Foreign Affairs Committee on April 25th, 2022

[The Chair, Liberal, Sven Spengemann]

Good morning, honourable colleagues. Welcome to meeting No. 15 of the Standing Committee on Foreign Affairs and International Development.

Pursuant to the motion adopted on January 31, the committee is meeting on its study of vaccine equity and intellectual property rights.

As always, interpretation is available through the globe icon at the bottom of your screen, and for members participating in person, please do keep in mind the Board of Internal Economy's guidelines for mask use and health protocols.

I would like to take this opportunity to remind all participants to this meeting that screenshots or taking photos of your screen is not permitted.

Before speaking, please wait until I recognize you by name. When speaking, please speak slowly and clearly. When you are not speaking, your mic should be on mute.

A reminder that all comments by members and witnesses should be addressed through the chair.

Colleagues, it gives me great pleasure to welcome now our first panel of witnesses before the committee and to thank them for agreeing to take the time to be with us this morning. We have with us from Gavi, The Vaccine Alliance, Dr. Seth Berkley, chief executive officer. From the United Nations Children's Fund, UNICEF, we have Lily Caprani, head of advocacy and global lead for global health vaccines and pandemic response.

Welcome to both of you.

Colleagues, we are also waiting to hear from Dr. Ayoade Alakija, special envoy and co-chair of the ACT-Accelerator. She is on our witness list this morning on behalf of WHO. She has some technical problems with respect to a connection, and we're hoping she'll be able to join us in the course of our discussion this morning.

With that, I would like to give each of our witnesses five minutes for their opening remarks, after which we will begin the discussion with members.

Dr. Berkley, if you would like to lead us off on behalf of Gavi with five minutes for opening remarks, the floor is yours.

[Dr. Seth Berkley, Chief Executive Officer, Gavi, The Vaccine Alliance]

Thank you, Mr. Chair.

Honourable parliamentarians and distinguished guests, thank you for inviting me here today. I thank the Canadian government for being such an incredible long-term and ongoing supporter of both COVAX and Gavi. Just earlier this month, you renewed the support of the Gavi COVAX AMC summit with additional pledges, bringing your total advanced market commitment to around $800 million Canadian. This has helped provide vital support with vaccine procurement, deliveries and ancillary costs. As well, you have committed to donate the equivalent of at least 200 million doses through COVAX by the end of 2022.

In addition to this, Canada has provided critical help with the design and operationalization of the dose-sharing mechanism. All of this has played an essential role in helping COVAX deliver more than 1.4 billion doses of COVID-19 vaccine to people in 145 economies, with the vast majority, nearly 90%, going to the 92 lower-income advanced market commitment countries that otherwise would have struggled to get access. Through the Gavi COVAX advanced market commitment, or AMC, this equitable access to COVID-19 vaccines has been absolutely critical to protecting people and increasing coverage in lower-income countries.

Today, on average, 44% of people in these countries are now protected with two doses. While this still falls well short of the 59% global average and 70% global target set out by the WHO, it is incredible progress compared to just six months ago, but clearly we still have a long way to go. While many wealthy nations like Canada have coverage above 80% and some are now offering fourth booster shots, in lower-income countries it's a very different story. Currently, 18 countries still have coverage lower than 10%. This is a huge improvement on just three months ago, when 34 countries were in this position, but even so, many are still struggling with their rollouts.

Therefore, even though many countries with high coverage have now relaxed restrictions and reopened their societies, we are still in a state of global crisis. So far, a new variant has emerged roughly every four to five months, and globally nothing has changed to give us reason to believe this pattern won't continue. With 2.7 billion people still unvaccinated, the virus continues to have ample room to circulate and mutate. This means that the threat of resurgence or new and potentially more dangerous variants still hangs over us and will continue to do so until global coverage increases and more people are vaccinated.

Until recently, the main challenge has been supply. Vaccine hoarding, export restrictions and manufacturing delays have seriously hindered global access, but now global supply has ramped up and access to doses is no longer the issue. One reason for that is the successful use of technology transfers during the pandemic. By sharing not just intellectual property but also vital know-how that is essential to the production of vaccines, technology transfers have played a critical role in enabling us to get such large volumes of doses so quickly.

While COVAX supports any efforts aimed at increasing equitable global supply, waiving intellectual property is only part of the solution, and it's questionable whether by itself it would have the same impact. It's also important to remember that IP is an important part of vaccine development and is absolutely critical for innovation, which is the main reason so many COVID-19 vaccines have been developed, with more than two dozen vaccines already in use and hundreds more in clinical and pre-clinical trials.

Diversifying global supply remains important, and Gavi and COVAX are committed to it. When Gavi first began its work in 2000, there were only five suppliers, mostly in industrialized countries. Today there are 18 suppliers, with the majority in developing countries. Moving forward, the best and most sustainable way to achieve this is through the development of regional manufacturing sites producing a variety of global, regional and locally relevant vaccines, especially in Africa.

