Foreign Affairs Committee on April 4th, 2022

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

I'd like to hear from Amnesty on that, too.

[France-Isabelle Langlois]

Thank you.

I do not have any knowledge of the Medicago case, so it is hard for me to answer your question.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

I'm very surprised that both organizations cannot answer that question. You're fighting for vaccinations. You're fighting for these people—the less fortunate—and you don't know the answer to that.

Thanks. I will stop right here.

[The Chair, Liberal, Sven Spengemann]

Thank you very much.

Our final intervention in this round with this panel goes back to Mr. Sarai for three minutes.

Go ahead, please.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you.

Can I get some clarity as to the numbers?

I think some of the numbers that you have of how much Canada has donated might be outdated. My understanding is that we have given close to 100 million doses through COVAX.

Can any of the witnesses maybe check that and speak on the record to that?

[France-Isabelle Langlois]

I think that Canada promised more than 200 million doses. However, so far only 14 or 15 million doses have been made available. At that rate, it will take a very long time.

[Brittany Lambert]

It's a bit complicated also, because Canada's 200-million commitment is a commitment to donate the equivalent of 200 million doses, so that includes actual doses, but it also includes money to buy doses through COVAX. In terms of its actual surplus doses, right now it's donated fewer than 15 million, as my colleague from Amnesty said. These are doses that it had in excess of what Canada needs and that it sent to other countries.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Is COVAX not purchasing? Obviously, there were the two streams. There was the excess that Canada would give, and that's obviously based on what excess it had. The second part was financial, that COVAX would procure, buy or purchase in supply. Has that been slow because the money coming into COVAX has been slow, or has that been because its supply agreements are not as robust or as strong as the other countries that have had them?

[Brittany Lambert]

I think it's starting to speed up through COVAX. December-January was a turning point. Until then, there was scarcity in the supply globally. COVAX couldn't move, because there were no vaccines for it to buy.

Now the landscape is changing. I expect the money that goes to COVAX will be able to purchase vaccines more quickly from this point on.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Do you not think it would be faster to immunize more people by funding those existing facilities that are now able to make excess production, rather than starting from scratch?

This is not a government position. I was just trying to see practicality. What's the fastest way to get people immunized? Would it not make sense now to just focus on that and make sure COVAX has enough financial resources to procure those vaccines and give them to those who are lacking them right now?

[Diana Sarosi]

I would point out in response that we have no control over what those companies charge for vaccines. Now it's this price; by next year, it could be double the amount. Keeping the pharma monopolies in power also undermines our ability, possibly in the future, to be able to purchase through COVAX, because prices keep going higher.

[The Chair, Liberal, Sven Spengemann]

Mr. Sarai, thank you very much.

That concludes our time with the panel.

I'd like to thank both of our witness groups for being with us today. It was a pleasure.

Thank you very much for sharing your expertise.

We will let you disconnect. Then we will suspend briefly to empanel our second panel and bring those witnesses on board.

Thank you so much.

[The Chair, Liberal, Sven Spengemann]

Welcome to the witnesses for our second panel.

I have a very brief point of housekeeping before I introduce you.

We have, in some cases, very tight time allocations. I'm going to signal you with this piece of paper when you have 30 seconds remaining in questioning or testimony time. It's a bit like a flag. If you could stick to the time limits, that would help us greatly.

We would like to welcome, colleagues, for our second panel, Shehzad Ali, associate professor and Canada research chair in public health economics at Western University; and Robyn Waite, director of policy and advocacy for Results Canada.

I will give each of you five minutes for opening remarks, beginning with Professor Ali.

Please go ahead, sir. The floor is yours.

[Dr. Shehzad Ali, Associate Professor, Canada Research Chair in Public Health Economics, Western University, As an Individual]

Thank you, Mr. Chairman.

Two years into the pandemic, 64.5% of the world has received at least one dose of the vaccine, but the percentage in the developing world is only 14.5%. This massive vaccine inequity is, quite frankly, an embarrassment. Companies have prioritized sales to governments that could pay the highest price, pushing low-income countries to the back of the queue. As a result, 70% of the doses produced by Moderna, Pfizer and BioNTech are going to wealthy nations, resulting in massive vaccine inequities. I think we still have an opportunity to correct course, and I will discuss two areas where Canada can play an important role.

The first is the issue of licensing and IP waivers. As we know, IP is protected under the WTO's TRIPS agreement.

There are several arguments for supporting IP waivers during the pandemic. First, much of the technology used to develop the vaccine is funded through public money. For example, Moderna received $2.5 billion and Pfizer received close to $2 billion from the U.S. government alone. Second, the current capacity of patent-holding companies and those that produce ingredients is not sufficient to get the world vaccinated in the short run. We need to pool global resources, but IPs are in direct conflict with this goal.

Canada has repeatedly referenced article 31bis of the TRIPS agreement and its operationalization via the CAMR, Canada's access to medicine regime, as an example of existing flexibility in the TRIPS agreement. However, the only time this process has been used in Canada was in 2008, for two shipments of an HIV drug that were sent to Rwanda after four years of struggle with the CAMR process. After this, Apotex, the manufacturer, decided not to go through the process again.

