighted the importance of the role of the healthcare workers on the ground. All provinces should expedite efforts to take vaccinations to the people in all communities of the country. He highlighted the role that community-level bodies and organisations could play within the vaccination programme.

Meeting Agenda

The agenda of the meeting was adopted.

Introductory Remarks by the Minister of Health
Minister Phaahla appreciated the support of the Committee. He stated that he had received messages, not only from members of the African National Congress (ANC), but from members from the ‘other side’ – he appreciated this. He added that he had ‘no hand in depriving the Committee of its Chairperson, Deputy Minister Dr Sibongiseni Dhlomo.’

He provided a brief summary of the progress of the vaccination programme. There was adequate supply of vaccines, the Department would outline this in more detail in the presentation. There was confidence that going into the next month, if the suppliers continued to supply as agreed, there would be enough stock to continue to administer the vaccine right up until the end of the year. There was sufficient human resource capacity and physical infrastructure to administer the vaccinations, this included both public and private facilities. A number of private businesses, especially pharmacies, including big chain pharmacies, independent pharmacies and medical schemes had come on board to make vaccination sites available. All provinces had come on board to ‘take vaccines to the people.’ All provinces were implementing outreach programmes.

The previous Friday, 20 August 2021, a decision was made to open up the vaccinations to all adult South Africans. Capacity had grown – there was sufficient stock and ability to administer. The vaccination programme had started with health workers, expanded to include educators, the security cluster and other sectors. Vaccinations were now open to everybody above the age of 18 years. The uptake had been quite encouraging from Friday 20 August 2021 onward. The Department was aware that while capacity had been increased, the interest in taking the vaccine needed to be sustained. There were challenges of fake news, especially in social media. There was now focus on communicating better. This was a challenge. It was hoped that by the end of the year, the Country would reach 60 to 70 percent of the adult population being vaccinated. That would help to open the economy and other social activities.

Introduction to presentation
Dr Sandile Buthelezi, DG, of the National Department of Health, indicated that he was joined by a number of senior managers. He made brief introductory remarks before handing over to the Deputy Director General (DDG).

COVID-19 Vaccination Progress Presentation
Dr Nicholas Crisp, DDG responsible for coordinating the COVID-19 vaccination roll-out in South Africa, presented to the Committee. The presentation outlined vaccine supply security, progress with vaccinations on a national and provincial scale and proposed demand-generation through information campaigns. A number of graphs and statistics were presented on the vaccine supply security and progress with vaccinations, refer to the presentation for more information.

Registration
-A total of 10 559 947 people had registered for vaccinations.
-888 858 - Healthcare workers
-3 519 704 - over 60 population
-2 019 257 - 50 – 59 population
-3 299 176 - 35 to 49 population
-832 952 - 18 to 34 population
-It was highlighted that there were a greater number of females than males who had been vaccinated across age-groups.

Demand Generation Interventions
High programme visibility: Specific Activities
-Visible signage of the vaccine roll-out on large key billboards in high transit areas
-Use of taxi rank TV, Digital Billboards and others to promote vaccination messages
-Conspicuous telescopic and other large banners at malls, places of worship, taxi ranks, retail stores, schools.
-Conspicuous and recognisable branding and clear signage at vaccine sites
-Champions: Identifying apolitical vaccine champions that are relevant to the target group and have wide reaching influence (key influential leaders; Traditional Leaders, Faith Based, Business sector, Civil society and Celebrities) e.g. Limpopo targeted ZCC church leader;
-Involvement of Political leaders as champions: Health MEC and other political leaders such as Premiers, Health MECs, Mayors, Ward Councillors
-Partnership with private sector to collaborate on media campaigns and vaccine roll-out branding e.g. Medical Aids like GEMS, Discovery etc. and other businesses

Information in people’s hands: Specific Activities
-Guide the community on where they should go to, who they should listen to and which number they should call to get the correct information on anything to do with vaccines
-Use the time that clients spend at vaccination sites to empower them to be vaccine ambassadors
-Use the observation time to educate the clients and equip them to be able to answer common misinformation questions e.g. Is it true that people are dying after they vaccinate?
-Provide comprehensive IEC material on vaccines and adverse events following immunisation with the call centre number clearly visible that they can refer to and share with others.
-Share information on the nearest functional vaccination sites; operating hours; dates for outreach with all stakeholders: radio stations, newspapers, community leaders, religious leaders, schools, workplaces, and all on all social media platforms
-Use of social media to get the correct information into young people’s hands so that they do not discourage the elderly from vaccinating through sharing of misinformation they consume on social media
-Use of teachers to get the right information into young people’s hands so that they can correct misinformation from social media and other sources at home
-Address the play-off between various vaccines and preferences

