FFC Analysis of health sector; CCOD & MRC 2021/22 Annual Performance Plans

Meeting report

Financial and Fiscal Commission Presentation
Professor Trevor Fowler (Commissioner), Professor Aubrey Mokadi (Commissioner) and Mr Chen Tseng (Research Specialist) presented to the Committee. 

COVID-19 Pandemic
-According to the Special Appropriation Bill (2021), an amount of R1.250 billion was appropriated to the vote of Health in order to procure COVID-19 vaccines and implement a related COVID-19 vaccine research project. This is in terms of section 16 (1) of the PFMA.
-Section 16(1): Use of Funds in Emergency Situations of the PFMA states that the Minister may authorize the use of funds from the National Revenue Fund in situations of exceptional nature.
-The increased funds are to lead and coordinate health services to promote the health of all by upholding national policies, standards guidelines and norms as well as to provide quality healthcare service delivery.
-Of the R1.250 billion; R1.1 billion will be committed through the Communicable and Non-Communicable Disease management. And R150 million will be used for the Health System Governance and Human Resources. 
-Furthermore, the DoH announced that, “a COVID-19 Vaccine Injury No-Fault Compensation (NFC) Scheme is hereby established in terms of section 27(2)(c), (m) and (n) of the Act…”. It may be Government-funded.
-The NFC would be a guarantee and assurance to citizens that their rights are fully protected during the process of the vaccination, and that there is sufficient recourse in place to deal with any adverse events that might occur once a person has been vaccinated.

COVID-19 Vaccines
AstraZeneca (was 5.35 USD per dose):
-Initially, the Department purchased a million doses of the AstraZeneca. However, through the human trials against the 501Y.V2 variant, it revealed that the vaccine had an efficacy rate of only 22 percent.
-The Minister confirmed that 1 million doses was sold to the African Union (5 250 000 USD) and 2.675 million USD was refunded by the Serum Institute of India for the 500 000 doses that were not delivered.

Johnson and Johnson (J & J) vaccine (Ad26.COV2. S):
-The J & J vaccine was the only alternative to have reached phase 3 testing in South Africa and has shown to have an 57 percent effective rate against the 501Y.V2 variant.

-Properties of the J & J vaccine:
1.The vaccine provided 64 percent protection against moderate Covid; 85 percent protection against severe Covid and 100 percent protection against death.
2.The vaccine had a shelf life of up to two years at -20°C. It could be stored at fridge temperature for 3 months.
3.It was administered in a single shot.

-The J & J vaccine programme was legally regarded as an expanded study and is currently not licensed in South Africa, (the documentation was with SAHPRA and it was reviewing it). With knowledge of this the Department entered into negotiations for formal procurement of the vaccine from J & J.

DoH
-Performance indicator for Programme 2: NHI indicates that “Total number of individuals registered on the national health insurance patient beneficiary registry” already registered 46 million in 2020/21, increasing to 50 million in 2021/22.
-The Department does not provide insight of how the registry integrates data from other data systems across private-public sectors to ensure information alignment between systems for efficiency of national health care services.
-Related to the above then, the 3.5 million patients in 2020/21 “…registered to receive medicines through the centralised chronic medicine dispensing and distribution system” seem to be a far cry from the 46 million patients registered on the NHI patient registry.
-The 2 100 “…primary health care facilities that qualify as ideal clinics per year” could consider measuring its proximity to the population, in order to improve ease-of-access (i.e., healthcare efficiency) as well as the service quality.
-The importance of accessible healthcare services is highlighted by the COVID-19 pandemic.
-“Number of points of entry where port health services comply with international health regulations per year” this is an indicator of the department striving for quality, yet the department (33%) ranks well below regional (41 percent) and global (63 percent) benchmarks regarding health service provision when using the same international health regulation standards.

South African Medical Research Council
-The number of published journal articles by (first and/or last) affiliated authors, grant holders with acknowledgement of the council etc. could lead to double counting of performance indicators. 4 indicators of number of awards by the council to MSc, PhD and post-doctoral candidates could also be double counting.
-There is a decrease in number of accepted and published journal articles associated with the Council in 2020/21, across all 3 indicators, projected to fall further over the medium term. Number of research grants awarded by the council were reduced from 247 in 2019/20 to 130 in 2020/21. 4 new performance indicators, for number of awards and innovation/technology projects, are presented in 2020/21, which do not allow for prior comparison.
-A budget deficit in 2020/21 of R36.4 million, after a surplus of R43 million in 2019/20, which is projected to balance by 2022/23. Total turnover is R1.2 billion in 2020/21. The deficit is mostly due to increased expenditure. However, revenue is projected to grow at a higher rate over the medium term. Expenditure on innovation and technology is expected to account for 24% of the budget in the MTEF. Additionally, there is an increase in cash and cash equivalents from -92 million in 2019/20 to 12 million in 2020/21.
-Regressive unit personnel cost for level 13-16 increasing from R1.7 million to R2 million; and for level 17-22 from R3.3 million to R4.0 million between 2019/20 and 2023/24.

Compensation Commissioner for Occupational Diseases in Mines and Works
-Substantial decrease in number of workers in controlled mines and works paid for loss of earnings while undergoing TB treatment per year from 4 498 in 2019/20 to 1 045 workers in 2020/21, with questionable projections for the outer years to remain at only 1 045 workers per year.
-Over the medium term, the Commissioner intends to focus on improving access to services provided to mineworkers, increasing the number of claims paid and fast-tracking the claims management process.
-Large cash outflows from investing activities, R57 million in 2020/21, increasing to R60 million outflow until a cash inflow of R35 million in 2022/23. In 2020/21, total revenue is estimated at R544 million. Substantial net increase in cash and cash equivalents, from R188 million to R261 million in 2019/20 and 2020/21 respectively, mostly due to changes in investing activities.

Council for Medical Schemes
-On 4 December 2019, CMS issued Circular 80 of 2019: Low-Cost Benefit Option & Demarcation Products that no Low-Cost Benefit Options (LCBO) will be allowed for low-income market segments going forward, and no products based on the Demarcation Exemption Framework and/or the Medical Schemes Act will be allowed beyond 2021. Over the MTEF period, CMS intends to develop a guidance framework for low-cost benefit options and finalise proposals for the Medical Schemes Amendment Bill and the health market inquiry.
-CMS reported substantial additional reserves and budget surpluses in 2020 across SA’s medical schemes as members avoided health care of all kinds. Furthermore, out-of-pocket expenditure has increased over recent years for medical scheme members. Combined with rising costs of medical scheme cover, this may indicate that health schemes are not serving their intended purpose amongst the Covid-19 pandemic, confirmed in Competition Commission Health Market Enquiry Report (2019).
-Unexplained performance issues and volatility in “percentage of category 1 clinical opinions provided within 30 days of receipt of complaints adjudication” – from 98% in 2017/18 to 54% and 69% in 2018/19 and 2019/20, respectively, before estimated to be 90% in 2020/21.
-Relatively stable financial statements of income and cash flow. Turnaround of the budget deficit of R26.6 million in 2019/20 to a surplus of R4 million in 2020/21, where total revenue is R177 million and R201 million in 2019/20 and 2020/21, respectively. Budget surpluses are projected to continue over the MTEF period.

