Deputy Speaker, hon President, hon Deputy President, Cabinet Ministers, hon Members of Parliament, ladies and gentlemen, as the Minister of Health, I would like to address you on the current situation faced by the country and the world at large because of the outbreak of influenza A: H1N1.
It is necessary for me to take this step because I believe we are all concerned by the recent rise in deaths in the country, particularly the deaths of pregnant women. The death of any individual is extremely painful and particularly regrettable, more so if that individual is a mother to be, who forms part of the foundation of any family and society as a whole.
As I've indicated in my personal letters to all of you, which I hope you have received, I wish to reiterate my message of my intention to use this opportunity to give you information that will assist you personally to deal with this disease and to request your assistance and personal involvement in effectively communicating the messages of influenza A: H1N1 2009 to our communities.
This is particularly important because whenever new diseases strike, rumours abound and take over the thinking process of citizens. These rumours will then inform the activities of the populace, which will usually be wrong activities. I'm happy that the letters I've written have reached all of you and hundreds of other people in all corners of this country. This is shown by the feedback we have been receiving on the letters.
Among those who have responded to the letters very positively, I wish to acknowledge the response of Prince Mangosuthu Buthelezi, Shenge. Thank you for your kind words indeed. I also wish to acknowledge the response received from Dr Wilmot James of the DA. I want to assure him that I will follow up on the proposals that he made in his response. Of course the continuous feedback and encouragement I received from comrades in the ANC and my colleagues in the Cabinet have also been extremely helpful in shaping our response to this pandemic. I also wish to thank Minister Manuel for responding on our behalf during yesterday's statements.
It is true that we have sent letters, not only to you, but to all members of the provincial legislatures, councillors, community development workers, principals of 30 000 schools, rectors of universities, ministers of religion, traditional healers and everybody who is a leader, including editors of newspapers, in trying to communicate this matter. What these responses and reactions indicate is the willingness and readiness of South Africans to hold hands in confronting common challenges.
Developments around this pandemic have been changing every week. So, since last week when I sent your letters, statistics have changed, and I wish to update them. At the moment the disease has spread to 170 countries globally and to 25 countries on the African continent. Today as I'm standing here in front of you, the virus has affected 182 166 people. These are laboratory confirmed cases. Globally we have 1 799 confirmed deaths, and in South Africa to date we have 5 118 infections with 20 deaths. As health officials globally and locally, we are worried by these deaths that have so far occurred, calculated globally as 0,9% of those affected, and as 0,3% of those people who are affected in South Africa.
It is worth noting that this virus affects people in the younger age groups, particularly between the ages of 10 and 29 years. Most of these individuals are in schools and institutions of higher learning. This is a very serious departure from what influenzas generally do. As you know, seasonal influenza typically attacks the elderly and kills between 250 000 to 500 000 people every year. But the H1N1 influenza, while it has killed very few people so far, has only affected 3% of people over the age of 65 years. This has never happened in the history of influenzas; it's a new phenomenon.
The World Health Organisation, WHO, has advised that countries must concentrate on mitigating the impact of the disease on their communities because containing it seems not to have happened. So, in mitigating, communication is the key. We have taken all the necessary steps to ensure that we are doing that. However, I want to mention to this House that more still needs to be done in the area of communication. That's why we are appealing for your assistance because you have constituencies and that is where communities are.
It is generally believed by experts, unfortunately, all over the world, including even those in the WHO, that at the end of this pandemic, 45% of humanity is definitely going to be affected. However, we wish to emphasise that while that is so, an overwhelming majority of people worldwide have mild symptoms and don't need any specialised attention and care.
The figures we are quoting here are for those who have been tested. We still believe that there are thousands and thousands out there who were not even aware that they had caught this influenza because it was very mild. So, people with very mild symptoms must just be treated as if they have any other common influenza which occurs on an annual basis, like I had last year and every other year in winter.
However, we are worried particularly about four categories of people: people with chronic heart or lung diseases seem to be succumbing; pregnant women, specifically; people living with HIV and Aids; and lastly, people with diabetes mellitus. We are particularly worried about these four groups of people.
We are emphasising once more that people who experience moderate and severe symptoms, which I've outlined in the letters and need not repeat here, must immediately seek medical attention. We are also saying that those who have mild symptoms, but fall within the categories that I've mentioned - chronic heart and lung diseases, pregnant women, HIV/Aids, and people with diabetes - must seek urgent attention, even if the symptoms are mild and seem like ordinary influenza
The distribution of letters in the provinces has changed since last week when I wrote you the letters. It indicates the following: the hardest hit province is Gauteng, with 49% of infected people; the Western Cape, with 21%; KwaZulu-Natal, with 12%; the Eastern Cape, with 6,4%; Limpopo, with 3,5%; Mpumalanga, with 2,5%; the North West with 2,3%; the Free State, with 2%; and the Northern Cape, with 1%.
