:
I call this meeting to order.
Welcome to meeting number 44 of the House of Commons Standing Committee on Health.
The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic. I'd like to start by welcoming the witnesses.
Appearing as an individual is Dr. Steven Hoffman, professor of global health, law and political science at York University. Also appearing as an individual is Dr. Shirin Kalyan, adjunct professor of medicine, University of British Columbia, and vice-president, scientific innovation, Qu Biologics.
From the Canadian Association for Neuroscience, we have Dr. Shernaz Bamji, professor, and from the COVID-19 testing and screening expert advisory panel, we have Ms. Sue Paish, panel co-chair, and chief executive officer of the digital supercluster.
Thank you, all, for being here.
I will invite you to make a brief statement.
Just as an FYI, I have magic cards. I will display the yellow one, if I don't get too engrossed in your testimony, shortly before the end of your time. I will display the red card when your time is up. Do try to wrap up when you see that. You don't have to stop instantly, but do try to wrap up.
Thank you very much. We will start with Dr. Hoffman.
Dr. Hoffman, please go ahead. You have five minutes.
:
Thank you, Mr. Chair, and thank you for the opportunity to appear before this committee as a private individual.
My name is Steven Hoffman, and I'm a professor of global health, law and political science at York University, where I direct the global strategy lab.
Today I'll speak about a collateral impact of the pandemic that I think this committee has likely heard less about, namely the significant damage this pandemic has caused for our global governance systems. That's bad for Canadians' health because there are increasing numbers of health threats that defy national boundaries and depend on international co-operation to be addressed: antimicrobial resistance, air pollution, climate change, microplastics, radiation, the list goes on.
Since Canada cannot tackle these transnational health threats alone, we are especially vulnerable to them as one of the most globalized countries in the world. That means that we have a special vulnerability to any weakening of our global governance systems and, as I'd argue, a special obligation to help strengthen them. Canadians' health depends on it.
To draw this conclusion, I will first point to the fact that our existing global governance systems are predicated on a model of independent sovereign nation states that dates back to the 1648 Treaty of Westphalia. This means we are literally using 17th-century social technology to address 21st-century threats.
This way of organizing ourselves might have worked when pathogens would cross continents over the course of decades, but today pathogens travel across the world in a matter of hours. It takes just 18 hours for a virus to fly from China to Toronto, where I'm based, and that includes a nice stop in Vancouver along the way.
Even more important than understanding what COVID-19 has revealed about our weak global governance systems is how COVID-19 is further breaking them. The reality is that trust is fundamental, yet today we are witnessing the greatest erosion of that trust that I've seen in my lifetime. I am speaking about the horribly inequitable global distribution of COVID-19 vaccines. Rich countries are getting vaccinated, while poorer countries have mostly been shut out. Of course, this is not new. Certainly for me, it brings back some bad memories of the HIV crisis 20 years ago when richer countries had access to antiretrovirals, while poorer countries went without. A whole lot of people needlessly died, and those who didn't became angry, distrusting and resentful.
I make these pointed remarks not as a critique of a particular government or even of a particular country. Rather, fundamentally, I blame our global governance systems, which are in desperate need of strengthening. Our current systems make it very difficult for elected governments not to prioritize the short-term needs of their citizens above others, yet considering this virus will continue to evolve and new variants of concern will continue to emerge, global vaccine inequity will lead to suboptimal health outcomes for Canadians, in addition to humanity more broadly.
Of course, there is some good news. Canada is not only leading the world in first-dose vaccinations, but we are also one of the most generous countries in pledging 100 million vaccine doses to COVAX as of yesterday. That's great, but I think it's also a sad reflection on our global governance systems when actions taken by Canada and its G7 peers can simultaneously be both generous and woefully inadequate at the same time. Even one billion vaccine doses from G7 countries means that just 5% to 6% of people in low-income countries will get vaccinated this calendar year. That means that as we prepare to go back to normal, nearly everyone in poorer countries knows that won't be their reality in 2021, and probably not in 2022 either.
Mr. Chair, we are witnessing and are active beneficiaries of one of the starkest injustices of our lives. Like with HIV, this injustice is breeding anger, distrust and resentment, both towards the global governance systems that enable it, as well as towards the people, like us, who benefit from it.
The consequences of this injustice and our broken global governance systems will be with us, Canadians, for decades to come. We will all be less healthy in the long term because of it.
Thank you again for the opportunity to appear before this committee.
I look forward to your questions.
:
Thank you, Chair, and thank you to the honourable members of the committee for the opportunity to speak this morning.