(See Presentation)

Discussion
Ms D Hlengwa (IFP) asked why there was an unfilled post. Unfilled posts affected service delivery. She requested clarity regarding the medical scheme cover, specifically how it worked. What was the effectiveness of the National System of Innovation (NSI); who were the beneficiaries of the NSI in the programme?

Ms E Wilson (DA) expressed concern regarding the presentation, especially relating to the use of words such as ‘disconnect, ‘bizarre protections’ and ‘unexplained volatility.’ She asked whether the presentation had been presented to the Department of Health, specifically the Director General and the Minister – and their response to such a ‘depressing’ report. There were more questions than answers; it was an intense report with quite a lot of information that needed to be digested. She expressed concern about the potential collapse of norms and standards and the bizarre projections regarding oversight on clinics and public health facilities, as presented in the presentation. If norms and standards were not maintained it could cause the collapse of the entire healthcare system – particularly financially. There was already a bizarre situation regarding the number of medical claims and investigations going on in terms of the misappropriation of funds when it came to personal protective equipment (PPE) and other tenders.

As far as provincial health was concerned, the situation was collapsing in the rural areas. The reductions in personnel and budgets were cause for concern. She requested that the FFC provide more recommendations to address the situation and asked what the response was from the Minister. This did not throw the Minister in a good light, let alone the Department, he was the accountable officer.

Ms H Ismail (DA) expressed concern about the number of negative aspects highlighted in the report. What was going to be done to address the issues that were raised. The presentation highlighted the discrepancies and the state of clinics. Service delivery was affected on the ground. She expressed concern about the number of open posts. The state of health facilities was already in shambles in some areas/provinces; the fact that the Health Ombudsman was not doing what was supposed to be done was not helping residents on the ground. There were people dying. There were people sleeping on the floors and issues of patients not being given food on time. These issues should not be occurring in light of the COVID-19 priority. There were so many other things to worry about to improve the health system. How were they going to ensure that the National Health Insurance system was free from corruption and ensure quality healthcare when they could not even implement proper standards. Did the Minister know about this? Did the National Department of Health know about this? What would happen now – from a fiscal point of view? What was being done to address the matters that were raised?

Dr K Jacobs (ANC) noted that the FFC had only presented on six entities, a bit on the National Department of Health and very little on the provinces. He requested that in the future the Committee should receive another presentation to understand what the challenges were with the other entities and be provided with more information on the provinces.

Mr P van Staden (FF Plus) requested an explanation as to what the challenges were in the Department relating to corruption. What effects had corruption had on the Department of Health and on the health system? He referred to page 30, where it covered the vaccine roll-outs across provinces. It was stated that the North West province had various challenges such as contact tracing. Was this the only province that would have challenges with the vaccine roll-outs? In terms of the effects of corruption on the Department of Health and the health system, he had expressed his concerns the week before that, the Livingstone Hospital in Port Elizabeth (PE) had their operational budget cut by R100 million. Basic services could not be provided but medical claims against the Eastern Cape Department amounted to approximately R36.36 billion. Thus, he requested clarity regarding the effects of corruption on the Eastern Cape Department of Health.

The Chairperson communicated questions on behalf of Dr S Thembekwayo (EFF). To ensure informative alignment between systems for efficient national healthcare services, how would the beneficiary register be improved? What were their recommendations pertaining to financial irregularities, especially fraud, associated with PPE?

Mr T Munyai (ANC) stated that in a previous presentation a concern was raised regarding NHI and organisations coming to present through public hearings. The NHI expressed a political opinion, maybe it was something that did not need to be put before them at present but he would encourage them to address the key issues. The Bill had reflected how they would deal with corruption within the NHI. He was sure that they would also invite the organisations and entities that were reflected to be involved in corruption to present to the Committee so that they could direct questions that arose out of the Commission’s presentation to them. The figures presented might be indisputable if they had been raised. He never knew there were SIU sanctions against SAHPRA – he was sure if they called them this issue would be clarified. Those were the key issues he thought they needed to put forward so that those issues were reflected in any future presentation.

The Chairperson asked what of the presentation was already known by the Department of Health. What was their plan to improve on some of those issues? He noticed that there were certain issues relating to entities - he was glad that some of the entities would be presenting to the Committee during the course of the week. The compensation for occupation diseases – he was concerned about what was being spelled out – the Committee would follow-up with the relevant entities.

He asked to see slides 22 and 26. It would be expected that Gauteng would always have a proportionally bigger budget than the other provinces, he wanted to check what the variables were in relation to that. He asked whether they took into consideration the population size – as it related to KwaZulu-Natal (KZN) and the Western Cape. He noted that the Western Cape was an outlier. What were the other variables that were removed in finalizing slide 22? In reference to slide 26, he referred to the health outcomes of South Africa but then established that slide 27 clarified his query.
Prof Mokadi addressed the questions relating to corruption. He stated that it was difficult to assess the full impact of corruption in the health system. That would require a special dedicated study so as to conduct a proper analysis and assessment. Fortunately, government had identified and put in place mechanisms in terms of law enforcement, such as the SIU. They had already identified where such intervention was needed in some of the entities. It was regrettable that at the height of the pandemic they had to look behind their backs and realise the devastation that corruption, misappropriation of funds and financial irregularities relating to PPE had caused.

He addressed the question regarding whether they had alerted the Ministry of Health or the Department of Health about the issues highlighted in the presentation. The purpose of the presentation to the Committee was precisely that, to ensure that the Portfolio Committee would then hold the Ministry and other entities to account in terms of their performance.

Mr Tseng referred to the question regarding slide 22. The provincial budget in terms of inter-governmental relations was driven by the provincial equitable share. The equitable share formula was also determined by the population size per province. In that sense, on a technical level it had controlled for population size per province indirectly. Regarding the other questions relating to provinces, it was quite a difficult one to look at in terms of its health expenditure as health was a concurrent function. When it came to a provincial budget, the provincial discretion played an important role. When they said how much a province should spend on health, that was really determined at the provincial level with the exception of a conditional grant. When the FFC performed its job advising the Committee, they needed to take cognisance of the complexities invested in the inter-governmental system and to what extent they were able to inform such matters in terms of the fiscal landscape, as it related to governmental spheres.

On a national scale, the information they had and the research they had conducted was not unknown. It was all information expressed in the estimate of national expenditure, in the Budget and in the many briefings in Parliament. The National Department of Health also had areas that they could not ‘get into’ to fix things. They had not presented that particular presentation to the Department. Their duty was to report that to Parliament and to the Portfolio Committee. They welcomed further questions or additional information on the matters that arose with the entities or Department.

He addressed the queries about the financial irregularities and beneficiary system. The data systems needed to integrate – they needed to be live. The system needed to facilitate live tracking across private and public health institutions. This system should also be tracking the doctors and healthcare workers – to facilitate that alignment of functions. In terms of the financial irregularities, the key thing to consider was procurement. This did not only apply to the health sector but applied across government. Procurement was rule-bound and tightly monitored – however they were still not efficient. It was much bigger than just the health sector or corruption, it was about systems and processes of procurement that would ultimately determine whether the process and money spent was efficient.

Prof Mokadi referred to the question regarding the state of clinics and accessibility, particularly in rural areas. It was an issue of equity and this was really where they expected the Portfolio Committee to put its foot down in terms of holding people accountable and really requiring specific programs. This needed to be monitored and assessed with the proper record and evaluation of what progress was being made – as it would be sad to continue to increase the level of inequity throughout the Country – especially in terms of the health system.