Use of local media: Specific Activities
-Continuous engagement to reinforce positive messages about vaccinations and to counter misinformation and disinformation
-Ongoing “human” stories by individuals representing the target group to show authentic stories of registration and vaccination on radio, local newspapers, and all social media platforms
-Radio stories addressing identified concerns about vaccines in local languages
-Radio slots to boost confidence in vaccination explaining all the key steps in the vaccination journey
-Collaboration with local newspapers, Radio stations, leadership, NGOs, Civil society organisations, tertiary institutions, schools, Unions, businesses, private vaccination sites in spreading correct information about vaccines
-Public health messaging to raise public awareness of the notable fatality rate and potential long-term sequela of COVID-19
-Weekly local radio station slots for advocacy messaging, adverts in local print media

Access strategies: Specific Activities
-Transport: provide transport where possible; ensure that clients know when, how, which number to call, where to go and who is eligible to access this service
-Home based vaccinations
-District based promotion of vaccination sites, available assistance at all sites, pop up sites taken to remote areas, ward-based vaccination sites, mass vaccination sites opened across the districts, more sites opened on weekends to provide access to those at work during the week.
-Increase outreach/mobile sites and strategical place them in areas with low uptake as informed by data
-Increase sites in underserved areas
-Increase sites that operate on weekends and make sure they are advertised widely including operation hours
-Adopt specific strategies like Churches on Sunday, Malls on Saturdays, especially on weekends
-Build trust in the system by providing excellent client friendly service so that positive reviews spread by word of mouth
-Use familiar sites as vaccination sites e.g. churches, synagogues, mosques, malls
 
Other Activities
-Continue with regular feedback and monitoring of daily performance through feedback sessions between Province & districts Mon-Fri
-Each district, through the district vaccination coordinating committees meets at least three times a week to monitor progress and identify pressure points and problem areas to reaching targets.
-Retain focus on >60 years as the most vulnerable population group until targets are met
-Encourage clinicians to counter patients’ anecdotal “bad reaction” stories with “good reaction” stories rather than statistics.
-Use messaging like “your parents made sure you were vaccinated as a child now it’s your turn to return the favour”, to encourage younger people to bring older people.
-Coming up with little songs about vaccinations that can be taught at ECDs and Schools and share it through ECD networks (Vaccine, Vaccine on your arm, Will keep you safe from COVID-19)

Minister Phaahla stated that the total, as of the end of Monday 23 August 2021, was 10 790 000 doses, by the end of Tuesday 24 August 2021, it would likely be close to 10.9 million doses. As of the end of Monday 23 August 2021 it had reached just under 8 240 000 individuals. He hoped that by the end of the week the country would have reached nine million individuals. The country would need to administer 1.2 million vaccinations per week to reach 60 to 70 percent of the population by the end of 2021. The biggest issue would be keeping the momentum and enthusiasm of South Africans.

Discussion
Dr K Jacobs (ANC) noted that the vaccination roll-out was a dynamic process, new targets were set at different times. It was good to see how the Department and Ministry could move according to the needs that arose. The hope was to get the population vaccinated, especially the minimum target of 40 million people. He appreciated the fact that the 18 to 34 year olds were able to start registering and being vaccinated as of the previous Friday 20 August 2021. It was encouraging to hear the numbers. It was hoped that the age group between 18 to 34 years would be higher - they would be able to show the older members of society that they had faith in the vaccines. It was hoped that they would be able to encourage older family members to get vaccinated. All efforts being made were welcomed. The strategy was welcomed. He appreciated the ‘demand generation strategy’ and all the aspects thereof, including the social media strategies. It seemed as if it would be quite a big campaign. He noted that two thirds of Gauteng had received their second doses of Pfizer, but only 50 percent in the Western Cape – he expressed concern about this. He noted the decrease in the uptake in Limpopo. The demand generation strategy made sense given the situation in some provinces, such as Limpopo and the Western Cape. He asked where the money would come from for such a big programme.

Ms S Gwarube (DA) asked that the Minister and his Team admit that communication, particularly community out-reach, at this stage of the vaccine roll-out had been less than ideal. When she had read the presentation given by Dr Crisp, while there were some commendable campaigns that would be rolled out including the transport initiative – the reality was that it had been a little bit delayed. This was something that should have begun right at the beginning when it was realised that the uptake, of the population group over 60 years, was dropping. It was always known that it was the over 60-year age group that would be more at risk of putting the health system under pressure. One would have assumed that a more aggressive approach would have been used to reach those that age group. There would now need to be some sort of ‘massive acceleration.’ The under 35 year population would not be the group that would shift the pressure off the health system. The people that needed to be reached were those that were more at-risk and who had co-morbidities. She asked that the Department admit to this.