I'd like to start off by just saying that the thoughts I'm presenting are really my own as a translational immunologist, and not necessarily those that are shared by my affiliated organizations.
My focus today is really on two issues.
The first is the apparent lack of strategy we had of ensuring that Canadians have a diverse portfolio of the types of vaccines we have in our tool box at this time. We have definitely procured a good number of vaccines and this is fantastic, but they're all of the new gene delivery platform variety, and I'll be elaborating a little bit on that subsequently.
Second is our apparent neglect to consider sex differences in immune response to infections and vaccinations in our strategy for immune protection.
To understand the first issue, I will provide a brief overview of the three broad categories of vaccines.
The first is whole vaccines and these come in two flavours. First is the live-attenuated vaccine, which provides a really fulsome training for the immune system. The one infectious disease that we have successfully eradicated through vaccination, smallpox, was done using a live-attenuated vaccine. These provide longer lasting immunity and they typically don't require multiple booster shots. I would say these are the best options for young, healthy kids. However, they take quite a while to produce.
The second type of whole vaccine is the whole inactivated vaccines. These are fairly straightforward to make. They don't take very long at all. It's essentially the whole microbe that's killed in some way. We already have one that has been approved for emergency use for COVID-19 by the World Health Organization. These whole vaccines, because of their multiple epitopes, are theoretically really less susceptible to result in a loss of efficacy with variants or aid in variants selection.
The second category of vaccines is what we call component, or subunit, vaccines. They're made by selecting immunogenic parts of a microbe and formulating these with an adjuvant. You can consider them to be highly processed versions of a double inactivated vaccine.
We have a lot of experience using the above types of vaccines for generating immune protection. In fact, the first category we've used for centuries, which really makes it easier to make educated guesses about their effects and also anticipating any safety concerns we may have.
The third category is these new cool nucleic acid delivery platforms that we have rolled out, which deliver genetic material either in the form of DNA or RNA into our cells to make or express viral proteins. We have very little, to no, knowledge on the long-term safety and efficacy of many aspects of this particular technology, especially when these vaccines are given in multiple doses. Given this lack of experience, it is very difficult to make well-informed decisions regarding their use. We've seen this play out in real time during the pandemic.
Given the above, why are all the options Canadians currently have in our tool box for immune protection in the midst of a pandemic all based on a technology in which we have the least experience and which have never been approved outside of emergency use authorization? I think we need to understand that issue a little bit more.
That leads me to the second issue. Not only do we need access to a diverse portfolio of vaccines to de-risk our response to the pandemic, but we should really strive to understand which vaccines would best serve different populations with different risk profiles.
To this point, I'd like to bring attention to sex differences that have been largely ignored, despite a very long history of sex-discrepant outcomes to infections and vaccine-associated adverse effects. This would be a prime example in which the implementation of GBA+, for example, would be highly relevant.
We know cis men are known to be, on average, more susceptible to severe infections, and we've seen that in the COVID-19 mortality data. Cis women, on the other hand, have a much stronger immune response, and this more vigorous immunity is a double-edged sword. Being female is also the greatest predictive risk factor for many autoimmune diseases. Women also bear the brunt of experiencing more serious adverse events related to vaccination, and we've also seen that with the COVID-19 vaccines.
Of note, a study has shown that women receiving half the flu dose generate a higher level of immune response compared to men who receive a typical or standard dose of the vaccine.
Given this body of knowledge, we should, at minium I think, be requesting that sex-based dosing studies for these new gene delivery platforms be performed for both safety and efficacy.
Thank you again for your time and considering these issues.
:
Good morning, and thank you so much for providing me with this opportunity to speak to you on behalf of biomedical researchers in Canada.
My name is Shernaz Bamji and I'm a neuroscientist and a professor at the University of British Columbia. I'm also the president of the Canadian Association for Neuroscience, but I'm here today to not only speak on behalf of my members, who are over 1,000 scientists doing brain research in Canada, but for all Canadian scientists doing biomedical research.
I'm here to request an increase in our investment of fundamental research in Canada. We all know that investing in research will diversify and strengthen Canada's economy and will create quality jobs, but really, over the past 18 months, after we've seen the world ravaged by the COVID-19 virus, it's clear that investing in biomedical research is of utmost importance for the health of Canadians and people around the world.
As you know, in Canada, discovery science is funded by three main granting councils, collectively called the “tri-councils”. We are requesting a one-time 25% increase in tri-council funding and a 10% budget increase every year until funding levels are commensurate with other G7 countries.