For now, though, COVAX's greatest challenge is no longer supply; it is coverage. The reality is that many countries are struggling with their rollouts to turn vaccines into vaccinations. That is where our priority must now lie—ensuring that these countries get the right vaccines and the right volumes at the right time. That means providing support so that countries can scale up their delivery systems and increase absorptive capacity and demand. This is what they will need to get doses out to people faster and ultimately achieve their targets.

Although we must help countries achieve their national targets, it's critical that we get high coverage of high-risk groups—health care workers, the elderly and those immunosuppressed or with comorbidities. Right now we estimate coverage of about 75% for health care workers and 57% for those over 60. This is not good enough. The pandemic is not yet over—far from it—so it's imperative that countries use the doses available for them to protect as much of their population as possible, starting with those most at risk. The good news is that we now have enough supply to help them not only meet these national targets but possibly even exceed them.

I'd like to end by thanking Canada for its incredible leadership, support and ongoing partnership to help make that possible.

Thank you, Mr. Chair.

[The Chair, Liberal, Sven Spengemann]

Thank you very much for your opening remarks.

We will now go to Ms. Caprani. The floor is yours for five minutes, please.

[Lily Caprani, Head of Advocacy and Global Lead for Global Health, Vaccines and Pandemic Response, United Nations Children's Fund (UNICEF)]

Good morning. Thank you so much for having me, distinguished guests and parliamentarians.

UNICEF, as you know, is the United Nations children's agency, and we're very proud to be the lead delivery partner for COVAX. That's everything from procuring vaccines to delivering the last mile and making sure that vaccines get into arms.

Lots of what I'll say may underscore what you've heard from Dr. Berkley: that the journey of the last two years has taken us from a position of insufficient supplies of vaccines to achieve coverage at the rates needed to protect populations around the world to today's problem of having sufficient supplies but being unable to always turn those vaccines into vaccinations and protect the most vulnerable populations around the world.

The pandemic is far from over, as we know. A new variant continues to emerge every four months or so, and the threat is not over, either to those vulnerable populations or to any country. Even with high vaccine coverage, it remains in our enlightened self-interest to continue to press for global co-operation and ensure that all vulnerable populations around the world receive the protection they need from severe illness and death and to reduce the ongoing disruptions to other essential services.

One of UNICEF's chief concerns is to make sure that the ongoing response to the pandemic doesn't come at the cost of other essential services, including routine childhood immunization, access to education, access to primary health care and all of those essential functions that protect children's lives now and their opportunities in the future.

As part of the vaccine global rollout, we've seen ongoing challenges to achieving a supply chain, and throughout 2021, as we know, the biggest challenge was making sure that low- and middle-income countries could access vaccines. That inequality, the stark inequality in access to supplies, has to some extent been addressed, with thanks to the global leadership of high-income countries, including Canada, generously funding COVAX and the ACT-Accelerator and donating doses when vaccine supplies were not available.

As you've heard from Dr. Berkley and others, today's challenge is primarily one of deploying those vaccines and making sure they reach the people who need them most. In order to do that, we need far more attention and investment on the delivery challenges. It's no good just delivering vaccines, the products themselves; they need to get from the tarmac and into arms. In order to do that, we need sustained efforts to invest in health system capacities in the lowest-income countries in the world.

We know that most of the countries with the lowest levels of coverage face many competing demands. I hope we will take a moment to put ourselves in the shoes of health ministers in low- and middle-income countries, who face conflict and security challenges, competing health emergencies, constrained budgets, insufficient health care workforce capacity and many other competing challenges to find practical ways to help provide the technical assistance, the operational assistance and the funding needed to overcome those hurdles. If we don't do that, we will not achieve the coverage needed to protect those countries and all of us around the world.

In order to do that, we need to address some critical bottlenecks that are becoming more and more clear. We ask Canada and all supporters of COVAX to join in demonstrating support for those countries to continue to be able to politically prioritize the COVID response in the face of these other competing challenges. In order to do that using predictable supplies and predictable arrivals of vaccines and other countermeasure products, they'll need sufficient funding to be able to support a highly trained, well-protected and properly paid health care workforce ready to deploy these vaccines in communities that need full risk communication and engagement so that populations are fully aware of where to access vaccines and can do so from a trusted, well-equipped and well-trained health care worker.

In order to achieve this, we would ask Canada to continue its global leadership by investing not just in procurement of vaccines but in the delivery of vaccines in the last-mile challenges, and to do so in a way that does not come at the cost of other essential services. Just to underscore how essential this is, we're seeing for the first time in more than 10 years a reduction in the number of children who are receiving routine immunization and the largest number of children who receive no vaccines at all.