It was quite disturbing to read in the Sunday Times about two weeks before that Dr Crisp was on record stating that ‘the Department did not have an in-house communications budget and that it would need to rely on generic government communications.’ Surely, this could not be the case? This was a massive undertaking. Social media campaigns and influencers would not cut-it if one was trying to reach people in far-flung areas. That was one of the reasons the transport initiative was welcomed. She requested clarity about the comments made about there being ‘no Departmental communications budget.’ Was this due to the issue of the Digital Vibes matter? Was that why there was no in-house budget in the Department?

She asked what mechanisms were put in place to follow-up with people who had registered but had not gotten vaccinated. What was happening with the No Fault Compensation Fund? Reports indicated that the Fund had not been setup yet. She requested an indication about what was happening with that and what processes still needed to be followed.

There were reports that the Department was commissioning another investigation into the senior officials who were implicated in the Digital Vibes matter – despite the fact that an Special Investigating Unit (SIU) investigation was conducted as well as an internal investigation in the Department. She requested comment on that. Surely, there was enough to act against the senior officials? She asked if the Minister would condemn the actions of the Member of the Executive Council (MEC) for Health in KZN, who was seen ‘partying up a storm,’ without any consideration for social-distancing or masking or other non-pharmaceutical interventions needed. MEC for Health, Ms Nomagugu Simelane-Zulu was reported to have hosted a party over the previous weekend. Would the Minister condemn such actions from a member of his Team?

Ms H Ismail (DA) asked what plan the Department had to ensure that people did not fraudulently produce and sell vaccine certificates. 4.8 Million people had been fully vaccinated, the goal was to vaccinate 41 million by the end of 2021. The country was not close to that target. What was government doing to counter the anti-vax information? The goal was now demand-generation - where would the money for this come from?

Mr P van Staden (FF Plus) stated that he was overwhelmed about the 832 000 people in the 18 to 34 year old age-group that had registered since Friday 20 August 2021 - It was astonishing. He agreed that vaccinations should be taken to the people. The fact that vaccinations were open to all was welcomed. It was something that he had suggested should happen at the end of June 2021.

He suggested that mobile clinics be introduced to assist with the vaccination roll-out. At this stage, communication was a big problem from government’s side. It was not up to standard. There was a lack of budget. This was confirmed in the Sunday Times a few weeks before. The Digital Vibes matter had certainly taken its toll. More needed to be done.

He was worried when he heard the words ‘compulsory’ or ‘mandatory’ vaccinations. He suggested this issue be discussed in the meeting. ‘Compulsory vaccinations’ against COVID-19 could not be allowed as it was every individual’s free-will and choice to take the vaccine or not to take it. Getting the COVID-19 vaccination could not be allowed to become mandatory. ‘Under no circumstances could the State or government attempt to compel or force anyone to be vaccinated.’ Not everyone at this stage could have the vaccine right away – there were many patients with severe underlying diseases, who had to first undergo a lot of medical examinations to see if they were able to take the vaccine. He, for instance, was one of them. If people were unable to take the vaccines due to underlying disease conditions, would the State or government not be discriminating against those people? Health services could not be denied to people who had not had the vaccination – it would be unconstitutional. He understood the frustrations of medics, scientists and health professionals when it came to COVID-19. He reiterated that health services could not be denied to anyone – it could not happen under any circumstances. This would violate the Constitution of South Africa, specifically Sections 12 and 27.

He was concerned about a professor who had made announcements in the media, on Channel eNCA on 23 August 2021, that the government was encouraged to force people to take vaccinations. This would violate the Constitution. The statement of the MEC in Limpopo that alcohol should not be sold to unvaccinated customers was also unconstitutional. Such announcements should not be allowed from government leaders. He pleaded that the government be careful of such announcements. People’s freedom of choice should not be undermined by this matter in any way.

Ms N Chirwa (EFF) spoke about vaccine hesitancy. There was not enough admission by the National Department of Health that it fell squarely at their feet. Part and parcel of vaccine hesitancy was issues of trust and weak communications strategies. The oversight to Gauteng was proof of that. The Committee had commended the work being done to communicate accurate information, however there was not enough being done to reach people at their point of living – it could not just be at taxi ranks. If one put up posters at taxi ranks, with the current unemployment rates, one was only speaking to people who used taxis. This was not the vast majority of young people who were trapped in their townships and rural areas with no prospects of going into the City and using a taxi because they were not working. There needed to be a committed effort to reach people in their immediate communities. That was not yet being done by the Department. That was a big reason why vaccine hesitancy was thriving, even amongst those that had access to information. There was not enough investment in the fundamental hesitancy or crisis of hesitancy.

People did not trust the government – this issue needed to be addressed with honesty. There was not a single project in the National Department of Health that reached its targets over the past two to three decades. The country saw the Department as a failure – ‘one could not trust failures with one’s life.’ The trust issues needed to be addressed with honesty of its previous failures. She highlighted the HIV/Aids denialism era etc. There was similar denial that presently existed around mental health issues. There needed to be much more intentional ground-work done to ensure people had access to quality healthcare.