Since COVID-19 is front and centre on everyone's mind, I'll share with you a Canadian success story. It's a story of my colleague at the University of British Columbia, Dr. Pieter Cullis, who has had a long-standing career studying lipid nanoparticles, which is a technology that wraps DNA and mRNA in a type of bubble so that we can safely inject them into animals and humans.
He started working on this back in 1995, but he firmly believed that one day this technology could be important for delivering therapies to patients. Along the way, he established collaborations with companies around the world, including BioNtech, which you guys probably know is a company in Germany that worked with Pfizer to generate one of the COVID-19 vaccines. If you received the Pfizer vaccine, you received a vaccine that uses lipid nanoparticle technology that was developed right here in Canada. I hope you are proud, because I certainly am.
This is just one success story out of hundreds, because of the investment that Canada has made in fundamental, non-targeted research. I say “non-targeted” because we don't know what the next needs of tomorrow will be.
The fact is that Pieter was doing his research back when the success rate for funding projects was higher. In 2005, more than 30% of grant applications were funded. Today, fewer than 14% of grant applications are funded, and I can tell you, as the chair of a research panel at CIHR just last week, there are many outstanding research projects, projects just like Pieter's, that will not get funded and, therefore, not get done.
Much of the data is pointing the same way. Canada is the only G7 country whose investments in research and development as a percentage of our GDP have actually been going down steadily in the last 15 years. Canada is now second to last in the G7 with respect to research funding. Not surprisingly, given this fact, the number of academic researchers, like me, per 1,000 people in Canada has been going down since 2011.
To show you what we are up against, in 2017 the budget for the National Institutes of Health in the United States was $30 billion U.S., while the CIHR budget was $1 billion Canadian. They spend more than 30 times the amount we do on research, but our population is only nine times less.
While the 2018 federal budget announced a historic addition of $689 million to tri-council funding, for which we are incredibly grateful, it is little more than just half of what was recommended by the fundamental science review report, which was commissioned by the government in 2017. Without this critical increase in funding, we will not be able to compete on the world stage. We will not be able to contribute to the next global health crisis, like we did with SARS and COVID—and there will be a next time.
Canadian researchers are ready to put in the hard work and we now look to you to help fund this work.
Thank you so much for listening.
:
Thank you, Mr. Chair and honourable members, for this opportunity to speak about the testing and screening expert advisory panel's fourth report, “Priority strategies to optimize testing and quarantine at Canada's borders”, which was published on May 27.
As vaccination increases and as we see the number of cases in the third wave subsiding, it appears many regions are now stabilizing. It's an opportune time to start to consider the appropriate balance of measures to protect public health while also reopening our borders. Supporting economic recovery depends on enabling the movement of people and goods across the border, while at the same time being vigilant in protecting the health and safety of Canadians and limiting the risk of importing variants and viruses.
Managing borders is complex. Measures must be easy to understand, equitable, feasible and consider both the benefits and the risks of harm. The panel took all these matters into consideration in preparing the recommendations that I'm going to summarize for you today.
The panel reviewed the various scientific evidence and presented to the recommendations for border measures relative to five different groups of travellers: unvaccinated, vaccinated, partially vaccinated, previously infected and exempt travellers.
For unvaccinated travellers, we recommend a testing approach similar to what is currently in place, including a predeparture test—either a PCR test within 72 hours of departure or a rapid antigen test within 24 hours of departure—an on-arrival test and quarantine. In respect of the quarantine periods, the panel found sufficient evidence to conclude that a negative test seven days after a traveller has arrived in Canada provides the same level of protection as a negative test on day 10.
Given the high efficacy of the vaccines authorized by Health Canada, the panel recommended that fully vaccinated travellers need only to complete an arrival test for surveillance purposes but no quarantine requirements, with a proof of vaccination. This approach also provides an incentive to encourage Canadians to get vaccinated.
For the partially vaccinated traveller, the panel found emerging evidence that a single dose of vaccine provides effective protection against severe disease, but it does not guarantee against infection. Therefore, we recommend that the measures for this population include a predeparture test, an on-arrival test and quarantine until a negative test result arrives after departure.
For a previously infected traveller, the panel recommends an on-arrival test and quarantine until a negative test result after arrival is confirmed.
For exempt travellers, based on the data the panel reviewed, we recommend voluntary testing at both land and air borders, primarily for surveillance purposes.
The panel also made a number of additional recommendations to improve the simplicity and adherence to border measures, including aligning travellers who are arriving by air and land borders so that they are consistent, and discontinuing the requirement for non-exempt travellers to stay in a government-authorized accommodation while awaiting their on-arrival test result.