Ms Wilson stated that there were still a number of unknown answers – and ultimately they would need to submit written questions in this regard. The report presented was fairly complex and as a Committee they would require further clarity on some of the issues. She referred to pages 26 and 27, where the NHI phased process was outlined. It spoke about an analysis of submissions, she requested more detail on this. She expressed that this was a critical issue. As a Committee they attended the public hearings, but they had not yet been in a position to process some of the written submissions. She thought they needed another view on the written submissions because the points made in the written submissions were important. Her concern related specifically to the inequality and access to the public health system.

In light of the fact that the NHI process was being asked to hurry, what had become obvious was that a lot of the information presented was not unknown. It was known, but what was also known was that there was no improvement. The public health sector had gone backwards – that was what was contained in the report presented. This was going to have a severe impact on the NHI. Until such time as those situations were addressed, NHI could not be considered at that point. Where there was inequality, lack of infrastructure and no personnel – they could not offer national health insurance. The health was not there. Without norms and standards, they could not have a national health system either. She asked whether they had been involved in terms of the large Cuban contingent who were brought out during the COVID-19 process at a huge expense. In their investigations in determining the state of the financial systems within the Health Department - was there any idea what effect the contingent of Cuban doctors had on the processes.
The Chairperson stated that he had hoped that he would have heard their comments regarding the investigation that was requested by the Minister of Public Service and Administration through the Council for Medical Schemes with regard to an allegation of discrimination by three medical aid schemes. Had they seen those financial discrepancies? What were their observations on the findings thereof?

Prof Fowler referred to the norms and standards. The investigation that had taken place occurred in the context of the COVID-19 pandemic – therefore one would note that a lot of the funds were diverted to the COVID-19 pandemic. The presentation was really about the impact of the COVID-19 pandemic. They needed to look at how they would respond to that issue given that funds were diverted to save lives and to ensure that the health system was not overwhelmed.

He responded to the question regarding the Cuban contingent. He could check with Mr Chen, but he suspected they did not have an opportunity to go into it in-depth as it was fairly recent.

Mr Tseng stated that they had not been able to look at the alleged discrimination by the medical schemes. As with most insurance instruments it would not make sense for any insurance scheme to have accumulated exorbitant amounts of surplus and deposits in redundant cash. That had been the characteristic of the South African healthcare market – especially health insurances. On the one end, one had private healthcare insurance and medical schemes that were over-priced and not fully utilised and so-forth – effectively very cost inefficient as identified by the Competition Commission. This created its own market through pricing. The issue was ultimately that, as a result of the separating equilibrium, there had to be ways to pull it together. There were only, in terms of economic theory and practice, two ways one could do that. One was through quantity demand and the other was through price. NHI was essentially a mechanism using price to force and pull that separating demand into one universal pricing. In their annual submissions they focused quite a lot on the sustainable financing and costing of healthcare services to try to conceptualise and think about how to pull the two markets together. When one walked into a clinic and was asked whether one had medical aid – if one said yes, a price list was pulled up that was way more expensive than if one said one did not have medical aid. That was the nature of the separating equilibrium. One had two markets. This was the root issue relating to inequality within the healthcare system – it needed to be addressed. In terms of the Cuban contingent, the FFC had not looked into that. They were happy to respond to this in writing, if included in a written query.

The FFC was excused.

Remarks directed to the Compensation Commissioner for Occupational Diseases
The Chairperson asked that the Secretary communicate the previous presentation to Dr Kristnasamy and asked that he consider slide 17. The FFC had raised the following issues regarding compensation for occupational diseases. The first, that the ‘Occupational Diseases in Mines and Works Act of 1973 mandated the Commissioner to collect levies from controlled mines and compensate lost earnings caused by occupational diseases of cardiorespiratory organs.’ The second, the ‘substantial decrease in the number of workers in controlled mines and works paid for loss of earnings while undergoing Tuberculosis (TB) treatment per year from 4 498 in 2019/20 to 1 045 workers in 2020/21 with questionable projections for the outer years to remain at only 1 045 workers per year.’ ‘Over the medium term, the Commissioner intended to focus on improving access to services provided to mine workers, increasing the number of claims paid and fast-tracking the claims management process.’ This was a positive statement on their side. The last concern was the ‘large cash outflows from investing activities, R57 million in 2020/21, increasing to R60 million outflow until a cash inflow of R35 million in 2022/23. In 2020/21, total revenue was estimated at R544 million. Substantial net increases in cash and cash equivalents, from R188 million to R261 million in 2019/20 and 2020/21 respectively, mostly due to changes in investing activities.’ The Financial and Fiscal Commission presented what they picked up in various entities. The Committee was lucky to be able to clarify these issues with the Compensation Commissioner for Occupational Diseases. He asked that these be clarified either when the members asked questions or should be followed-up in writing.

Compensation Commissioner for Occupational Diseases (CCOD)
Dr Barry Kristnasamy, Commissioner, CCOD, made brief introductions. He and his colleagues, Mr Gert van Heerden, Senior Manager of Legal Services, and Mr Mishack Maswanganye, Financial Director, at CCOD presented the presentation to the Committee.

The CCOD reported that the Annual Performance Plan reflects the performance targets for the CCOD for the 2021/22 financial year. The focus areas will be:
• The submission of amendments to the Occupational Diseases in Mines and Works Act, No. 78 of 1973, to the Director-General of the National Department of Health (NDOH);
• Maintenance of the database of controlled mines and works;
• Enhancing the claims management system; and
• The submission of annual reports of the Compensation Fund for the 2019/20 and 2020/21 financial years to the Auditor-General of South Africa.

There was a decline in the payment of claims at the CCOD as at 31 December 2020. The decrease in payments for the year was due to the national lockdown due to the COVID-19 pandemic. Over the 9-month period ending 31 December 2020, the CCOD paid 3,476 claimants R141 million with 35% going to claimants in neighbouring countries and 12,400 certifications were done by the Medical Bureau for Occupational Diseases. The Compensation Fund continued to pay monthly pensions to 69 pensioners in terms of the Pneumoconiosis Compensation Act, No. 64 of 1962 which preceded ODMWA. The monthly pensions are paid from voted funds.

Compensation of ex-miners is the CCOD’s largest area of expenditure. It is funded by levies collected from controlled mines and works, based on the number of risk shifts worked in the mine, and multiplied by a specific rate per commodity mined. Inspections are carried out to ensure that the numbers of risk shifts are not understated.

The budget for the administration of the CCOD, the provision of Benefit Medical Examinations and the activities of the Certification Committees are provided for within voted funds in the NDOH. There have been no substantial increases in the CCOD budget and the business reform processes at the CCOD have been supported by human, technical and financial resources from the Minerals Council South Africa. Substantial resources estimated at R150 million per annum are needed to expand and scale up the services of the CCOD, recruit specialised staff in the legal, information technology, occupational hygiene, medical and financial management disciplines and provide for the medical assessments, certifications, payment and infrastructural backlogs in buildings, medical facilities and information technology

The Covid-19 pandemic has had consequences for the provision of outreach activities and medical assessments for workers given the restrictions on gatherings, the movement of vulnerable persons and in particular concerns around administration of lung function tests. The CCOD also had operations stopped for varying periods of time based on the lockdown level and the need for health and safety interventions to prevent transmission risk of Covid-19 in the workplace. Inspections of controlled mines and works were also put-on hold. Telephonic enquiries were made to the controlled mines and works to assist with revenue assessments.