The issue of vaccine hesitancy was raised by Members of the Committee on 10 February 2021 – six months earlier. There were recommendations that were made about how to strengthen communication, how to strengthen issues of stigma, how to communicate information to remote rural and township communities. That work had still not been done. It needed to be admitted that the Department had ‘dragged its feet,’ in addressing this. The strategy to reach youth on social media was good – but it was not enough as not everybody had access to social media or the internet. One needed to meet people where they were consistently. The Department had not addressed the narratives put forward by the anti-vax movement. 

During the oversight visit there was a stark difference between the vaccination sites in township areas to that of suburban areas. That was a concern – particularly in Alexandra Township where the Committee had visited. This was also a problem more generally. Facilities, clinics and hospitals in townships and rural areas were marginalised and not taken care of in comparison to the ones in suburbs and private healthcare facilities - which were also subsidised by government. Issues of choice, such as which vaccine to take were not equal across areas. People in Houghton were able to get their vaccine of choice. At Alexandra Community Healthcare Centre, the nurses told the Committee, that they chose which vaccine would be administered to which people. This was because they had an instruction to balance out demand for both vaccines. Did that not fuel hesitancy – when people were told they could only get a certain vaccine? Those people would land up going back home and be thought of as being ‘vaccine hesitant.’ People’s right to choose was being impacted by State facilities. This applied to contraceptives as well. Women did not have the liberty to choose which contraceptive they wanted. Those issues were not being addressed properly.

The matter of men accessing healthcare was not a new issue. ‘South African men and healthcare was a crisis on its own.’ It was bound to catch up with the National Department during the COVID-19 pandemic, because it was not something that had been addressed adequately at ground-level. This applied to HIV/Aids as well. The Department was not doing the work at ground-level – the Department was speaking to people who that had already been lobbied. People who were willing to give an ear to the National Department at press briefings were already clued up and not necessarily people who distrusted the Department. The Department needed to think of strategies to reach people who were not even trying to listen to the Department.

She asked if DDG Dr Anban Pillay, was still working in the Department and what his current role was following his direct involvement in the Digital Vibes ‘cash heist,’ per the SIU investigation report. What were the repercussions against officials who were found to be involved? Would the Committee still be ‘subjected’ to his presentations after that whole debacle which had happened under their noses and resulted in the former Minister having to resign?

Mr M Sokatsha (ANC) congratulated the Minister and Deputy Minister on their new positions – he was sure they would make a ‘formidable team.’ He asked questions about the last three slides of the presentation which outlined programme visibility, putting information in the hands of the people and local media. He was concerned about those slides. He noted the ‘radical bias’ towards people in the villages. He asked that the Ministry consider provinces such as the Northern Cape. From his experience, there were a lot of villages in the Northern Cape that struggled with water and other basic services. During the period when he was MEC in the Northern Cape, the mines donated a lot of mobile units to the Northern Cape. During the peak of HIV/Aids, those mobile units went into the villages with a basket of health services, including dental and screening of health issues, such as high blood pressure etc. That programme worked well; people went for testing for HIV/Aids in the villages. The mobile clinic would be based in each village for a couple of days. People were able to go to the mobile units and be assisted. The slides highlighted the issue of mobility in rural villages. What was the possibility of the Department looking at mobile units in such villages? In Kuruman there were a lot of mobile units no longer in use. Those mobile units were donated by the mines, they had done an outstanding job in the villages of the Northern Cape.

Dr S Thembekwayo (EFF) stated that there were a lot of families that had lost their loved ones due to COVID-19. Had the Department been approached by the families for compensation? If so, how many had approached the Department and what had been done about that issue? There were a lot of learners who were identified as associates of those who tested positive for COVID-19; those learners were asked to quarantine for ten days. During that period those learners lost a lot of time in the classroom. How far was the Department with the preparation/identification of the correct vaccine that could be given to the under 17-year-old age group?

Ms M Sukers (ACDP) echoed the questions asked by Ms Gwarube. What was the current status of the No Fault Compensation Fund? She asked that the Department provide the Committee with details about that. Gauteng had sent out a COVID-19 community vaccination assessment survey. The survey asked, among other things, about people’s intention to be vaccinated. Were other provinces doing the same? How many people had indicated in this, and other government surveys, that they intended being vaccinated?

She had been notified about healthcare staff being moved to cover vaccine sites. What impact was this having on primary care services? Was the Department monitoring this? What steps was the Department taking to ensure that these areas did not continue to suffer? She noted the attention that was being given to communication at present. Who were the service providers that were being used and what were the costs of this? She noted that both the Minister and Deputy Minister were medical doctors, there were many people, like herself, who had gotten COVID-19 twice; she asked if the Department could comment on natural immunity as well as provide clarity to work places that were enforcing guidelines on vaccinations.

