COVID-19 Update & Vaccination Programme: Department briefing

Meeting report

DoH briefing on Covid-19 and vaccination programme

Dr Melvin Moodley, Director: Health Intelligence, Western Cape Department of Health (DoH), took the Committee through the Covid-19 situation and the vaccination programme in the Western Cape.

He said it was estimated that 15 million people worldwide had died of Covid-19. The progression of Covid-19 in the Western Cape was similar to the rest of the country. Wave one was more severe than wave two. Wave two had a higher peak, but was not as wide as wave one. Wave three had a high peak, but was wider than wave two. The more cases there were, there more deaths there were until wave three.

In December 2021, the Omicron variant went high, but the deaths seemed proportionally lower. This was referred to as de-coupling. It meant they had a lot of cases but with not many deaths. There were a number of factors for this. One was the virus itself. Scientific evidence pointed out that Omicron was less severe than some previous variants. The second point was that people had achieved a level of protection in the form of vaccinations and previous infections. If one got an infection, one got a degree of protection. The combination of the two resulted in de-coupling of the cases versus the deaths. When it came to the resurgence of cases during May and June 2022, there had been a few deaths but much fewer than in the previous waves. Wave one took 106 days, wave two took 292 days, wave three covered 120 days, and wave four had only 64 days.

Currently, there was a movement away from the Covid-19 regulations and things were getting back to normal because people needed jobs. There had been a severe drop in Covid-19 cases. Fewer people were testing. There were measures that showed the cases were decreasing. The hospital admissions were very low. Deaths were significantly lower than the number of deaths in previous waves. There was also something called "proportion positive," which referred to the number of positive tests when tests were done. The higher the number, the more significant the impact of Covid-19. At the peak of the previous resurgence, if ten tests were done, four would come back positive. Now, ten people would test and one would come back positive. Geographically, the numbers were going down throughout the Western Cape, including the rural areas.

Dr Moodley informed the Committee about the reproduction number -- how fast the virus could be transmitted. For example, if one got sick, one could pass on the virus to another person. If there was a reproductive number of two, this meant one got sick and passed the virus on to two people, and the two people would pass it on to another four, growing exponentially. If the reproductive number was below one, the number of cases would decrease over time until it reached a very low baseline. At the moment, the reproductive number was below one. The province was on a downward trend.

He said the DoH was also doing wastewater sampling. This meant if one was sick with Covid-19, in your stool, there would be a Covid-19protein in one's stool. When public sewage was tested, they looked at the amount of those particles to tell if there was a wave increase. There were generally no increases in wastewater at the moment.

Dr Moodley spoke about a new variant with eight pieces slightly different from the other variants. The Department was still studying this virus at the moment, but was not much worried about it because it believed it would behave similarly to Omicron and protection from vaccination and previous infection would remain. The Committee would be updated about this development.

Concerning excess deaths, he said one needed two things to know if a person had died of Covid-19. One needed to have the person tested, and to know that the person had died. When a person had not been tested and dies, but had Covid-19 and that had not been known, then one would technically know that the person had died of Covid-19. So scientists look at all the deaths and ask themselves why there were more deaths now than at any other time. Something had to account for it. Since there had been Covid-19 for the past two years, it has been the major contributor to excess deaths. The excess death matched the Covid waves in SA. Excess deaths during wave four had decreased in the country and the Western Cape. The excess deaths had not been seen rising above the upper limit in the country and the Western Cape. The country had had 326 000 excess deaths, while 32 000 excess deaths were in the Western Cape. This meant most people have died of Covid-19.

Measles and monkeypox

Dr Moodley referred to measles and monkeypox, and said there were four confirmed cases of measles in the Western Cape. They were not linked, and the Department was concerned. The potential for a measles outbreak was very high because of the decrease in Covid-19 vaccinations. The measles outbreak would have a huge impact on children and adults. The Department was not concerned about monkeypox for a number of reasons. There were three cases in South Africa (SA), including the Western Cape. The cases were not linked, and there had been no secondary cases from it. The Department was keeping a close eye on it.