(See Presentation)

Discussion
Ms N Chirwa (EFF) asked what the update was on the one-stop services, as it was reported that they had failed to follow it through in 2019. The second issue, that was previously raised, was that respiratory illnesses were not the only issues that came up in the industry; there were issues such as diabetes, strokes, loss of hearing, neonatal and maternal fatalities etc associated with the industry but these were not outlined. Why had they not covered the other issues associated with the industry – health issues specifically - and why people were not compensated in that regard? What happened when someone was put off work as a result of a stroke – how was that recorded? What was the possibility of CCOD expanding its lens in terms of occupational diseases that miners got? There was substantial evidence to support the fact that there were not just respiratory illnesses. She requested the names of the mines that failed to pay levies. What action had been taken to ensure that they did pay? There was a stark contrast of priorities. They should not be debating with CCOD why mines were not paying. They needed to provide tangible processes i.e. this was what needed to happen for a particular mine to pay. It happened year in year out. What punitive measures should be taken against mines that were not paying levies?

She stated that there was a lot of evidence regarding the after effects of COVID-19 that expanded beyond respiratory illnesses. Miners were significantly exposed, especially the previous year. There were also suggestions that COVID-19 regulations were not being followed by mines. What was CCOD doing in that regard? They had spoken a lot about the fact that the claims management system would be enhanced – she requested clarity as to what exactly the ‘enhancement’ involved. She also requested clarity as to what claims system was presently in place – what did it look like and how would it be enhanced? When would the enhancement be completed? It was frustrating to hear the hopes and aspirations of entities – it was not cutting it anymore. There needed to be reporting of tangible progress. The same questions were asked in 2019.
Ms A Gela (ANC) appreciated the questions previously raised by the Chairperson, and she hoped the Committee would get responses to the concerns by the time the CCOD next appeared before the Committee. She requested an update on the working relationship between the CCOD and the Tshiamiso Trust on the court case on silicosis – had the memorandum been signed? What was its contents? Did CCOD foresee its offices being regionalised – given its role in society? Did they own their own office space or were they renting? If they were renting, how much did they spend annually? She raised the issue of ex-mine workers – how long did it take for them to be paid? There were some concerns about the delays in payments. Could they check across provinces what was happening? In terms of the financial statements, she requested further clarity on how they would correct the concerns; she suggested that they provide updates to the Committee at a later stage on the audited financial statements. She realised they were trying to put their house in order in assuring compliance. Her chief concern related to the financial statements – specifically the submission of reports on time.

Ms Ismail referred to the report where it stated that the Risk Committee was not functioning optimally – she requested clarity as to what was meant by that and what their mandate was. The report stated that they had issues with the system which had resulted in their inability to pay claimants. The mitigation strategy was to ensure regular updates and manage turn-around times. She wanted clarity as to how exactly that was going to be done and what measures had been put in place to address that. How many mines were currently non-compliant? She requested the names of the mines that were non-compliant. If year on year there were changes in terms of which mines were non-compliant – the Committee should be aware of this. It was stated that there was a shortage of financial inspectors. She requested clarity as to how many financial inspectors there were presently and how many they required in order to perform their work constructively.

Dr Jacobs stated that while the Committee appreciated the work it took to get the financial statements in order, they also noticed a few things that were raised by the Compensation Commissioner. He requested clarity regarding the finances awarded by the National Department of Health within the budget vote and the levies. What was the impact of COVID-19 on the receipt of levies and how had that impacted the work of the CCOD? What was their understanding of how cooperation with the Department of Mineral Resources and Energy would enable them to certify any closed or redundant mines? What was the process to get to that point? How far was the process of moving everything to the electronic database system? When would this process be completed? When did they foresee the Risk Committee assessing the mines and works to be improved? He wanted to support the Compensation Commissioner on the amendment of the Bill - he would appreciate an update as to the progress they were making in this regard.

Ms Wilson stated that a lot of emphasis had been placed on mines - she understood the importance of that. What had come to light and continued to come to light was the amount of asbestos that was in the schools and clinics around the country. She understood that the team was particularly short staffed in terms of inspectors and financial inspectors. She requested an update in this regard. The shortage of staff was a significant issue – what was being done to address that? Did the Committee need to do something to ensure that it happened?

There were not just respiratory diseases, many of the diseases turned into cancers and they had seen a huge spike in cancers in the Country. Getting these issues under their belt was quite important. With regard to the Bill, the Committee was obviously looking forward to it being finalised. It was a critical issue. She appreciated seeing some progress on the annual reports, it was still very slow. She stated that the Committee looked forward to getting that finalised.

The Chairperson stated that he had spoken to the Chairperson of the Portfolio Committee on Labour – the issue of the compensation of miners for lung and heart disease took place within the Department of Health. However, if one had any other challenges in the body – it was handled by the Department of Labour. This responsibility was with Parliament – the two Portfolio Committees needed to sit and agree on their respective mandates. This matter should be resolved amongst the committees this year and they would get the Ministers to agree in that regard.

He requested that slides 20 and 21 be shown. He wanted to know where they were in terms of the departmental schedule of the vaccination of mine workers. He requested clarity regarding the register of mines that were and were not doing well. There was a particular project referred to that related to the management of TB – he had not heard the name of the project – and requested clarity on that.

Dr Kristnasamy stated that they had hoped to resolve a number of issues much quicker – however it had unfortunately taken a significant amount of time. He realised that it often sounded like promises and aspirations – especially to those who had sat on the previous committees. They had struggled to manage within the funding constraints. They had to negotiate funding of the Compensation Claims Management System – the cost was around R30 million to setup. They previously had manual documentation and they had IT systems that had completely collapsed. They would compile a formal report back to Parliament regarding the timelines – they were awaiting the finalisation of the Budget from Mineral Resources. The system was state of the art and would change various aspects of the process. They had an interim management system operating presently which was carried by IP Capital. This system was meant to be fully in place by at least the end of the year.
In terms of the FFC, they would provide a response to that. There were about four or five issues that the FFC had raised. They raised the issue around the collection of the levies. There were two budget lines and the Compensation Fund was the R4.8 billion fund that only paid benefits – lump sum amounts to the claimant. That was the budget where they collected levies from the mines. They could not use any of that money for administration or for benefit medical examinations or setting up the one-stop service centres or to pay for the Certification Committee members (the doctors that came and rendered services). That Fund was strictly to pay for the evaluation, bank charges and the social protection benefit. They did get a legal opinion on this. This was one of the issues they were trying to address through the amendment.
The second issue was the decrease in the number of workers in controlled mines and works. It was a special programme that started in 2015 on reducing TB in mineworkers. It was a programme run through the Minerals Council. The measurement, reporting and intervention on TB in mine workers. Part of that was silica dust exposure and follow-up with workers. If one looked at the ‘hay days’ of the mining industry – there were about 1 million mine workers historically in the 70s and 80s which had come down to about 500 thousand. If one looked at the number of workers doing risk work, where they had exposure to diseases and dust levels – there were close to 200 000 that were doing underground mining. Many of the gold mines were in the process of closing. Many of the multi-nationals had exited gold mining. There were predominantly open surface cast mines such as platinum, coal, iron-ore and chrome. There was still some dust associated with these mines – but it was not as bad as with silica dust exposure in gold mining. That was part of the issue relating to the decline in the number of exposures. Consequently, there was a decline in the number of workers who were coming up with occupational lung diseases.