She echoed the concerns raised by Mr van Staden and alluded to by Ms Chirwa. What was the Department doing about the threats being made in workplaces mandating workers to get vaccinated? She emphasised people’s constitutional rights. As Parliament, there needed to be a discussion about people’s constitutional rights around health rights and freedom of choice where vaccines were concerned.

Ms E Wilson (DA) congratulated the Minister and Deputy Minister on their appointments. She stated that she was largely covered by the questions asked by other Members. She requested the statistics of the number of deaths amongst the vaccinated population and unvaccinated population. It was known that people who had been vaccinated could still get COVID-19 and that they might show symptoms. When it came to issues of anti-vax and vaccine hesitancy, it was important that the statistics of those who had the vaccine and recovered from COVID-19 (without ventilation, oxygen and the Intensive Care Unit (ICU) and deaths) were emphasised. Her understanding, from what she had recently read, was that the majority of people who had been vaccinated, who subsequently got COVID-19, had made fast recoveries, and at this stage there were no or very few deaths.  People who had not been vaccinated were far more vulnerable. It was important to get that information into the public domain. If people got a real understanding of the consequences of not being vaccinated that would assist in going forward in encouraging people to get vaccinated.

Community or herd immunity was vital. While she understood that there was a bit of vaccine hesitancy, there were people who were desperate to get vaccinated. There were a number of foreign nationals who were currently legally residing in South Africa – they were human and vulnerable to COVID-19. Many of them were in the country and had the required work permits and residence permits; they were part of the community. Getting them vaccinated for community immunity was vitally important. Stopping them from potentially spreading the virus onto other people was important. She had received a lot of calls from foreign nationals who were presently in the country legally – who had all the paperwork and documentation and wanted to be vaccinated – and yet they were being turned away from vaccination sites. She was concerned about this issue as this would not help the Country with community immunity. What would be done to address this issue?

It was a very sad day when a brave woman, who had come forward and exposed the Personal Protective Equipment (PPE) corruption going on in Gauteng, who was a key witness to the case there, was ‘gunned down’ outside her home. It was very disturbing! She could not believe that the country had come to this. Ms Babita Deokaran was brave and courageous. Nobody should be shot down in South Africa for exposing the kind of corruption that was going on in the Department of Health.

Mr A Shaik Emam (NFP) congratulated the Minister and Deputy Minister on their promotions. He echoed what was said by Ms Wilson about Ms Babita Deokaran who was gunned down. He emphasised the lack of protection provided and the fact that she was gunned down when wanting to do the right thing. It indicated the high level of corruption and how people were connected.

He noted the Minister’s mention of social media and fake news. What was ‘fake news?’ If one did not agree with what was said by the Department, pharmaceutical companies or South African Health Products Regulatory Authority (SAHPRA) – was that then ‘fake news?’ How did one decipher if something was ‘fake news’ and respond to it? There were health experts and scientists that were saying the opposite of what the Department and SAHPRA were saying - why should those people be suppressed for having a different view? Those people should be allowed to express their views. Surely, the Department, together with its ‘loyal’ SAHPRA should enter into some deliberations with people who had different views, so that the public could then get a clear understanding of what was going on. One could not blame people who knew nothing about health for the way they were behaving - not wanting to get vaccinated. It was not that they did not want to, experts and scientists were saying that ‘people would not live two years.’ Why would people not listen to scientists who had been right ‘in the Pfizer laboratories.’

The reason why there were vaccines available was because a very large portion of the population group aged 60 years and older had not been vaccinated. That was why there was such a big supply being made available to younger groups. Vaccines had always worked. What he was not sure about was the fact that the vaccine was developed over a couple of months and there were an increasing number of variants of the virus. What was the actual efficacy rate at the moment of both the Pfizer and the Johnson and Johnson (J&J) vaccines? He had heard that it had gone down to ‘17 percent’ - was this true?

There were certain doctors and medical experts that were making statements that ‘the Department was trying to suppress them, threatening them with legal action and removing their licenses.’ Could these people not be given a voice?

He asked that the rationale of using J&J be explained. Who entered into the agreement with J&J? Who negotiated with J&J and not the others? He was told that the others had a much higher efficacy rate of 97 percent – why was J&J chosen? Why did the Department in the first place procure vaccines without SAHPRA approving them? He requested clarity about the issue of herd immunity. People who were ‘pro-vaccines’ were saying that the vaccine would help those that took it and nobody else. The first argument about getting 60 percent of the population vaccinated to achieve herd immunity did not seem to apply – was this correct? If it only helped those who got vaccinated – then everyone needed to get vaccinated. He asked for comment on that.