Similarly, the panel concluded that testing requirements that vary by country of origin should not generally be implemented for travellers entering Canada except under unique circumstances, because once a variant is detected, it is likely already present in many countries, including Canada.
The panel also noted the critical importance of quarantine adherence and recommends increased monitoring of quarantine and adherence to requirements for testing, as well as the prompt reporting of a positive test result to local public health authorities where individuals reside to allow an immediate follow-up from that local health authority.
In conclusion, I noted carefully the announcement recently that the government will be easing travel measures in a phased approach, including by reducing potentially the testing and quarantine requirements for vaccinated travellers. Taking a phased approach to implementation aligns with the panel's view that changes to border measures need to be incremental. They need to be carefully evaluated in the context of increasing experience and data, the global situation regarding variants of concern and new evidence that might emerge as vaccination continues to increase.
Thank you for your interest in this work. I'd be pleased to take any questions from the committee.
:
Thank you for the question.
This is our fourth report. We initiated our work on the report in late February, and we consulted very broadly, listening to industry groups and medical experts, as well as a variety of experts in other fields. We delivered our report to Health Canada on May 2. They serve as our secretariat for the panel. That's when we, as a panel, concluded.
After that, there was a period in which officials went through processes to evaluate and get the report ready to publish, including things like—you know this more than I do—translation, and things like that.
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Yes, and please hold up your red card when we're on to four minutes so that I know that.
My questions are for Dr. Hoffman. Certainly the question of when and how we reopen the border is absolutely important, but I would suggest that an even more important issue is the global governance structures with respect to health and particularly the spread of infectious disease. As much as vaccines have been the answer with respect to managing this pandemic, this is certainly how we can do better in the future.
With that in mind, I want to ask you, Dr. Hoffman, a question about the international health regulations that were passed by the World Health Organization in 2005 in response to the SARS pandemic, though I'm not sure if it was ever actually categorized as a pandemic. This was supposedly establishing a mechanism for WHO to deal with an outbreak of an infectious disease like this. A committee determines what is classified as a public health emergency of international concern, and WHO then has the power to deal with it.
Dr. Hoffman, are the international health regulations a sufficiently robust document? Can and should they be reformed, or should we have an international treaty?
I expect you can speak for the rest of the four minutes on that, so go ahead, Dr. Hoffman.
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Great. Thanks so much for the question.
I would succinctly say that our global governance systems are not up to 21st-century threats, as we're seeing with COVID-19. There's a full range of different threats for which they are not up to standard.
When we look to the World Health Organization, we see that it is the leading [Technical difficulty—Editor] authority on public health, but for at least a couple of decades, it has been chronically denied the resources that it needs to actually carry out its job effectively. We're at a point now where only 20% of WHO's budget is funded by core contributions. Eighty per cent is conditional. It's voluntary. The organization can't count on it, such that when bad things happen, like COVID-19, the organization is left to scramble.
Now there are the international health regulations, which are the legally binding instrument that govern how 195 countries around the world are supposed to respond to outbreaks, but it is itself a rather weak instrument. It was revised most recently in 2005, as was mentioned.
Its origin, though, is actually 1892. It used to be called the international sanitary convention. Again, we are using mechanisms that don't have compliance mechanisms and don't have sanctions if countries don't follow through. As a result, most countries in the world are currently violating that binding international legal agreement.
Consequently, there is a proposal on the table for a global pandemics treaty. Every global health law professor in the world, myself included, would be supportive of that. The reason I can say that so clearly is that I currently chair the Global Health Law Consortium, which is a network of all the world's global health law professors.
If you bring different law professors into the same room, we all disagree on basically everything, yet the one thing we agreed on is that the international health regulations need to be reformed. They need to be strengthened, and there is also consensus that there's a big opportunity with the potential global pandemics treaty.
Ms. Paish, I just wanted to follow up on the questions around quarantining. I won't have enough time to get into all of the details, so forgive me if I'm speaking a little fast. I understand the phased approach, and I think that makes a lot of sense for those five categories. You can't just open it up immediately. There would be an influx in terms of having to deal with that, so with that phased approach, I think the government has already committed to some of those elements moving forward. However, you also talked about the land versus air border.
I think there is a conversation that I may not have time for here in terms of the risk profile of being on an airplane and in an airport, versus in your own personal vehicle going to your own personal residence, but you said something there. You said that it's about catching travellers. Is there not some acknowledgement that when dealing with the quarantine hotels, it's not about the incubation period. It's about the testing and ensuring that those test results come back negative before someone would move on to their community. It's about catching those positive cases so that they aren't spread into the community first. This is something that provinces and territories spoke a lot about.