As a consequence, we're beginning to see outbreaks of other vaccine-preventable diseases. Those will cause further disruptions and further strains on those health care services. Therefore, an investment in the delivery of the COVID-19 vaccine is an investment not just in tackling the pandemic but also in protecting the health of all from other diseases at the same time. Further, we know that evidence from the Vaccine Delivery Partnership, which WHO, UNICEF and Gavi are part of, shows that this is one of the main reasons countries are struggling to prioritize the COVID-19 vaccine rollout.

I don't want to repeat too much of what's already been said, but I'd like to underscore that investing in capacity to ensure there's further geographical diversity of manufacturing and lifting of intellectual property rights are some ways. As you've already heard from Dr. Berkley, all of the agencies involved in the COVAX rollout will support anything that encourages the lifting of barriers to expand the capacity and diversity of the availability of vaccines; however, the TRIPS waiver, which I know is the mechanism under discussion, is probably neither necessary nor sufficient to achieve this.

I'll end by saying thank you again for the leadership of the Canadian government and for your generous contributions. The pandemic is far from over. It's a risk to health services everywhere and to global health security. It's also a great opportunity, if we use this pandemic response, to invest in sustainable expansion of health care capacity everywhere. That will not only help end this pandemic but also protect future generations from future pandemics.

[The Chair, Liberal, Sven Spengemann]

Thank you so much, Ms. Caprani, for your opening remarks.

We will now go to our rounds of questions. For the benefit of our witnesses, these rounds are very carefully timed and, in some cases, very short rounds. I use a signal to indicate when 30 seconds of questioning or speaking time remain. If we can stick to that, it will help us to navigate the rounds of questions that are ahead of us.

The first round consists of six-minute segments. Leading us off this morning will be Mr. Genuis for six minutes.

Please go ahead.

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

Thank you, Mr. Chair.

Thank you to the witnesses.

Dr. Berkley, are you seeing developing countries' leaders expressing preferences with respect to the kinds of vaccine they receive? Do you have instances of people declining certain brands of vaccine or seeking some over others? What reasons are being given for those preferences?

[Dr. Seth Berkley]

I'm sorry, Mr. Chair, but do you want us to respond immediately or are we waiting?

[The Chair, Liberal, Sven Spengemann]

Yes, please, Dr. Berkley, go directly to the member's question. It's basically up to the member to navigate his or her speaking time.

[Dr. Seth Berkley]

Okay.

The answer is yes, we are seeing preferences.

When we started, basically people wanted any vaccine at all. People were accepting a full range of vaccines. They were getting them from different sources, and they would also accept vaccines that had relatively short shelf lives when they came by donations. That has since changed. Countries that have experience with vaccines have chosen to use a particular vaccine. An example would be the AstraZeneca vaccine, which was very important at the beginning. Recently, there has been less demand for that vaccine—not from all countries, but from some. In particular, countries do not want short shelf life vaccines because they don't give them ample time for planning and making sure they can get the doses out to the periphery. Now COVAX is offering a six-month timeline of doses coming forward. With that, they get to choose their priority vaccines.

Also, in the case of donations, we've asked that donations come with at least two months' shelf time in country so they can be provided as doses.

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

Thank you so much.

You sort of answered my next question as well, which was about expiry of doses. I recall the case in Nigeria, where I think something like a million doses had to be destroyed.

Would you be able to provide us in writing with a sense of which particular kinds of vaccines are being sought and which ones are not, just a sense of what countries are asking for? Would you have those documents available to share with the committee at a later point?

[Dr. Seth Berkley]

We do have that information. Obviously, we have plans for every single country. The good news is that right now, there's been a pretty broad distribution of vaccines, both mRNA vaccines and vector-based vaccines. In the past, we've used some inactivated vaccines, but those have been less in demand. We now have adjuvanted proteins, which have not yet taken off, but we expect over time, as people understand their characteristics, they will be taken up. We can submit that.

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

Thank you very much.

I want to ask you about the impact of indemnification clauses in vaccine contracts in the developing world.

I know that our country, our government, has signed indemnification clauses around claims that might be made against vaccine manufacturers. What is the application of those clauses if Canada donates vaccines to countries in the developing world? Do developing countries sign their own indemnification clauses? Do those clauses not apply? Could you shed some light on that issue, please?

[Dr. Seth Berkley]

One thing that we did early on was to set up new mechanisms to work in a pandemic, many of which, surprisingly, weren't set up before. One of them was a standardized indemnification liability agreement. We got all of the manufacturers to agree to that. That has now been approved by all of the countries that are receiving COVAX doses. When the doses that Canada donates are transferred to the COVAX facility, they get covered by those indemnification and liability agreements.