In terms of improving access, they had pointed out that they were trying to do so. They were talking to the Tshiamiso Trust in terms of service delivery access and they pointed out that the Global Fund had stopped funding the neighbouring countries. They were still trying to improve access to services – despite the overlap with COVID-19. Hopefully the vaccinations would help although it did not prevent transmission – at least it negated the severity of the disease. The same grouping they were working with, ex-mine workers, were in the vulnerable age category in terms of COVID-19. The cash out-flows related to decreasing levies based on the evaluation – in terms of moving funds from the investment side. These were money market accounts; they were not in dubious investments but they were moving them into operational activities to pay for the social benefits – hence the FFC had flagged that. They would provide a formal written response relating to the slide of the FFC.

He addressed the question regarding expanding the role of the CCOD. Unfortunately, the law restricted them to occupational lung diseases including tuberculosis and the Department of Employment and Labour handled other diseases of the body. They hoped that this separation would be resolved within the current term of office of the administration, through the leadership of the Portfolio Committees. Hearing loss was covered under the Compensation for Occupation Injuries and Diseases Act No 130 of 1993 (COIDA). When they next had a joint sitting with the Portfolio Committee on Employment and Labour this could be presented. They knew that occupational lung diseases like silicosis, TB and hearing loss had been severe problems for mine workers. Interventions needed to be made beyond TB.

In terms of mines paying levies, the CCOD had needed to clean up its act, in terms of the revenue framework but it did know the names of the various mines. He offered to send a formal written response once they had checked this. They had discussed ‘naming and shaming’ with the Minerals Council. They could go to court in terms of forcing the agenda, but the closure of a mine or temporary suspension of licenses was with the Department of Mineral Resources – they had the stick, CCOD only collected levies. That would be one of discussions they would need to have with the Department of Mineral Resources in terms of how they could assist the Department of Health in the collection of levies. They also had inspectors. CCOD had needed to straighten out its own income statements and financials as many of the mines had complained that they had already paid their levies.

In terms of COVID-19, the long-term issues were concerning. They did not have a proper surveillance system in place but they had raised the issue and suggestion with the Minerals Council of trying to do a special study on long-term COVID-19 implications on mine workers, specifically the impact on the respiratory system. These were issues that were in progress. Later that week the Medical Research Council would present, this was perhaps some of the work they ought to be doing. So far there had been limited support in terms of research into occupational health and diseases – as well as support for interventions. This might be something that the Committee members could follow-up with the Medical Research Council.
In terms of the vaccination programme, there were three delivery mechanisms. There was delivery to community, delivery to work places and to institutions (i.e prisons, frail care homes). They were working with the mining companies and auto industry. There were 50 million workers in the formal sector and seven million in the informal economy. They would provide a report back in this regard – in line with their regular updates. There was a readiness system in place presently for the private sector in terms of occupational health services. There were 181 sites, many of those sites were in mining companies, whom were readying themselves for the phase 2 roll-out of the COVID-19 vaccination. The big difficulty they were having was in the retail and trade sector where there were about three million workers – and they did not have any occupational services. They were looking at some models around max vaccination sites such as Sandton shopping mall for example. They were currently in discussions in terms of that delivery mechanism. They were looking at saving lives, opening the economy and ensuring that mining amongst other sectors of the economy were covered in that regard.

In terms of the Compensation Claims Management System (CCMS), they would provide feedback regarding the dates, times and inputs – provided they could get funding from the Department of Employment and Labour. In terms of the working relationship with the Tshiamiso Trust, they currently had a data sharing agreement, but the memorandum of agreement (MOA) would need to be carried out through the legal section of the Department of Health because it was a substantive agreement which covered overlapping certification committees, database links and payment processes. The Trust gave an additional amount of money over and above what they paid – if CCOD paid R100 thousand, the Trust would pay an additional R250 thousand to the individual. These were some of the discussions they were having. Within the next two months, they would get the MOA going.

In terms of regional offices unfortunately they did not have a budget to decentralise the administrative core, presently they had severe problems in terms of maintaining the current work. They would not be where they were with many of the services that they delivered historically. Many of their colleagues who had presented had been seconded from the mining industry. If the levy changed and they became a new governance structure on their own – they could run their own business. Right now, they were dependent on the goodwill of the mining industry – notwithstanding the cross-subsidy.

The rental amount would be communicated to the Committee in writing. It was a Public Works building, but they did spend annual rent on it which was paid from Pretoria directly to the Department of Public Works.

It could take as long as five years for ex-mine workers, once they had registered a claim, to get it paid out. For the most recent grouping it was within three-months. In the first month the claim was registered, in the second and third it was certified. They were sticking to that in terms of the annual performance plan (APP). In terms of the past performance, they had managed to do that for 81 percent of the new claims registered on the system. There were problems with the ex-mine workers and legacy issues, partly because they were working with the Eastern Cape Office of the Premier in terms of trying to move the process forward. In terms of the financial statements, he had pointed out the legacy they had come from. They hoped that by July 2021, they would have submitted this year’s financial statements, ending 31 March 2021. They would try and have one meeting where all five financial reports were presented.

The Risk Committee was chaired by the Chief Director of the Department of Mineral Resources and unfortunately the law made it quite clear that it could only be chaired by the chief inspector or the deputy chief inspector. It had been a major problem in terms of their time constraints – they owed their allegiance to the Department of Mineral Resources. This was one of the big issues they had – this would be changed as part of the amendment – specifically the governance structure. The Risk Committee continued to be an impending problem. They did not have a solution.

They had three finance inspectors presently. They covered the whole of South Africa. This was a major issue as many of the mines were scattered across the Country. The ideal number of inspectors was between 15 and 20. There was currently a moratorium in terms of the filling of any posts. There had been substantive cut-backs in terms of this process. They were trying to pick-up the non-compliant mines dealing with telephonic interviews and problems of working with the Department of Mineral Resources and Energy Inspectorate.
There were two funding streams but they did not overlap. The one was the administration of the cluster and the other was the R4.8 billion fund that covered social protection. COVID-19 had really impacted their work, both in terms of the lockdowns and as workers within the Department of Health. There were problems experienced as the new building got off the ground – hopefully this would be resolved. The mining companies were operating at 50 percent during the lockdown level 5. They had done some rotation of staff and there had been some mines that had come up to 80 to 90 percent of their operating capability. CCOD had worked quite closely with the mining companies, in terms of interventions, including with migrant workers in bringing them across the border. In terms of the receipt of levies – it was purely an issue around dormant mines and it was on their books as open. There were also non-compliant mines that were not paying levies. COVID-19 and levies were disjointed issues. If the mine was operational and the risk work was being done – the levies needed to be paid. There was an electronic database – he was happy to demonstrate this online.