CAMR as it currently exists is not fulfilling its purpose. A more comprehensive and global approach is the quadrilateral TRIPS waiver initiative, which is spearheaded by India and South Africa. Some WTO members, including Canada, have pushed back on this, arguing that existing flexibilities are sufficient, but these flexibilities operate on a country-by-country and product-by-product basis. They are not sufficient at all, given the scale of the pandemic.

After 18 months of negotiation, the text of the TRIPS waiver is being developed, but early reports indicate that it has several limitations. Even the current draft of the waiver could be in danger if some countries oppose it. While in the past Canada has not actively supported this initiative, this is the time to play a role in pushing for an all-inclusive TRIPS waiver.

The second initiative that Canada can support is the WHO's mRNA vaccine technology transfer hub, which was established last year in South Africa. The aim of the hub is to facilitate the manufacture of vaccines in developing countries by transferring the technology and technical know-how to local producers. It has produced the first batch of COVID vaccines based on publicly available information, but without support from patent holders. However, many steps remain before the vaccine can be distributed, and it won't help to curb the pandemic this year.

For this hub to be effective, it is essential either that the technology used here be free of IP constraints in low-income countries or that such rights be made available to the hub through non-exclusive licences. The hub will require significant resources and technical expertise.

I think this is an opportunity for Canada to support a historic initiative to reduce vaccine dependency and inequity.

Thank you.

[The Chair, Liberal, Sven Spengemann]

Professor Ali, thank you very much. Also, thank you for remaining within the time allocation. It's very much appreciated.

Ms. Waite, please go ahead with your opening remarks. The floor is yours for five minutes.

[Dr. Robyn Waite, Director, Policy and Advocacy, Results Canada]

Thank you, Mr. Chair, and hello everyone. I'm Dr. Waite, director of policy and advocacy at Results Canada.

Results is a non-profit, grassroots advocacy organization committed to raising voices for a world free of extreme poverty. Our network of 500-plus volunteers has been advocating for vaccine equity since the start of the pandemic.

I am pleased to have the opportunity to share some of our organization's reflections on these issues, informed by our own perspectives and those of the many experts, advocacy allies and civil society partners we work with here in Canada and around the world.

Despite the relaxing of public health measures here in Ottawa, the pandemic is far from over. Around the globe, we are seeing a rise in cases, and the threat of dangerous new variants persists. A failure to coordinate a global response to the pandemic and the resulting inequity in access to COVID-19 tools is having costly consequences.

Eighty-five per cent of all COVID-19-related deaths are in countries with low access to tests, treatments and vaccines. Associated disruptions to health systems and the redeployment of resources and attention to COVID-19 have wiped out decades of development in global health progress.

Twenty-three million children missed out on basic childhood vaccines in 2020, the highest number missed since 2009. In 2021, the World Health Organization reported the first year-on-year increase in tuberculosis cases since 2005. Also, schoolchildren around the world have missed more than two trillion hours of in-person learning, the consequences of which are learning and earning losses. The global economy is projected to lose U.S. $5.3 trillion by 2027.

Now, the war on Ukraine, growing humanitarian crises and looming food and energy emergencies will exacerbate the strain on economies, peoples and systems around the world. The collision of crises of COVID, conflict and climate all unfolding and rapidly escalating in real time demands that global leaders such as Canada double down to end the pandemic. While this study is focused on vaccine equity, we should really be talking about all the tools needed to end COVID-19, including diagnostics, treatments and vaccines, plus the health system infrastructure and the people needed to roll them out.

While Canada has performed well in the interest of vaccine equity in some respects—for example, it was one of the first countries to invest a fair share in the ACT-Accelerator—it is lagging in comparison to its G7 and G20 peers in other areas, the TRIPS waiver issue being one.

Canada should step up and explicitly embrace the temporary removal of the intellectual property rights that are protected and enforced by the World Trade Organization on all COVID-19 tools, as well as actively engaging WTO members to get any compromise proposal right. It's a must for an equitable response to COVID-19; for the world's ability to respond collectively and quickly to future pandemics; for the protection of public funds and the interests of people over profits; and for global health solidarity. When high-income countries such as Canada fail to stand with less advanced economies, commitments to decolonization become mere rhetoric.

Our government often acknowledges that global challenges demand global solutions, yet Canada's international assistance envelope is woefully low. Since 1970, the UN target set under Canadian leadership has called for advanced economies to invest 0.7% of their gross national income in development assistance. Canada's levels of spending reached a near all-time low of just 0.27% of GNI in 2019, well below the rich country average.

With the onset of the pandemic, this downward trend was thankfully reversed and, moving forward, sustained increases must become the new norm, starting with getting Canada's IAE to $9 billion in budget 2022. This is critically important in continuing to respond directly to the pandemic, mitigate its knock-on effects to recover globally, and prepare for future threats.