I wish to warn members that this has nothing to do with the way the disease is spreading. It has a lot to do with where the testing facilities are. People are testing every day, even those who are not sick. The majority of laboratories are in Johannesburg. That is why 49% of the cases that are reported are there. That is followed by the Western Cape for the same reason. The death rate up to now is nine in the Western Cape, six in Gauteng, two in the Eastern Cape, two in KwaZulu-Natal and one in the Free State.
We will thoroughly investigate each death. However, present information shows that nine of the dead people were pregnant women, four had chronic heart diseases,one had diabetes and two had renal transplants. That is in keeping with all the risk areas that we have mentioned up to now. We are still trying our best to get more information on the other four.
Official testing is done by the National Institute of Communicable Diseases. In other words, you can test in a private laboratory, but if they reveal a death we will not communicate it until it has been confirmed by the National Institute of Communicable Diseases. This is because it is the only laboratory in Africa that has been accredited by the WHO. The fact that many countries on the continent don't seem to have the disease is simply because they don't have testing facilities. Most of them depend on South Africa for testing.
We want to appeal again to people that waking up at your home in the morning and rushing to the nearest private laboratory demanding to be tested simply because you can afford to do so financially does not help anyone. In fact, what it does is to clog up the health system as is the case now. This practice has disadvantaged people who really deserved to be tested.
Initially, when the pandemic started, laboratories could produce results within 24 hours. Now it takes up to seven days to produce results because people are just queuing up not because they have any symptoms, but simply because they just feel the need to be on the safe side. We do not know how testing puts you on the safe side anyway. Really, as one caller to SAFM said, there doesn't seem to be a breakdown of disease but a breakdown of testing, and we should not allow that.
The treatment of choice is Tamiflu, and we are only using it for moderate symptoms, severe symptoms and the categories of people that I've mentioned. Mass treatment with Tamiflu will lead to mass resistance. I want to warn members here today to be aware. We are not trying to hide treatment from them.
If you are attacked, hon Speaker, you defend yourself. Don't ever think viruses will also be attacked without defending themselves. They do so and in a cruel way. If you attack them continuously, even when it's unnecessary, they mutate. When they mutate, they become more dangerous. That's why we don't want to give every South African Tamiflu. If we start doing so, we'll be destroying ourselves. It's like that all over the world.
In line with the department's commitment to reducing maternal mortality, we have given instructions and directives to all doctors and health workers that whenever they come across a pregnant woman who shows any symptoms, they must give her Tamiflu immediately. They must not wait or try to do any testing, it's not necessary. They must just give her the treatment.
It is saddening to see pregnant women, in particular, who are dying because of this influenza. Unfortunately this phenomenon of pregnant women dying is a global one. I wish to announce to this House that because of this, the department is busy increasing the stock of Tamiflu by R30 million so that as we get very busy we can be prepared.
The closure of institutions of learning, workplaces, shopping complexes and malls has not proved to be helpful in the countries that have practiced that. We advise that if there are more people - learners or educators or even workers - absent from work or from school, institutions must consult the Department of Health and the Department of Education and we will take a joint decision on the correct course of action.
I wish to assure you and members of this House that everything is being done by scientists the world over, working together with the WHO, to try and produce a vaccine for this disease, because that is the only thing that will save humanity. If things go well, such a vaccine might be available within a few months. Over the last weekend I attended an international conference on this pandemic influenza in Beijing, China. Most of the Ministers from the heavily affected countries were at that conference.
The WHO briefed us that at the moment, 13 candidate vaccines have been collated and distributed to all vaccine manufacturers all over the world who must start the process of trials and production. However, producing a vaccine as it is going will not be completed in less than six months; that is not possible. So, it is estimated that if we are very lucky, the first acceptable vaccine from these candidates might be available by November 2009. If we are not very lucky, we might have to wait until April 2010.
Unfortunately, there is no capacity in developing countries to produce their own vaccines. At the moment, all vaccine production is being processed in Europe and America, with China also in the process of doing so. They are busy doing tests on 13 000 people within China.