In terms of the progress on the Bill, they had four meetings to date with stakeholders and five trade unions. They worked with the Minerals Council and the Steel and Engineering Industries Federation of Southern Africa (SEIFSA). The Department of Health legal team was leading them in the drafting of the Bill. They were probably around 50 percent of the way on the redraft of the Bill. There were three Bills being amended – thus the joint meeting with the Portfolio Committee on Employment and Labour would be beneficial. The amendments would focus on changing the government structures and producing a streamlined process in terms of the levies. In terms of the Occupational Diseases in Mines and Works Act (ODIMWA) Bill – hopefully by July 2021 they would have a draft ready to undergo internal processes. They also needed to conduct a socio-economic study on the implications of the Bill. They had been in discussions with the Department of Employment and Labour as to whether there would be an equity consideration in terms of new workers, rock drillers, being under the Compensation for Occupational Injuries and Diseases Act (COIDA) and the old workers being under ODIMWA.

In terms of occupational health prevention, there was the Occupational Health and Safety Act which covered all industries except mining under the Department of Employment and Labour. The Act that governed occupational health interventions, like monitoring the asbestos in schools, was a function of the Department of Employment and Labour under the Act. The Mining Act covered prevention activities in the mining sector. Two preventative Acts under two different Departments. There were also two compensation laws under two different departments. There was a 1999 Cabinet resolution that they were trying to get hold of which stated that they should have had one uniformed system in the Country for prevention, treatment and care of workers, screening of workers, doing risk assessments of workers and compensation of workers. Unfortunately, it never saw the light of day. It was a mess – it was a major difficulty to have two different departments dealing with prevention interventions.

The wellness programme was being extended to cover hypertension and other interventions. These were work place interventions and did not fall specifically under the Department of Health.

Dr Nhlanhla Mtshali addressed the question around the occupational centres. They gave technical support to all the health centres in the country including mining – that were registered under the CCOD. They conducted monthly, ad-hoc and quarterly training programmes. They had taken the four provincial centres ‘under their wing.’ The challenge was that they were located in the hospitals – most of the doctors and nursing staff that were allocated to the centres were utilised in the hospitals for emergencies or where there were challenges. During COVID-19 one of the centres was converted into a COVID-19 screening centre since the end of 2020. They received about 120 submissions as of March 2021 in terms of claims. There were challenges with connectivity – which was being dealt with. During COVID-19 they had conducted pulmonary screening in line with strict infection prevention.

The online system was flighted.
Mr van Heerden gave a brief demonstration of their online system. One could search by name or identification – it would provide an overview of the person’s claim. One could then get detailed information on the claim by clicking on it. It was easy for someone in the field to pick up the current status of the claim at the CCOD for a specific person. The system would be superseded by the CCMS system from the end of May 2021. They were also taking over the connectivity at the one-stop service centre.

Dr Kristnasamy stated that they currently used the system through the call-centre and it was funded through the Minerals Council. The one-stop service centres relied upon the system. This system was linked with the Tshiamiso Trust. One cannot see the amounts paid on the system – but one could see that they were paid and what the claim was. The database was linked to the social protection funds. They had major problems with pension funds and insurance policies where many workers were denied – but this could be followed up at another time.

The Chairperson stated that the timelines outlined in the presentation needed to be met this year. Certain amendments that needed to be worked out with other departments and committees needed to be worked on. They looked forward to seeing CCOD when they presented their Annual Financial Reports.

CCOD was excused from the meeting.

South African Medical Research Council Presentation
Professor Glenda Gray, President and CEO, Dr Mongezi Mdhluli, Chief Research Operation Officer, Dr Jeffrey Mphahlele, Vice President, Mr Nick Buick, Chief Financial Officer (CFO) and Professor Johnny Mahlangu, Board Member at the South African Medical Research Council (SAMRC) presented to the Committee.

Response to COVID-19 in South Africa
-Investigating the link and impact of COVID-19 to GBV, mental health, and livelihoods amongst selected population groups
-Sexual and Reproductive Health and Rights of Young Women in eThekweni
-Proposed study on Femicide and child homicide and COVID-19 in SA
-Community stakeholder knowledge, perceptions, beliefs, behaviour and responses to COVID-19 in South Africa
-Prevalence, clinical characteristics, immunologic responses and outcomes of children with suspected or confirmed COVID-19
-The impact of the COVID-19 lockdown on access to SRH services, interventions and commodities
-SAMRC and DSI-funded epidemiological study on COVID-19 transmission and natural history in KZN

Impact to date
-Multiple SARS-CoV-2 epidemiological outbreak investigations undertaken, e.g. St Augustine’s Hospital that laid the foundation for enhanced infection control practices in health care settings
-Trained Community Health Care workers to undertake door-to-door SARS-CoV-2 education and screening and referral to hospitals or isolation facilities that was the basis for the National active case finding household survey
-The Network for Genomics Surveillance in South Africa (Prof Tulio de Oliveira, KRISP) led the discovery and identification of the SARS-CoV-2 501Y.V2 variant, which has had far reaching policy and research implications for the globe, especially relating to vaccine design.
-The South African component of the ChAdOx1 SARS-CoV-2 vaccine trial (Astra Zeneca vaccine), led by Prof Shabir Madhi, showed the reduced efficacy of the vaccine on the local variants. This changed the country’s immediate vaccine strategy, resulting in a move to the Johnson and Johnson vaccine and the design and implementation of the Sisonke study by the SAMRC.
-A project at the University of the Witwatersrand, led by Prof Bavesh Kana, has been instrumental in developing controls for the COVID testing platforms which allows for standardisation of the assays. It has now been deployed in the SA healthcare system, as well as several African countries, through the NHLS.
-South Africa participated in the global Solidarity Trial, with co-funding from SHIP, which demonstrated that the Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens tested on a total of 11,266 adults had little or no effect on hospitalised COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay
-The SAMRC, in partnership with the DSI and TIA, is funding several product development projects aimed at developing local reagents and/or kits for the gold standard COVID-19 diagnostics as well as novel, rapid, point-of-care tests for the presence of the virus. Several of these are applying for regulatory approval with SAHPRA.
-Hyrax is supporting the South African COVID-19 response through the deployment and utilisation of a SARS-CoV-2 sequence data solution within the Exatype platform, previously developed with SHIP funding. The platform was fully operational and launched within 3 months (https://sars-cov-2.exatype.com) and can support all versions of the ARTIC protocol. It is offered for free to any researcher and laboratory technician to remove the complexity and hands-on burden of analysing NGS data.

SAMRC highlighted its goals, planned outcomes and ouput indicators.