The community has suggestions for how Canada could target resources to high-impact solutions. Results wants to see Canada continue to invest its fair share in the ACT-Accelerator and its implementing partners, such as the Coalition for Epidemic Preparedness Innovations, the Global Fund to Fight AIDS, Tuberculosis and Malaria and FIND, the global alliance for diagnostics.

There is no escaping that the world needs repairing, and it is everyone's job to educate people and raise public awareness about global solutions to global problems.

Results Canada volunteers from across the country are doing a stellar job of it. They care about vaccine equity. They are committed to taking action and want you and the Government of Canada to rise to the challenge of the modern day with the level of ambition and global-mindedness required. That means increasing investments in international assistance; squeezing all the impact possible out of each dollar; spending political capital to build political will; and a whole-of-government approach committed to international co-operation.

Thank you, Mr. Chair.

[The Chair, Liberal, Sven Spengemann]

Dr. Waite, thank you so much for your opening remarks.

We will go to round one. These are six-minute allocations for the members of the committee.

Leading us off will be Mr. Genuis.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you so much, Mr. Chair, and thank you to the witnesses for your presentation. I'm going to focus most of my questions on the topic of the study, of course.

Dr. Waite, could you quickly speak to the situation in Ukraine in terms of concerns about food shortages and how that might impact global health more broadly? We're hearing a lot of concerns about the global food supply and the possible implications.

[Dr. Robyn Waite]

Of course.

COVID-19 has reminded us that diseases know no borders and that nobody's safe until everyone is safe. We live in a globalized world. Our economies are globalized. Our food production is globalized.

We know that people living in Ukraine are being very catastrophically impacted right now by the war, and they're fleeing the country. Their fleeing is of concern for their direct health and also the global health security and stability of the world.

We know that another conflict and a collision of crises are going to put increased demand on constrained budgets, so that's significantly concerning. More resources going to COVID and Ukraine mean less resources going other ways, unless we increase that international assistance envelope that I spoke about earlier.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Could you or other of our witnesses address the question of the distribution of unused AstraZeneca doses? This is something that has come up previously.

We're talking about vaccine hesitancy, but we're talking about that in the context that it's a vaccine that—and I don't know if I'm using quite the right language—is maybe not recommended for Canadians—or it's approved but there are other things that are preferentially recommended—and we're distributing doses. How does that impact the perception of vaccine safety and the perception of Canada's role in all this, and what are your recommendations around AstraZeneca doses?

[Dr. Robyn Waite]

Sure. I can go first.

Results Canada has been loosely engaged and supportive in the advocacy around dose donations. We haven't been out in front leading, one reason being that we're quite disappointed that we're in the situation of a charity approach to getting vaccines around the world in the first place.

I would say, yes, with AstraZeneca, they came online fast and early and got out the door early. Now, though, we're seeing that we're not using AstraZeneca in Canada, and that definitely does impact the demand for AstraZeneca in other countries around the world. We're already seeing that AstraZeneca is not necessarily preferred as a product in COVAX recipient countries.

I'm happy to see that Moderna and hopefully Pfizer are going to come online from Canada soon, but it definitely does impact perceptions of vaccines.

I know we have been talking a lot about vaccine hesitancy, but I want to also caution about too much of a siloed focus on that. The head of the CDC said not too long ago that “vaccine apartheid”, not vaccine hesitancy, is contributing to prolonging the COVID-19 pandemic, so we should be careful about what we're focusing on.

I'd love to talk about it maybe a bit later, but vaccine hesitancy also ultimately has to do with trust and an erosion of trust. We're seeing massive erosion of trust around the world, particularly in government institutions and leaders. Building that trust is absolutely critical to getting uptake of medical products like vaccines.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you.

I'd like to hear from all of our witnesses, in particular on what your engagement has been like directly with the government and what it has said about the TRIPS waiver. I think it came out in the first panel that there are a lot of nice words being said by the government, but still a lack of a sense of what it's actually doing or planning to do here, a couple of years into the process.

Tell us a bit about your engagement directly with the government and your understanding of its position and the things it's been saying to you.

[Dr. Shehzad Ali]

I'm happy to go first.

I have not engaged directly with the government on this particular issue, but I've seen several accounts of how Canada has engaged or not engaged in this process. In fact, last year a number of accounts emerged suggesting that the Canadian government has, in fact, been discouraging other countries from engaging with the TRIPS waiver procedure. It has been showing CAMR as a mechanism that is an alternative to a TRIPS waiver, which—as I said in my presentation—is not really the approach to take.

The other thing I would like to add is that the recent experience of Biolyse has been full of frustration. Just getting a drug on schedule 1 of the Patent Act can take several months.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

I'm sorry, but I'm almost out of time. I just want to get you to clarify one thing you said, which sounded as though you were saying that the government might be advocating against the TRIPS waiver behind the scenes. You have some reason to believe that. Is that correct?

[The Chair, Liberal, Sven Spengemann]

Could we have just a very brief answer, please?