However, the disturbing feature about today's world and the manner in which the world is arranged has been expressed by the Minister of Health for Cambodia in the conference, who noted that the developed world, after producing the vaccine, may prefer to cover their own population first before thinking about the developing world. China made it very clear in the conference that if they can produce a vaccine, they will first start with the 67 million people who are pregnant in that country.
I've spoken to my colleague, the Minister of Science and Technology, and we both think that ... [Interjections.]
Order!
... 67 million people is only 4% of China's population. [Laughter.] There's nothing funny about that, it is a fact. But for us it is obviously a very tall order.
I've spoken to my colleague the Minister of Science and Technology, hon Minister Naledi Pandor, and we both think that South Africa has arrived at a situation where we have no option but to start developing our own vaccine capacity, not only for H1N1, but generally and for other diseases. [Applause.] I just want to disclose that the statement from Dr Wilmot is also about that. It's very important, that's why I want to follow it up.
A special word of gratitude to the hon Speaker of the National Assembly, hon M V Sisulu, for acceding to our request to address the House this afternoon. Thank you very much, hon Speaker. We take advantage of your kind advice to keep on informing this House about this matter because it is a very important matter. I wish to thank you and all South Africans in anticipation of your active involvement in communicating and helping to mitigate the effects of this disease. Thank you. [Applause.]
Deputy Speaker, hon President, Minister, may I, on behalf of the DA, convey our deepest sympathy to the families who have lost loved ones due to the H1N1 virus.
While the DA realises that we have seasonal flu and that there are unfortunately casualties every year, we still believe more could and should have been done to educate the public about H1N1 as well as the ways of reducing the spread of the virus.
We welcome the Minister's statement here today. The Minister knows that I have great respect for him, but honestly, Minister, it is a few months too late. Since 28 April 2009, that is four months ago, the DA has been calling on you to do what you have just done today; make a public announcement and take the public into your confidence. We have also been calling for an educational ... [Interjections.] We have, Minister.
We have been calling for an educational programme to educate the general public on how best we can reduce the spread of the virus. This is because we wanted to prevent a huge spike at our health facilities which we are experiencing currently, and we cannot cope. By educating the public, you not only reduce the spread of the virus, but you also spread it out over a longer period and thus enable the health facilities to cope in a better manner.
It does seem, to some degree, that we are now closing the stable gate after the horse has actually bolted. But we do appreciate, Minister, the actions you are taking today and the public education programme that you have embarked on recently.
The purpose of educating the public on basic hygiene, as I have said, was to slow down the spread of H1N1. There are some questions, hon Minister, that we would have liked you to have elaborated on; maybe one of the ANC's speakers can elaborate on them. Are the staff at hospitals using N95 respirator masks as opposed to common surgical masks in order to reduce the risk of being infected with the virus? The N95 respirator masks are the only ones that have been shown to reduce or alter the infection ability by 95% in order to help medical staff not to contract the virus.
Minister, you also mentioned that you would like vulnerable groups to receive Tamiflu at the first signs of flu or H1N1 infection. But on our recent trip to the Eastern Cape - and the portfolio committee members can attest to this - we saw queues at public health institutions where people couldn't even access ARVs. ARVs were at the dispensary, but people couldn't even get to the front of the queue in order to get that medication. In fact our bus driver's wife had been waiting for a week for her ARVs and was sent to hospital because she fell ill. What steps are in place to ensure that vulnerable groups will receive Tamiflu timeously and not have to wait in long queues?
We would also like to know what strategies the government has for infection control at public health facilities. A sure way of ensuring the fast spread of H1N1 is to have people with those symptoms waiting in waiting rooms for hours on end, infecting everybody around them. So, what strategies do we have in place for people we suspect have the virus to receive medication other than them waiting in waiting rooms all the time?
We commend you for your comments with regard to creating our own capacity for vaccines. But what have we done in order to place orders, hon Minister? While we appreciate that Europe and America want to look after their own people first, have you taken any steps to order the vaccine and how do you envisage ensuring that vulnerable groups get the vaccine? [Interjections.] [Time expired.]
Deputy Speaker, while we welcome the belated interventions with regard to the H1N1 virus, the strategy - assuming that there was a strategy - appeared to be to simply pull down the shutters and hope that it would go away; just like an ostrich that hides its head in the sand believing that danger will pass.