SAMRC listed the key risk factors which may affect the achievement of the outcomes:

Goal 1 – Potential non-compliance to legal and regulatory requirements as well as policies and procedures; Sustainability of the Defined Benefit (DB) fund; Lack of a broader SAMRC business continuity programme; Inefficiencies within various corporate processes; Insufficient facility management, including movable and immovable assets; Loss/theft of data and Relationship between SAMRC and organised labour

Goal 2 - Poor research governance; Inferior quality of research output of extramural research units; Inefficiencies within various research processes; Maintaining research integrity; Transformation and diversity challenges and Inability to sustainably grow funding

Goal 3 - Ineffective support for, collaborative partnerships, platforms and technology development; Lack of further development and commercialization of (a) SAMRC-owned and (b) SAMRC-funded innovations

Goal 4 - Limited research capacity

Goal 5 - Lack of research impact on strengthening policy and practice
Budget Strategy
-Over the period 2017/18 to 2020/21, the SAMRC’s income grew by 7,8 percent (R88m), with an average growth rate of 2,5 percent p.a.
-Over the MTEF period 2021/22 to 2023/24, the SAMRC’s estimated funding will increase by 2,5 percent (R30m), with an average growth rate of 0,8 percent over the period
-Over the period 2017/18 to 2020/21, the expenditure of the SAMRC increased by 6,6 percent (R78m) with an average growth rate of 2,2 percent
-Over the MTEF period 2021/22 to 2023/24, the SAMRC’s budgeted expenditure is estimated to increase at an average growth rate of 0,5 percent
-Figures in the Statement of Financial Performance do not include COVID-19 baseline allocations from NT, R150m in 2020/21 and R100m in 2021/22
-Only critical new posts to be funded from the reduction in vacant posts
-Salaries will increase at an average rate of 5,5 percent and goods and services is estimated to decrease at an average rate of 2,7 percent
-Priority should be given to projects which leverage funding at a rate of at least 1:1 when funding available
-Budgeted for deficit of R3,3m in 2021/22 to be funded from reserves to maintain current contracted funding commitments

(See Presentation)

Discussion
Ms Chirwa requested clarity on the issue of transformation. With respect to the distribution of bursaries, 68 percent were African, one could not necessarily note that as a momentous achievement, considering the demographics of the Country. They would be moving in the right direction when they were moving towards 90 percent Black people being funded by the Medical Research Council. The poverty line affected Black women and children at a much higher rate than any other demographic group.

As part of surveillance being conducted by the South African Medical Research Council - had the variant that was found in India been tracked or recorded in South Africa? She requested the details surrounding that, given the anxiety around the Country in that regard. Had the South African Medical Research Council recommended to the Minister to put in place more surveillance measures or mandatory quarantine for travellers – if not, why not?

She requested clarity regarding the vaccination of healthcare workers in rural areas – which areas were targeted? In Tsitsikamma in the Eastern Cape there was no such programme and that was a rural area. Which areas were they talking about? She was specifically asking this because distribution was being handled by the South African Medical Research Council. She also wanted to know the reach with respect to vaccinations and traditional healers - particularly in Sisonke.

Mr van Staden referred to the training of community healthcare workers and the door-to-door screening. Were they still training community healthcare workers to undergo further processes as they went along in the pandemic. Given the different variants, he thought that it was important that they kept that going. With respect to the bursaries, how many students were awarded bursaries? How were they all doing? How many students were successful? What number of students were not successful?

Ms Gela asked a question relating to the 15 infrastructure projects that the SAMRC was conducting. She asked that they brief the Committee on the funding thereof. How did they choose the implementing agent? What was the relationship between the National Department of Health and the DPME in terms of the performance targets? How was the Institution addressing all the intimidating challenges identified in the short analysis presented? She asked a question relating to the antibody – and the trial of Johnson and Johnson – she requested that they list their achievements in that regard.

Ms S Gwarube (DA) stated that during the oversight visits the Committee had undertaken across the country, what was clear was that healthcare facilities that had rolled out the Sisonke trial were essentially ready to magnify their mass roll-out. The big weak link in the whole cog was the primary healthcare facilities which were neither equipped with the requisite equipment nor infrastructure. What consideration was being made in situations where they knew that their primary healthcare facilities were not necessarily equipped to do mass roll-outs? What considerations were being made in terms of taking those weaknesses and shortcomings into account? Was there any work being done in that regard – there were vaccines earmarked for rural roll-out and some for peri-urban areas. What other considerations were made? It was not just about storage, it was about security and capacity of healthcare facilities to roll-out a mass vaccination programme.

With regard to the Sisonke trial, the Committee was made aware that the ‘3b’ phase would only end after the primary healthcare workers were vaccinated. What would happen with the 800 000 left of the 1.2 million allocated to healthcare workers. Would they go toward the population over the age of 60 years, along with the Pfizer vaccine? If so, would they need to wait until 17 May 2021, considering the timelines that were now in place in terms of quality control on the Pfizer vaccine batches that arrived in the Country. She requested clarity on how that would be managed over and above the timeline that was set.

Regarding the variant identified in India, she realised the Minister had stated that morning that they were calling for calm. She wanted to understand from the entity what work was being done with the surveillance teams to ensure that they were vigilant. In the event that the variant was found, what work was being done from a scientific perspective to prepare themselves? Would they find themselves in another scenario like they did with AstraZeneca where the vaccines in the Country would be ineffective?

Dr Jacobs realised that the Sisonke study would be continuing soon; he asked when they foresaw the study ending. What role would that research play in the future beyond the vaccinations – did it bring about new knowledge about pandemics for the future? In terms of research – he referred to slide 62 in terms of the application of knowledge in policy formulation. How did they think they would be able to use that knowledge in terms of advancing policy making and decisions? What would that process involve?

Ms Wilson referred to the COP19 Conference which would be taking place soon – one of the big issues that would be raised there was the tobacco versus ‘vaping’ issue. The World Health Organisation (WHO) had also been questioned on this. It was something they were coming across quite often. She requested clarity as to where they were in terms of studying the effects of vaping. It was an issue that was torn right down the middle. She requested further information on this.

Prof Gray addressed the question regarding transformation. She agreed with Ms Chirwa, there was nothing to celebrate yet, there was still work to do. The only way they could show their commitment was to show the Committee the indicators year on year. The indicators would show their progress – hopefully in an accelerated fashion. In terms of the issues around surveillance, they did expect the virus to evolve over time. It was surprising that the virus did not evolve for so long and they were only seeing variants now. Her colleagues at the NICD had indicated that they had not seen any evidence of any local transmission of the variant that was coming out of India. Obviously, they needed to continue to observe this as there were travellers coming into the country from India. It was important that they ensured that people coming from India were adequately checked in terms of their health status, that they knew how contact them and that they had been tested recently for COVID-19. She asked her colleague who was on the Ministerial Advisory Committee to provide some comments on that. They also needed to ensure that all swabs were stored properly to ensure adequate surveillance on that. As COVID-19 was a notifiable disease, the swabs had to be kept which was important for their surveillance, particularly as people came into the Country. It was important that they kept tabs on viral evolution over time.

In terms of traditional healers, they had been working with them and they were very supportive of vaccinating them. There was a team working with the traditional healers to carry out the vaccinations. In terms of the Eastern Cape, they hoped to be able to vaccinate another 28 000 people in the Eastern Cape. This had meant that they had to move to mobile vaccine centres. They developed mobile units; they had to move a whole lot of their teams. As this was a research study – they needed to ensure that they had investigators, registered pharmacists and scientific staff that could go in the mobile units to all the areas in the Eastern Cape. This was critical for them; if they could demonstrate their ability to do it in mobile units it would help them with the vaccine roll-out in rural areas. If this worked they hoped to continue with the rural programme. She had showed the Eastern Cape one as an example. They spent a lot of time with the Rural Doctors Association, trying to work out what would be the best way to deliver vaccinations in rural areas. It was decided that the best way was to move their mobile units into different areas and be there for two or three days at a time so that they could vaccinate those healthcare workers. She would be going down there the following week to ensure that the type of programmes that they had implemented could be transferred to the roll-out.