Did you hear that from provinces and territories in your work, in terms of ensuring that enforcement of quarantine after travel and before the negative test result is in place?
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Let me just summarize very quickly again what the provisions around those hotels are.
Right now, it's not being applied equally to land and air travellers. We saw a lot of evidence at our panel that travellers were choosing to fly from an international destination into a United States airport and then drive across the border to avoid those quarantine hotels, so it's not working in that context and it's very expensive for taxpayers to administer these hotels.
We also received evidence that arriving at a land border, a traveller could [Technical difficulty—Editor] hotel by paying a fine, which completely undermines the purpose of the hotel. As I mentioned, it doesn't comply with the incubation period for SARS-CoV-2. When we presented to the FPT health officers, as well as the ministers, we did not get any specific comments or questions that disagreed with the approaches we were taking. We were all, I would say, ad idem that we are trying to reduce the importation at the borders and that the current approach could be improved.
My question is for Dr. Bamji.
First of all, I'd like to thank you for being with us.
The pandemic has highlighted the fact that investments in basic research are paramount, as they have an impact on people's daily lives; they help prevent diseases, cure people and deal with the climate crisis, just for starters.
We need to stop compartmentalizing everything and seeing increased funding for basic research as simply an expense. Instead, we need to see it as a societal investment, one that allows society to better develop over the long term.
Do you agree with that and, more importantly, can you explain your point of view?
I absolutely agree with you. This is why we believe that funding fundamental science—and by fundamental science I just need to kind of explain that it is non-targeted. You don't say, here's $2 billion towards COVID or whatever, because we don't know where the next big important crisis is going to be coming up. Canada has always been able to compete on the world stage and also been able to provide help whenever we have needed to, for example, in the SARS situation, as well as in the COVID situation.
We used to be funding science very similarly to the other G7 countries, and now it is going down. The actual research funding is going down. Our ability to compete is going down, and we're in a very dire situation. When you're funding 14% of the project grants that are coming in, you're not funding the majority of the really excellent applications that are coming in.
Thank you.
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Canada is a really attractive location for scientists. Whenever I go to a conference, people are always quite impressed by Canada as a country. We have so much to offer as far as our society goes.
However, when we are sending out applications or when we are actually trying to find people to come to our university, we're finding that people are balking at the investments we are making. They are very interested in coming to Vancouver, for example, to the University of British Columbia. They apply for the actual job advertisement, and then they start digging a little bit further and looking to see how much we are willing to invest—the amount of the average CIHR grant, the ability to get the CIHR grant, the success rate—and that is causing a lot of the brain drain, I would believe.
The other issue is that we are also losing our own Canadian students. The students are looking at us frustrated, writing grant after grant and not getting funded. The students are saying to themselves, “I don't want this lifestyle.”
I have only one student who has gone on to continue in an academic setting. Many of them decide to leave academia. They go into industry, etc., and that is because they are horrified by what they're seeing. We cannot disillusion our own trainees like this.
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Absolutely. COVID is not a thing of the past. It is still here, and it's going to be here with us for many years. However, we do not know what the next thing is going to be, what the next crisis is going to be. It might be a virus. It might not be a virus. We have no idea where it's going to come from.
The fact is that every single thing that we have been able to do—we've been able to catch the viruses, etc., all the different global issues—is because of fundamental research. We have no idea where breakthroughs are going to come from.
The biggest breakthrough, I believe, is CRISPR technology, which started off studying bacteria. With CRISPR technology, we now possibly have the ability to treat many genetic diseases, and it will be coming up fairly soon, I hope.
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The COVID-19 pandemic has provided an important opportunity to identify and rectify our deficiencies in having a cogent plan to deal with emerging infectious threats that takes into account not only the short immunological health of Canadians but also the long-term health. This is a nice segue from what Dr. Shernaz Bamji was speaking about.
My first wish for the immediate response would be to immediately diversify our portfolio of the types of vaccines we have in Canada, specifically procuring or acquiring in some way whole inactivated vaccines. As I mentioned, one was just authorized by the World Health Organization for emergency use.
Another, which I particularly favour due to its formulation, is in development by Valneva and the U.K. National Institute for Health, for example. They're in phase three development. They've been looking at Canada for a potential phase three trial site, and I'm hoping we would take advantage of that. [Technical difficulty—Editor] inactivated vaccines would be better booster shots for people who have already had COVID-19 and recovered, because they would be able to retain that more fulsome memory.