At first, the country was told not to panic, that everything was under control and that this epidemic was something happening far, far away. Furthermore, the country was told that this must just be treated as normal influenza and that people must stay at home and it would go away. Then people began to die. Suddenly the department began to issue warnings to vulnerable people, the HIV positive, pregnant women, etc. The department admitted insufficient laboratory capacity and medicinal resources to protect the citizens of the country against this potentially lethal virus. Given the dynamics of the very mobile population, it should have been expected that no country could escape the spread of this virus and others. It is therefore incumbent on a responsive government to ensure the timeous and efficient implementation of strategies to minimise the impact of such eventualities, and have transparent communication and education at the earliest possible opportunity.
We extend our sincerest condolences to the loved ones and the dependants of those who have succumbed to this dangerous virus. We wish all those who are currently fighting the virus a speedy recuperation and call on the Department of Health to take all steps necessary to prevent further spreading of the virus and ensure sufficient availability of personnel, laboratory capacity and vaccines. I thank you.
Madam Deputy Speaker, hon President, hon members, the IFP has been made aware of the promotion of the rapid testing kits for the H1N1 virus, which are not endorsed by the National Institute for Communicable Diseases, the national Department of Health and the WHO. The IFP wishes to caution against reliance on non-laboratory- based tests with low levels of sensitivity to test for the H1N1 virus.
We call on doctors who have high-risk patients to continue treatment for flu while they are waiting for the outcome of results. We support the hon Minister in his call for doctors to prescribe Tamiflu to high risk groups, including pregnant women. I thank you. [Time expired.] [Applause.]
Deputy Speaker, I would like to start by thanking the hon Minister for his honesty when he said that we have not done enough to deal with effective communication on this matter. When I raised it in the House yesterday, hon Minister Manuel stood up and defended it. Obviously, today the hon Minister of Health has confirmed that we have not done enough.
I want to share with hon Minister Manuel, in his absence, some advice late that my dad gave to me: "You must learn to shut your mouth when you don't know what you are talking about." So, I hope he takes that message with him.
Deputy Speaker, I still believe that we are not effectively communicating the fact that symptoms differ slightly from adults to children and to pregnant women, the fact that HIV positive patients are more susceptible to contracting the virus because of low immune levels and that this has the potential for disaster in our country.
The Minister called for the urgent administration of Tamiflu to pregnant women yesterday, but the manufactures of the product state on their website that this medication is not recommended for pregnant women as the effects on the unborn child are unknown.
Discouraging people from visiting their doctors or undergoing routine lab tests will only serve to further exacerbate the problem. [Interjections.] [Time expired.]
Deputy Speaker, I prepared this statement first, but I feel it has been overtaken by events after the hon Minister presented his statement.
The Minister's statement today reiterates a message that should perhaps have been spoken sooner or more loudly. However, the UDM appreciates the statement by the Minister as it has allayed the fears that the UDM had.
The fears are as follows: avoiding the unnecessary cause of panic and potential detrimental rush for treatment; the balance that needs to be struck between general public awareness on the one hand and targeted treatment for those who actually need special medication and treatment on the other hand; and the identification of high risk potential patients by medical professionals, particularly pregnant women and HIV infected people and providing them with the relevant medication. These have really been addressed by the Minister. That is why I say the Minister has allayed the fears that the UDM had. Thank you, Deputy Speaker.
Deputy Speaker, the ACDP extends their deepest sympathy to the families and friends who have lost their loved ones due to this virus. The ACDP has also been calling on Minister Motsoaledi for some time now to address the nation regarding the increasing numbers of people being infected with the H1N1 virus and to detail measures put in place to ensure that public hospitals and clinics are on alert and prepared to handle patients as serious cases increase.
The public needs this reassurance as a lack of communication increases speculation and a panic reaction. So, we appreciate the Minister's efforts to address Parliament and the nation and to communicate broadly.
The need to sensitise the population regarding this virus and the need to treat all flu symptoms seriously has been and still is important. This is not just because H1N1 flu poses a threat, but also because all kinds of flu are becoming increasingly problematic and that simple health and hygiene education significantly reduces our vulnerability.
South Africa's susceptibility, due to the vast numbers of people living with HIV and Aids, has been of particular concern. The fact that pregnant women, children and young adults appear to be vulnerable adds to this concern. [Interjections.] Okay. Thank you. [Time expired.] [Applause.]
Re le UCDP, re isa matshidiso go malapa a ba ba latlhegetsweng ka ntlha ya bolwetse jo. [We, as the UCDP, would like to convey our condolences to the families who have lost their loved ones due to this disease.]
As colleagues have already maintained, the virus is deadly. Precautions have to be taken through advocacy campaigns to register its symptoms, what to do when one has symptoms, when to seek emergency care, the medication available for the disease and who is at risk.