In terms of the variant, they would see the virus evolve over time. The most important thing about the variant was to ensure that the vaccine was still effective against the variant. They had spent a lot of time working with the NHI team to merge the electronic vaccine data system together with their programme so that they could pick up any COVID-19 infection. This could be tested against those who had taken the vaccination. This could be done in real-time so that they had an idea of field effectiveness.

The door-to-door screening was targeted. They would continue to evaluate the door-to-door screening especially when they saw outbreaks. The surveillance work they had done had helped them to detect outbreaks 10 days before they occurred. They could use the door-to-door screening vaccination programmes to try and target areas where there were outbreaks. The targeting was important. The threats and weaknesses were mentioned in the strengths, weaknesses, opportunities, and threats (SWOT) analysis. They kept addressing those issues to make sure that they were in their risk register and they reported to the Board on a quarterly basis as to their progress made on the risk register.

The issues relating to the vaccine induced blood issues were rare, they usually occurred a couple of days after the vaccination. They included an unrelenting headache and severe abdominal pain. Fortunately, they were rare, but because of those events they had increased their safety oversight and management of clotting disorders in Sisonke. This would help them with roll-out to make sure that when those events occurred they could be managed properly so that they were not fatal.

In terms of the healthcare readiness and facilities - those were all very important things that needed to be addressed. From what she had seen from the vaccine centres, they were excellent. They had suffered in terms of connectivity. There were well-trained vaccinators. There would be weaknesses and challenges in some areas. Their job was to identify and address them. They were currently in the phase 1a of Sisonke. There would be a phase 1B. After Sisonke they thought they would have gotten to most of the patient facing healthcare workers – this would be good. They had been monitoring the effectiveness of Sisonke as they had rolled out the programme of the 320 000 healthcare workers. There were about 25 breakthrough infections that occurred after 14 days of vaccination. Three had occurred 28 days after the vaccination. This was brilliant, because in the phase one study where they enrolled around 43 000 people globally, they had about 300 breakthrough infections. One could see that there has been wonderful impact. They had monitored the healthcare workers that had gotten COVID-19 as it was believed that the vaccine would downgrade the illness. They were evaluating how many of those breakthrough infections had to go to hospital and how many could be managed at home.

Sisonke had taught them a lot, and the knowledge they had gained would help them with the pharmacovigilance of the roll-out. It would also help in terms of the safety reporting, breakthrough infections, the evaluation of the vaccine programme and evaluating the impact of variants on the vaccine efficacy. It had provided tremendous information on safety and the safety of vaccines. All the information had been directly impacted knowledge translation. They did not believe they were double counting – it was important to publish as part of a complex team. It was important to show how much the Medical Research Council had contributed to that publication. They did want to see lots of authors from the funding. They had shown a number of indicators relating to the publications – they did usually over perform. It was hard for them to predict how they would do. Those were just projections; the count was more important – she requested one of her colleagues to explain that further.

In terms of the tobacco versus vaping, there was nicotine in vaping. Nicotine created addiction. In the vaping spectrum, not only did they have nicotine, there were other additives such as glycerol and flavourants that were unknown in terms of their safety. Nicotine was a very dangerous drug, it had health implications. They could get away from the tar and some of the other things contained in cigarettes, but if one did not get away from the nicotine there would always be health issues. No matter what those people told them, vaping did not stop tobacco use or nicotine addiction and they should be trying to make sure that they addressed the nicotine addiction. She also noted with concern that a lot of the vaping shops were close to universities and targeted young people. It could be a gateway to ongoing nicotine addiction.

Dr Mdhluli answered the question relating to the relationship between SAMRC, the National Department of Health (NDOH) and the Department of Planning, Monitoring and Evaluation (DPME). DPME issued a framework for reporting in terms of the annual performance plans. Once they had drafted those plans, they submitted it to NDOH for review around October/November and the second draft around the end of January. They had submitted the draft and it was subsequently approved by the Minister in March 2021.

Dr Mphahlele addressed the first question regarding the variants – it was important to add they would certainly be concerned if the variants posed a threat to immunity that should have been created by the vaccines. They had infrastructure in South Africa that not only facilitated surveillance but was able to show whether the variants were able to escape immunity. He referred to slides 60, 61 and 62, they recorded the number of Masters and Phd students who graduated from the SAMRC progammes. If one looked at the last two financial years, one could see the respective numbers. What was missing on the slides was a breakdown of the students in terms of demographics and the institutions where they were based. This was what prompted SAMRC to actually come up with additional indicators so that in future they did not just give them what was on their records but that they would be able to share the numbers with all stakeholders including the Portfolio Committee. He referred to indicator 413 and 414, they would be looking at the number of awards going forward.

Mr Buick responded to the financial questions. In terms of the infrastructure projects, these were mainly to do with the renovation of their buildings in the Western Cape, KZN and Gauteng. They had been in those buildings for many years and most of the projects related to the upgrade of those facilities. They also related to the update of the IT infrastructure to keep it current and modern in terms of the MRC systems. With regard to funding they budgeted R42 million in the last financial year and another R10 million in the 2021/22 financial year to fund that specifically. That would come out of their reserves. With regard to the implementers, they tended to vary from project to project, but were appointed through an open tender process in line with the Public Finance Management Act (PFMA).

In terms of the budget deficit, he was not sure – he had not heard the question. To expand on the budget deficit in general, there was a R3 million deficit. It would be funded from the reserves. The MRC had a strong balance sheet, they would not require any additional funding for that. They had received the required permission from National Treasury for the deficit relating to the 2021/22 financial year.

Prof Mahlangu addressed the question relating to the thrombocytosis related events and stated that it was very rare. It was identified in at least three vaccines. The most important thing was that they were aware of the existence of the syndrome and they had put out a number of guidelines – in fact the latest guidelines came out in the Strategic Management Journal (SMJ) the week before. It guided healthcare workers on how to be vigilant, identify and diagnose the syndrome. It was a new syndrome; they were in new territory. Some of the pathology associated with it seemed to be old knowledge - it had similar things to what they had seen when using anti-coagulants. It should not be a reason for vaccinations to be stopped. The fact that it happened should raise concern – if they were able to recognise it clinically – make a diagnosis and treat it – it was manageable.

The Chairperson stated that there had been a lot of issues around alcohol and tobacco – the Committee might see them again in the near future in that regard as they were the epicentre of research in the Country. This would assist them in terms of law. They were one of the entities that had a clean audit – and that was a source of pride to the Committee.

Minutes of the 28 April 2021

The minutes of the 28 April 2021 were presented.

The Chairperson stated that they had a meeting the week before where the Minister updated the Committee on the COVID-19 situation. They were told that there were new vaccines, that the Pfizer vaccine was on board. There were close to 60 million vaccines and members had asked various questions that were answered. Those who did not have an opportunity to ask questions were asked to write and communicate them to the Department. He asked whether any of the members had any issues with the minutes.

There were no direct flights from India, however there was a fear that people were coming into the Country via connecting flights from elsewhere. The Minister had asked his team to check whether there was anyone who could have come in from India. That was a work in progress. By Friday they might get an input in that regard from the Minister. They were tracking whether there were any cases of the variant in the Country.

The minutes of the 28 April 2021 were adopted.

The meeting was adjourned.