When there was exchange of money such as in the case of pharmaceutical companies or the World Health Organisation (WHO) - was one able to be absolutely objective about the products and the procurement thereof? The Western Cape had a serious problem of people who were dying of COVID-19 – there were not enough emergency services and paramedics to go and certify deaths. Bodies were starting to ‘smell,’ because of the delay.

He asked if, in the interest of the country and the health of its people, the Department would be willing to engage with the experts and health scientists and get both views. Both sides had never come to a common platform in South Africa so as to deliberate on the issues. That could convince the South African public that it was in good hands.

The Acting Chairperson stated that a meeting had been scheduled with SAHPRA. At the end of the meeting, the Secretary would clarify when this was set for.

Ms A Gela (ANC) congratulated the Minister and Deputy Minister on their appointments. She appreciated the number of vaccinations amongst the 18 to 34 year age group. She was encouraged that the Department was looking broadly at new strategies to motivate people to get vaccinated. The registration in workplaces was to be commended. She asked for the statistics of the number of people receiving vaccines in workplaces. She asked in which sectors this was taking place. She noted that she had observed some improvements in some of the areas where the Committee conducted oversight – the Oversight Report would reflect this. The drive-through vaccine site in Gauteng was something that other provinces should consider.

Minister Phaahla responded to the questions about the outreach programmes. He accepted the criticisms that some of the initiatives could have been implemented a lot earlier. The Department had first needed to start with the vaccine availability. There had initially been limited stock of the J&J vaccines in the first phase trial. As supply started coming into the country, capacity was increased at fixed sites. Once the initial facilities were saturated, the matter of outreach and transport needed to be addressed. It was hoped that in the next couple of days the country would pass 11 million doses administered. It was encouraging that the uptake was steadily rising, 247 000 plus doses were administered the day before. That day there were 267 000 doses. As capacity increased, the Department’s ability to reach out to communities was made possible. As capacity was built, more opportunities could be explored. The fixed sites remained and outreach was taking place.

He responded to the question about another investigation into the Digital Vibes matter. There was no ‘further’ investigation. There was an internal investigation and an SIU investigation. Those were the only investigations. He had not heard any information about the MEC for Health in KZN. He did not know the facts except for that which was contained in the media. The MEC reported to the Premier.

He responded to the question about the vaccine certificates and potential fraud. The Department had not reached the stage of deciding that vaccine certificates needed to be issued. It was a matter that was still being discussed. Going forward this might need to be done, for example for travel purposes. Currently, when people travelled, proof of testing negative was required; one needed to produce a recent Polymerase Chain Reaction (PCR) or Rapid Antigen Test. Vaccine certificates might be required going forward. It was a matter that was being considered.

He noted that when there was low supply of vaccines, it did affect the ability to attract people, as some people went to some sites and could not get vaccinated. He hoped that with improved communication the demand could be sustained.

Mandatory vaccination was not a policy of government. Quite early on the President emphasised that the vaccination roll-out was being approached on a voluntary basis. The question was being raised by various commentators, including workplaces. Some private institutions, such as private schools had already issued a circular to their teachers ‘to get vaccinated or risk losing their jobs.’ That was not a government policy. A lot of commentators were suggesting that this needed to be done. He was asked twice the day before in two different interviews about this. His response had been that it was not the government’s policy, and the President had stated this clearly. If there was a need at some stage, it would need to be properly reviewed. It was preferred that people come forward on a voluntary basis and take the vaccines. There was no need for alarm.

The vaccines procured were based on what was available, efficacy and approval by regulators. It was a scarce commodity so there had been limited choice. Once acquired, those vaccines were made available. As J&J required only one dose, it was suggested that this be prioritised for rural areas. In the urban areas, where there were shorter distances to the vaccination sites, Pfizer was prioritised. J&J was used for groups – such as health workers and teachers, as there was limited supply initially with a short lifespan. It was not a policy to state that there would ‘never be choice’ – but at present there was not that luxury. He stated that he would follow-up about infrastructure in the Northern Cape being used optimally.

He responded to the question about compensation for families that had lost loved ones. This was a difficult period. The No Fault Compensation Fund was for adverse effects following vaccination – where adverse affects qualified for permanent disability and compensation. There was no such scheme that would compensate family members of persons who died from COVID-19. He would imagine that it would be quite difficult. He was not aware of any country in the world that had such a scheme.

There was work being done in various countries to look at vaccinating children under the age of 18 years. A lot of the vaccines were only approved for adults 18 years and older. Where there had been further trials to see if they were safe for children below 18years – it was something South Africa would look at. Even if that came through, it would not be the country’s immediate priority as the risks were lower for children. The main issue was to cover persons who were vulnerable. The risks of serious illness and death were lower amongst children under 18 years old.