The UCDP supports the fact that should a significant number of learners or students or residents of an institution be affected by the spread of the influenza, an outbreak investigation should be made and decision-making should take place on how to asses and address the situation.
The number of death cases was reported as 20 this morning, and the Minister has already confirmed this. We are saying, as hon members and public representatives, let's join our hands together with the Department of Health and fight the virus. I thank you. [Applause.]
Madam Deputy Speaker, Mr President, Mr Deputy President, Ministers present, Members of Parliament, I am not going to take very long, but I want to start by making a positive statement. I don't think we can be defeated by a unicellular organism whilst we are multicellular organisms, including our brains. [Applause.]
Before I touch on the H1N1, let me digress a little. If someone confides in me about something, and I do investigations to find out what is actually going on, that person and I have a contract. If I go and blurt it out to the media, then I would be breaching the confidentiality. This is with reference to our young lady, Caster Semenya, where health professionals did something that should not be done.
I was looking at most of our laws - I am not sure if I've missed it - trying to find a law on genetics. We need to look at whether we can't have a law on genetics in South Africa so that we can try and handle some of these things. Those health professionals need to explain why they breached the confidentiality. I was just digressing.
Let me come back to the H1N1. This is a virus, and it is unicellular. It is not only unicellular, it is a nucleus. It could be RNA or DNA. Because viruses are small and unicellular, they can mutate. All I'm trying to say is, let's not think this is the last of them. Next year we might get a new one that is going to mutate. All we need to do is to ensure that our researchers are on their toes searching for solutions to diseases that mutate and cause problems. Most of us who are well and do not have any particular disease need not worry much. I am not saying that this does not cause death. People do not die as a result of viruses, but from other conditions associated with the viruses. If a person suspects that they have H1N1, they must protect themselves because there are opportunistic infections that can kill more than the virus itself. The only viruses that kill are those that affect the heart and cause it to stop suddenly. This happens when someone has cardiac arrest. That is where the problem lies.
The Minister said very clearly that people who are vulnerable to this disease must be considered. For the 20 patients who have died, I wish I could get their postmortems so that we could know what caused their deaths. There might have been something that was underlying that might have caused the deaths over and above the virus. I am trying to allay some of the anxiety. I am not saying this is not a serious topic, but we must know that it might be around for some time and that we might even get new viruses. This won't be killing everybody but only those who particularly have problems.
With regard to emergency institutions like hospitals, if somebody goes there displaying lethal symptoms, they must be attended to before other patients. For example, if you are pregnant or have cardiac problems or lung problems, then you must be treated before other patients because you might have this virus. You must be admitted before it causes problems. These are some of the things we need to do, and the department is capable of handling these things.
We must remember that our country has poor people. Poverty goes with malnutrition, and malnutrition goes with low immunity. Low immunity might cause problems in the rural areas. The department is aware of this and it is going to handle it.
This virus is transmitted through touching. It does not jump from person to person, but it is transmitted through touching or getting close to another person. The closeness does not involve sexual intercourse. It is just closeness to a particular person.
When we talk of a low immune system, we must remember that stress and depression can lower your immunity. If you have stress from your parliamentary work, you must be aware that the H1N1 virus might attack you.
In conclusion, I would like to say that we all need to get Tamiflu. I know that the department has it, but we must remember that if we use it before being infected, the virus is going to develop resistance because it mutates easily. Like I said, it is unicellular and mutates easily. In fact we might not have another drug that could be used on this.
As the ANC, we are confident that we cannot be defeated by a unicellular organism. In fact, the ANC, being a uniparty, defeated all multiparties since 1994 until today. So, we cannot be defeated by this virus. Thank you. [Applause.]
Order! Hon members, I wish to take this opportunity to acknowledge the presence in the gallery of His Royal Highness Prince Guduza Dlamini, the chairperson of the SADC Parliamentary Forum and his delegation. You're welcome to the National Assembly, even though it's at the tail end. [Applause.]
Madam Deputy Speaker, on a point of order: I am sorry that the hon doctor has finished. I wanted to ask him why he looked at the President and at me when he talked about vulnerable people. [Laughter.]
I looked at you and not at the President. [Laughter.]
There are two reasons why I looked at you and the President. I looked at the President because as the President of the country, he carries all the stress of the country. That might lower his immune system. The reason I looked at you is because you said you are an elderly person. [Laughter.] The elderly might have problems. [Laughter.]
Debate concluded.