He also confirmed the death of an individual from a vaccine in SA. The case had been investigated by the South African Health Products Regulatory Authority (SAHPRA). The individual had been vaccinated and later developed Guillain-Barre Syndrome (GBS), and had died from it. This was the first reported death in SA, while 37 million vaccines had been administered. The excess deaths were over 300 000, so the vaccines were still the safest medications available, and the benefit far exceeded the side effects and deaths that the vaccines might cause. A recent study estimated that during the first year of the Covid-19 vaccination programme, 19.8 million lives all over the world had been saved, thus avoiding plus minus 20 million deaths.

Western Cape vaccination programme

Dr Moodley also took the Committee through the vaccine inputs in the Western Cape. The province has now administered up to 5.5 million vaccines. It was a combination of first and second doses and boosters. Three million individuals had been vaccinated. 52. 5% had received their primary (first and second) doses. More older people had been given priority regarding vaccination over younger people. 579 000 booster doses had been administered. The percentage of people who received the boosters was much lower. The province had achieved the 70% target among those over 60 years of age. Concerted efforts were being made to increase vaccination uptakes in the younger age groups.

Around June/July 2021, the uptake of vaccines in the whole country was very high, but it went down after that. It was not about the capacity of the province to give out vaccines, but a question of fewer people coming in to receive the vaccines.

As far as the rollout strategy was concerned, the Department wanted to integrate vaccines into routine care. While the focus had been on Covid-19, it should be remembered the Department had to take care of other matters like HIV/Aids, TB, cancer, etc. Across the world, there has been a decrease in service delivery in some of these areas. Covid-19 should be part of the routine services. Also, people should understand it was easy for them to come to the Department for vaccination. 

The focus was going to be on the younger age groups, and the outreaches would focus on a school-based vaccination programme. This would be done in collaboration with the Department of Education. The number of sites for vaccines was going to be rationalised. It was all about maximising efficiency. The Department wanted to do geographic mapping of the vaccination coverage. The aim was to do targeted outreach. It would continue working with the private sector sites and pharmacies to ensure people continued getting their vaccines there. The strategy was to make people want to be vaccinated and be knowledgeable about them and their risks to make good decisions about themselves. The Department would continue with its communication campaigns to encourage the uptake of vaccinations. The 72% integration meant one could go to the facilities for routine services and get vaccinated.

The Department was proud of the Vaxi Taxi because of the mobile service it provides. This was about taking the services closer to the people, especially in hard-to-reach places. The communication was high-end and targeted to give the people the information they needed to stay safe.

Lastly, he said there were challenges as well, because the vaccination figures had dropped and the vaccination sites were empty, or had very few people. This was the reality across the world. There was a decrease in the uptake of primary vaccines and boosters in all age cohorts. The Department would continue community mobilisation to encourage people to take vaccines. Every opportunity was an opportunity to inform people and encourage them to get vaccinated. Vaccinations remained the best protection against Covid-19, particularly against severe illnesses and death. Long Covid was a very serious problem, because it could be debilitating.

Discussion
The Chairperson wanted to know if the data on low vaccination rates presented to the Committee was still the same in some of the areas of the Western Cape that have been mentioned, and if there should be adjustments to the outreach programmes.

Dr Moodley pointed out that the areas of concern were Khayelitsha, Mitchells Plain, Delft, Blue Downs, Matroosfontein, Macassar, Blackheath, Eerste Rivier, Khayamnandi, Crossroads and Central Karoo. It was mainly the young people. The dashboard indicated low registration in these areas.

Ms R Windvogel (ANC) asked how dangerous monkeypox and measles were, and if there was a connection between Covid-19 and these two. She also asked for clarity on the reproduction rate and what the Department had used to measure it. What programmes were in place to allay the fears of the people about vaccination?