It was suggested that the Minister of Higher Education, Science and Innovation approach the Human Sciences Research Council (HSRC). The HSRC did a study previously. It was suggested that the HSRC be requested to do a second round of the survey. If Gauteng had done its own, that was good. At this stage, he was not aware of other provinces that had conducted surveys. A national survey would be ideal – there should be feedback from the Minister of higher Education, Science and Innovation soon on this.

He noted that other health services were struggling. When he had been in the Western Cape recently, it was mentioned that they were delayed with over 300 planned surgeries. He agreed with Ms Wilson about the need to communicate information and statistics about how many lives were saved due to vaccination. There was a report received from the South African Medical Research Council (MRC) based on the Sisonke vaccination programme. The report was compiled based on the previous four months and showed the safety of the vaccines.

The only struggle the country had was with undocumented migrants. There should not be a problem with foreign nationals. Anybody who had a valid document should be able to get vaccinated. He would be surprised if foreign nationals in the country, with valid documents, would be left behind. It should not happen.

He refuted the efficacy rate of ‘17 percent’ as suggested by Mr Shaik Emam. That information was false. He emphasised that no one was suppressed – there was no suppression of information. There were rules and regulations of engagement. In the science and medical world there were rules of how to research, report and produce peer reviewed articles which were then submitted to relevant authorities. The Department was looking at registered professionals who were not following those rules and communicating with the registered bodies about that. A lot of the false information being spread had not been proven. The claim that there would be ‘no herd immunity’ was likely a misunderstanding. He asked that Dr Crisp and Dr Pillay respond to this.

He responded to the question about Dr Anban Pillay. He was still part of the Department. He suggested that the Member had information that was ahead of the Ministry. Whatever came from the SIU investigation, everybody had rights. Where there were allegations against staff members, those members would be given a chance through the formal processes to respond. The process was governed by laws; one could not simply be dismissed when there were allegations.

Ms Gwarube asked what the Department was waiting for in taking action against those implicated in the SIU report. Was the Department waiting on the Report being made public? She requested clarity on this.

Minister Phaahla stated that when the SIU made findings, they would refer matters. At this stage, he had received some of the matters referred, to take action on. Those matters would follow proper labour relations processes. The Members would know when those actions were being taken.

Dr Crisp stated that the Department was examining, on an individual basis, people who had been registered but not vaccinated. The Department regularly monitored the comparison between the date of registration and the date of vaccination, partly to identify how many were walk-ins and to understand the limitations of the pre-registration options that were offered. He did not have the figures in front of him, but he would certainly look for them. The vast majority of people who registered did go for vaccinations.

At the moment there was a limited number of J&J vaccines in the country. From the end of August 2021 the country would start to receive J&J vaccines. Should supply improve there would be more sites that would be able to have J&J vaccines. There were a large number of other health services that had suffered due to moving human resources. This was exactly why there was a need to vaccinate people. The more people that were vaccinated, the greater protection provided, the less people fell ill, the less they arrived at health facilities and the less they were in hospital and ICU consuming more resources. The faster the country was able to vaccinate people, the quicker the country would be able to get back to proper and more coherent chronic health programmes and other services that were compromised.

He responded to the questions about the communications budget. The amount of resources required for a campaign of this sort was huge. The Department had partners in government, such as the Department of Basic Education, that could educate teachers and the Department of Transport that could get involved. The Government Communication and Information System (GCIS), would predominantly be involved, which had a fundamental communication role and skilled personnel in that area to manage communications. There were also a number of private players that were involved, such as private trusts and the Solidarity Fund; together there was a substantial programme. That programme was being rolled out and should gain momentum over the next week or two; private television, radio and print media had volunteered to come and use the technical materials that were available to prepare their own communications. Trying to put a budget to everything was a little bit difficult, because there were so many contributors - the Department was certainly trying to do that.

He reiterated what was said by the Minster about foreigners. If there were instances of foreign residents, with foreign passports or foreign nationalities who were turned away from vaccination sites while they had any documentation, the Department would like to know about it. That was not part of the Department’s policy at all. The Department would like to intervene in such cases. He had heard one or two concerning reports, one of which the Department followed up on where there was indeed some misunderstanding and aggression shown at the site. In the other case there was definitely nothing untoward. Anybody registered could be vaccinated, irrespective of nationality.

There was a challenge, the Department was working with various bodies, including the Human Rights Commission and the United Nations High Commissioner for Refugees (UNHCR) to make sure that the Department was able to vaccinate in due course, those who had no documentation. The Department recognised that challenge.

He responded to the question about herd immunity. Normally with vaccinations, where there was a ‘stable virus,’ where the virus was not mutating all the time, it was possible to calculate the reproductive rate of the virus to be able to anticipate how many people in a community, and there was a scientific mathematical calculation to do this, what percentage of a given population would need to be vaccinated to protect the remaining unvaccinated portion of the population. The problem with COVID-19 was that it mutated quite rapidly. Each mutation was quite different. Trying to get ahead of the game to anticipate what the next mutation would do was not viable. What was known was that every individual that was vaccinated was protected. There was plenty evidence from the J&J vaccine, where there was a long track record of using the vaccine since February 2021. With the early statistics that the Department was able to pull out of its own data system on the Pfizer vaccine, the number of people vaccinated with Pfizer, who were coming into hospital and getting severely ill was extremely few.