Secondly, we need to ensure we have capabilities to develop a vaccine of our own preferred design in Canada. We have no GMP facility here at this moment, and this is not new. We've heard a lot about this. India, China and Kazakhstan have their own facilities, and they've all developed inactivated vaccines for their populations. Not having this capacity and expertise has left us vulnerable and potentially at the whim of external interests, which are I think what we're beholden to at this time.
Thirdly, we need to ensure we have a more diverse expertise to advise on vaccine development and/or procurement, which includes a deeper understanding of the immune system and what constitutes immune competency to a given pathogen.
Lastly, I would say we need to make it a policy for drugs, particularly vaccines and immunotherapy that are approved in Canada, to include sex-based dosing analysis for both safety and efficacy.
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What we don't know is what we don't know. For me, one of the biggest black holes is that we have no clear biodistribution or in-situ expression data for these gene delivery vectors, meaning we don't know where these go and where they're being expressed.
As an immunologist, it's still unclear to me how these expressed proteins are presented to the immune system. Typically our immune system relies on a danger signal, or what we call pathogen-associated molecular patterns or PAMPs. This helps us to differentiate cell from non-cell and what's dangerous from not dangerous, to launch an appropriate type of immune response. Antiviral immunity is different from antifungal immunity, which is different from antiparasitic. These strategies are different.
In respect, for example, to the lead mRNA vaccine candidates we have, I don't see where that instructive information is contained for the immune system to know what exactly it's supposed to be fighting. It's like eliciting an answer without knowing what the question is. The long-term consequences of this immune ambivalence I think are yet to be determined.
Lastly, in terms of the DNA vector vaccines, we have not evaluated and we should—so I would add that to my wish list—the antibody and the immune response to the adenovirus vector itself, the thing carrying the message. Presumably we'd be generating a pretty strong response to the vector, which theoretically means that each subsequent booster shot would elicit a lower immune response to the message, because the messenger is being wiped before it delivers it.
We have not asked for any of this more detailed nuance. We could be giving booster shots eventually, by the third time, and they're just blanks for our immune system. We're not launching sufficient immune response to the spike protein that is being encoded in the message there.
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I'm going to throw two questions in here.
First, why do you prefer the live attenuated vaccines for children, and second, I mentioned women.
I think women are generally not considered in our male-dominated health care system. We know that women bear the brunt of experiencing more severe adverse events related to vaccination. You commented on that. We know that women have twice as many antibodies as men and we know that they have increased susceptibility to autoimmune diseases, yet we're giving the exact same medication, the exact same dose, to children and women.
What's your position on that?
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I'll take the easier question first.
For the live attenuated vaccines, they engage and train all parts of the immune system so it acts as one. That includes training the innate immune system, which also has that type of memory that's contained at the epigenetic level, and mobilizing the awareness of the adaptive immune system to respond appropriately to a given type of pathogen. Multiple studies have shown that this type of training provided by live attenuated vaccines protects kids not only against specific pathogens that are a target of the vaccine, but they also provide a more broad range of protection against immune pathologies.
For example, the BCG vaccine, which is a really old-school live attenuated vaccine, is now being tested for the treatment of type 1 diabetes. Young immune systems require this education and exercise, if you will, to function properly, just like other complex systems such as muscles, bones and language acquisition.
In respect to women, this is not new. It has been forever. I think a large part is that drug development doesn't want to make anything more complicated than necessary, and looking at sex-based differences has been ignored across the board. However, I think when it comes to the immune system, given the profound difference, it is unfortunate that we continue to just have a regression to the mean, essentially. That is what we do, and women tend to bear the brunt for things like vaccination. We really should be looking for more sex-based analysis in terms of dosing and safety.
:
Thank you very much, Mr. Chair.
Quickly, this question is to Ms. Paish.
You were talking about inconsistency between land and air borders.
Did the panel take a look at the Alberta pilot project, which was on initially during COVID, where they were using rapid testing at the airports and the land border? There were very strong results from that, very positive results. Did the panel look at that as an option, comparing that to the hotel quarantine?
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Historically, given that it's the only one that has succeeded in wiping out infectious diseases, I would say yes, but it takes longer to develop these live attenuated vaccines.
I was looking at the types of vaccines being developed on the spreadsheet of the World Health Organization. There are a couple that are in development. That kind of training that engages the entire immune system and puts everything on the same page, as opposed to giving a piece of information to only one arm, is going to be by far, in my opinion, more effective. Also, it provides the right exercise for your immune system to operate more functionally overall.