Dr Moodley pointed out that monkeypox did not have a high fatality rate and did not spread faster than measles and Covid-19. It did not happen all over one's body. Three cases had been reported in SA. Measles spread faster than monkeypox, and mostly affected children in poorer communities due to malnutrition and other reasons related to a lack of basic necessities. The population needed to be vaccinated to curb the outbreak of measles. With Covid-19, people went less frequently to doctors, mainly because of the lockdown regulations. The number of measles vaccinations had dropped all the world over.

He said the reproduction rate was working backwards, especially when one looked at the cases and the number of increasing cases. The DoH looked at how the cases were increasing, and worked backwards. If the cases were increasing exponentially, the reproductive rate was higher, and if they were going down, a backward calculation was done to get that number. It was below one at the moment.

Mr D Plato (DA) wanted to know what the stance of the Department was concerning the much talked about fifth wave and the wearing of masks. He had recently listened to the RSG and SAfm radio stations, where medical experts had indicated their concerns about a fifth wave during September. He wanted to know if they were at a level where they could say Covid-19 was behind them. These medical experts indicated that one should continue wearing masks in buildings like shopping centres and big sporting events. On the other hand, government had indicated wearing masks was unnecessary. Now the public did not know what to believe.

Dr Moodley said there was a new variant, and a waning immunity caused by antibodies and measures that were used to prevent Covid-19. South Africa had decreased regulations. There were no limitations anymore. The government had tried to balance how to react to Covid-19, including protection. It had considered the decrease in Covid-19 deaths and tried to strike a balance. The scientists had supported the dropping of regulations. The decision had been carefully considered. A National Blood Transfusion Service study stated South Africa had good protection measures against severe illnesses. The best thing was to wear a mask and get vaccinated.

Ms A Bans (ANC) enquired what the Department's concern was about the measles outbreak. She remarked there had been a drop in figures on Covid-19 testing, and asked if it could be that people were getting healed without the vaccination. She further wanted to find out if scientists had identified the possibility of side effects when testing the vaccines, as a death had been recorded because of the vaccine for Covid-19.

Dr Moodley said there was a concern about measles, and it was important to vaccinate.

He said there were two ways of getting protection from Covid-19. One must get vaccinated and get a booster shot. That was good protection against severe infection. If one gets infected, one develops a degree of protection, and when one gets vaccinated, one also gets a degree of protection. It was better to be vaccinated, and the risks of getting infected were lower. Everything one did in life had risks. The vaccines – Johnson & Johnson and Pfizer - were the safest medication they had and had been extensively tested. The side effects were exceedingly rare. Nothing in life was without risks. The individual who died because of the vaccine had received the Johnson & Johnson vaccine. He had developed an illness called GBS. It affects the nerves and one's body becomes weaker and weaker. One would start to recover after two to three weeks.

Ms Windvogel asked what criteria had been used to educate the vaccine sites in Khayelitsha, Mitchells Plain and other areas.

Dr Moodley said the Department was trying to keep everyone vaccinated. It needed to be strategic about where it used its resources, especially when there was a low uptake of vaccines in places like Mitchells Plain, Khayelitsha and Central Karoo. There were outreach programmes, and the Department was mindful of equity and poor areas. It was working with religious groups and community organisations to encourage vaccination to increase demand. It was all about creating a demand. He indicated the Department had multiple strategies and programmes to increase vaccination in the Central Karoo. He would find out if Vaxi Taxis were operating in the Central Karoo to increase demand at these vaccination sites, and more information would be sent to the Committee.

Mr Plato remarked that the presentation had been informative. There was a low vaccination uptake in the younger generation group, which was a big worry and more needed to be done. The low uptake of boosters by elderly people was also a great concern.

Dr Moodley said he wanted everyone to get a booster, and people were encouraged to take them to keep themselves safe.

The Chairperson said the Department should try to revise its communication strategy, because young people needed to be spoken to by other young people.

Resolutions
The Committee resolved it would request information from the Department about the vaccination taxis in the Central Karoo, and to provide it with data on vaccination complications in the Western Cape. The Committee further indicated the Department had good intentions, but it was not communicating them to the people.

The meeting was adjourned.