One other thing we've done, which has really been an innovation, is to also have a no-fault compensation scheme set up for all these countries. In the case of severe disease or death from vaccine-related effects, that allows countries to go ahead and receive a certain amount of financing that is available. That is funded by a certain price on each dose of vaccine that is part of the COVAX facility. That covers both the doses that COVAX purchases as well as the doses that are donated through the COVAX facility.

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

Thank you.

Just to clarify, that no-fault compensation package, then, is paid for by the purchaser of the vaccines. A portion of what every government or actor is paying when they purchase doses is going into that fund for no-fault compensation.

[Dr. Seth Berkley]

No, that's not correct.

What we're doing is paying for it as part of the COVAX assets that exist. A country can, if it wants, as part of its donation, pay for the delivery costs, ancillary costs, etc., but we are using the financing we receive to pay those costs.

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

Thank you.

I'm going to ask one more question before my time's up. How much has been paid out of that no-fault compensation fund so far? If you don't have the answer, could you provide it in writing? Thank you.

[Dr. Seth Berkley]

I can't give you the exact number, but there have not been a lot of claims on that account.

[The Chair, Liberal, Sven Spengemann]

Thank you very much, Mr. Genuis, and Dr. Berkley.

We will go to our next intervention. Go ahead, Mr. Ehsassi, please, for six minutes.

[Ali Ehsassi, Liberal, Willowdale, ON]

Thank you, Mr. Chair. Allow me to start with Dr. Berkley.

Dr. Berkley, as you know, the WHO did previously set a goal of vaccinating 70% of the population of every country by this summer. Where are we as far as that specific target is concerned? Do you believe we can meet it?

[Dr. Seth Berkley]

First of all, I did go over the numbers. In terms of the global average, 59% have received two doses of vaccines. In terms of the AMC 92, the 92 lowest-income countries, that number is now at 44%.

I also went over the fact that there are some low-coverage countries that are still at less than 10%. There are 18 of those now. It is very unlikely that those countries will be able to get to 70% by the middle of this year. It may be possible that countries will get to 70% by the end of the year. Some countries have set goals that are far beyond that, talking about mid-2023 or later. We have to rely on what the countries choose as their goals rather than a global aspirational target for coverage. That's what we do. We work with each country to determine their goals.

Of course, the one thing I emphasized in my remarks is that we want to make sure the high-risk populations—health care workers, the elderly and those with comorbidities—are vaccinated. Today, that means not just the primary doses, the two doses, but also boosting. Boosting has come up late in the WHO recommendations. That's something, again, that countries are working on now.

[Ali Ehsassi, Liberal, Willowdale, ON]

Thank you for that.

As I understood it, in your testimony you were saying that supply is not a challenge at this particular point, but we heard from Ms. Caprani that there are a number of different bottlenecks. It appears that the greatest bottleneck is actually building capacity insofar as health care workers are concerned.

I know that Canada has set aside quite a bit of money for capacity building, but what is it going to take for the international community to achieve that objective of building a more professional workforce in various countries to make sure we can meet these targets?

[Dr. Seth Berkley]

First of all, I think Lily was particularly talking about these low-coverage countries. There are many developing countries that actually have done pretty well in increasing their coverage and getting to high coverage levels, but there certainly are countries with weak health systems.

Fifteen of the 18 countries that haven't gotten to 10% yet are fragile countries. In those circumstances, there haven't been adequate investments, and there are usually not adequate finances to do that. Of course, immunization is the most widely distributed of all health interventions, and as Lily suggested in her testimony, we've been working on building a sustained and resilient health system in all countries, but of course in countries that have fragility or that have problems or warfare, it is very difficult to do that.

Financing is part of the solution, but good governance and the ability to access all populations will also be critical. These are things that we're working with, not just with the partners that we've talked about here, but with humanitarian partners, civil society and others to try to make sure we can enhance those systems.

[Ali Ehsassi, Liberal, Willowdale, ON]

Just in terms of enhancing those systems, as you put it, would it not be fair to say that financial assistance alone is not going to be sufficient and that there have to be more experts that can assist these countries to bring their systems up to the standards that are required? As you know, many countries have provided assistance of a financial nature, but maybe more is required to make sure that we can move forward.

[Dr. Seth Berkley]

When we talk about assistance, we talk about financing and we talk about technical assistance and we also talk about technology assistance. One of the things that's important is to build better technology to have better data systems and a better ability to have supply chains that are resilient. This is all part of what we talk about in building capacity, and it's why in fragile countries it becomes even more difficult than it is in countries that are relatively stable, where that investment over time can be sustained.

An example would be in a country like Syria. We saw a very strongly functioning health system and immunization system get completely destroyed, including the cold chain, the supply chain and everything, so that at the end it really was about rebuilding it and tolerating the fact that the war situation meant that we were going to have to continue to invest.

[The Chair, Liberal, Sven Spengemann]

Mr. Ehsassi, you have about 30 seconds, so you can get in a quick one.