For children, definitely there has been quite a large body of evidence showing that live attenuated vaccines are better.
Ms. Paish, following up from where we left off, at that meeting on May 10, I believe I wrote down that you were consulting with provinces and territories on the findings and on the panel's recommendations. If I heard correctly, you didn't get much push-back in that there was agreement around the table for that.
At that time, in my home province, for example, there were ads being run showing “blood maps” of closing the border and how the third wave was completely to blame on the border. At the time of these blood maps, of the virus spreading, in the political realm you're saying that provinces and territories were actually supportive of lifting restrictions. This would be in your conversations. I'm not asking you to comment on the political side of things, but in those conversations, they were supportive of lifting border measures.
I'll continue with Dr. Bamji.
In 2019, you asked political parties some questions that we found very relevant.
I have a question for you, because I am sincerely curious to know your opinion on this subject.
My question is this. How do you see the role of government in research, given that government agencies should perhaps themselves play an active role in targeting scientific research priorities?
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Thank you for the question.
I think the government people are there to govern, and the scientists are there to actually do the science. The scientists definitely have the ability to target their research to what they think is the most important thing. We would once again prefer not to have the government come in and ask us to do any sort of targeted research as they have in the past.
Even with COVID-19, again, we're very happy with the influx of funding into the COVID-19 research because we absolutely have to do that. That is going to be a very big thing for the next even 10 years down the line. However, we are not totally sure where the next crisis is going to come from—I keep saying that—and that is why we need to have completely unfettered funding, which is open funding for the tri-councils—CIHR, NSERC and SSHRC.
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I call the meeting back to order.
Welcome to meeting number 44 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic.
I'd like to welcome back the witnesses.
We have, from the Department of Health, Dr. Stephen Lucas, deputy minister. From the Department of Public Safety and Emergency Preparedness, we have Mr. Rob Stewart, deputy minister. From the Department of Public Works and Government Services, we have Mr. Bill Matthews, deputy minister. From the National Advisory Committee on Immunization, we have Dr. Matthew Tunis, executive secretary. From the Public Health Agency of Canada, we have Dr. Theresa Tam, chief public health officer; Brigadier-General Krista Brodie, vice-president, logistics and operations; and Mr. Iain Stewart, president.
I will notify the committee that Mr. Stewart, Dr. Tam and Brigadier-General Brodie have a hard stop at one o'clock. They have other engagements.
With that, we will go straight into the questions.
I believe it's Ms. Rempel Garner who will start.
Thank you to our witnesses for joining us today.
My question is for Dr. Tunis.
As of this morning, most Peel residents and residents across Ontario hot spots can book their second dose of vaccine, thanks to the increased supply. At our last meeting, Dr. Loh was here and told us about the importance of getting second doses to protect us from variants.
What can you tell us about the effectiveness against the delta variant of any of the vaccines authorized in Canada?
:
Thank you for the question.
NACI has been monitoring global vaccine effectiveness against a number of variants of concern. We have seen recent evidence from the United Kingdom looking at the delta variant or B1.617.2. That variant does seem to respond very well to two doses of either Pfizer or AstraZeneca vaccine. In both cases when the second dose is provided, then you see a really strong improvement in protection. There is also some protection offered by the first dose of vaccine, as has been studied in the U.K.
This hasn't made its way into any advice from the NACI to the agency yet, but the committee has been monitoring that evidence closely. Obviously, it is a point of concern as that variant is emerging in Canada. The committee continues to study it. I believe it was somewhere in the 60% range for AstraZeneca. It is somewhere in the 80% range for the Pfizer vaccine.
I will note that's against symptomatic infection. We have not yet seen the evidence regarding how well those vaccines protect against severe outcomes like hospitalization and death. They are expected in general to give higher protection than what we get against symptomatic infection, as we've seen across a number of other vaccine-effectiveness studies. It's quite encouraging that these vaccines that we have access to and are using in Canada, once provided with that complete series, are expected to provide protection against the delta variant.
Thank you.
:
Thank for that question, Mr. Chair.
I think we've been communicating that this particular variant, the delta variant, is more transmissible. It spreads more easily. Doubling down on making sure that they are observing their personal protective measures and observing public health advice are very important for the individual.
The data is not as robust about the impact of this variant on the severity of outcomes. There are some early indications that there may be increased hospitalizations as well with this variant.
My message has been that you have to be very vigilant between your first dose and second dose. Please roll up your sleeves and get two doses for a two-dose vaccine schedule. The provinces right now are accelerating their second doses. We see that in the data that we have on what's being provided right now.