Dr Barry Kistnasamy, Coordinator: Occupational Health & Safety (OHS) COVID-19 Work-stream, responded to the questions about workplace vaccinations. He stated that since 19 August 152 055 workers had been vaccinated of a target of 561 986 people in 70 workplace sites across South Africa. This was 27 percent of workers at those sites. Overall 6 million workers were being targeted out of 15 million formal workers – this was ramping up now. The sites covered all provinces. The industries included the agricultural forestry sector, the automotive sector, communications sector, hospitality and tourism, finance, manufacturing, mining, retail services, the taxi industry in the informal sector, State owned enterprises and telecoms. He would send information to the Minister on this. There were two sites in the Eastern Cape, five in the Free State, 24 in Gauteng, nine in KZN, 18 in Limpopo, 12 in Mpumalanga, seven in the Northern Cape, 11 in North West and 12 in the Western Cape. The Department had reached 20 percent of the mining sector the week before.

The Acting Chairperson suggested that the presentation be forwarded to the Minister and the Committee may need some time to schedule a presentation on this.

Dr Anban Pillay, Deputy Director General: Health Regulation and Compliance, NDOH, responded to the question about efficacy. It was important to differentiate the vaccine efficacy in breakthrough infections to hospitalisation and mortality. Very often when one heard of vaccine efficacy, breakthrough infections were being referred to. If one compared the Pfizer and J&J vaccines, both vaccines were sitting at 90 percent protection in mortality. There were differences in breakthrough infections amongst Pfizer and J&J vaccines. J&J was at about 60 percent, not ‘17 percent.’ Natural immunity appeared to have a shorter duration than that created by the vaccine. That was why people who had been infected with COVID-19 were given the opportunity to get vaccinated. One of the reasons Ms Sukers may have had the second COVID-19 infection was because it was a different variant, thus her immune system was not able to respond to the different it. 

Dr Buthelezi assured the Members that the Department did not procure any vaccine that was not registered by SAHPRA – that was a prerequisite. There was no additional investigation on the Digital Vibes matter. The Department was working with the senior counsel appointed through the Office of the State Attorney to assist. This was being dealt with following the relevant legislation. The Ministerial Committee on vaccines was working on the issue of the under 18 year olds and waiting for some data that had been submitted to SAHPRA. As soon as that was ready, the Department would report on this to the Committee.

Deputy Minister Dhlomo stated that the Committee had been like his family. The Minster had been like a mentor to him for the past 40 years. They had met in 1980; the Minister had mentored him both academically and politically. He took solace in the 10.9 million doses, even though some people were waiting on the second dose, as there was a scientific view that after the first dose, one was 80 percent protected. Men globally were generally reluctant to visit clinics to check-up if things were alright. The Ministry and Department would welcome ideas of how to accelerate that campaign. The Minister had invited him to be part of the WHO Regional Committee meeting. One of the important statements that the leaders made was that vaccines did not prevent further COVID-19 infections but they prevented COVID-19 related complications and death. The issue of fake news was troubling the whole world.

Mr Shaik Emam stated that he had one issue, that of the AstraZeneca vaccine which was procured by the Department - there was no Section 21 application. It was not registered or approved by SAHPRA at that stage. Why was the Department denying this?

The Secretary stated that SAHPRA had been invited to appear before the Committee on 1 September 2021, from 9:30am to 13:00pm.

Closing remarks
The Acting Chairperson stated that the issues raised about SAHPRA could be addressed in that meeting with SAHPRA the following week. He made brief closing remarks noting the value of the regular reports from the Ministry and Department on the vaccinations and related matters.

South Africans should be given the opportunity to access vaccines. The Department must work with the broad structures of society to make sure that this work became successful. He had looked at the trends of the virus across the globe, it was inevitable that the country would face the fourth wave which could cause havoc – it was important that the country is prepared. It was important that the issues raised by the Members be resolved. The Department alone might not succeed – it was important that community leaders and organisations get involved. It was critical to ensure that there was a coherent programme to reach out to the people to access vaccines. There was no doubt that the vaccines contributed to the protection of people but nonetheless they needed to deal with media, anti-vax and fake news that was distributed. It was important that there be a mass media campaign on various community radio stations and other platforms. As Members of Parliament they needed to be ambassadors to carry out the message to mobilise people to get vaccinated. Where it was felt that questions were not sufficiently answered, the Committee could formally write to the Ministry to get a written response.

The meeting was adjourned.