I received the testimony of a couple who documented their entire journey with Switch Health to get their results.
Let me give you some context. The group arrived on June 2, but they have yet to receive the results of their second test, even though their quarantine ends tomorrow. The man is scheduled to return to work on Wednesday. In her testimony, the woman mentions that she has waited more than two hours on the phone to get the results of her test. In many cases, Switch Health has been contacted ten times.
However, Switch Health officials assured this committee on May 28 that the wait time on the phone had been reduced to 15 minutes, quite a contrast from two hours. They also claimed that people were receiving their results by the 14th day, which clearly will not be the case in this situation.
As a member of Parliament in a riding with many farmers, I don't need to draw you a picture of the failures Switch Health has experienced in the past.
My question is for Mr. Lucas. Has the Department of Health followed up with Switch Health to make sure that these timelines are being met?
What steps has his department taken to ensure that Switch Health responds in a timely manner?
:
Thank you very much for the question.
We've had a number of areas where performance has not been what we were hoping for with respect to call waiting times, with respect to test kit delivery times and with respect to test kit turnaround times. In each of those areas, we've worked with Switch Health, which has been a constructive and engaged partner, and have found solutions. In addition, we've also been working to expand the service providers in this space, where capacity issues are driving the problem.
I would say, Mr. Chair and honourable member, that if you provide the details, I will make sure that's resolved as well. You have my email, of course, or you can get it through the chair. I don't want to see any such situation of that nature, of course, and we'd be very happy to follow up with your constituent to address that right away.
:
I think there are two things, Mr. Chair.
In relation to which motion, I believe there was a motion at this committee that said if we couldn't get the documents to the law clerk in time to send them to committee. If I erred in sending them here, I apologize.
In terms of the redaction, it's the Department of PSPC, as the contracting arm of government, that knows what's sensitive and what's not. We have an obligation to consult with our vaccine suppliers in making those determinations. It was felt that the department was best placed to make those judgments to protect the integrity of the contracts.
:
Okay. I'm going to switch here.
The federal government previously claimed that it would donate up to 100 million vaccine doses to low-income countries. However, yesterday, the confirmed that Canada will donate only 13 million of Canada's surplus doses. The other 87 million are accounted for through money.
Given that it's virtually impossible for low-income countries to buy doses, given the severe global supply shortage, why isn't the Government of Canada willing to make a larger donation of surplus doses?
Mr. Matthews, this is not necessarily to you, but whomever would be best placed to answer that.
:
I was trying to remind myself out loud.
On the breakout that you mentioned for Novavax, Novavax is, as you say, a forward-leaning product, but it is a product that is in the process of being lined up for manufacturing. Its clinical trial results are beginning to come out, and it's looking like an extremely promising vaccine. With respect to AstraZeneca, as you know, these doses are in fact in production. Those kinds of doses are therefore available doses.
Over time, we're going to need to get everybody in the world vaccinated. We're going to [Technical difficulty—Editor], so yes, some right away, as you're pointing out, and others over the coming months will be actually extremely valuable as well.
:
Thank you very much, Chair.
I'd like to put the following motion on notice. It is that the analyst and clerk be directed to prepare a brief report to the House outlining the material facts of the possible contempt, discussed with Bill Matthews, deputy minister of Public Services and Procurement, on June 14, 2021, concerning the documents ordered by the House on October 26, 2020, and further requested by this Committee on February 19, 2021; and that report be tabled as soon as it is ready.
I'll cede the floor to my colleague Mr. d'Entremont.
:
Mr. Chair, thank you for that question. I hope I'll give the answer you are looking for.
The mRNA vaccines have been extremely effective in terms of the clinical trials and the real-life data, including against variants, which I think some of the previous answers covered—and also the viral vector vaccines. We have data from clinical trials and live data as well.
The question is this: What about the other vaccines? You do need to have the clinical trial data coming out of the other vaccines to know how effective they are. Novavax is coming out with some very promising data, which has to be reviewed by the regulator.
Protein subunit vaccines are technologies that have been used for other vaccines for human use, so we know that kind of technology. Some of these vaccines have an adjuvant as an immune-boosting aspect to the vaccine as well. These are vaccines that we have used in the past.
Some of the previous questions pertained to concerns about the repeat use of vaccines and whether they will become effective as boosters, for example. That is something that we will have to examine through data. Whether the whole virus or live attenuated virus vaccines will come to fruition and be an option in the future remains to be seen. It is possible that we will be using boosters that are different from what we used for the initial vaccine programs. Again, we will have to look at the evidence.